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Does going to therapy mean you're "crazy" or something is wrong with you?
No, not at all. Even therapists often see the benefits of going to therapy themselves. We see it as a healthy tool for maintaining mental health care and coping with emotional wounds as needed. People go to doctors for check-ups, injuries, etc. for their physical health, so it makes sense to do the same for your mental and emotional health when you need to as well. So, no, it doesn't mean you are "crazy," but instead you are likely having a normal reaction to something abnormally stressful or challenging and you are proactively seeking help to cope with it from someone who has the appropriate knowledge and skills to help you, and that's a good thing! Everyone has problems and rough patches in life, but not everyone is willing to put forth the effort to try to change themselves and/or their lives to make things better. If you are, that's a major strength, and if you need assistance in doing that, that is perfectly okay! It's also possible that you may start therapy and realize you aren't ready or willing yet, and that is not uncommon; it's okay to acknowledge that and ask to slow down or pause therapy. It's also okay to say when you feel like you're not making enough progress and either move on to try a new therapist or discuss with the therapist what you can do to refocus your goals and start to make more progress.
What do people actually do in therapy? Are they just going to ask me how I feel about everything?
There is a lot more to therapy than asking people, "How does that make you feel?" like in the movies!
Generally, we will give you assessments to help determine what kind of symptoms you are having and gather your history to help us make an accurate diagnosis. Then, we (the therapist and you) will create treatment goals to help guide us through the process, but this plan will be reviewed periodically, it is flexible, and it is okay to deviate from it as needed, based on whatever is going on in your life or whatever you need to talk about that week.
Beyond that, what we do depends on your situation, your needs, and our clinical judgment about what would be most helpful for you. We are all trained in many different treatment modalities and techniques, so we tend to use a combination of them, and may even change it up if we feel like something is not working well for you. Everything you do is voluntary and if you feel like something is not helpful or you don't want to do it, you don't have to, and you are encouraged to let your therapist know if there is something else you would rather talk about or work on. It's actually very helpful for us when people are willing to give feedback, as therapy should be a collaborative process where we are helping you achieve what you want to achieve with yourself, your relationships, and your life.
I feel embarrassed about all my problems. Will my therapist judge me about everything going on in my life?
That would be like a doctor judging you for having the flu. We do not judge people for anything they say, and more than likely, what you are dealing with is more common than you think. We have also dealt with our own personal struggles as well, so we understand what it's like to go through difficult things and to allow ourselves to be vulnerable enough to ask for help with the most sensitive areas of our lives. It takes great trust and strength to do that, and we are honored to be the person to offer you that help. If you ever feel judged, please tell your therapist that. It is very important that we know if we are doing something unhelpful, not just for your sake, but for all of our clients' sake. We are very open to feedback and growth, so please share with us if you felt bad about something we did or said so that we are aware of it and can make improvements. I promise, it's okay!
Can I cuss in therapy?
Yes, you can cuss. We have all heard plenty of cuss words, we are not so delicate or easily offended by language, and we understand that sometimes when you are discussing emotionally charged topics, you will let it out however it comes out, which can be pretty raw or dark sometimes. We are human, we get it! Many clients feel like they have to hold back with us because we are "professionals," and we would prefer you are comfortable and don't hold back on however you want to talk about your own life. We will work on expressing yourself effectively in other contexts as needed, but how you express yourself to us is up to you as long as you are not disrespecting us personally in some way. For example, you can say someone else is being a b**** in your therapy session, but don't call us a b****. If we were to apply the "focus on the problem, not the person" concept here, a more productive thing to say to us would be, "It made me feel ______ when this situation happened (and describe situation)." More than likely, we didn't realize we were doing something off-putting and will be happy to adjust. Or sometimes our personalities just might not vibe and that's okay too; sometimes you may just need to try a new therapist out and see if their style and personality fit you better.
Do therapists cuss in therapy?
