Psychotherapy is a relationship between you and your therapist, which is devoted to your well being and growth. Relieving your pain, reducing your symptoms, or changing your behavior or lifestyle may be parts of that goal. The only direct benefit to the therapist is the fee that you will pay. It is never your responsibility to take care of your therapist's needs, health, or well being, other than to pay the fee.

           The main way we achieve the goals of psychotherapy is talking together. Sometimes other kinds of "expression," such as doing art, playing (most often used with children) or writing a journal can be used. Other methods (such as relaxation training, meditation, and so on) may be suggested, but your therapist will use only approaches to which you agree. You have a right to be informed and to understand the purposes, activities, risks, and reasonable chances of success of any approach.

          Psychotherapy (or "therapy") is not physical, that is, we do not ordinarily touch one another. It is not necessarily about past memories, although it can be. Basically, therapy is about you striving to know yourself better and finding ways to solve your problems and live more happily in the world.

          At MAPS, we believe that a person’s spiritual values, beliefs, and traditions can be important to acknowledge and explore in the therapy process. We do not “push or advocate” any particular religion or tradition, but we are especially interested in helping you explore your own unique customs and beliefs. For some clients, spirituality is not seen as important, and it may not be discussed much. For others, it may be very important and thus occupy a central place in the therapy process.

          We think of therapy as present- and future-oriented, although some forays into understanding the past may be needed and beneficial. Although nothing can undo the past, we agree that those who are unaware of their past may be condemned to repeat it.

           Therapy cannot protect you from real-life dangers, oppressive circumstances, and threats. It can assist you in evaluating and problem-solving them. Therapy cannot rescue you from danger or evil persons. It can help you learn to recognize them and to avoid them. Therapy cannot simply end your unhappy story, but it can strengthen you to compose a new story.

           Therapy is often hard work. You will learn to pay attention to your thoughts, your feelings, and your relationships; to honestly acknowledge them (including feelings you wish you never had); to work with unwanted aspects of yourself, to learn to feel painful things and to face ugly realities; to talk candidly and respectfully with people you'd rather avoid; to accept impossible but inevitable situations; to change frightening but changeable ones; to face one's inner monsters and to learn to love the outer ones or to name and run away from them! The therapist does not do this work.

           The therapist's job is to listen carefully, to point out strengths that have been unnoticed and weaknesses that have been ignored, to look for hope when you are hopeless and danger when you are naive, to allow you to be dependent when you fear depending and to challenge you to grow up when you would love to stay little. In short, the therapist's job is to assist you to learn to meet your needs, satisfy your desires, and live more freely in this world.

 Goals of Therapy

          The chief overall goal of therapy is to help you to become better able to meet your needs, satisfy your desires, and live more freely in this world. Happiness, "feeling better," or similar states are not necessarily the goal, although they may be appropriate by-products.

          Some health insurance companies may insist that "problem reduction" or "symptom relief" are the only appropriate therapy goals. They may reimburse for what they consider “crisis intervention,” or “medically necessary” treatment. These are minimum goals. Authentic psychotherapy can be more than that. We will help you in achieving symptom relief, but it is not our only interest. However, as the client, your interests are the main focus of psychotherapy.

          Psychotherapy cannot reverse history. If you were abused or hurt in the past, it cannot be undone. We believe it is the current effects of past experiences that can be changed. This comes from our belief that psychotherapy aims to help you do two major things:

To change, primarily your ways of meeting your needs and seeking your pleasure in the world.

To strengthen primarily your self (that is, your capacity for choice, resilience, and adaptation to the demands of the real world).

           Some problems and sufferings are physical, or are made worse by physical pain. Therapy can be greatly assisted by medication, by exercise, and by bodily self-care.

           Some problems and sufferings are beyond therapy. Therapy can help you identify its own limits, and support you in the search for greater meaning and resources.

