- Therapy can be life-changing
and help us finally let go of our past
and live the life we deserve.
But it's not always that simple.
There are a lot of issues with therapy,
things people don't wanna talk about,
but it's important that we are all informed
so we can make the best decision for ourselves.
If you're new here, my name is Kati Morton
and I'm a licensed marriage and family therapist.
I talk about all things: eating disorders, anxiety,
depression, and really anything mental health-related.
So if you'd like to subscribe, we would love to have you.
I promise you will always leave
with some helpful information
for you or for someone that you love.
And subscribing really helps creators keep doing what we do.
Okay, let's jump into this topic.
(gentle music)
The first thing I wanna address is cost.
Now, in order for therapy to be effective,
we should be seeing a therapist every week
or, at least, every other week.
I know a lot of you already...
I know in other parts of the world too,
they don't even offer it that often.
But I'm just here to tell you that that's necessary
because otherwise there isn't really any continuity in care
and we won't even have the amount of time
that we're gonna need to go over what's happening now,
as well as dig into things that happened to us in the past
and what brought us into therapy in the first place.
50 minutes every, I don't know, three weeks,
or four weeks just isn't gonna be sufficient.
And when therapy is $100 a session or even higher,
I mean in LA when I left, it was around 200 to 225 an hour,
that's gonna make it inaccessible to most people
because if we're supposed to do that every week
or every other week I mean, I'm no mathematician,
but that's a lot of money and that can be
something that most of us can't afford.
And so the cost of therapy, even though as a therapist
I understand were it comes from, right,
we have to rent a space, we often have to pay someone
to do our billing, or have a billing system
that we run through, maybe we have an assistant,
we also have malpractice insurance.
There are a lot of costs to becoming a therapist,
not to mention educational costs.
I mean, I finally paid off my student loans, praise Jesus.
But it's expensive, right?
And so while I understand it, I also understand that
that makes it something that a lot of people can't afford.
Therefore a lot of people can't get the help that they need.
And there are a few possible solutions for this.
Number one is we can always ask a therapist
if they work on, what's called, a sliding scale.
Like when I was in college seeing a therapist
I saw someone at my school who was free
through your school, so look into that.
But when I got out, the therapist that I worked
with after that didn't charge me her full amount.
I think it was like 150 bucks at the time.
She only charged me 85.
Now that was still a lot for me,
but it was something that I could manage.
And so it's okay to ask if they work on a sliding scale.
Spoilers, all therapists do.
Also, one of my first jobs out
of graduate school was at a low-cost, or free clinic.
The people that I saw paid me $20 an hour.
Now actually I didn't even get paid
because it was supervised hours
and it was towards my licensure.
But look for those clinics, ask around,
hospitals will know of them,
you can also search them online.
Just look for, you know, family clinics,
or low-cost therapy clinics in my area.
And if you're in a city, you're gonna have
more access to that but again, it's just something
we can look up 'cause you never know,
your small town might have one of those.
The next problem with therapy is burnout.
So many therapists are burned out right now.
And I have many friends and colleagues
who've taken a year or more off.
My good friend Alexa, who you guys know,
recently took a year off because of feeling burnt out.
And I have a few, Alexa went back...
but I have a few friends who just aren't going back
to seeing patients... ever.
And I think the pandemic has really taken
its toll on our caretakers because...
I mean obviously we talked about like the nurses
and the doctors having to put themselves at risk
and to work over time and take care of all the sick people
but the therapists on the back end, right,
we are the ones that are dealing with the trauma of it
and the overwhelm and, you know, kids going back to school,
all of the things that are coming up for people
more and more people have been reaching out for help.
And I forget the stat, but it was something
like 3.6 million people weren't able to get the therapy
that they wanted when they needed it in 2020.
So we really have an issue with burnout
and it's really important for therapists, or anybody
in the caretaker industry to take care of yourself.
That's why I always encourage people,
I'm like, "You need to make sure
"you're getting enough sleep.
"We need to have work-life balance."
And trust me, I'm saying this to you
as much as I'm saying it to me.
But as a therapist it's been really important
and really helpful for me to be in my own therapy
because I gotta work out my own stuff, right?
I don't wanna bring that into my sessions.
And I also don't wanna feel triggered by people, right?
I need to be able to manage my own shit.
Overall, I just wanna make mention of this
because it's been affecting more and more of us
and it's something that we need to be aware of.
Taking real breaks are important,
we need to take vacations.
That shouldn't be something that is looked down upon,
or something that's difficult to do.
We need to prioritize it.
And we need to prioritize that basic self care.
Drinking enough water, eating regularly,
getting enough sleep and getting at least two days a week,
you heard me, at least two days a week off from work.
