Answering Questions

Search Keywords Reveal Reader's Questions

Two questions have come up a few times in the search words used that brought a reader to this blog.  One is about whether or not you need to tell your therapist "...every detail."  The other was about how to pay for therapy.

The first puts us back to the trust issue.  First and foremost, find a therapist you can trust.  Or, at least, find one whose competence to help, you have confidence in and whom you believe you can come to trust.  The trust isn't always instant.  For some patients, it is.  They have a sense or an intuition about the person they have chosen and are able to pour everything out right away.  To others, they have it firmly in mind that, credentials or not, this is a complete stranger, and they simply cannot open up right away; in that case the trust builds gradually.  

Depending upon the degree of trust, you will share more or, less, of what is up with you--- past, present, and future plans and hopes.

As for, specifically, how much to tell your therapist?  Well, of course, that is up to you.  The therapy is for you, after all.  It is your therapy.  But once you have someone you trust and a good relationship, I suggest you share as much as possible.  By withholding certain details you deprive yourself and handicap your treatment provider.  On the first, you'd be surprised how much you can get out of just hearing yourself and what you say, when you speak spontaneously. 
The second is probably obvious now that you've had a few seconds to think about it.  How, for starters, can the therapist truly understand your problem or dilemma without all the pieces of the puzzle?  Obviously their ability to do that effectively will be hampered.

(As the friend of one of my patients told her recently:  "You don't take your car to a mechanic and expect him to fix it without telling him what's wrong.")

As for paying therapists, there is a wide range in fees.  The fee depends upon the therapist's credentials and the setting in which you are seen.  By and large, psychiatrists get paid the highest fees as they are medical doctors and can prescribe medicine.  Psychologists get paid on the higher end; the difference between them and counselors like me is the PhD rather than the Master's degree and that they are certified to do psychological testing.  The LMFT and LCSW both have Master's degrees, the latter in social work, the LMFT has a Master's degree in clinical psychology or counseling theory.

If you go to a clinic for treatment, there is often a sliding fee scale (fee based on your ability to pay), or medi-cal is accepted.  In some school-based counseling centers, you can be seen by a trainee for a very low fee or even free.  Some group practices engage an intern(s) and offer their services for a lower fee than that of the licensed therapists. 
The therapist in private practice usually commands the highest fee.  As I've written before, this setting is very private, very confidential (if you pay for your own therapy, that is; if you use insurance, the insurance company will be able to have certain information about you).  However, there is a bit of a range here too.  What community the therapist practices in will determine the fee, in part; if the therapist has garnered some renown from writing a book or having a radio show, etc. they will cost more, and more experienced practitioners with an established practice and a good reputation will usually draw a higher fee.  By the same token, if you can find a therapist who is in a relatively new practice, the fee will probably be on the lower end of the range.
Now, in case those of you who were searching were really wondering about basics, most private practice therapists and clinics will accept cash or check as payment, most require payment before or on, the date of the session.  Most don't have support staff so, billing is burdensome and they usually don't run the practice that way.  A few are now accepting charge cards.  If you use insurance, you pay the insurance's required co-pay again, at or before, the session and then either you (in this case, you pay the full fee at the time of the session and then collect the reimbursement from your insurance yourself), or your therapist bill the insurance for the remainder.  Hope that helps. 

Any more questions?  If you write them as a comment, I will know better what exactly the question is and will be able to answer accurately.