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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by daisym on September 28, 2004, at 19:07:56
I've been thinking about this, especially given the thread on books and on office decorations. What questions should every therapist ask, not in an interview format, but off and on during therapy? I have a few:
Have you done any of your own research around this? (whatever "this" is)
How are you doing between sessions?
Is there anything that you need/want/could suggest to would make you more comfortable during sessions?
Tell me about your typical schedule and any upcoming variations I should know about.
What else? Either things they have asked that surprised you or thinks you wish they would ask.
I also think each therapist should begin with new clients by clearly addressing some house keeping issues, like yes or no to food/drink, feet on the furniture is Ok, books can be borrowed, or not, how to reach between sessions and what their phone policy is. I know, some theories believe that how the client negotiates these things is revealing, but I think it is just common courtesy.
Posted by Racer on September 28, 2004, at 20:01:38
In reply to Questions Every Therapist Should Ask, posted by daisym on September 28, 2004, at 19:07:56
Well, for anyone who might have an eating disorder, a therapist should certainly ask very specific questions about what the client eats. Not just casual questions, but detailed questions. If a client says, "I had a ham sandwich for lunch today," ask what went into the sandwich. How much ham? How many pieces of bread? Was there anything else on the sandwich? Did the client eat all of it? (I know that three therapists in the past six months have glossed over this question, including our otherwise fabulous marriage counselor. The MC asked for the menu from the day before, and left it at that -- until my husband brought up actual amounts to her.)
And ask what the client prefers to be called! Personally, I really, really *hate* to be addressed by the shortened form of my name that many, many people use. From some people, it's kinda OK, because they're using it as a sign of affection and intimacy that I find appropriate, but from most of the world -- I will either speak up and ask to be addressed by my proper name, or I will silently fume and wish I could speak up. That seems like such a minor thing, but it amazes me how often even professionals don't even seem to think of it.
(And don't even think about getting casual about spelling my name!)
That's the only one I can think of right now. Good idea for a thread, though.
Posted by rubenstein on September 28, 2004, at 20:39:23
In reply to Questions Every Therapist Should Ask, posted by daisym on September 28, 2004, at 19:07:56
I love this thread...what good ideas....I don't have much else to say about that, but it really made me think.
:)
Posted by Speaker on September 28, 2004, at 20:49:31
In reply to Re: Questions Every Therapist Should Ask, posted by rubenstein on September 28, 2004, at 20:39:23
The questions I would like to answer are:
Do you feel we have a good working relationship?
Is there anything that would make it easier for you to be open with me?
Posted by mair on September 28, 2004, at 21:45:15
In reply to Re: Questions Every Therapist Should Ask, posted by Speaker on September 28, 2004, at 20:49:31
I think every therapist should ask whether the client wants to be acknowledged if the therapist sees them outside of a session.
Posted by crazymaisie on September 28, 2004, at 21:59:29
In reply to Re: Questions Every Therapist Should Ask, posted by mair on September 28, 2004, at 21:45:15
good one, mair. this came up for me early on in therapy when i ran into my T one evening. it was awful. she ignored me and i went to the bathroom (hoping she would follow me in and we could acknowledge each other discreetly and get on with our seperate evenings) when i came back she was gone and i was sure she had left because i was there. we talked a fair bit about it but i have never been completely satisfied about it. of course, we have a plan in place for any future occurences. good idea, though
maisie
Posted by mair on September 28, 2004, at 22:00:24
In reply to Questions Every Therapist Should Ask, posted by daisym on September 28, 2004, at 19:07:56
>" I also think each therapist should begin with new clients by clearly addressing some house keeping issues, like yes or no to food/drink, feet on the furniture is Ok, books can be borrowed, or not, how to reach between sessions and what their phone policy is. I know, some theories believe that how the client negotiates these things is revealing, but I think it is just common courtesy. "
Daisy, I've written on this before but i think the phone policy stuff goes way beyond common courtesy. My therapist never brought this up at all and I took her silence to mean that she didn't want to be called between sessions, or certainly at home. I clung to that stubbornly, though one crisis after another for a couple of years - even when i could acknowledge to myself, on an intellectual level anyway, that of course she'd want me to call her if I was about to hurt myself. And I, also stubbornly, never raised it. My own feelings about her failure to give me any guidelines only came up when she made a casual comment to me one day to the effect of "of course you have my home phone number." Well I did have it because she's listed, but it was huge to me that she never gave it to me. We've hashed this issue over countless times ad nauseum since then. She told me, in her defense, that at the time I first started seeing her, she was more protective of her personal space because she had been stalked fairly recently, and that I started out anyway as a prospective short-term CBT patient (that's a laugh now). My point was that she should have revisited this when she realized that i wasn't the kind of person to abuse a privilege of calling, and when things were clearly going down hill for me. By that time she probably just presumed we'd talked about something we had not.