Known Benefits of Psychotherapy

         Research has shown that most of the common approaches to therapy are about equally successful. In general, the typical psychotherapy clients are better off after therapy than they were before it, and they are better off after therapy than 80% of untreated persons. This means, in other words, that you may have about a 20% chance of feeling better if you simply wait a few months or couple of years. Of course, statistics are usually more complicated than that. You should know that there is about a 5% chance that therapy may make you feel worse. A study by Consumer Reports said that typical clients in typical kinds of therapy for long enough periods of time actually find significant improvement. And it shows that generally speaking, the longer one stays in therapy the more the improvement one experiences.

         Therapy is very helpful when the client is depressed, anxious, unhappy, a survivor of trauma of many kinds, or suffering from a life-problem which requires careful thinking and involves lots of emotional energy. People who can talk and listen reasonably well, who are reasonably comfortable being alone with another person, and who are willing to pay attention to their own feelings, thoughts, and motivations probably will do well in psychotherapy. Often, psychotherapy can be enhanced by medications designed to decrease depression or anxiety symptoms. If so, your therapist will discuss this with you.

          Psychotherapy has been shown to help people who are passive to become more assertive, and to feel better because more of their needs are met. It has been shown to help people with high anxiety to feel calmer and to become more able to calm themselves down. People who are depressed often are helped a great deal, especially to identify and change the ideas and beliefs that may contribute to their depression. Most successful therapy clients change behaviors and lifestyles that keep them unhappy or stuck. Of course, none of these people are helped if they do not pay attention to their actual feelings and thoughts and talk them over candidly with the therapist. Nor are they helped if they refuse to change anything in their attitudes or their behaviors.

           People who are helped by psychotherapy typically report that they feel less unhappy, that their physical sense of well being is improved (for example, their appetites improve, their sleep habits improve, they have more satisfying sexual lives, and often their general health improves). People with chronic pain problems may not have less pain, but they often report feeling more able to live productively despite the pain and to not be so distracted by it. Sometimes, especially when they use additional tools such as hypnosis, they find that even their level of pain might decrease at least some.

Common Risks Associated with Psychotherapy

          There are risks to psychotherapy. The first and most important one is that people often feel worse as the therapy progresses. Sometimes this is natural; after all, talking about problems breaks down our usual avoidance of them, and the pain associated with them can then be felt more vividly. In some cases, however, the worsening is due to mistakes on the therapist's part, such as moving into painful material before the client is actually ready. In this case, recognizing the problem and "slowing down" usually takes care of the worsening. If the therapist does not "slow things down," however, the worsening can sometimes be serious.

          It is very important to let your therapist know how you are experiencing the therapy. If it seems to be making you feel worse, maybe it is. Telling your therapist allows exploration of what is happening, so you can decide whether the worsening is to be expected or whether the therapy is moving too fast.

          Some clients develop strong feelings about their therapists. This, especially in longer therapies, is normal, even if it is sometimes uncomfortable. Any feelings are possible, and the rule for them all is to talk them over with the therapist. We do not want you to feel shamed or humiliated by your therapist for anything that you discuss in therapy. If you do, inform your therapist; perhaps the feeling comes from you, but therapists must take great care not to intentionally shame or humiliate their clients.

          Therapy can complicate your life. After all, you may discover that you have feelings about people that you never realized you had. You may want or need things you had overlooked, and may not have access to them yet. You may have had experiences in the past that must be reconciled, and sometimes that is cumbersome.

         Of course, the fee you must pay for therapy can pose a risk to you financially. You should carefully consider the fee and your ability to pay it over the entire estimated course of therapy before you begin, lest you find halfway through that you cannot pay the fee. Usually, health insurance or managed cost companies (HMOs) will pay some portion of the fee; but they often stop payment at certain limits, after which you will be responsible for the entire fee. Will that pose an unacceptable financial burden? If you need to continue therapy at that time, this could cause significant distress to you.