We're not robots, right?
Another issue with therapy is access.
And not only is this the financial component,
which we already addressed,
but this can also be location related.
For those of you who don't know,
I grew up in an incredibly small town.
I didn't even realize how small until recently.
But finding a therapist in that area is nearly impossible.
I tried to help my mom find someone
who could help her with her anxiety
and I could only come up with two possibilities.
And guess what?
Neither of them were seeing new patients.
I know, shocker, and that's actually
some of the silver lining with COVID
because everyone is now offering online therapy.
I know some are returning to in person
and yes, I do want to to acknowledge that even I,
personally prefer seeing my patients in my office.
Video calls, it's just not quite the same.
We kind of miss something there
but it's better than nothing.
And the great news is that you can now see
anyone within your state.
And I know it's probably different wherever you live,
but I know it's the same in Canada.
And I'm sure in other countries they have similar,
you know, licensing restrictions.
But this is amazing if we're looking
for a specialist and we live in a small town
like where I grew up, right?
We could look to the bigger cities, like Seattle,
or maybe we could look to Dallas, if you're in Texas.
You can look at anyone within your state
and they are legally able to see you.
So it's really helpful to maybe look
into things like BetterHelp, or Talkspace.
I always link BetterHelp down in my description.
So if you're looking for that option, it's available to you
and it's a way to make this access issue,
maybe not such a big issue anymore.
The next issue with therapy are limits to confidentiality.
And I've heard from many of you
that you're concerned about this so let's talk them through.
What I mean when I say limits to confidentiality
is that when you see a therapist, if you're an adult,
so if you're 18 or over, you hold the confidence,
meaning everything that's said in therapy stays in therapy
and it's up to you who else gets to hear about it.
Meaning that like if you're seeing me
and you want me to talk to your psychiatrist,
or your regular doctor, you decide that,
you sign what's called a release of authorization
giving me the authorization to talk to that person.
So you hold it, you get to decide.
And that's really important because we can share,
you know, deep, dark secrets in therapy
and it's nice to know that it's gonna stay there.
However, there are limits to this.
And a lot of you know of these, but I just wanna talk you
through some of those limitations so that you feel informed
when you make the decision to go see someone.
And one of those limitations is what's known as Tarasoff.
Now Tarasoff is named after this girl
who was actually killed by a person
who was in therapy and they told their therapist
that they were gonna go harm her.
Now we call it like duty to warn now, but Tarasoff
is part of the reason that I can actually break confidence
to warn someone if I know that one of my patients has
the means and is planning, you know,
is gonna go harm someone, I can do something about it.
Because before that happened we couldn't.
And so if you're a danger to yourself,
or to someone else I have, within my legal rights
as your therapist, to break confidence.
Now I want you all to know that that's not something
that therapists do like easily, or take lightly.
There are a lot of steps that we take.
So especially when it's danger to self.
I've dealt with a lot of patients over the years
who struggle with suicidal thoughts.
That doesn't mean I'm gonna all of a sudden
call your parents, or put you in the hospital,
right, and break that confidence.
I'm gonna talk with you, I'm gonna do check-ins.
We're gonna try to put in safety plans
and see each other maybe more frequently to ensure
that you are okay and you get through this tough time.
However, if you tell me, "I'm gonna go harm myself right
"after this session," and you won't do a check-in,
and you won't like sign a no harm agreement with me
I'm not gonna have any other choice,
but then to take care of you, to make sure you're safe
to keep you from harming yourself.
And the same goes for if we're a danger to others, right?
If we're homicidal, or wanting to go
maybe kill the person who abused us,
I have to tell people because overall
we just wanna keep everybody safe.
Now there's also the fact that, as a therapist,
also teachers and I'm sure other...
I know other people like nurses and doctors
and other people in the care industry,
we are mandated reporters as well.
So another limitation to confidentiality is that we have
to report child abuse or dependent adult abuse.
Meaning even if I'm over 18, right, I'm not a child anymore
I am dependent on others for my wellbeing.
This could be because I have a disability,
or I have, you know, some kind of physical illness,
or mental illness, or something
that makes me not able to care for myself.
So if I'm a dependent adult, or a child, or an elder,
anybody over 65, if someone is abusing me physically,
sexually, emotionally, financially
I, as a therapist, if I hear about it
and know it's either going on,
or it could be putting another child in harm's way
I am mandated to report that to, you know,
let's say it's child abuse it'd be
to Child Protective Services.
Or if it's an elder, it's Elder Protective Services.
Either way, I'm going to have to break
your confidence and report it.
Now, I know I'm just rattling these off
and I don't want anybody to think
that these things happen frequently,
or that there are things, again,
that we take lightly 'cause we don't.