My god, I didn't realize until I just read what I've written here, that this still bothers me some. I think this is sticky for Ts because when they might rather set a policy after they have a sense of whether the patient is going to be a constant caller or a person who's loathe to ask for help. So, like my therapist, maybe they don't say anything, and it sort of gets lost in the shuffle.
mair
Posted by gardenergirl on September 28, 2004, at 22:30:30
In reply to Re: Questions Every Therapist Should Ask » daisym, posted by mair on September 28, 2004, at 22:00:24
Posted by fallsfall on September 29, 2004, at 9:13:44
In reply to Re: Questions Every Therapist Should Ask » daisym, posted by mair on September 28, 2004, at 22:00:24
Mair,
I started a new thread based on your comment:
>>that I started out anyway as a prospective short-term CBT patient (that's a laugh now).
I didn't want to hijack this thread...
http://www.dr-bob.org/babble/psycho/20040925/msgs/396776.html
Posted by Racer on September 29, 2004, at 12:23:21
In reply to Re: Questions Every Therapist Should Ask » daisym, posted by mair on September 28, 2004, at 22:00:24
Absolutely! But I'm gonna take it a step farther than you did.
Not only would I want a therapist to be pretty clear about policies regarding calls between sessions, but I'd want it done in a generous, open-handed way. None of the "You can only call if [x]" or "No more than [x] calls per [time period]" More of a, "If something happens, or you feel the need, you can call" or, if the therapist is concerned about boundaries, "Here's how to contact me, and it is my policy to revisit this topic after [x] months." Something that tells me that I can call, but doesn't tell me up front that the therapist expects that I may abuse the priviledge. I've had therapists start out by saying, basically, "You might get so dependent on me that you call for every little thing, so I'm going to set firm limits from the start to avoid this." Well, all that does is activate my Stubborn Gene, which refuses to call no matter what's going on. Saying that standard policy is to revisit the telephone policy after three months, say, would relieve that sense that the therapist is already suspicious of me, right from the start.
Of course, any therapist who's suspicious from the start that way is also unlikely to form a good working connection with me, so it is a good way to weed out the also rans.
Posted by pegasus on September 29, 2004, at 14:28:34
In reply to Telephone policies... » mair, posted by Racer on September 29, 2004, at 12:23:21
I agree that this is a biggie. I had a major conflict with my old therapist about calling policies. He was not very clear about it, until about a year into therapy, and then one day when he was worried about me he laid it all out in detail. And then I called him that night, and he didn't follow his own policy (i.e., he didn't check messages as late as he'd told me he would). So I waited 24 hours for a reply to a message that I thought he'd get within an hour. And let me tell you, that was not a pretty 24 hours.
He always maintained that he said "usually" when he explained it all to me, but I never heard that. So, IMHO, they need to not only clearly explain their policies, but then also make sure you got it all. Especially when they wait until you're having a really bad time to explain it to you, but really it would be good as a general policy.
My new T had her calling policy written into her disclosure statement, so I have a copy of that to refer to now whenever I want. Her policy is that she checks messages between 8 and 5 M-F. So, she's protected from phone abuse, without having to actually say anything to any clients about worrying about them calling too often. It works for me, but I recognize that there is a lot of no contact time that might not work for other folks. She has also at particularly bad times offered to call me to check in, or for me to call her on the weekend.
pegasus
Posted by mair on September 30, 2004, at 22:20:20
In reply to Telephone policies... » mair, posted by Racer on September 29, 2004, at 12:23:21
" Something that tells me that I can call, but doesn't tell me up front that the therapist expects that I may abuse the priviledge."
