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A dozen questions about “Therapy Revolution” for author, Richard Zwolinski

October 27, 2009 at 3:51 pm

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Today, your fly on the wall is asking Richard M. Zwolinksi, an internationally licensed psychotherapist and addictions specialist about the inner workings of the therapy business.  He tells us all what we need to know to be sure we are educated consumers of these types of services and not victims of a system that is little questioned. Richard’s written a great book for HCI called Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money... Not that I would ever need to know about these things personally…. ahem

1. Why did you write Therapy Revolution?

Many people told me they had been in therapy for years and weren’t being helped. I wanted to understand why therapy was failing them and I wanted to help people feel better. I also wanted people to stop wasting their time and money. After interviewing dozens of patients, I realized that most of them had no idea how therapy was supposed to work – it was a mystery. So, I began developing an easy, step-by-step plan to help people get the effective therapy they deserve. Therapy Revolution is the result—it’s a step-by-step guide for patients and their families.

2. What are the basic requirements for a good therapist?

There are essentially, four. A good therapist should be 1) experienced, 2) motivated, 3) ethical, and 4) caring and compassionate.

A good therapist has plenty of professional experience. He is motivated to take the time to get to know you as a person – who you are beneath your diagnosis or symptoms – and will do the groundwork necessary to help his patients progress at a pace that is reasonable, not too fast or too slow. He will make sure he understands what his patients’ goals are and will create a written plan that helps people reach their goals in a reasonable amount of time.

A good therapist must be ethical—he must have integrity. And, it is hard to know when you first meet someone if they’ve got it, no matter what their reputation or credentials. That’s why in Therapy Revolution, I outline numerous tips and pointers that help you figure out if you are getting the best possible therapist for your money. Of course, a good therapist has to care about people.

3. In your book you say there is a “Therapy Crisis” in America today. What is this crisis and what can people do about it?

The Therapy Crisis is very real, and I am not the only one to notice that we have a big problem in the United States. For example, let’s take talk about depression, which is an epidemic in our country. In a major 2008 government study of adults with depression, over thirty percent – that’s nearly one third – who talked with a therapist or other professional reported that therapy was little or no help. They didn’t feel better after therapy – in fact, sometimes people even feel worse after therapy. That means that millions of people are paying for therapy – and not feeling better.

There are also people without serious emotional problems who end up stuck in therapy for years. Why are they dishing out tons of money and time to therapists who aren’t helping them? Why aren’t they able to get on with their lives? Why don’t they feel better? Many even have therapy addictions. I call all of this the Therapy Crisis. My book is a step-by-step guide that helps people find a great therapist, get better, and move on.

4. Why hasn’t this Therapy Crisis come out before? Why haven’t people been talking about this?

Actually, people are talking about it. In fact, there is a quiet therapy revolution going on at the state level. Some states are rewriting their regulations to ensure that patients get better care. For example, I am part of a NY State patient rights committee designing regulations that hold therapists accountable for the work they do.

( http://www.oas.samhsa.gov/2k8/depression/depressionTX.cfm-some statistics about failing therapy)

5. With economic issues at the forefront of everyone’s mind, what can you suggest to make therapy more affordable?

So many people waste money on ineffective therapy. My book gives people simple steps to make sure they are getting value for their therapy dollars.  For example, people should make sure to check out free or low-cost clinics and other programs. Many excellent therapists, even those with prestigious reputations and successful private practices, work in these programs.  And, if people do decide to see someone in a private practice, they should ask about sliding scale fees. They may be available. Don’t be shy – just ask your therapist if he or she will give you a discount.

6. Any more ideas?

Another way to cut costs over the long run, and of vital importance, is people must make sure that they and their therapist plan out the course of therapy by writing a Treatment Plan. A written Treatment Plan is like a roadmap that states what the patient’s goals are, outlines the actual plan for reaching these goals, and describes how long it will take to reach them. During therapy sessions the Treatment Plan should be discussed in order to see if the progress is on track. In my opinion, if you are in therapy without a treatment plan, you are wasting time and money. The more goal-directed therapy is, the more effective it will be, and the more quickly a patient can become independent and leave therapy.

