Tag Archives: psychiatrists

Therapy: What it is and What it isn’t

Whether you call the process Therapy or Counseling, there are many misconceptions about it. I don’t pretend to know all the issues, but there are several I have run across – as a seeker and as a provider.

Your therapist cannot “fix” you. First, this assumes you need fixing, and secondly, it assumes the repair work is completed by someone else.  Healing from loss or trauma is a process that you take on.  Changing  behaviors that create barriers to your happiness takes a process of awareness and practice. In therapy, you choose a guide to assist you with the processes. Remember, the answers are within you and your therapist helps you find them – your solutions, not theirs. As you engage in a relationship with your provider, your patterns of interacting with others rise to the surface. So do the relationship behaviors of the provider (more about that in another post).

Your therapist is not your friend.  You are not paying for friendship. This seems to be an accusation that comes from others who for reasons of their own, need to discourage your healing experience. Your relationship with your provider has specific boundaries regarding when and where you meet, and has a specific purpose – to guide you in identifying and achieving your emotional  or relationship goals, or to relieve your symptoms of distress. Friendships are reciprocal in a way that counseling relationships are not.  Both parties have roles, but they are not the same as friends.  Don’t call your therapist for a ride after dropping your car off at the dealer’s, and don’t expect to be invited to their summer barbecue.

The actual rigidity of professional boundaries is affected by many things, including the size of community you live in. Living in Seattle, you might never even see your provider out of the office. If you do, they might not acknowledge you unless you have indicated a connection first.  In a much smaller community, you may interact frequently, sharing the kids’ soccer field, the grocery store, church, or even social groups. Not acknowledging you in public in this setting might be viewed as “snubbing.” How you prefer to deal with these situations will probably be a session discussion topic. Whether in a small or large community, you have the right to have your professional relationship kept confidential if that is what you prefer. No matter the setting, sexual relationships and providers using the therapy relationship for personal gain are never appropriate.

When I say that your counselor is not your friend, I don’t mean they do not care about you. It is a relationship and a collaboration. My experience is that providers share consumers’ successes and concerns.  Depending on treatment orientation, your therapist may have accepted the responsibility of modeling nurturing behaviors such as acceptance, encouragement, and responsiveness. They expect to care about you.

Paying for assistance does not reduce its value. You have chosen to engage in a relationship with a specific purpose. For the provider, this specific purpose is a professional service. You are paying for the education, training, and experience of your provider, as you would a doctor, mechanic, or plumber. Remember, in this process, you are the buyer and you have a right to choose the service you get. You are not obligated to “stick it out” if  you are unhappy with the provider or the process. Ask for what you need.  There is nothing wrong with looking for  a provider and a methodology that works for you, or with changing providers and methodologies after you have started.

The credentials of your provider do not indicate relative competency or quality of care. There are several paths into the profession of psychotherapy.  These include several master’s level degrees, nurse practitioners, PhD’s and MD’s. Other than the ability to prescribe medications, Psychiatrists (MD’s with specialized training) and Psychiatric Nurse Practitioners (Registered Nurses with specialized training and experience) do not necessarily have more counseling expertise. Many have less counseling /talk therapy training than the others.  Clinical psychologists in Washington State have to have academic doctoral degrees and pass a licensing exam. Some states allow folks with Master’s degrees to be licensed as psychologists, and some states permit psychologists limited prescribing authority.  Psychologists also do not necessarily have more counseling training or experience.  They are often valued for their testing and assessment credentials.  Master’s level degrees in social work, psychology, and counseling also offer entry into counseling.  If you are looking for a therapist, explore their training and experience in the areas of concern you have. Above all, ask yourself after an interaction, ” Is this someone I could work with?”

Sometimes, the most difficult aspect of participating in therapy is the reactions of the people closest to you: The mother who believes she will be blamed for all your sorrows; The friend who wants your time and attention; The spouse who is afraid your therapist will tell you to leave your marriage; or the person who thinks you should just “buck up.”

The goal of therapy is positive change. Change is difficult for most people  – even good change, so there may resistance on your part and from the people around you. Try to be accepting and patient with yourself and with them.

This is a journey of self discovery and healing.


Remember, this forum is not intended to be therapy.  I have no way to view your body language, hear your tone of voice, or see your emotional expressions.  These are essential to effective communication and great tools for the therapist (and for the consumer when reversed.) I will attempt to be as helpful as I can. I will refer you the best I can to needed services. Even though I will not be your therapist, I am a health care professional bound by law and ethics to act to protect persons from harm. I am required to report my concerns of  harm to self or others, and suspected abuse of children and vulnerable adults.  I am located and providing these services in Washington State.

Again, I am open to communicating directly with you here.  If you have questions or concerns, please leave a comment. I will attempt to address the content if I can.

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Filed under counseling, emotional healing, healing, mental health, Penny Milczewski, psychotherapy, relationship, therapist, therapy