Racer - I think this is really hard for Ts and hard for those of us who have that Stubborn Gene (me too). When my T and I finally aired some of this out, she kept saying things that she thought were magnanimous like "you can call anytime you think (fill in the qualifier)" and then she'd realize that stubborn me would never see an emergency, for instance, unless I was sitting in a motel room somewhere with a loaded gun pointed to my head, and then it would only be an emergency if I really thought I was about to pull the trigger. In fact I'd probably be saying to myself "why should I bother her if I'm not really going to kill myself." We finally arrived at the policy that I could call anytime I felt like talking to her. I'm sure we got to that wide open door because she knows I'll practically never call.I've thought alot about what she should have said at the beginning to make someone like me feel that it was ok to call her and yet not expose her to those who really might go overboard if offered too liberal a policy. Maybe I should give her your suggestion of the open door and a periodic review.
Mair
Posted by Dinah on September 30, 2004, at 22:28:46
In reply to Re: Telephone policies... » Racer, posted by mair on September 30, 2004, at 22:20:20
I just read about a study done to see what phone policies result in the fewest calls to therapists. Let's see if I can remember it.
Therapists who say they don't want to be called at all get the most crisis calls.
Therapists who have a policy that clients can call whenever they need to have the fewest crisis calls.
But therapists who have a policy that clients can call whenever they need to, and reiterate their policy frequently have the most non-crisis calls.
I think the conclusions drawn were that permission to call provides clients with a sense of security that allows them to try to get through difficult situations on their own, but excessive reiteration of the invitation to call gives clients the idea that they aren't expected to be able to handle things on their own.
My own therapist tells me at the end of each session that I can call him if I need him. It's part of our session ending routine, and it's very comforting to me. If I am feeling especially non-needy I give him an "I won't need to" grin. But no matter what, I appreciate the ritual, and if he forgets, I remind him.
Posted by Speaker on October 1, 2004, at 8:01:19
In reply to Re: Telephone policies..., posted by Dinah on September 30, 2004, at 22:28:46
This has been the hardest thing to get past with my new T. (almost a year now). He didn't cover phone policies and after a few months I asked about how he handles the phone. He talked about a bad situation he went through with a client and that is why he just doesn't address it with clients until they bring it up. OK...for me that means he thinks I am going to be like the former client and he doesn't want to take a risk...therefore he doesn't really want to help me outside the two hours a week he is getting paid. OK...I have the Stubborn Gene also! We have now talked and he says if I need to I can call...Right! To me thats like asking for flowers and then getting them...its not the same and its not caring. I don't need someone to fill an obligation - if I just want someone to talk to I can call a hotline. Do they just not get the point or am I the one missing something? As you can see this hits a hot button...sorry.
Posted by Racer on October 1, 2004, at 12:28:48
In reply to Re: Telephone policies..., posted by Speaker on October 1, 2004, at 8:01:19
That's a hot button I think hits for a lot of people, and I think your irritation is fully justified. That's the message I'd get from hearing that from a therapist, and that's pretty much my response, too: "Very well then, I just won't ever call you, because you just don't want to be there for me."
Ironically, my current therapist asks me to call each weekend to check in with her and leave a message telling her how I am. As often as not, I forget to do it. (Got a lecture about that last session, too.) Now that I have a therapist I trust to return my calls within a reasonable time, someone I trust does care and is there for me, I don't have the same sort of need to test that, I don't have the same sense of being alone and helpless -- when something comes up, I can handle it better because I *know* that I can call for help if I need to. So, instead of calling for help, I try to deal with it myself first. Much better, and I feel much more secure.
I think what Dinah wrote, about that study, makes a lot of sense to me. I think that's a great policy. And I really hope most therapists know about it, too!
Posted by Daisym on October 1, 2004, at 21:38:11
In reply to Don't be sorry » Speaker, posted by Racer on October 1, 2004, at 12:28:48
On a thread about questions, it seems that telephone policies is surely the biggest one. It makes me wonder if we haven't been trained, socially, by the media, in some way, to think of therapy as a place where we have no power to ask for clarification of the rules. There is no other setting can I think of that I would allow this. I always tell my home visit clients how to get hold of me.
Are we unsure of what it says about us to ask? Do we think asking about a phone policy sends a message that we ARE needy? If we went to a doctor and we had a question about a medication or we developed a pain, we would call. But often, even in anguish, we wait because...why? Because it is "just" our feelings? Because we don't want to burden those folks that we have chosen to try and help us? Because we accept that we need therapy but we don't need it THAT much?
I think in some ways, phoning brings therapy more into our real life. It isn't contained in the sacred space. So the reality of needing the support is greater. Are we invading their space? No, it is their job and their business. And we are their clients/patients. But we still feel that way. I've yet to hear anyone talk about calling their medical doctor with the same reservations.
