22 Secrets Your Therapist Won’t Tell You

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

We say that when we get caught thinking about something else. (Don’t miss these therapist-approved tricks to finding a therapist you trust.)

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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. (Here’s how to nicely suggest that someone needs therapy.)

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Do we talk about you at cocktail parties? Absolutely

The stranger your story, the better.

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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. If you have these symptoms, you should consider seeing a therapist.

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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.

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It never hurts to ask for a lower fee

Some of us will say yes.

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

Some start to believe that every thought and dream they have is important. These are the signs your therapy is working.

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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.

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Sexual fantasies about patients? Unfortunately, it happens

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

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

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

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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.

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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.

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

You aren’t going to shock me.

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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. Try these therapist-approved tricks to deal with anxiety.

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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.

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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.

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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. Here are the simple but powerful ways therapists deal with depression and anxiety.

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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.

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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.

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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.

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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.

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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. Find out what your therapist knows about your relationship (but isn’t telling you).

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