But there are, you know, limitations to protect people.
Another limitation to that is a court order.
So if you put your mental health on trial in any way,
I could be ordered, meaning forced to testify,
and I would have to, you know,
answer their questions at the best of my ability.
And that would, again, be a limitation
to the confidentiality that we hold together.
And the final, well, I guess there's also,
if we're under 18, but another thing is the Patriot Act.
Now, I've never had this come to be,
but it is something that I was taught
in school that we're aware of.
Because of things that happened on 9/11,
we lost some of our rights to privacy.
And so, if someone comes in my office and is like,
"Patriot Act," and they give me this piece of paper,
they can essentially take my records and I can't stop them.
Now again, this isn't something that I've ever heard happen
to me or anybody I know, but it is one
of those limitations that you should know about.
And if you have any concerns
about any of these, ask your therapist.
You're supposed to have, what's known as,
like informed consent, meaning you understand
these limitations, you understand
what it means to be a patient with them
and you're okay moving forward.
And it's perfectly normal for you
to ask questions so that you understand
what's gonna be shared and what's not.
And if you're under 18, your parents
can be be told things about your therapy sessions.
Although ethically they can't share everything
and they should talk to you
before they tell your parents anything.
That's always frustrated me when people, I've heard
from many members of our community and they're like,
"Oh they told my parents everything and I didn't even know."
I think that's ethically wrong.
I feel like it's really important for us
to communicate with our patients about it
before we go telling their parents things.
When I was in school my law and ethics professor,
who I love, she always said it's,
"Sex, drugs, and rock and roll," that's what she said.
The only things you would tell a parent would be
if you think they're, you know,
in risky sexual behavior that could be dangerous.
Or if they're doing drugs or alcohol,
again, things that can be dangerous.
And rock and roll she said was like
if they're just engaging in risky behavior,
mainly safety concerns, but communicating that
with you so that you know is really important.
Couples counseling, all therapists have this rule
that like we're not the secret keepers.
Meaning that if you call, or email me something
about the situation with your spouse,
I'm not keeping that from your spouse.
So I'm not gonna go into session
and not tell them that you told me.
It all has to be out in the open.
And that's, frankly, for the therapeutic benefit
because if we keep hiding things,
and keep secrets and we talk behind their back
that's not really healthy behavior
when it comes to building and maybe healing a relationship.
And so that's not really a limitation to confidentiality
but something that you should know that your therapist
when you're in a group like that, like family or couples,
the therapist is not the secret keeper.
The final issue with therapy is
that finding the right fit can be hard.
I heard from a lot of you you've seen a therapist three,
four, or five times, you're just not sure.
And it can be an investment in time
and money only to have to start over again
with someone else because they just don't get us.
Unfortunately, there's no easy fix for this.
And we know through research that the relationship
we have with our therapist helps determine the outcome.
Meaning that it's the relationship that's the most important
because we wanna feel like they see us,
they hear us and they're rooting for us.
And that's actually more important
than what their license is, or their specialty.
And so, I know finding that right fit can be hard.
Not only, you know, time consuming, but also expensive
but stick with it, I encourage you to check out
a therapist's website and ask a lot of questions up front
because therapists don't have a ton of money
and all the text that you read on their website
is something usually they've created,
so you can kind of get a feel for them.
Usually they have a picture so you can see them
and just see if you can get a feel
before you make that first appointment.
And then trust your gut, you know,
if after two, three sessions you just maybe
it's really hard to get to their office,
maybe you don't feel comfortable.
I mean I know therapy's not the most comfortable experience
but we should feel kind of okay there
and get more comfortable as time goes on.
We shouldn't feel triggered, we shouldn't feel overwhelmed.
We shouldn't feel like they're not listening,
or they forget important things, or they fall asleep.
It needs to be, "Hmm, I feel like they're at least good
"and they're listening and I feel somewhat comfortable.
"This could work," we should feel that little spark.
You know when you meet somebody new in your life
and you're like, "I don't know what it is about them
"but I just kind of like them."
We should feel that for them.
And so pay attention to your gut.
Listen to those feelings that you have
after those first couple of sessions
so that we minimize the time and money put into it
before realizing maybe it's not the best fit.
Overall, just know that therapy is worth it.
I know it's an investment in time, and energy, and money,
but I can tell you even personally
it's been incredibly life changing.
And so I hope this helps you be more informed
because there's a lot of things
that people, we don't know, right?
How are we supposed to ask questions,
if we don't even know these are issues?
So hopefully this helps you feel more educated
and informed so you can make the best decision for you.
But if there's things you thought I left out,
leave it in the comments down below.
Thank you so much for watching
and I will see you next time, bye.
(gentle music)