Psychotherapy Blog

A few days ago, I read yet another article comparing the costs and effectiveness of psychotherapy and medication. While both have benefits, the article stated, medication is cheaper. Hmm. I wondered. My insurance company has a handy calculator that allows me to estimate the costs of various types of care, so I figured I’d check it out. Well, as it turns out, generic antidepressants are pretty inexpensive—definitely cheaper than psychotherapy for insured and insurer. But let’s consider my modal client. You’ve...

I once took an informal survey of clinicians to find out a) where in their office they keep their clocks and b) how they ended their sessions. I found out we are a crafty lot indeed. Clever too. Some of us keep a big round clock somewhere behind where the client sits, so it can be seen either directly or with peripheral vision at all times. Some of us rely on our wrist watches. Some of us sport large analogues and...

It’s the kind of telephone call that every therapist gets and every therapist hates to get. “I’m sorry to disappoint you on such short notice, but I can’t come in today.” It was a patient who had come only once before, the week prior, and though he was articulate about what troubled him, one could discern that he was deeply conflicted about who he wanted help from or whether he even wanted help at all to solve his problems or even ease...

On sunny days, the koi rise to the surface of the pond. Occasionally a particularly interesting one rises through the murk, and for a few moments it is clearly visible in all its mottled, sun-dappled glory, fins lazily stroking the water, eyes unblinkingly assessing my shadow before it propels itself back into the depths. That is the image that comes to mind when I think of Cassie. She contacted me initially through an email, sending me a clear, carefully composed assessment...

It was not one of my better moments. It was a very busy time of year, getting ready for Passover, juggling my schedule with patients and the kids' spring break. It was one of those times where I stood at the intersection of my mothering and my profession and my head was spinning. On the top of the TTD list (things to do) was getting my five year old daughter a haircut. Routine errand as it seems, it did require a...

I was standing in the waiting room before my first session with a new therapist some twenty years ago, when I perused a cartoon that she had displayed on her bulletin board. In panel 1 of the wordless cartoon, a woman with a dark cloud over her head is talking to a friend who has a shining sun over hers. In panel 2, as the first woman gestures in a way that indicates complaining, the cloud covers her friend’s sun....

Like most of you, as a psychotherapist, book author, and educator, I am often asked to give workshops, and educational seminars. For many of us, sharing our unique expertise is a part of our professional mission. A while back I was contacted by a church group who wanted to give a series of eight different mental health workshops during the spring. Each of the workshops would be presented by a different expert. I was going to be the final presenter, number...

Once upon a time and many years ago when I was a very new therapist, I worked with a client who had completely made herself up. A lot of things never added up with her. For starters, there was her presenting problem. Some days she would report a diet of jelly beans (not many) and carrots, and yet she was never low weight. But since clients with eating disorders are so often metabolically out of sync, it didn’t seem completely unbelievable...

A close friend of mine is a wonderful therapist, a child of the 60s, a gifted man, large-souled, big-hearted and wise. His practice nourishes him and is saturated with life. He is committed to a worldview that eschews anything close to greed. “I won’t ask my patients for more, at least not if I can avoid it,” he says. “Often I will wait years to do it.” My friend’s position makes perfect sense to me. He is a thoughtful and principled...

There’s a beleaguered mom on the couch in my office, and she’s feeling skeptical about my idea that she needs to “double-up on self-care.” She shakes her head—tosses it—and says, half-pitifully/half-defiantly: “Even if I had a few minutes alone, I don’t even know what to do to take care of myself. All I want is to sleep. Creativity is not even really a need right now—it’s like wishing for the moon. I just want to work, pick my kids up...