Individual Therapy, Part 1

I want to shift directions today. After several months writing about relationships, I am going to switch gears and blog for a while on more individual issues. I am making this switch because I see individuals as well as couples, and because many people reading this also have questions about individual issues.

I will try to write about these issues with a minimum of technical terms. Do you know psychologists have created words called "ego syntonic" and "ego dystonic?" These simply mean something that feels good or bad, respectively. What's really scary is that this language starts to sound normal after several days in a professional conference.

Starting this topic is like standing before a blank canvass that stretches out for miles, and miles, and miles. There's so much potentially to say about it. What I think I will do, for my own sake if not for yours, is begin this process by telling you some of the things I tell clients who are coming to me for the first time. I always have to remind myself that the basics I consider givens are things that need to be spelled out. And in today's posting I will spell out some of the basic structure.

Most therapists work on a 45- or 50-minute hour. That is, if you have a 1 p.m. appointment, you will be done at 1:45 or 1:50. There are a number of reasons for this, mostly having to do with the logistics of running a therapy practice. I don't know if this story is true or not, but I also heard one reason therapists work on a 50-minute hour is because that's the longest Freud (who basically started the whole field of psychology and psychotherapy) could last without a cigar.

For the rest of us, it simply is necessary to have a few minutes to write case notes, shift gears, and go to the bathroom before the next person comes in. I sometimes wish someone could see what drastically different worlds we are exposed to from hour to hour. It's a little like being transported to completely different planets and the next person who comes to us rightly expects our full and undivided attention when they sit down before us.

Which brings me to my second basic point: I don't know of any sane therapists who see 40 clients in a week. I've worked at a lot of different jobs: some physically demanding and some mentally demanding. The reality of being a therapist is that each hour of therapy is equivalent to approximately 1.5 - 2.0 hours of anything else. So a therapist who's seeing 40 clients in a week is working the equivalent of 80 hours.

Clients who come for therapy may do so either via their medical insurance, which allows for a certain number of therapy sessions if the therapist determines they are "medically necessary" (I could spill a lot of ink on that term alone) or pay out of pocket. Copays using insurance vary from no copay (nearly unheard of anymore) to $50 per session. This depends on the plan, on whether the therapist is "in network" or "out of network" and a host of other things. The average copay for most people is in the $20-$40 range.

Next week I'll write about the kinds of things which make someone pick up the phone and reach out for help from a therapist.

Do you have a question about your marriage or relationship? Is there a particular topic on relationships or individual psychological issues you would like addressed in this blog? Ask Josh in the comments below or email him at josh@joshgressel.com.

Josh Gressel, Ph.D., is a couples and individual therapist based in Pleasant Hill, CA. Visit his website at joshgressel.com.