Some therapists may disagree about this, but many of us value being "real" with people because there is great value in authenticity, and it often helps people to feel more comfortable when we talk more casually. There's certainly an appropriate balance to be found though and if something your therapist says makes you uncomfortable, you should tell them that so they can be more cautious with you and others in how they speak.
What if I don't like my therapist, don't feel like it's helpful, or don't like something they are doing?
1) First, reflect upon why you don't like them and identify the reason. There could be several different reasons:
Is it something they did that offended you?
Is it because they facilitated an uncomfortable feeling or discussion that you didn't particularly enjoy? It's really easy to misdirect negative feelings towards a therapist who is helping you go through something that is emotionally difficult.
Is it just that you don't feel you are connecting well with them?
2) If it is something they did wrong, the first preference is to discuss it with them. We are a big fan of being assertive about what you want and need, not just with us, but in all your relationships.
3) If you just didn't connect well with them, that's totally okay and we can assign you to a new therapist if we have one with availability or give you referrals for counselors elsewhere. Your therapist will not be offended, as we all understand that sometimes it's just not a good match. If you have preferences that will help us determine what kind of therapist would be a good match for you, please let us know.
Can I ask my therapist questions about themselves?
You can. They may or may not give you thorough answers, but that will depend on whether they think it would be beneficial for you to know. Therapists will voluntarily self-disclose information about themselves and their experiences when they determine it might help you feel more comfortable or otherwise benefit you. For example, if you are a new parent struggling with postpartum depression, your therapist may have had that experience as well and may share that with you. But keep in mind that therapy is about you and even if your therapist has not been through the same experiences, we have many years of education and experience with a wide variety of diagnoses, acuities, issues, and subject matter. So, if for example you are suffering from an addiction, your therapist need not have suffered an addiction themselves to have valuable knowledge and experience in the area of helping people through addictions, even though personal experience is very valuable as well. Also, therapists do not practice outside their scope of practice, which means that if they don't feel they are qualified to help you with a certain problem, they will either take measures to correct that, such as by consulting with another therapist who is experienced in that area to gain the skills and knowledge needed to help you, or they will refer you to someone else.
Do therapists have mental health struggles?
Therapists are people just like anyone else and have likely gone through their own mental health struggles and life challenges, which may have contributed to their ability to relate so well to others who are going through such things. However, even if they have not gone through the same mental health struggles or challenges that you have, therapists are required to have many years of education and likely already have many years of experience in the field to help them understand your problems and the most effective ways of navigating those problems successfully.
How long does therapy take?
That depends on a lot of factors: the severity of whatever you are facing, your motivation to change the situation(s) you are struggling with, your willingness to follow recommendations and try to apply what you are learning between sessions, your consistency in showing up to sessions, and whatever may come up in your life while you are going through counseling, and many other factors. There are no guarantees on how long it will take because too many factors are outside of our control, but we do our best to help you resolve past issues that may be barriers, build supports in your life that you need going forward and develop the skills you need to navigate challenges on your own in the future. Some people can get to a point where they feel confident moving on after a few months, but others may take a year or more to feel comfortable, in more complex cases it could take longer than that before you feel ready. Regardless, it does not have to be an abrupt process. When you start to feel like you have nothing to talk about in therapy or the therapist feels you are ready, we can review your treatment plan to see where you are at with all your goals and reduce counseling to a lesser frequency, and if that goes well, we can reduce it to a follow up every month or so for a while before ending counseling. That is not required and you can end counseling whenever you like, but sometimes a gradual process can help people build the confidence they need to resume their lives without therapy. And if you later need it again, you can always come back later as well.
Why is therapy so expensive?