          When clients cannot stay in conscious connection with their feelings, thoughts, or behavior, psychotherapy is not as helpful. The risk is that it might make them feel worse, or cause anxiety. In general, if the requirements of psychotherapy (such as talking, listening, being able to feel reasonably safe with the therapist, being able to learn from discussion with someone, and so on) cannot be met, psychotherapy poses a risk of making the client at least waste time and money, and at worst of becoming worse.

          Psychotherapy can also help with marriage and relationship problems. However, you should know that some research suggests that when one spouse or partner meets alone with a therapist to discuss problems involving the other partner, although it may help the person in therapy, the chances of separation may go up.

           The therapist could also offer suggestions and advice when they are appropriate, but you must know that research shows that a therapist's advice about life problems is often no more helpful than that of other persons. Helping you find your own solutions is far more important a job of the therapist than telling you what the therapist's solutions are.

 Risks Associated with Memories

          Since therapy depends on talking about your experiences, even in the past, your memory is involved, and memory is not always completely dependable. Your therapist can help you learn more about how memory works, if you are interested in that. But there are two main risks in therapy regarding memories: First is to take memories as being too dependable (as if all memories were always accurate); and second is to take memories as being too fallible (as if no memories from the distant past are reliable). In fact, the truth is in between.

          If you assume your memories are always accurate, therapy can be risky. For instance, if you perhaps remember abuse by someone in your past, and without any proof that it actually happened as you think it did, you accuse them, this may needlessly harm another human being, which, in our opinion, is never acceptable. A further risk is that the accused may retaliate and sue you or your therapist. This happens with increasing frequency. This of course will jeopardize your therapy, and may require that it be terminated prematurely.

          The other large risk associated with memory, especially memory of abuse, is to assume that it is never reliable, especially if the memory is unclear, vague, fragmented, or seemingly absurd. There is strong evidence that extremely traumatic memory is not stored like normal memories, and may be recalled in fragments, images, and sensations without logical stories attached. So just because a memory seems hard to put together does not automatically mean it is false, any more than it is automatically true. The risk is that we can miss the truth either way.

Risks Associated with Diagnosis

         Every good therapist makes some kind of "diagnosis" of your problems. This means that there is a "summing up, which describes in shorthand what is wrong and what is going to be the target of therapy. Even saying, "You are unhappy because you lost your job" is a form of diagnosis. Psychiatric diagnoses are condensed phrases that tell what your symptoms are and what the therapist assumes to be the cause(s) of your difficulties. The risk of making a wrong diagnosis is that the wrong treatment will follow.

          The benefit of making any diagnosis is that therapy has a much better chance to succeed when it has a reasonable focus, which a good diagnosis can provide.

          To avoid the risks of misdiagnosis, be sure that the therapist knows the whole story. Tell the truth as well as you can, and if something occurs to you, tell the therapist. Therapists are supposed to take thorough histories, and to consider carefully what medical problems might be causing your symptoms. Sometimes they will ask you to see a physician to make sure some medical problem is not causing your symptoms. All this is to help them make the proper diagnosis. If you have any concern that the therapist does not sufficiently know or understand your situation, don't hesitate to stop the process and say so. In this way, you can help avoid a misdiagnosis and the wrong decisions about treatment.

          Another risk associated with diagnosis is that your diagnosis, if you use medical insurance of any form, becomes quasi-public knowledge. Insurance companies insist that you be given a psychiatric diagnosis and this diagnosis will be a permanent part of your medical records. These records are available to any insurance company you apply to in the future. It is difficult to guarantee your privacy under such conditions.

           We strongly recommend that you not discuss your diagnosis with anyone except your therapist and your most trusted associates. Employers or people who do not have your best interests at heart are not appropriate persons with whom to share your diagnosis. The risk is that they may take as a "permanent truth" something that is in reality only a therapeutic shorthand description of something you hope to change.

          Another risk associated with diagnosis is that some persons are upset by it. Some people do not understand it and some people even feel ashamed of their diagnoses. Please ask anything and everything you need to in order to understand and accept your diagnosis. If you feel ashamed or belittled by it, talk this over until the feelings become manageable. No diagnosis needs to be a permanent, life-long prison sentence. One of the early hurdles in therapy is arriving at an accurate and helpful diagnosis and then helping the client become educated and reasonably comfortable about it.

