The (Sometimes) Awful Truth

Early in my own psychotherapy, my therapist once asked me, “Are you interested in how you actually feel, or do you want to feel one particular way?”  I don’t remember what prompted that question, but I probably said something like, “I just want to be happy.”  Over the years, I’ve heard many of my own clients say similar things and I’ve responded in more or less the same words.

Wanting to be “happy” is understandable but in truth, it’s not possible.  I don’t mean we can’t find a basic contentment with our lot, but life is full of frustration, pain, disappointment, loss, grief and other “unhappy” feelings.  Even if we’re in a strong relationship, satisfied with our career and in good health, we’ll inevitably have our down days.  We may have difficult co-workers, friends can move away, a loved one will eventually die.

For those who seek professional help, the pain of their existence is usually much deeper and harder to bear than ordinary loss and disappointment.  Their suffering may be extreme; the symptoms of depression or anxiety can make their lives an ongoing agony.  “Take away my pain,” they plead, whether or not they say those actual words.  Empathizing with their pain, health care professionals understandably prescribe them drugs to relieve them of their unbearable emotions and feelings.  Whether you can actually eliminate anxiety or depression with psychotropic medication is an open question, though recent studies suggest that the anti-depressants currently in use work no better than placebos.  I believe these medications at best blunt awareness and in the process often create a new set of problems:  loss of sex drive, weight gains, emotional deadness.

[For a detailed discussion of the actual effects of psychiatric medication, read my later post about the dubious theory that medical illness is caused a chemical imbalance in brain functioning; another on the false claim that psychiatric medications have let to actual improvements in mental health outcomes; and a third discussing the false representation by pharmaceutical companies and the medical profession that taking “anti-depressants” for mental illness is just like taking insulin for diabetes.}

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Why Most People Don’t Really Change

Most people don’t change; they just become more the way they already are.

I must have said these words hundreds of times in my life — to clients, family and friends.  While there are exceptions, most people find change difficult for several reasons.  They don’t know themselves very well, to begin with.  Few people have an accurate view of who they are and therefore don’t recognize the aspects of themselves that could use improvement.  Most people want to believe they’re well-balanced and even exceptional in many ways:  how many of your friends would describe themselves as creative, talented or intelligent?  Do you know anyone who would say to you, I’m just average?  We all want to think of ourselves as special and gifted.

Then there is the human propensity to explain one’s difficulties, short-comings and failures by blaming somebody else.  Look around you at the people you know.  The co-worker who’s careless and lazy but blames her poor evaluations on an exacting boss, or colleagues who have it out for her.  The cousin who gets under your skin because in every story he tells, he paints himself as a victim.  Have you ever known anyone who told you, “I got fired because I was doing a lousy job,” or “A lot of bad things have happened in my life because I make so many impulsive bad choices?”  Few people are willing to accept that their own character traits and choices are the main determinants of the kind of life they lead.

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Choosing a Therapist with a Psychodynamic Perspective

If you value my approach but feel that going it alone isn’t for you at the moment, here are some guidelines for choosing a therapist who might have a compatible orientation.  I’ll begin with some general suggestions about how to interview any mental health professional; I’ll conclude with specific suggestions for finding one who’ll offer you insights and guidance similar to those provided on this site.

First of all, remember that you are the customer and you have the right to ask as many questions as you like about the potential therapist’s background and credentials.  What degrees does he have and where did he earn them?  What professional licenses does she hold?  Is she a marriage and family therapist, a psychologist, a social worker, a psychiatrist (which means holding a medical degree)?  You can ask about internships, where they received their on-the-job training, and how many years they’ve been practicing.  If you’re in pain and hungry for help, it’s difficult to remember that you need to make an informed decision, the best you can make, and not simply sign on for treatment because one of your friends recommended her own therapist, or your physician referred you to his colleague. The answers themselves may not mean a lot to you (one university versus another, for example) but the process of interviewing the potential therapist can give you a lot of insight.  You might find she’s an authoritarian type who feels irritated by being questioned; maybe he seems insecure about his background and lacks the kind of confidence and experience you need. Beware the charismatic therapist who exudes the over-confident aura of knowing everything.

