13+ Things Your Therapist Won’t Tell You

Whether or not you're part of the 25% of adults who've seen a therapist, these insider secrets will give you a dose of mental medicine.


1. Sometimes, when we say, “That’s interesting,” it’s really not.

We say that when we get caught thinking about something else.

2. Don’t take it personally if you see me outside the office and I ignore you.

If I’m with someone, introducing you as my patient would violate patient confidentiality.

3. Do we talk about you at cocktail parties? Absolutely.

The stranger your story, the better.

4. Mental illness can damage the brain. You can’t just wait for it to go away.

The longer you wait to get treatment, the worse it will get and the greater the chances that prescription drugs won’t work.

5. Anyone can call him- or herself a psychotherapist or a therapist.

You want a psychologist, a psychiatrist, a clinical social worker, or a marriage, family, and child counselor. You have to be licensed to use those titles.

6. It never hurts to ask for a lower fee.

Some of us will say yes.

7. Long-term therapy makes some patients much more self-absorbed.

Some start to believe that every thought and dream they have is important.

8. I might exaggerate a diagnosis to get an insurance firm to pay for more coverage.

I use a diagnosis I call adjustment disorder, which means you are having trouble adjusting to your life. That can apply to almost anybody.

9. Sexual fantasies about patients? Unfortunately, it happens.

When it does, it’s very distracting and troubling.

10. The people who pay for their therapy themselves seem to get better faster.

The patients who rely on insurance are typically not as motivated.

11. Sometimes I tell you to do the opposite of what I really want you to do.

For instance, I might tell you that this week I want you to be really depressed, to think about all the reasons you are depressed each day. It works for two reasons: First, nobody likes to be told what to do. And it helps you realize that you have a choice in how you feel.

12. Please don’t ask things like “Don’t you agree?”

If you’re looking for approval, you’re not going to get it. A good counselor is not there to say yes to everything.

13. No matter what you tell me, I’ve probably heard it before.

You aren't going to shock me.

14. Unlike with cancer and heart disease, people with mental illness often think it’s their fault.

So when they get better, they’re proud of themselves for conquering adversity when, really, it was just the Prozac.

15. Get it straight: Psychiatrists are doctors who go to medical school. Psychologists usually have a doctoral degree.

Both of us can do therapy, but in most states, only psychiatrists can prescribe medication.

16. If you feel isolated and alone in the world, I probably can’t cure you in psychotherapy.

That is the main issue for a lot of the patients I see. But the best thing you can do is go out in the world and help people.

17. Today I’m on this side of the couch, but tomorrow I could be on that side.

A lot of us have our own issues.

18. In expensive cities like New York and Los Angeles, if you want a good psychiatrist, you’ve got to pay cash.

The best psychiatrists don’t take insurance anymore, because they don’t pay us enough. If you go through your insurance, what you’ll get is a five-minute med check, not therapy.

19. Yes, I may think you’re crazy.

But if you ask me, “Do you think I’m crazy?” I’m never going to tell you that.

20. Pharmaceutical companies love to give us free samples of the newest drugs.

But a lot of the new drugs—at a much higher price—are very similar to drugs that have been around for a while. So if the first drug your doctor gives you is a new, expensive one, ask if you can try something generic first.

21. Most of what you say is confidential.

But if you admit to me that you committed child abuse or that you’re planning to physically harm yourself or someone else, I’m legally bound to report you.

22. It makes me crazy when patients call me at all hours to have a chat.

The fact that you can’t remember what it was I told you you’re supposed to do in a certain situation is not an emergency.

Sources: Psychologists and psychiatrists in California, Washington, Pennsylvania, and Texas

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