A Patient's Guide To Therapy: An Educated Consumer (Part One),Moshe Zwolinski, LMHC, CASAC, SAP, ADS, ICADC

Thoughts conceived in counsel will be firm; wage war with strategies.

Proverbs, 20:18

Patients entering treatment for mental health and/or addiction are no different than any other kind of consumer. They have the right to receive quality care at a fair price. As in any other customer-provider agreement, patients entering therapy should be able to anticipate a (reasonably) predictable outcome. A therapist and patient should agree upon, in advance, the approximate amount of time and expense therapy will entail. A patient has the right to expect good results in a certain period of time for a reasonable price!

Choosing an accountant, a doctor or even a housecleaning service is usually a straightforward affair. Choosing a therapist should be just as clear. If you hire a service company to spring-clean your house, you would most likely ask: How much will it cost? How long will it take? Do you do windows and move furniture? If I am not satisfied with the work, what will you do to correct the situation? What results will I see?

Psychotherapy is not much different than any other kind of service one purchases, though it is often perceived as being very different, even shrouded in mystery. There really isn't any deep mystery about how psychotherapy works, however, and there shouldn't be. Like any other service, the process should be fairly transparent. To ensure transparency and ethical treatment, a patient (or his advocate) must be informed about what services the therapist is ethically and/or legally obligated to provide. Using the following list, a patient will be better able to make the right choices when choosing a therapist. This list will help create an environment where patient and therapist are able to work together to resolve problems. By knowing what to expect and demanding a high standard of care, a patient will be able to receive treatment that is compassionate, effective and not excessively lengthy.

The Evaluation

Every patient entering therapy has an initial evaluation. The evaluation will include a "bio-psychosocial history" which is a complete overview of the patient's developmental and recent past history. A biography if you will, of the patient, up through the present. The therapist will also ask what issues or problems have prompted the patient to seek therapy. The therapist will ask the patient to describe all life areas that are affected by this issue. He will ask questions about the patient's physical health, as well, and may refer the patient to an M.D. instead of, or in addition to, psychotherapy. If he finds that a patient needs help negotiating government benefits, or other areas of social need, he may refer the patient to the New York State Department of Social Services where the patient will be assigned a designated social worker.

Technically, an evaluation is a continuous and ongoing process. As the therapist earns the patient's trust, the patient will feel able to disclose more information to the therapist, and, in turn, the therapist will gain a deeper understanding of the patient. Therapy itself, from the perspective of the therapist, is largely an evaluation process. However, the initial evaluation is paramount because it is the foundation for the next step in the therapy process: the treatment plan.

The Treatment Plan

All psychology professionals, whether they are psychologists, licensed mental health counselors, addiction professionals, psychiatrists or social workers will create a detailed written treatment plan. In most cases, usually beginning with the second session, this will be done together with the patient. In this way the patient plays an active part in deciding how therapy is going to work for him.

If the patient is disabled or mentally ill, the therapist may choose to do a treatment plan in conjunction with the patient's psychiatrist, family, advocates and/or guardians. Many patients require group therapy in addition to individual therapy, especially patients battling alcoholism, and chemical or behavioral addictions. Group therapy and other aspects of patient care may be part of the treatment plan. All patients should have access to their own treatment plans; it is highly recommended that a patient ask for his own copy.

The treatment plan will include: identifying the issue(s) the patient would like to see resolved, such as anxiety, depression, anger, alcoholism, etc... It will usually include the types of clinical intervention (techniques) that the therapist will use when treating the patient. It will also include target dates when the patient and therapist will "check-in" and evaluate the patient's progress. At these points, the patient should be able to see signs of improvement. These "check-in" dates can take place weekly, but some therapists prefer to schedule monthly "check-ins" instead. The therapist may prefer to schedule these check-in dates based on the number of sessions rather than a time period.

Treatment plans may set the length of therapy parameters for real improvement at, for example, five to ten sessions, depending on the diagnosis and the skill of the therapist. The therapist, with the input of the patient, will decide over what amount of time the sessions will take place. If after the target number of sessions has been reached and the patient does not see the expected changes, a new target number of sessions may be recommended. Alternately, if the patient does see changes but the therapist and patient feel more changes are needed, the treatment plan will again be modified. If substantial changes are not seen after a reasonable period of time, the treatment plan should be carefully reviewed and modified again. Perhaps other types of therapy would work better for this patient. If the therapist does not have the experience or training to do other types of clinical intervention, then he is ethically obligated to refer the patient to another qualified therapist.

If the therapy is so ineffective that the patient has not progressed and cannot manage to be largely independent of therapy at the six-month point, no matter how many sessions have taken place, all ethical therapists, without exception, will suggest other options. These may include radically different types of therapy, treatment with a different type of therapist, etc.

There are some instances, thankfully rare, where therapists allow patients to continue on and on, never getting better. I call this the "therapy merry-go-round." Sadly, children and adolescents are often the victims. They begin therapy for "behavior issues" perhaps at age eight or nine and end up still in therapy at age 18 or 19, victims of a system, which holds the patient responsible for failure, instead of the psychological professional! It shouldn't be that way, but unfortunately this remains the case, in part because patients and their families can be intimidated and ill informed, so bad treatment practices often go unchallenged.

When therapy fails, a complaint sometimes heard from the therapist is that the patient was unmotivated. It is important that patients and their advocates understand that a large part, perhaps the most important part, of a therapist's job is to find the key that unlocks the patient's motivation. In essence, it is the therapist's responsibility (just like a medical doctor's responsibility) to help the patient. Even patients who are forced into therapy (by families, courts, etc.) can usually become motivated to change if the therapist is skilled enough.

In addition, there are some disorders, which are extremely difficult to treat because the patient may be enormously resistant to change. Good therapists enlist the assistance of other professionals, family members, rabbis, treatment programs, etc. when developing a treatment plan for these patients, and, if necessary, refer patients to therapists who specialize in these types of problems. Therapists must be accountable for the work they do.

Good therapy practices and a clear, concise treatment plan encourage the kind of transparency of process that produces results. No patient should ever enter into any kind of psychotherapy or counseling without a written treatment plan. The plan should contain clinical interventions, measurable goals, the number of sessions and the time period over which these sessions will occur, and target dates for improvement. Remember, therapy should not be a mystery; it should be a process the patient can, in large part, understand.

Moshe Zwolinski, LMHC, CASAC, SAP, ADS, ICADC, is a member of numerous professional mental health and addiction treatment associations. Zwolinski is a nationally and internationally licensed addiction specialist and psychotherapist with 25 years of experience and is a recognized expert in the fields of mental health and addictions. He has worked extensively with the Jewish community; the New York City and State governments; New York City hospitals; the federal government including Homeland Security; the airlines and other transportation industries; Wall Street corporations; the NFL; and many other groups and individuals. He has a private practice in Brooklyn, New York. For more information please call 888-712-1988 or 917-470-5349 or e-mail RMZwolinski@triaba.com.

Read Comments (1)

A Patient's Guide To Therapy: An Educated Consumer (Part One) , Moshe Zwolinski, LMHC, CASAC, SAP, ADS, ICADC

Thank you, A breath of Fresh Air
Date 08:04, 04-15, 07

Clear and concise, a wonderful overview of therapy.