Dear Therapist:

I'm a thirty-year-old wife and mother who's been recommended for therapy by my rov to address trauma and a difficult childhood. I am concerned about some obstacles that I think will come up—and that I have heard from others—and am curious if the panelists have any solutions. 

Being that the average session time is 45-50 minutes, how is it feasible to get anywhere in therapy? It takes a good fifteen minutes just to "warm up" and often, once you're deep into something - you have five minutes left. This leaves the client hanging (even if the therapist wraps up well) and now has a week lapse, during which you lose momentum. At the next session they can't just pick up where they left off; they need to 'warm up' again. How is any deep work supposed to get done in this time frame? Why is conventional therapy set up in this way? 

Additionally, our lives are so busy and although it would be nice to put our lives on hold for therapy, realistically, therapy happens in middle of the workday etc. It is so difficult to transition from running carpool, getting the kids out, work etc. to therapy. And then from therapy back to work, errands etc. It's as if therapy is another appointment/task but in order to do real work, one needs to be focused and calm. Any suggestions on how to overcome these hurdles? Is the only alternative going off to an intense residential program where the only focus is therapy and healing? 

Response:

You mention a number of obstacles to therapy. They all appear to be logistical concerns related to the way in which therapy is delivered. They refer to timing, duration, and frame of mind. The suggestion seems to be that if the therapy process were set up differently, it would promote better and more efficient healing.

It is certainly possible that longer sessions at more opportune times would be beneficial. It is also important that we are in the right frames of mind when in therapy.

From a logistical perspective, these are concerns that can be discussed with the individual therapist during the initial phone call. (I generally recommend a personal discussion prior to scheduling the initial appointment.) Many therapists offer sessions at times that can work for you. Weekend and evening appointments are not uncommon. One-hour sessions are also fairly common.

The need to “warm up,” the degree to which this is necessary, with which clients, and within which therapeutic modality are all factors that are highly individualized. Different people have differing needs for a variety of reasons, which can vary greatly from session to session. Taking these and other factors into account will help to determine whether the need to warm up will be an issue. If it is, this is something that should be discussed with the therapist, who can help to address it.

Logistical concerns can be addressed collaboratively between the client and therapist. I notice, however, that your discussion of conflicts appears to be coming from a theoretical, intellectualized perspective. You mention obstacles that you “think will come up,” and what you have heard from others. If you have not encountered these concerns through your own experience in therapy, I would caution you not to become caught up in others’ experiences. As mentioned, we all have very different experiences in therapy. Although you may believe that these concerns pertain to you, it may be very different in reality.

Going in with the assumption that you will encounter these obstacles can actually cause these to appear (a self-fulfilling prophecy). Imagine, for instance, that you have an appointment at noon on a Monday. If you were to go in with no preconceived notions, you might find that the atmosphere puts you at ease, allowing you to calmly focus on the issues at hand. If, however, you enter the office feeling like you will not be calm, you are less likely to be calm. This can easily lead to a long warm-up time at the beginning of the next session, causing you to avoid touching on deep issues.

When we are uncomfortable with something, we tend to utilize defense mechanisms designed to help us avoid dealing with it. Although these defenses are normal and appear to help us in the short run, they ultimately prevent us from resolving our problems. The fact that you appear to be speaking hypothetically and have identified numerous concerns in advance has me wondering whether this is an unconscious attempt to avoid therapy. Although you consciously recognize that therapy can be helpful for you, it may be uncomfortable for various reasons.

It is natural for the unconscious mind to convince us that what we are feeling is in fact objectively real. If your unconscious mind is pushing back at the idea of seeing someone, simply telling you that you are uncomfortable won’t work; you would immediately respond that it is nonetheless necessary. Therefore the unconscious mind “tricks” you into believing that there are legitimate reasons to put off seeing a therapist.

Of course, I don’t know what is actually going on for you. I would recommend, however, that you try and explore these ideas. I would also recommend that you speak directly to any therapist that you consider, and directly address these concerns. You may find that those obstacles that seem most likely to affect you are the very ones that have little to no impact on your therapy process.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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