I don't know. I don't have the answer. It STILL is so hard for me to accept that my therapist wants me to make those phone calls. In fact, I did so poorly last weekend that I got put back on weekend check ins. He called it "an experiment for a month" because he knows it goes down easier for me to have it set up, than to admit need in the moment. Which is pride, I guess.
It is just confusing that this topic is such a hard one. But clearly, it is.
Posted by Skittles on October 1, 2004, at 22:11:41
In reply to Phone Policies » Racer, posted by Daisym on October 1, 2004, at 21:38:11
The whole calling issue IS very difficult. My T has said I can call any time I need to and I've done that 3 times (all during normal business hours). The first time she was with a patient, called back quickly and I went in that day for an emergency appointment. The other 2 times were probably far more an emergency than the first, but she wasn't in and even though the receptionist said she could get a message to her, I wouldn't leave one (and I never mentioned to my T that I had called). I think that I'm so afraid of crossing a boundary/invading her privacy that I keep myself 1000 miles away from them. I'm perfectly aware that I am her job and not her life. So, my thought process is that if she isn't in the office, she isn't planning to be working(which is the only place I fit into her life), so leaving a message would be invading her personal time. There are lots and lots of times when I want to call, but then I wonder what exactly it is that I expect to get out of it and I can't figure it out, so I don't call. She can't fix it, so why bother her?
I realize none of this is helpful, I'm just processing what's in my own head.
Posted by Daisym on October 1, 2004, at 23:04:54
In reply to Re: Phone Policies, posted by Skittles on October 1, 2004, at 22:11:41
>>>>So, my thought process is that if she isn't in the office, she isn't planning to be working(which is the only place I fit into her life), so leaving a message would be invading her personal time. <<<
I understand your thought process here, but it seems to me that part of being a therapist is being "on call" too. Again, I would expect my pediatrician to call me back, even after hours. As long as it was reasonable. Or I would talk to the "guy" on call. Not that I want the therapist on call, but you know what I mean. The therapy process is more than just the hour face-to-face. What goes on in between is important and powerful too. And, I'm reasonably sure that most therapist know that they open your emotions wide, bring stuff to the surface that just can't be contained sometimes.
>>>>>There are lots and lots of times when I want to call, but then I wonder what exactly it is that I expect to get out of it and I can't figure it out, so I don't call. She can't fix it, so why bother her?<<<<I've said this a million times to my therapist. Almost word for word. "I don't know why I'm calling, I don't know what I want you to do for me, but you told me to call if I felt like this." He points out over and over again that it probably isn't what he'll say, it is the fact that he is there. I want to hear his voice, not the meaning of the words. I don't want to be alone with "it" and I don't want to feel like he has disappeared. He talked recently about being part of a double container. I try to contain my feelings but he wraps around also and provides reinforcement of that container. And if the feelings leak out or spill up over the top of my container, it is OK, because he is there backing me up. I liked thinking about it that way. So it takes some of the stress off.
Equally as important, I think, is the idea that people like me, who have spent a lifetime stuffing their feelings, are so good at it, that when a length of time goes by, I don't remember how I felt 4 days ago. If I was having a hard time, I rarely would tell him about it because I handled it and I was taught to push forward, not back. And then I could never figure out why I felt like I felt or how to not let the stress accumulate and then overwhelm. More frequent contact has allowed better communication of these feelings and better stress managment.
And even given all that, with all I know, it is still really, really hard. Because I still feel like I've turned into the exact thing I was afraid of, the Pain in the A## client who is needy and demanding. *sigh*
Posted by Skittles on October 1, 2004, at 23:23:41
In reply to Re: Phone Policies, posted by Daisym on October 1, 2004, at 23:04:54
Thank you, thank you, thank you for your post. Hearing her voice/just talking to her is EXACTLY what I want. Why is it so hard to admit that to myself and even harder to accept it as okay?? You hit that on the head too - I fear being a pain in the a$$. My mother always told me I was "so damn demanding." I don't think I was, but now it's one of the things I fear most, so in turn I ask for nothing (because I that's what I deserve??). It all goes back to not wanting to be a pain in the a$$.
Posted by Aphrodite on October 2, 2004, at 7:24:13
In reply to Re: Phone Policies, posted by Daisym on October 1, 2004, at 23:04:54
This whole phone policy thing has been a thorn in my side in therapy. I never called for anything more than a scheduling issue for the first 6 months. Even in my worst moments, he never gave me the "phone policy" or told me what to do. I finally asked. In his long-winded explanantion, he said I could call, gave me his pager number, but ended with a caveat about abusing a privilege. Yeah, like I would really call after that!
