Email & Therapy

Here's a question I received: Why don't you prefer clients to use email when contacting you?

This is a fair question. Let me see if I can explain:

1) I cannot guarantee your confidentiality. There's no way to maintain privacy through email mediums.
2) Emails get "lost." You may send an email and I may never receive it.
3) If it's an emergency, I may not receive it until hours after you've sent it.
4) Emails can be easily misconstrued. Without facial expressions, body language or even voice volume and sound, I have no idea what the emotions are behind the email.

For this reason, I have a personal policy that clients may email me ONLY for the purpose of scheduling/canceling an appointment. I recognize in the world of Blackberries, SmartPhones and iPhones, people are on the go and keep their calendars close at hand.

If emails are your preferred means of communication, speak with your own therapist what their policy regarding use of email is and how that will work for the both of you.

What If I Feel My Therapy Isn't Working?

Do you go to therapy wondering what you're going to talk about? Do you feel like you're spinning your wheels and getting nowhere? Feeling discouraged that you're constantly taking one step forward but 3 steps back in therapy?

Therapy requires time, patience and work, but you probably don't want to feel like you will be in therapy forever. If you're feeling discouraged, it's real easy to call your therapist, cancel the appointment and never reschedule. But is it really the best decision for you? Could be....maybe not.

Therapy is a complicated art. There are many factors which contribute to the success or failure of therapy, the main factor is the rapport between the therapist and yourself. Other factors include: your commitment to therapy and yourself, the therapist's competence and confidence in their own skills, the issues you bring to the table and the length of time you've been dealing with the problems, just to name a few.

Dropping out may prevent you from facing the problems that brought you to therapy in the first place. So what do you do?

First, talk to your therapist as soon as you start to feel discouraged. Let your therapist know how you're feeling, what you are seeing is happening with the therapy, and what your expectations are. Opening this channel of communication helps the therapist understand what you are wanting and an open discussion of your needs and expectations can be laid out on the table.

After having such a discussion, you and your therapist can lay out a new treatment plan addressing your concerns, which may include additional resources in addition to therapy such as support groups, medical evaluations, etc. After processing all your options, you may agree transferring to another therapist may be needed. If this is the case, your therapist should be able to provide you with appropriate referrals so you can continue your journey.

Why is My Therapist Ending My Therapy?

Someone asked me recently, "Why would my therapist end my therapy? I don't think I'm ready." This could feel scary, especially if you've worked with your therapist for a while.

There are many reasons a therapist may discontinue therapy with a client. However, whatever the reason, a competent therapist would discuss the reasons with you and provide you with the appropriate referrals so you can continue your journey.

•The issues you are presenting are beyond the therapist's level of knowledge or competence.
•The therapist recognizes a serious detriment with the rapport between the two of you, which isn't providing you with safe environment you need to succeed in therapy.
•Your therapist recognizes underlying issues (eg., medical, psychiatric, drug dependence) which may need to be addressed and rectified before therapy can be beneficial.

There are a multitude of reasons. These are just a few. If your therapist does determine that a referral needs to be made, you have every right to ask your therapist about what they are seeing, which is influencing their decision. Your discussion is necessary as maybe you have omitted information that could change your therapist's decision.

Losing your therapist can be a significant loss for some clients. The therapist should be willing to process this with you and help you make the transition as smoothly as possible.

Can I Be Friends with my Therapist?

Many people seek counseling due to some sort of crisis within their lives. They seek out someone neutral, objective, like a counselor, because their family and friends provide advice based on emotions and the connection with the person.

Once in counseling, you may start to have feelings for your therapist. This is very common. You start to feel like you really could like being friends with them. You feel like the therapist understands you and really listens to you. They may laugh with you n sessions, they allow you to cry when you need to. They accept you for where you're at. As a result, you may want to see your therapist over lunch, at a coffee shop, etc.

The California Association of Marriage & Family Therapists (CAMFT) establishes the Code of Ethics. They state, therapists should not engage "in a close personal relationship with a patient" as it may skew the therapy. Is this person now your friend or your therapist? How do they maintain that professionalism? Are you now paying your therapist or a good friend to help you? It can all become confusing and counterproductive.

Another issue is your relationship wasn't based on the makings of a friendship. Counseling is a business transaction with personal impacts. How much do you know about your therapist, really? Friendships are struck based on commonalities, such as interests, likes/dislikes, and personal experiences. How much of these things do you know about your therapist? Probably not as much as you think. Therapists don't disclose too much about themselves during your sessions. They can be likable people, but it doesn't mean you know that much of their lives outside the office.

CAMFT recommends a 2-year waiting rule to be extended to all types of relationships with clients, including friendships. There are several reasons for this. First, you may decide to return shortly after ending the therapy, which is common. Second, there is a belief that if a client and therapist want to engage in a relationship (friendship or otherwise) outside the therapy, 2-years to determine if a friendship could really sustain beyond the parameters of therapy.

If you have additional thoughts about becoming friends with your therapist, I recommend to discuss this directly with your therapist. It would be a good process for you in figuring out what characteristics you need for friendships as well as keeping the therapist in their role and allowing them to do their job...to provide you with a safe, valuable service.

Disclosing to the Counselor -- How much is too much?

Counseling is an interesting phenomenon. You pay a complete stranger to open up to them, become vulnerable and place some level of expectation they will be able to help you through your problems and come up with better solutions. This can feel weird, overwhelming, even downright scary. But, how much should you disclose?

Your counselor can only help you if you're upfront and honest with them. This may not mean you have to unlock every skeleton in your closet, but if you're holding back, they may not be able to help you move forward. For example, if you are actively engaging in the use of alcohol or marijuana and you emphatically deny this to your therapist, they may attribute your symptomology to more severe mental disorders. They cannot assess, and thus intervene, appropriately.

Communicating with your counselor can also be beneficial if you find you are having difficulties with the direction your therapy is going. Sometimes, I find clients may experience difficulty bringing up problems to the counselor when it has to do with the counselor; however, counselors are people too. We make mistakes and misinterpret client signals, which could inadvertently derail your therapy.

If you find yourself uncomfortable with your counseling experience, I recommend you bring it up with your counselor. Let them know how you're feeling and what your concerns are. Again, the counselor can't read your mind and will want to know how they can best help you.