Tuesday, November 15, 2016

"How long does therapy take? Do I have to spend months and years at it?"


With the free agony aunt service this November, it’s become clear that lots of people don’t really know what going to a therapist involves. So I thought I’d explain exactly how I work, and hope it sheds some light on what goes on with the virtual couch.

So, in the films Tony Soprano went once a week for all 7 seasons and Monk went twice a week for 8 seasons.  They just chatted about life, with Jennifer Melfi and Neven Bell contributing insight and support.

Is that how it works?  In a word, no.  You can sign up for that kind of therapy if you want to but I don't work that way.

The people in the films are about delving into the deep inner you and trying to analyse Life, The Universe and Everything. I'm into seeing how you work in specific situations and helping you make changes so that you’re happier. They're big picture philosophical and I'm more mind mechanic.

Also, that bit in the films when the therapist says, “Our time is up” is something I don’t do.  I charge by the session and not by the minute as is standard practice. I do this because I think it’s vital for getting good results. If you have to stop because your hour is up, or you are worried about having to pay extra if you talk too much, then we may miss something.

So, how long do we talk? I did some number crunching and found that the number of sessions depends directly on the kind of issues we’re dealing with. 

Here’s a rough breakdown:
   
The 1 session gig
This is what one of my clients called, "Mental plumbing." It's where people are faced with a problem and they want someone to help talk them through it. This is like being an agony aunt, really, helping people talk through whether they should give up their job, move to another country, take a particular course of study...
 
Usually they've already thought things through and they want an intelligent wall to help them make sure they've considered all the angles. We talk through practicalities as well as the potential emotional impact (will you be happy, will you be stressed, what happens if...).
     
What it typically takes and costs:

Pay via Paypal
Direct bank deposit
Initial conversation to discuss needs and goals
15 minutes
Free
Free
Paid session where we discuss the issue
2 hours
$100
RM400
Review session
15 minutes
Free
Free
Total
2.5 hours
$100
RM400
     
The 3 session system
This is usually a very specific issue that the client needs resolving in a very structured way. For example, they may have a problem communicating with a specific person, are facing a very challenging project proposal or contract negotiation, or perhaps they're defending their PhD thesis and so on.
 
Usually they have an idea what they might do but they want to work out a complete strategy, test it out, analyse results, and then go through it again.
 
What it typically takes and costs:

Pay via Paypal
Direct bank deposit
Initial conversation to discuss needs and goals
30 minutes
Free
Free
First session where we establish your needs, goals and the approach
2 hours
$100
RM400
Creation of treatment plan which is sent to you
2 hours
Free
Free
Second paid therapy session
1 hour
$100
RM400
Third paid therapy session
1 hour
$100
RM400
Review session
30 minutes
Free
Free
Total
7 hours
$300
RM1200
     
The full-on 6 sessions
This is usually for people who want to learn coping techniques for recurring or longterm issues. For example, they may have periods of mild to moderate depression, recurring episodes of high stress or anxiety, or perhaps they've moved to a new country and they're having trouble adapting.
 
Usually the early sessions are long, like 2 hours or 90 minutes, because that's when we're examining exactly what's going on. But after that, the sessions are shorter, just an hour or so, because the client has learned the techniques and is reporting back on how they're working so we can assess effectiveness and perhaps make adjustments on how we're working it.
 
What it typically takes and costs:
   
Pay via Paypal
Direct bank deposit
Initial conversation to discuss needs and goals
30 minutes
Free
Free
First session where we establish your needs, goals and the approach
2 hours
$100
RM400
Creation of treatment plan which is sent to you
2 hours
Free
Free
Paid therapy session
1 hour
$100
RM400
Paid therapy session
1 hour
$100
RM400
Paid therapy session
1 hour
$100
RM400
Paid therapy session
1 hour
$100
RM400
Final therapy session
1 hour
$100
RM400
Review session
30 minutes
Free
Free
Total
10 hours
$600
RM2400
   

Multiple long-term sessions
Sometimes the people who think they have one issue that may take 6 sessions discover they actually have a second issue that needs coping with.  Sometimes we can fit that in, and sometimes it takes an extra session or so. That’s something we work out as we go along.

However, there are issues that require 6 months or more of regular sessions. Such clients are usually coping with long term serious issues such as the impact of rape, cancer diagnosis and other life altering events.

I would love to say that you can contact me for that kind of support however I am concerned that online therapy isn’t appropriate. You see, crisis psychology and support involves so much stress that I think they are best handled with face to face sessions, at least at the very beginning. 

I had these clients in the past when I was working in clinics. However, I am now self employed and I work from home. As most of my clients are expats in South East Asia (and too far away to ever drop in) I have no plans to set up a clinic. The day I do, I will expand my services.

Having said that: if you’re not in Malaysia, and you are in a place where you don’t speak the language, then do contact me. I’m not promising to take you on as a client but I’d rather you reach out to someone than cope alone.

If you are in Malaysia, and you need help in a crisis, then you can always reach out to AWAM and WAO.  They have clinics and they can put you in touch with someone in your state who can see you, too.

Hope that helps, and do keep those agony aunt questions coming!

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