So, we talked about it later and he apologized. He said he had been struggling with the phone issue and the timing of my question was bad. He was trying to formulate a policy, but was realizing he couldn't have a cookie cutter approach, that we would have to give a different policy to each client based on their particular situation. He said some clients call him every day. He said he knew I wouldn't call as much as I should and had no reservation about me calling him. I said, "Damage done! I'll never call!" So, he started calling me himself and doing check-ins. I've only called him a handful of times and promptly paid him for anything beyond 15 minutes even if he initiated the call. He doesn't have a payment policy about calls, but for me it keeps it "clean." At first he protested the payments, but acquiesed when he realized the only way I would call is if I could pay for his time. I've spent a lot of money on those calls lately!
I now believe in between calls are necessary during the hard times, but I'll never get past our original "misunderstanding" and doubt I'll ever feel comfortable with it.
Posted by Racer on October 2, 2004, at 9:37:11
In reply to Phone Policies » Racer, posted by Daisym on October 1, 2004, at 21:38:11
In my case, there's a bit more to the whole thing than that. With the agency where I saw Dr EyeCandy, their reaction to me calling with a problem was such that I did my best to stop calling. I'm still having trouble calling when there's a problem, even though I'm dealing with a different set of treatment providers.
I think that's largely why SparklingBright asks me to check in every weekend. I think that, while it might really have something to do with making sure I'm "OK" between sessions, it's also her way to try to 'retrain' me that it's OK to pick up the telephone and call.
Just to make it all confusing, now that I have some evidence that it's OK to call, I don't feel nearly the same need to call. Of course, there's another thing, too: now, with this treatment team, it feels as if they're working *with* me, for *my* benefit, rather than trying to push me into a box and slam the lid on me. That difference, alone, is enough to reduce my anxiety, and reduce my need to call for support. With Dr EyeCandy's agency, I felt trapped -- as if they had forced me into a coffin and nailed the lid down on me, despite my telling them that I wasn't dead. They just kept telling me I was wrong, and forcing me into that box.
And then, of course, reprimanding me for trying to get out of that coffin, since they kept telling me that I was dead and just wouldn't face up to it.
So, that's got a lot to do with me and picking up the telephone...
Posted by rubenstein on October 2, 2004, at 10:12:09
In reply to Re: Phone Policies » Daisym, posted by Skittles on October 1, 2004, at 23:23:41
> Thank you, thank you, thank you for your post. Hearing her voice/just talking to her is EXACTLY what I want. Why is it so hard to admit that to myself and even harder to accept it as okay?? You hit that on the head too - I fear being a pain in the a$$. My mother always told me I was "so damn demanding." I don't think I was, but now it's one of the things I fear most, so in turn I ask for nothing (because I that's what I deserve??). It all goes back to not wanting to be a pain in the a$$.
I agree this is exactly what I fear as well. Thanks for this thread, everyone, I called my therapist for the first time last week and I am still feeling guilty about it....even though he was great about the whole thing...this thread has really helped.:)
Rubenstein
Posted by Daisym on October 2, 2004, at 12:43:30
In reply to Re: Phone Policies » Daisym, posted by Racer on October 2, 2004, at 9:37:11
God, Racer, such vivid metaphors. A coffin? Those people really screwed with you! There ought to be a law...
I think if you are being retrained, this is a great way to do it. It meets her need to get you to think about how you are doing, not just push through and to then articulate it, even if it is "just" on the message machine. You leave her the option of calling if you need her, or she thinks you need her, but also of not calling if you don't. It is a great system, imo.
And I can see why you wouldn't want to call the "other" agency, they just made you feel worse and worse. So now you have to relearn the story of the stove, so to speak. I wrote this for my kids:
One child thinks a stove is bad, because she burned her hand, when it was hot. Her mother didn't keep her safe. One child thinks the stove is worthless, because nothing good ever came from it. Her mother didn't cook. It just sat there. But the third child knew that while the stove could be terribly dangerous, she also knew that this is where her mother made the hot chocolate she loved, and where the cookies she loved were baked. And her mother taught her to take great care around the stove and appreciate all the things it did for her.
Maybe you need to think of therapy as the stove and your therapist as the person who know how to make it work for you and keeps you safe as you are learning.
Sappy, yes, I know.
This is the end of the thread.
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