Most states have laws requiring mental health professionals to provide you with a statement of their policies about issues like cancellation, privacy, vacations, etc., but there are other areas where you might want information.  Here are questions you could ask:  What are your areas expertise?  Have you worked with many clients suffering from [name your pressing issue]?  What are your views on length of treatment and frequency of sessions?

Questions you should NOT ask:  Are you married?  Do you have kids?  Are you gay?  How old are you?  The therapist is entitled to his or her privacy and that information is none of your business unless he or she chooses to disclose it.  (You may notice that I speak frankly about my internal dynamics but am careful to keep the details of my personal life private.) I’d also beware of the therapist who discloses TOO much personal information.  This may indicate poor boundaries.  The therapy is about you, after all, and your therapist is NOT your social friend, however you may feel about one another.

Also feel free to schedule more than one evaluation appointment.  You don’t have to make up your mind after one session, nor do you have to interview only one person at a time.  As I said, you are the customer and you should approach this decision in a way that will give you as much information as possible.

As for finding a therapist with a specific orientation, that’s a greater challenge.  The mental health profession at present is dominated by cognitive behavioral theories and psychopharmacology.  I’m not saying anything against those orientations, but if you want treatment akin to my approach, your search may be difficult.  In addition to holding licenses as a clinical psychologist and marriage and family therapist, I was trained as a psychoanalyst; as part of my training, I had to go through years of treatment myself.  Most people think of psychoanalysis as an outdated modality that began and ended with Sigmund Freud, but in fact, it has grown enormously and continues to evolve.  Specifically, I was trained in an area of pschoanalytic thought known as “object relations”. If you find someone who describes him- or herself as having “an object relations orientation,” you may have gotten lucky.  Psychodynamic psychotherapy, depth psychology, transference-based therapy, insight-oriented therapy — these are some terms that also apply to the kind of work I do.

The most important element in making your choice is how the therapist makes you feel.  If he makes you feel all warm and fuzzy, totally accepted for who you are, I’d look elsewhere. If she intimidates you, seems controlling or has poor boundaries, I’d likewise move onto the next candidate.  In my first session with my own therapist, he made some observations about me that made me extremely uncomfortable and seemed undeniably true.  Feeling at ease isn’t the best indicator; feeling understood is what matters. The distinction here is between sympathy and empathy.  What you’re looking for is a person who can speak the truth to you, however uncomfortable it might make you feel, not someone who expresses a great deal of sympathy but doesn’t startle you with unexpected insights.

I don’t do Internet or phone therapy, but if you’d like to ask for specific advice about consulting a professional, please feel free to contact me:  AfterPsy@gmail.com.

I hope this help!

Online Therapy

Joe Casual - online therapy

As an online psychologist, I work exclusively by Skype and other video conferencing platforms. Since many prospective clients are in time zones different from mine (Mountain Standard Time), I do my best to accommodate different schedules, though my evening hours are very limited. I do not work by phone. In my experience, the visual contact made possible by video is necessary for online therapy to succeed and allows us both to get a “feel” for one another.

If you’re considering me as an online psychologist, I suggest you read a number of the posts in the category entitled The Psychotherapy Relationship, in the menu to be found at the right of this page. They’ll give you a fairly clear idea about who I am and how I work. As an alternative, you might try reading one of my non-fiction books, available on Amazon here and here, or watch some of the videos on my YouTube channel. I’d also like to say a few additional words concerning the kind of work I DO NOT do and what I’m not good at, to avoid any misunderstanding.

Though you’re free to consult with me for as few or as many sessions as you like, I honestly believe that several weeks or even a few months is too little time for us to make any real difference in how you’re feeling and the ways you suffer. This is not to say that all short-term treatments are ineffective; practitioners of cognitive-behavioral therapy, for example, can teach you their methods and techniques in a matter of weeks. I’m not a behaviorist, however; I’m a psychodynamic psychotherapist, and the kind of change I work for with my clients takes a long time.

