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

Counsel is like deep water in the heart of man; and the man of understanding will draw them forth.

Mishlei − Proverbs, 20.5

A therapy session might begin with a therapist asking how the patient is doing since they last met. Sometimes a patient might be given "homework" by the therapist. He will ask how the patient has progressed, whether he has any insights he wants to share, or if he has any questions. A good therapist will always keep the patient's goals at the forefront of a session; that means he will steer a patient towards speaking about relevant issues, rather than tangential ones.

Techniques

Though there are different styles of therapy, (some of which are used strictly in specific cases and others used more broadly) the techniques a therapist uses should produce real and measurable changes within a few months of entering therapy. In order for this to happen, sometimes the patient's past must be explored. However, it is ineffective for the patient to be led to believe that his past defines him. It can actually be harmful in many instances, and focusing on the past, has, in my opinion, limited use.

In most cases, a therapist should not spend the majority of session time encouraging the patient to rehash his past. It is helpful for a patient to learn how the past can be a lens through which to view the present. The past can also help the patient lay a foundation for his future. But, "professional patients" (patients who spend years in therapy) and the therapists who enable them often go over past incidents again and again. This can keep somebody in therapy forever. Patients can even become addicted to therapy.

I had a patient once who escaped this fate by his own intervention. His previous therapist told him that because his childhood was so difficult he would most likely be in therapy the rest of his life. He looked at his therapist in wonder, asked, "Want to bet?" and walked out. Thirteen months later, with results-oriented treatment, he left therapy for good.

There is no recommended technique, which trains a therapist to "label" the patient's feelings for him. Experienced, well-trained therapists do not tell a patient what he is feeling. They will not tell him he feels "guilt" or "anger" that need to be resolved, for example. An experienced therapist guides the patient to discover and identify his own emotions. A therapist should respect the patient and encourage the patient to develop the skills he needs.

All clinical intervention techniques are only as good as the training the therapist has received, and the effort he puts into practicing them. Techniques are tools, like a painter's brush, or a violinist's bow, which eventually, with enough practice, can be used fluidly and intuitively. For example, I use many techniques, but rely on Cognitive Behavioral Therapy and Motivational Interviewing as my foundation techniques. I have been extensively trained in these techniques, and have practiced them for well over a decade; they therefore have become "second nature" to me. Therapists should choose techniques not just because they have an affinity for them, but rather, because they are proven effective. Techniques are being developed and re-developed constantly. A good therapist looks at the studies and only gets training in techniques that are evidence-based, and proven to work in a reasonable amount of time.

Unfortunately there are techniques out there that focus on minutiae, lead the patient down useless paths of exploration, which may even harm the patient. It is difficult, even impossible, for most patients to discern which techniques work, and which don't, without extensive research. It is necessary, therefore, to be able to rely on the therapist's expertise and sense of ethics in this matter. Patients should feel free, however, to ask their therapists questions about the effectiveness of the techniques they use, and if concerned, might want to ask for names of resource materials, which prove their effectiveness.

Partnership

A good therapist sees his relationship with his patient as a partnership, and empowers the patient to take charge of his recovery. Patients that hand over the key to their recovery to a therapist are not making a healthy choice. What generally happens when patients grant excessive power to a therapist is that when therapy ends, the patient relapses, often multiple times. He can't stand "on his own two feet." That is because the patient has completely relied upon his therapist to identify and solve his problems. The therapist becomes the "only one" who can offer the patient relief, but this relief is not recovery, it is illusory, and temporary. This type of therapist-patient relationship is a dysfunctional relationship. The therapist has enabled the patient to continue having problems because he has encouraged the patient to become dependent on him. This is a relationship that does not allow the patient to think and act independently of his therapist's counsel, and is very unhealthy. A therapist is a guide, not an idol.

Trust

You should like, and must be able to trust your therapist. You should have the sense that he is open, honest and kind. You should feel that he has compassion for you, but is able to remain objective. It is important that you not feel condescended to. Your therapist should respect you.

If a therapist "looks down" on a patient, it is impossible for a patient to trust and work with the therapist. In order to facilitate partnership, the therapist should use language the patient understands. The therapist should understand the limitations of therapy, and not aggrandize the process.

The therapist should also maintain healthy boundaries. He should not hug or touch the patient, (except an occasional handshake or pat on the back, if acceptable to the patient); he should not socialize with the patient or meet with him outside of the therapy session. That would be an expression of poor boundaries.

Trust operates on many levels. For example, a therapist should be able to assure you that he will not disclose information about you (unless required legally) to anyone. You must trust your therapist in order to work with him.

Moshe Zwolinski, LMHC, CASAC, SAP, ADS, ICADC, is a member of numerous professional mental health and addiction treatment associations. Moshe 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 email RMZwolinski@triaba.com.

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