How long does therapy take?

Hopefully, until we’re finished, or until you decide it is not what you need. I typically work with people for 3-6 months, but it is common for therapy to be briefer or longer than that, depending on your concerns, the depth or duration of your struggle, and a host of other factors that are too complex to make simple predictions. However, you should know within 3-6 sessions whether working with me is “going in the right direction.”

Do you just work one-on-one, or do you do other kinds of therapy?

Approximately 70-80% of my practice is individual therapy. I also work with couples, and conduct group therapy. I do not specialize in (multigenerational) family therapy, but on occasion (and when appropriate) I will meet with entire families as support for an individual’s ongoing work.

Can you work with my child?

Child therapy should be conducted by a psychologist or other therapist who specializes in that form of treatment, which I do not. I work with adults, ages 18 and up. On rare occasions I will work with adolescents, but not younger than 14. I am happy to refer younger individuals and their families to some of my trusted colleagues with more expertise in this area.

How often do we meet, and how long are sessions?

I typically work with patients once per week. On occasion, two sessions per week may be helpful or even necessary. On rare occasions, I work with individuals more intensively. Sessions are 50 minutes long, except for group therapy, which is 90 minutes. Other arrangements can sometimes be made if necessary. I will not work with you less frequently than once per week, except when clinically indicated as part of ongoing treatment. I find that such infrequency is usually counter-therapeutic.

Can we do therapy over the phone or through email?

I sometimes will make arrangements with a patient to do phone sessions as added support, or during an extended break in treatment. In my opinion, phone therapy is not an adequate way to do psychotherapy, and cannot stand on its own. I do not do any therapy or consultation with patients through email, for security and ethical reasons. My phone number is 303-377-0999.

I know therapy is expensive. How can I be sure I’ll get my money’s worth?

Therapy is more like tricky surgery than auto mechanics. If a mechanic can’t fix the problem with your car, then you might ask for your money back: you have a concrete expectation about the outcome, and there is a concrete ‘thing’ to fix. For more complicated procedures, where there are many factors affecting outcome, and no guarantees, you cannot be sure you will get your money’s worth. That’s why “interviewing” your therapist over a trial period, and getting a referral from someone who has benefited from treatment with your therapist, or who has seen others benefit from working with your therapist, are among the best ways of ensuring a good investment of your money, time, and hope. We will be tracking the process and outcome of therapy using two very brief measures that take less than a minute to complete; so you will have a good idea of whether therapy is working for you based on your goals and needs.

I had a therapist in the past who was late to sessions and seemed distracted, as if they had some other agenda most of the time. Is that typical?

Typical? Sort of. Acceptable? No. Therapy depends on the development of trust and a “solid container” in which to work. A therapist who is late, or who does not return phone calls, or who (worse yet) forgets sessions will prevent therapy from succeeding—or could make you feel worse than when you started. Similarly, a therapist who doesn't listen, or who focuses on areas that seem irrelevant despite your objections, is not doing their job well and should be fired. Your therapist should be timely, respectful, responsive, and tuned-in to your experience, your feelings, and your point-of-view.

Will you try to put me on medication?

No. In my experience, even very long-standing and “treatment-resistant” problems do not require medication in the vast majority of cases (click here for more on this topic). I view the use of medication as a last resort for extreme circumstances, not as the “standard treatment” as portrayed in advertisements. I am first and foremost concerned with safety, and on rare occasions, medication can increase safety (e.g., for prolonged sleep deprivation or extreme agitation). Yet, as frightening and painful as life can be, passing through a deep or overwhelming crisis can yield clarity and much-needed change. A therapist who regularly advises the use of medication probably does not understand how to effectively conduct intensive psychotherapy.

Will taking medication help or interfere with therapy?

An increasing number of people are obtaining medications from their physicians for psychological problems, and begin taking the medication prior to entering psychotherapy. I never advise a patient to stop taking medication without one of us first consulting with their physician and determining how or whether to discontinue that medication. Sometimes, psychiatric medication may interfere with obtaining therapeutic goals by numbing a patient’s emotional response, when we are trying to connect with certain emotions to work on them. Other times, a patient may have a mild or serious reaction to medication that is countertherapeutic, such as anxiety, agitation, or sedation. Each situation and each person is different; so I cannot give a simple answer to this question.

I’ve been in therapy with a few therapists and nothing really helped. Are they the problem, or is it me?

It’s hard to tell just from that description. There is a lot of interpersonal “chemistry” involved in therapy. Sometimes the fit between a patient and a therapist doesn’t work, yet the patient may benefit from working with a number of other therapists, and the therapist may do excellent work with other patients.  On the other hand, there are plenty of mediocre (or worse) therapists to choose from. A string of bad experiences with therapists can leave you feeling hopeless, or as if you’re doing something wrong. I have worked with many individuals who have worked with four or more (sometimes a lot more) therapists with little effect, but who achieved good or excellent results in therapy with me. That is no guarantee, but should give you some hope for your prospects even if therapy has been a big disappointment in the past. Alternatively, there may be something you are doing that gets in the way of getting what you want from therapy. A qualified therapist should be able to figure that out with you, without “blaming” you for it. Finally, therapy is not the only approach you can take to treat emotional, psychological, or spiritual problems. Other kinds of experiential work, volunteering, martial arts, mentoring, painting, and a thousand other activities may be very therapeutic. Sometimes, medical problems or dietary problems can interfere with psychological health (and vice versa!). It is always a good idea to consult a well-trained, holistic physician to screen for such issues. (Click here for links to good doctors).

Do you have a pager? Do you have emergency hours?

I do not use a pager, and I do not, as a rule, keep any emergency hours. Being an effective therapist requires a great deal of energy and self-care. In order to provide consistently good service to my patients, I set limits on my availability. I try to return phone calls within a few hours when possible, and sometimes even answer the phone when people call! However, for true emergencies, I advise people to call 911 or go to their nearest emergency room for safety, and ensure they get immediate attention. Many (but certainly not all!) therapists operate this same way, but you may need more availability than this. If so, this should be part of your “interviewing” process when selecting a therapist.

I have panic attacks and agoraphobia and you seem to be saying on your website that I should just “go with it,” or “feel my feelings.” How is wallowing in my anxiety or feeling like I’m having a heart attack going to help me feel better?

There is a big difference between “wallowing in” and “connecting to” painful or scary feelings. Wallowing is about wandering without direction or getting stuck. Who wants to do either of those? Connection is about walking into the fire to find out that there is no fire. While every situation is different, I have found that the quickest way through a panic attack is to (with guidance) “open up to the panic.” Sounds horrible, but with practice (and there are exceptions), the deeper the connection to one’s feelings to “see what happens next…” the more those feelings tend to resolve themselves. It is as if the last thing on Earth you’d ever want to do is exactly that which will help you the most.

I’m a _________ (fill in with demographic, cultural, racial, or religious identity). How are you going to relate to me if you haven’t lived my kind of life and don’t get my experiences?

I blew the very first session I ever had as a clinical psychology graduate student when I was asked this kind of question. My answer: “I don’t know.”  Wrong answer. By the end of that year, I knew the formula answer: “Sounds like you’re used to people not relating to you.” By the end of my training, I knew the right answer: “I don’t know. Will you tell me about your life so we can find out if I can really get what it’s been like for you?” I have had patients from very different walks of life tell me that I “got” them much better than past therapists who were “the same” on a demographic or cultural level. As I say elsewhere in this FAQ, you will know very quickly, in 4-5 sessions, whether we are on the right track together. If not, I am very happy, and obligated, to refer you to someone who I think might be a better fit.