7. Therapy is expensive, yet many people have been in unnecessary therapy for years, even though there is nothing really wrong with them. Are they really being helped?

Endless therapy should not be an option – it isn’t helpful. It breeds therapy dependence, even therapy addiction. And it wastes a lot of money. Unless someone is seriously and chronically mentally ill, there is no reason to spend a lifetime in therapy. Far too many patients end up in go-nowhere therapy for years and years and no one, least of all their therapist, is telling them that this is not the way things should be.

8. Why do people stay in therapy, then? Especially when it is so expensive?

People often enter therapy when they are at their most vulnerable. They are willing to believe almost anything their therapist tells them and have blind loyalty to them – even when therapy is clearly not working. They keep paying and paying. That’s why it is so important to find an ethical, caring therapist who is goal directed and will help you achieve your goals in a reasonable time-frame and for a reasonable amount of money.

Of course I want to see everyone get the health care they need. Mental health isn’t just a personal issue – it affects more than the patient. It affects the patient’s family, friends, employers, and community. Currently, I am on a New York state committee that is trying to cut down on the legally required documentation that is already so overwhelming and repetitive it bogs down the therapy process. My fear is that if mental health care is run by the national government, there will be a paperwork avalanche and patients will get lost in the shuffle. The quality of treatment really will suffer. I believe that psychotherapists, insurance companies, communities, and individuals must take each instance of need on a case-by-case basis. This will ensure personalized, quality care rather than the one-size-fits-all kind of care governments tend to impose on people.

9. Today, so many therapists do therapy over the phone, or even the internet. Can that be effective?

I strongly believe that internet or phone therapy should only be used in emergency situations. First of all, a therapist needs to be able to see body language in order to gain insight into how a person is really feeling. People say one thing with their lips, and another with their bodies. Frankly, patients can easily be ripped off if they aren’t seeing a therapist in person, like Madeline who we interviewed for our book. Madeline could actually hear her therapist feeding and playing with her dog during her $250 an hour phone-therapy sessions! Even a dedicated, well-meaning therapist will be tempted to do the dishes or sort through the mail while listening to someone on the phone – it’s natural. A therapist must give a patient his or her undivided attention during a session, otherwise therapy just won’t work.

10. You mention spirituality in your book. You are a religious person. How do you think this has influenced the book?

In the book, I do mention that spirituality is certainly a vital component of therapy. However, what is most important is that your therapist respects your beliefs and is able to work with them.

Of course, my personal spiritual path has strengthened my work. My spiritual tradition teaches that true compassion is a blend of generosity and restraint. And compassion is an essential – perhaps the most essential – personal quality a therapist should have. I want to help patients to do their homework, make informed choices, and work together with their therapist to make progress. So, I guess that is compassion – the blend of giving and restraint, working in synergy to create a healthy outcome.

11. Do you have a personal turning point in your career that helped you become a good therapist?

Though there are many, many experiences that contribute to the making of a good therapist — one particular turning point for me happened early in my career when I said “good morning” to a patient and he turned to me and said, “Don’t say “good” morning to me – just say “morning” and I will decide whether its good or not.” This led me to one of the most important insights every good therapist comes to and that is: Never make assumptions about how a patient feels or thinks. Even though this patient had a rather extreme response, I think every patient wants their therapist to view their struggles with a fresh clarity rather than assumptions. One of the pitfalls therapists can fall into is to see the diagnosis rather than understand the person behind the diagnosis.

12. In your book you say there are 5 essential ingredients in what you call the Successful Therapy Formula. Can you tell us what one of the essential ingredients is?

Sure. Although all 5 ingredients are important perhaps the one patients are most surprised to find out is that therapy must be carried out in a Reasonable Time-frame. People are going to therapy year after year and not getting helped. They need to know that, in general, the point of therapy is to help the patient become independent enough to not need therapy – to be able to feel better and move on!

And, in some circles, a therapist has become an accessory, like a Gucci handbag. That means many patients have grown attached to therapy and their therapists. They are in therapy year after year after year. Even though they have no serious mental illness or other problem that would justify the time or expense.

Therapy Revolution

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