Other Risks Associate with Therapy

         Unexpressed feelings about any of the "rules" of therapy can derail your progress. If you resent paying the fee or wish for longer sessions, please tell your therapist of these feelings. Even if nothing can be done to change the situation, the feelings can change if they are discussed.

          Therapists are required by ethics codes and by law never to have an outside relationship with their clients, including any form of sexual relationship. Even semi-sexual touching is forbidden. The privacy, intimacy, and personal nature of therapy sometimes can make feelings quite strong between a therapist and a client. If this happens, tell your therapist immediately. If your therapist does not respond in a way you can be comfortable with, you can stop therapy and notify the proper authorities.

          Sometimes problems that were not apparent to you at the start emerge during the therapy. When this happens, it is discussed between therapist and client and a new treatment plan is developed to solve them, or they are not addressed. Sometimes, present problems that seem minor become larger and must be addressed. Again, a new treatment plan wil1 be developed if that should happen, and nothing will be done without your full consent.

No Absolute Guarantees

          Based on experimental research, there are no guarantees that therapy will help you get better. But based on over a century of consistent clinical experience, we know that therapy helps many people achieve meaningful improvement in their lives. We have found five variables to be predictive of success: (1) When the therapist is comfortable with and believes in what he or she is doing; (2) When therapist and client share a collaborative relationship in which they respect each other and feel a positive bond; (3) When the client is allowed to talk freely and to feel emotions fully; (4) When the therapist is well-trained, has experience, and competently uses skills known to be helpful; (5) When there is enough empathy between the two that the client feels safe and supported taking risks and accepting the therapist's challenges or confrontations.

           Some people claim that there is little "scientific evidence" that therapy is beneficial. This is not actually true. Furthermore, "scientific research" has serious limitations when studying real-world situations like therapy. Many things known to be important and useful in life are not "proven" scientifically. Aspirin is a simple yet useful example.

          Though we cannot guarantee that therapy will help you, and would remind you that there is a slight chance (5% or less) that it might make you worse, we believe that it is quite likely to help you at least to overcome your immediate problems or symptoms and to feel well enough to live more productively.

          At times therapy will be difficult and uncomfortable. We cannot say how long it will last, but we will share our best estimate with you, once we know what the problems are. If anything changes as we go along, we will talk it over with you and will never do anything without your consent.

Guidelines for Therapy

           You may or may not have been to a therapist before. If this is your first experience with therapy, you may feel a bit nervous or apprehensive. That's normal!

           Therapy is a process that allows you the freedom and privacy to discuss issues that are often painful or difficult to discuss with family and/or friends.

           The following are a few suggestions to help make your counseling experience most effective:

 1.       Before your scheduled appointment, write down questions, topics, or issues you would like to focus on in your session.

 2.     Communicate your expectations to your therapist so that you are working together toward your goals.

 3.     Provide ongoing feedback to your therapist so that you know how you are doing (example, "I want to focus on my anger more" or "I like doing relaxation exercises").

 4.     If you feel a need to increase or decrease the frequency of your sessions, or to end counseling, feel free to communicate that to your therapist.

 5.     If you feel a need to bring a partner, relative, or friend in with you for your session in order to work on interpersonal issues, feel free to do so. Please discuss it with me prior to their arrival.

 6.     If you have another professional involved in your care (i.e. physician, chiropractor, attorney, etc.), your therapist would be happy to coordinate with him/her if you wish. Usually, is not advisable to have more than one mental health counselor involved in your treatment at one time.

 7.     Try to make a commitment to yourself to remain in therapy and attend regular sessions for as long as you feel necessary. If you wait until you have a crisis, it will be more difficult to build long-lasting coping ski11s.

 8.     If for any reason you would like to see a different therapist, please feel free to tell your therapist. He/she can provide you with names of other therapists.

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