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Positive changes come from positive goals. By positive goal I mean stating what you want, not what you don't want.
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You are changing. The level of change depends on your original goals. Do you want symptom reduction? Do you want deeper changes in your life, more than what meets the eye?
In my view, therapy is working if you are gaining more clarity about who you are, what you want from your life, and how you are holding yourself back from being you. The grip of shame, blame, fear, magical thinking, and the sense that your past determines your future, is easing up on your throat and you are starting to breathe on your own. You are becoming more and more courageous to be you. You start to do what you think is the right thing to do, without constantly having to ask for the approval of others. And of course, you have come to understand what is right by realistically evaluating the evidence for your beliefs, the short and long term effects of your decisions on your self an others and how your planned actions align with your values. To use a movie metaphor, you wake up from the Matrix and start owning your feelings, your decisions, your responsibilities and stop blaming others for your misfortune. This is my image of good therapy. What is yours?
10-12 sessions we need to "warm up" and get to know each other, as well as to clarify what each of us can do in your situation: what I can do for your and what you can do for yourself. I have to have enough information to suggest a move and I also have to have your trust so you'd try and test those moves. Then we'll see how flexible you are in your cognitive faculties. The faster you can wrap your mind around the idea that the world that you live in is not out there but inside your mind in the form of ongoing narratives and automated behaviors, the faster you can change the ideas, beliefs, and behaviors that don't work for you, that are inconsistent with your current values. The faster you can realize that you are the active player in your life and you don't have to believe everything that others, or rather your fears and expectations, tell you, the sooner you can free yourself from the chains of your suffering.
My first instinct is to say that "you'll feel it". But our feelings sometimes deceive us. Not everything that is frustrating or uncomfortable is bad for you. Sometimes, when you feel that nothing is working and you are ready to quit, that's when the work is about to start. When you stop being the "nice guy" and allow your dissatisfaction, disappointment, and anger to come through and start really speaking of what secretly bugs you, that's when transformation is possible. You have to be honest with yourself (and to your therapist) to change your ways. I've learned so much more from how a person left therapy than from months of "therapeutic" interaction with them. We want to quit because we don't get what we need or want. We often quit before we try to negotiate for our needs and wants. So here is what I really have to say about this. First, get clear about your needs and wants in therapy. Tell your therapist if you are not getting it and ask for another kind of treatment. If you are still not getting heard and your therapist is not responsive, then quit. Don't quit before you speak up for yourself. Nobody can read your mind if you don't let your voice heard. And this is true not only in therapy.
It depends on what you want to achieve and where you currently are in relation to that goal. Weekly sessions, for at least 10-12 weeks, are typical. But I can see you twice a week if it is a serious matter that you are dealing with (we'd need permission from your insurance first if that's your preferred payment method) or biweekly once we have established a "common language" and some basic changes in your behavior have stabilized.
That is a million-dollar question on Jeopardy. Many times it is. Sometimes it is hard to get there. Depression is an adaptive behavior in an environment when the individual perceives that no action would make any difference for their wellbeing, or any action would even make things worse. So the brain calls the body on ceasing desire, satisfaction, motivation, and energy production. The body would stop caring and go into a vegetative state. Exploring and transforming those mostly unconscious cognitive patterns that conclude in inaction can have lasting positive effects. A medical checkup for a potential brain injury should also be considered.
Technically yes, you could. But what purpose would this conjoint session serve? Do you want someone to back you up when you feel challenged? Do you want them to speak for you? Will you feel free to say anything you want when new, unexpected questions arise? Is there something you would want to talk to them about that you cannot do at home in private? Do they have to translate your thoughts to me because you think that they know you better than you know yourself or that they speak more eloquently than you do?
If you want couples counseling, then yes, I absolutely want to see you together. If their presence is necessary and is only for a couple of sessions (conjoint session), then they won't enjoy the same confidentiality that you do.
"We’d like to have back-to-back sessions. Can you see both of us?"
I could. But I'd like you first to think about how it would affect your child to see the same therapist that you see. Or how the siblings would secretly assume that they are talked out behind their backs? Will they trust that their "stuff" will not be shared with you? Will you want to know a little insight from me about how your child is doing? Will you want to find a way, through me, to manipulate them into obedience? Even if you don't actually ask me anything, will you wonder whether you could?
Probably not. When there is active violence in a relationship, couples counseling is not recommended. Each of you should do your individual sessions first; have recognized your role in the violence; and have made significant changes in your behavior to manage your temper and how you trigger each other. Until violence has ceased, couples or even conjoint counseling would not be safe for either of you or for the therapist.
Yes it is true. As a therapist I am a mandatory reporter of suspected child, elderly, and dependent adult abuse. Sometimes parents hurt their children, physically, verbally, or even sexually, when they get angry, frustrated, and stressed out. Sometimes parents don't know how to handle a child that appears to challenge their authority. Or perhaps parents have habits that are not conducive to caring for children. The list is long. I as a therapist, have to and want to make sure that I protect those who cannot protect themselves. Likewise, some adults (65 years and older), or those who are dependent on others due some debilitating cause, get subjected to physical, financial, or other kinds of treatment that threaten their wellbeing. If I suspect abuse, I report. If you, my client, prepare to cause major damage to person or property, I have to report to authorities to keep everybody safe. If you threaten to kill yourself and I cannot make sure that you are safe through a third party or your own motivation and actions, I will call 911 to keep you safe. Suicidal and homicidal gestures are very often passing "whims" - people feel better the next day if they don't give in to their urge to act. And there are a few other issues. If you are serious about this, ask me when you first call me.