It is a common misconception that therapists' rates are their "hourly" rate, but they actually don't usually do therapy the whole day for a couple of reasons: 1) therapy requires a high level of cognitive and emotional functioning and attention, so they shouldn't do that for several hours straight without a break or else the quality of therapy may suffer; 2) there are a lot of other tasks that have to be done, such as treatment plans, phone calls, emails, billing, therapy notes, researching resources for clients, training, meetings, consultations with other providers, CEU's and license maintenance, marketing, financial management of their practice, and other tasks that are required to operate, just like doctors or any other type of practitioner; 3) for providers who have to have a Master's degree and maintain a license to practice, the average income of therapists is actually pretty low in comparison to other such practitioners, for a few reasons--one is that large groups and facilities collect the fees from insurance and clients, but only give therapists providing those services half or less of those fees; 4) because some insurance companies refuse to reimburse services at respectable rates, medical providers of any kind are forced to offset this loss in their regular rates, or by just not accept those insurances at all. Some providers are choosing not to accept any insurance because of the loss and expenses involved in doing so.
Can I friend or follow my therapist on social media?
We do understand the temptation to be "friends" with your therapist outside of therapy, but therapists are not allowed to be friends with our clients on social media or in any context outside of therapy. Sometimes you could end up in each other's networks by accident, such as when you have a large network of people you may not know in person, people's names are not the same as their legal name, or some other accidental reason, but we do not intentionally accept any requests to connect on social media. If your therapist has a blog or some other publicly shared professional profile, you are allowed to follow them in a professional capacity, but it is strongly discouraged to follow them or cross any boundaries into personal social media, even if it is publicly available. Not only is it unethical for us to engage with clients in that capacity, but it is also a much-appreciated courtesy to us to respect our personal lives as well and it could tarnish the quality of your therapeutic relationship to know too much about their personal life.
What if I feel attracted to my therapist? Can I date my therapist after therapy has ended?
It's not uncommon for people to feel attracted to their therapist because a therapeutic relationship requires vulnerability and trust, however, it is against our Code of Ethics to date clients during or after termination of services. It is unethical and exploitative on the part of the therapist to cross such boundaries. There are certain power dynamics that could end up being emotionally harmful to clients if they were to engage in a romantic relationship with their therapist, or even a friendship. For example, if your therapist knows things about you that you shared in a confidential setting, those things may go far beyond what you would have told them had you met them in a dating or friendship context. Hence, if later the protection of that confidential setting is removed (it is never technically removed - you always have that protection - but theoretically, if it is removed by a crossing of those boundaries), this would be an unfair advantage to them. You can sue a therapist for engaging in a romantic relationship with you as a client and/or make a complaint against their license if a therapist attempts to cross the boundary into any romantic or sexual relationship with you or reciprocate any attempts on your part to do so, as they should understand the potential for such dynamics and address that appropriately and sensitively if that happens.
What will happen if I see my therapist in public?
If you live in the same town and feel this is a concern, feel free to discuss with your therapist how you would like them to handle it. Generally, we will not acknowledge you in public. This is for your protection. If you choose to acknowledge us, we will talk to you, but we will not disclose how we know you. If you choose to disclose that to anyone, that is completely up to you. Your status as a therapy client is protected by HIPAA laws and we are required to keep your protected health information private, just like any medical practitioner.
Can I invite my therapist to my graduation, wedding, etc.?
You can, and your therapist can attend, but you will need to discuss how you would like them to handle any questions about how they know you, as they are not allowed to disclose that to anyone. Some therapists may prefer not to attend such events and that is at their discretion, based on whether they believe it would be beneficial (or harmful) to you for them to do so. We understand that a therapeutic relationship can be a long and meaningful relationship and if such attendance is important to a client, we are allowed to consider attending important events as a caring and supportive professional, not as a friend or any other kind of relationship, as that would be crossing boundaries into a dual-relationship, which we are not allowed to do.
Am I allowed to give my therapist a gift?
First, you are never expected to do so for any reason. But if you want to, you are allowed to do so within reason, and it will be the therapist's responsibility to decide if it should be accepted or not.
The American Counseling Association addresses gifts directly in their Code of Ethics. Section A.10.f. States, “Receiving Gifts: Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift.”
Can I keep in contact with my therapist after therapy has ended?
