In Therapy

A user's guide to psychotherapy

Overrated/Underrated in Psychotherapy

Separating the wheat from the chaff in therapy

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It's time to knock cherished concepts off high horses and give deserved credit to dark horses. Therapy is so broad and complex it can be hard to distinguish the essential from the expendable. Let's give it a shot:

Overrated: "A Ha!" Moments – The light bulb, the epiphany, the OMG! moment is a peak experience for many clients and therapists. Powerful as they are, you can’t force them to happen, they don’t guarantee life change, and chasing the Ah Ha dragon can cause you to miss many other transformative elements of therapy.

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Underrated: “Mm Hmm” Moments – Nothing conveys understanding and acceptance like a well-timed, sincere Mm Hmm. A lazy therapist can overuse this response when more input is warranted, but for a simple, unobtrusive utterance that says “I’m tracking you, and I’m curious about more,” you can’t beat it.

Overrated: The Reframe – Again, reframes are important, but only one piece of the puzzle. It’s nice to see negatives in a different light so this fresh perspective can feel quite liberating. But growth and change involves more than realizing you’ve been looking at it the wrong way. Working through emotions, finding root causes, and changing behavior requires that you move beyond the one trick reframe pony.

Underrated: The Frame – Therapy becomes a microcosm of life, meaning issues that arise outside the room will eventually appear within. By exploring feelings about the payment, the session time, the communication styles, termination, and the roles and rules of the therapy relationship, you’ll also address many issues that bring people into therapy.

Overrated: TV Network Therapists – Any shrink on TV who self-refers as “Dr. [firstname]” should be viewed askance. The questionable credentials, egocentric motivation, and shady ethics cause me to wonder who benefits the most from making private issues into entertainment. Truth is, most therapy wouldn’t make riveting television. Ten minutes of silence can be transformative in therapy, but ratings suicide on TV.

Underrated: Out-of-Network Therapists – Insurance panels are convenient and many qualified, caring therapists join their ranks to provide quality service. Despite this, some clients are looking for a specialist or level of expertise that is missing from their In-Network provider list. Out of Network costs more money out of pocket, but insurance plans often reimburse a decent percentage. In order to find the right fit, this expense and hassle might be worth it. (yup, this is me.)

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Overrated: Earned Credentials – Look, I’m as big a fan of education and rigorous standards as the next guy. But on an individual basis, degrees and credentials alone don’t guarantee a positive therapeutic outcome. One client may form an excellent working relationship with an Ivy League therapist with a Scrabble® deck behind her name, while another may achieve optimal growth with a second year grad student seeing his first client. We’ve said it over and over, it’s the relationship, not the title or modality.

Underrated: Earned Credibility – Trust is critical in any relationship, and it takes time and consistency to establish. A therapist may have the perfect pearl of wisdom to share, but if they haven’t earned credibility with a client, this gem is worthless. Credentials may help someone approach trustworthiness, as will their website statement and the testimony of friend or colleague vouching for them, but personal experince in session says much more about their credibility. Be patient and trust your gut.

This list barely scratches the surface and demands sequels. What would you add?

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My facebook page and website are definitely overrated, but you’re welcome to drop by. Please, don’t call me Dr. Ryan.

While you're at it, go join National Psychotherapy Day, the underdog of national days. Somehow, National Frozen Food Day has more fans. 

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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