Dear Therapist:

I have gone through a lot the past few months and after reading this column thought that it would be a good idea to see a therapist to help me deal with my issues.

I thought it would be a simple process but when I contacted a respected local therapist, she told me that I would need to see her twice a week and she also recommended that my family go through a regimen of weekly therapy sessions. That’s quite a lot, not to mention an expensive undertaking. Is this considered standard? I never viewed myself as a basket case in need of serious help, just as a girl with a couple issues.

Response:

I don’t know what your conversation with this therapist was like. I don’t know how long you spoke or what you talked about. Different therapists have varying processes, based on one or more therapy modalities. Some will focus on directly addressing specific symptoms and complaints. Others will help identify underlying issues leading to current problems. Some therapists focus on family systems to help identify and resolve interpersonal issues. Many therapists will use one modality or a combination thereof, depending on the situation.

Generally speaking, therapists do not make recommendations about frequency of sessions, duration, or about whom else should be seen, without first doing an intake appointment—at a minimum. Specific recommendations about these types of details are generally not made until the therapist has a clear sense of the entirety of the issues and the details surrounding these.

It seems highly improbable that a therapist could gain a clear, concise understanding—in a short phone conversation—to the point where she could make definitive recommendations of that nature. If you had a prolonged conversation in which you were able to give this therapist a broad understanding of all the issues, their causes, triggers, interpersonal factors, and other aspects, this might make some sense. But such a conversation would entail many questions and quite a bit of time, essentially representing an intake session.

To a large degree the way in which the therapist made her recommendations is key. Perhaps she recommended that you begin with twice weekly sessions, but recognizes that this may quickly be modified (and she is willing to consider other options). Perhaps she feels (based on specific discussions) that your family can benefit from therapy as well. If this is the case, she may have gleaned enough information to make these tentative suggestions. If, however, based on a relatively short and basic conversation she insisted that her recommendations be followed exactly, I would definitely obtain a second opinion.

Regardless, it is not a bad idea to go for a second opinion. Not all therapists are the right match for all clients. If you feel uncomfortable with this therapist’s recommendations, you may feel resentment or doubt about the process. This can be an impediment to your progress in therapy. A therapeutic relationship is just that—a relationship. Certainly, you should see a therapist who is experienced and well-regarded. But you should also see someone with whom you feel comfortable.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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