Your therapist may potentially follow up with you if there is reason to do so, and you are allowed to contact them in a professional context for various reasons, such as to ask a question, ask for a resource or recommendation, resolve billing inquiries, provide follow-up surveys, or contact them for therapy again, but you may not continue regular casual communication with them after therapy has ended, as that would be considered a friendship or relationship that is no longer able to be defined as a client-therapist relationship. It should be understood that they are no longer providing therapy or treatment of any kind once the therapeutic relationship has been terminated, unless it has been agreed that you wish to resume therapy with them.
Can my therapist patronize my business or services?
Your therapist may patronize a business if it's something that would not be personal to you, such as if you own a store and they happen to shop at that store, but if you are a professional who offers services personally, such as a lawyer or accountant, your therapist cannot hire you to provide those services. Your therapist should never offer you other services either, for example, if they are also a realtor, they cannot sell you a house or list your house for you. If they are a researcher, they cannot recruit you as a research participant. The reason for this is because a client would likely feel pressure to agree, even if they didn't want to, which is an unfair advantage and not appropriate. They can help you find community resources you need, but they cannot provide you with such services themselves.
What if my therapist does something that warrants an official complaint on their license?
All therapists are required to provide information on how to make formal complaints, which is also located in your intake paperwork. We are licensed by the Texas Behavioral Health Executive Council and their steps for filing a complaint, along with the form, can be found here: How to File a Complaint – Texas Behavioral Health Executive Council
NOTICE CONCERNING COMPLAINTS
The Texas Behavioral Health Executive Council investigates and prosecutes professional misconduct committed by marriage and family therapists, professional counselors, psychologists, psychological associates, social workers, and licensed specialists in school psychology. Mail or email your Texas Behavioral Health Executive Council Complaint Form complaint and supporting documentation to:
Texas Behavioral Health Executive Council
333 Guadalupe St., Ste. 3-900
Austin, Texas 78701
Main Line (512) 305-7700
Investigations/Complaints 24-hour, toll-free system (800) 821-3205
Enforcement@bhec.texas.gov
The Council is open Monday – Friday, 8:00 A.M. to 5:00 P.M., but closed on state
holidays.
Although not every complaint against or dispute with a licensee involves professional misconduct, the Executive Council will provide you with information about how to file a complaint. Please call 1-800-821-3205 for more information.
What are things that warrant a formal complaint? Some examples of reasons clients file complaints are sexual misconduct, discriminatory comments or behavior (racist, sexist, homophobic, etc.), ethical concerns like dual relationships (such as trying to sell you real estate while also being your therapist, or trying to date you), abandonment, fraud, and any other types of professional misconduct that you feel was harmful to you as a client. It doesn't have to fall under those categories; you can complain about anything you want, and the council will decide how to handle the complaint.
What if I have a complaint that doesn't seem to warrant a formal complaint? If you don't feel it warrants an official complaint on their license, you can talk to your therapist about it or even writing them an email or text about it if you are uncomfortable with a conversation. Remember that they are human beings who make mistakes and need to know if they've done something to make you uncomfortable in order to improve. However, if it is something serious, such as sexual misconduct, discrimination, or a blatant violation of professional ethics, please make a complaint, as they will likely repeat the misconduct and harm other clients until held accountable. Therapists also carry professional liability insurance in the event that they are sued for such violations against clients. While most of us are very mindful not to violate our laws, ethical codes, and other rules and mandates, and frankly kind of terrified of getting complaints on us, there are unfortunately some therapists who show blatant disregard for these rules, and they should be held accountable for harm caused to clients who have come to them in good faith for treatment.
Still have questions on your mind that we didn't answer here?
If you have any other burning questions on your mind that you would like to know, please feel free to ask. You can contact us directly in our inbox at info@courageousaf.org, or you can ask your therapist whatever you want to know. If you have a good question we didn't think of, we may even add it to this list if we think it will be helpful for others!
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