For the most part, I don’t give advice. My own therapist once told me that, even if he were to give me his opinion about what I ought to do, I’d then have to decide for myself whether to follow that advice — i.e., I’d still have to think for myself. I also feel that giving a client advice only encourages the wrong kind of dependency. What I will do is listen carefully and try to tell you what I hear you saying that you might not have heard for yourself — the unconscious part of your communication. I was trained as a psychoanalyst: listening for and interpreting unconscious material lies at the heart of the online therapy work I do.

Although I sometimes talk about myself and my own issues on this website, I will rarely talk about myself during your sessions. As far as I’m concerned, it’s your time and your money: those 50-minutes should be all about you. For that reason, if you ask me personal questions, I’ll usually find a polite way not to answer and redirect the attention back to you. On the other hand, I will sometimes talk about what goes on between you and me as a kind of microcosm of your emotional issues. While I believe that the client-psychotherapist relationship is unique, unlike any other relationship you’ll ever have, I also know that people bring their characteristic modes of relating into that relationship; understanding the ways you interact and behave in therapy often provides insight into your “outside” relationships as well.

I don’t do marital counseling or work with couples. Earlier in my career, I used to see children, couples and families, but I soon realized my strength lies in long-term, in-depth work of a psychodynamic nature. I don’t treat particular symptoms, nor will I focus exclusively on one aspect of your issues. You’re a complex person, and we can’t isolate parts of you from that whole if we’re truly going to understand your pain. If I’m doing my job well, you’ll find that I often address something completely different from what you expected. This doesn’t mean I’m not listening! But if you’re looking for short-term, issues-oriented therapy that focuses on immediate results, I am not the online psychologist for you.

One final note: Since the publication of The Narcissist You Know, I’m often contacted for therapy by people who are married to or romantically involved with someone they identify as a narcissist; or perhaps it might be a child or member of their family. They want my help in learning how to understand and deal with this person. In my experience, this kind of therapy is rarely effective. Advice for how to cope with an extreme narcissist in your life can be found in my books, but it’s not a useful subject for individual psychotherapy.

About My Fee

I currently offer two different fee arrangements. For a one-time online therapy consultation, or for occasional sessions that do not occur on a regular basis, I charge $400. These sessions do not involve an ongoing commitment and may be cancelled with a full 24 hours’ notice. If you cancel the same day of your scheduled session, however, or less than 24 hours in advance, you must still pay for it.

I also offer a $250 per session rate with a no-cancellation policy. In other words, you commit to paying for your regularly scheduled sessions even if you don’t use them; I commit to holding your weekly session times exclusively for you. If you give me notice of a future scheduling conflict, I will always offer you an alternative time for us to meet during that same week, but even if we’re unable to find another mutually convenient time, you agree to pay for your session. If you take vacation during a period when I am at work, you agree to pay for the sessions you miss. If you miss sessions due to illness, you agree to pay for them. When I miss a session or take vacation weeks, I of course do not charge you.

I understand that some people object to a no-cancellation policy, and that is why I offer this two-tier system for online therapy sessions. For those people, the $400 rate is available.

Because my new clients will most likely be out of my jurisdiction and I will have no legal recourse for non-payment, all sessions must be paid for in advance via PayPal or Venmo. If you see yourself as struggling with the kind of emotional volatility and unstable relationships that are a part of borderline personality disorder, or if you’re currently cutting yourself or engaged in other self-injuring behavior of a serious nature, I’d most likely need to see you more than once a week, at least until that behavior has stabilized. In my experience, working once a week when someone is suffering so deeply only sets the work up for failure.

I am offering my services to you as “psychoanalysis,” partly because I’m a graduate analyst but more because psychoanalysis is not a regulated profession in most states and we won’t have to deal with the gray area of licensing and jurisdiction.

For more information or to ask any further questions you may have, please feel free to write to me at: afterpsy@gmail.com. Please do not look up my phone number and try to contact me that way. If you’re interested in scheduling a session, please complete the following two forms and send them to me at the preceding email address. Once I have received them, I’ll contact you about scheduling a session.

New Client Questionnaire

Disclosure Statement

Joe Burgo
Online Psychologist