14 - Safety Is In The Details
Fees and times may seem incidental to the actual therapy; but consistency in the temporal aspect of the frame contributes greatly to your sense of security, of being held. If your schedule is constantly changing, you will find that it is difficult to get any work done in therapy, and you will likely find yourself with subtle feelings of danger, chaos and abandonment. If, however, these details remain solid and secure, your unconscious mind will see your therapist as healthy, consistent, safe, strong, and devoted to your care.
SCHEDULE and TIME -- The usual schedule is once a week, though you and your therapist may decide to meet more frequently; twice a week is not uncommon. In cases of financial hardship, a therapist may agree to see you every other week.
At your first session, you and the therapist should agree on a regular day and time and place for your appointment. After that, your appointment should, ideally, stay the same as long as the therapy lasts; that is best for the success of your treatment. You may think that flexibility in the schedule is helpful to you; but it has been shown over and over again that to your unconscious mind, it is not. If you are depending on a structure for support, any change to that structure will leave you feeling unsafe.
Therapy sessions are typically 45 or 50 minutes. To maintain the secure frame, your therapist will hold you to that time absolutely. If you arrive late, you still must stop at the agreed time. At some point, it will probably happen that you will be in the middle of something deep and anguishing when the time comes to stop. This may be extremely frustrating to your conscious mind, but a good therapist will not allow you to run over the time, and that should satisfy your unconscious. If, on the other hand, the therapist is late, he/she should give you the full time.
Your absences and lateness, as well as persistent silence, wanting to leave therapy, forgetting to pay or delaying payment, and bouncing checks, are often symptoms of "resistance", or fighting therapy. These may (or may not) reflect outside issues, and should be discussed with your therapist.
In most cases, you will be responsible for paying for any regularly scheduled sessions that you miss or cancel; you are not responsible for paying for sessions cancelled by the therapist.
FEES -- At your first session, the therapist should propose a fee. What is normal? It varies enormously with the area, the therapist's qualifications, and the setting. I have heard of psychotherapists in private practice charging anywhere from $25 per session in Nebraska, to $150 or more in Manhattan. Non-profit counseling centers and clinics with sliding scales may reduce the fee significantly. Your health insurance may pay a portion of the fee. For your own mental health, keep your bill paid up to date.
PHYSICAL CONTACT -- Many therapists have a standard policy that they usually do not engage in physical contact with clients (hugs etc.). Such contact has many ramifications for your unconscious mind. Certainly, no therapist should ever suggest sexual contact with you. As therapy progresses and you build a deep connection with your therapist, you will find that because of the intensity of your relationship, you can feel "held" emotionally without actually being held physically.
PRIVACY AND CONFIDENTIALITY -- It should go without saying that you can expect absolute privacy and confidentiality. ABSOLUTE. Under no circumstances may your therapist ever reveal, without your permission, even the fact that you are a client, let alone any information at all about you or your case, to anyone, even to a family member. As an example, a friend of mine called his wife's therapist hoping to discuss "his side" of the issues. The therapist politely but firmly refused to talk to the man. She simply offered to refer him to another therapist if he wanted to work on his own issues.
You can ask your therapist not to take notes or record your session in any way. (One therapist I went to wanted to videotape all my sessions. Not!) Again, some differ on this issue; however, most clients find that it compromises their sense of privacy.
There may be instances when you choose to allow information to be released; in that case, your therapist should obtain a signed consent form from you. If your therapy is provided as an employment benefit, there should be no requirement for the therapist to report back to an employer about your progress. Managed health care programs increasingly intrude on this.
TERMINATION -- In most cases, you will be the one to decide when it is time to stop therapy. This decision should be discussed in great depth with your therapist, to make sure you are not terminating prematurely as an unconscious reflection of some important issue in your life. If, however, you both agree that problems have been resolved and termination is appropriate, set a specific date for termination and stick to it. The frame should remain absolutely intact right to the end. After terminating, you have no further contact with your therapist, unless you experience some new emotional disturbance, in which case you can arrange another course of therapy.
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Copyright 1991,1996, 1999 Martha Ainsworth. All rights reserved. Please refer to reprint information before reprinting or distributing all or any part of this text.