Sydney Pulver, M.D.
PSYCHIATRY, PSYCHOTHERAPY, AND PSYCHOANALYSIS
Common Questions
How can therapy help me?
 
A number of benefits are available from participating in therapy. Therapists can provide support, problem-solving skills, and enhanced coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that therapists can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. They can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of those benefits include:
  • Attaining a better understanding of yourself, your goals and values
  • Developing skills for improving your relationships
  • Finding resolution to the issues or concerns that led you to seek therapy
  • Learning new ways to cope with stress and anxiety
  • Managing anger, grief, depression, and other emotional pressures
  • Improving communications and listening skills
  • Changing old behavior patterns and developing new ones
  • Discovering new ways to solve problems in your family or marriage
  • Improving your self-esteem and boosting self-confidence
How effective is psychotherapy?

I, of course, feel it is very effective. But that's based on my personal experience, which is subject to bias. One of the best summaries of the actual evidence for the effectiveness of therapy is in a recent resolution adopted by the American Psychiatric Association, the national organization of psychiatrists of all persuasions, those who do psychotherapy and those who use many other modalities of treatment. Here's their conclusion: "Be It Resolved that, as a healing practice and professional service, psychotherapy is effective and highly cost-effective. In controlled trials and in clinical practice, psychotherapy results in benefits that markedly exceed those experienced by individuals who need mental health services but do not receive psychotherapy.  Consequently, psychotherapy should be included in the health care system as an established evidence-based practice."  You can find the whole resolution by clicking on www.apa.org/news/press/releases/2012/08/resolution-psychotherapy.aspx

Do I really need therapy?  I can usually handle my problems.  
  
Everyone goes through challenging situations in life, and while you may have successfully navigated through other difficulties you've faced, there's nothing wrong with seeking out extra support when you need it. In fact, therapy is for people who have enough self-awareness to realize they need a helping hand, and that is something to be admired. You are taking responsibility by accepting the situation as it is, and making a commitment to change the situation if needed by seeking therapy. Therapy provides long-lasting benefits and support, giving you the tools you need to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face. 


Why do people go to therapy?

People have many different motivations for coming to psychotherapy.   Some may be going through a major life transition (unemployment, divorce, new job, etc.), or are not handling stressful circumstances well.  Some people need assistance managing a range of other issues such as low self-esteem, depression, anxiety, addictions, relationship problems, spiritual conflicts and creative blocks.  Therapy can help provide some much needed encouragement and help with skills to get them through these periods.  Others may be at a point where they are ready to learn more about themselves or want to be more effective with their goals in life.   In short, people seeking psychotherapy are ready to meet the challenges in their lives and ready to make changes in their lives. 

What kind of therapy is right for me?
  
As the question implies, there are many different approaches to psychotherapy. Probably the two most frequently used are Psychodynamic Psychotherapy and Cognitive Behavioral Therapy (CBT). The first focuses on understanding and change, while the second emphasizes the correction and changing of maladaptive patterns of thinking. The experience of each is very different, and, unfortunately, there is no good way of telling ahead of time which will be right for you. Getting advice from an experienced therapist may be helpful, but beware: most dynamic therapists think that dynamic therapy is best, and most CBT therapists feel that CBT is best. Unless one or the other therapy strongly appeals to you, perhaps your best approach would be to get an initial consultation from a therapist of each camp. The next question goes into this in a little more detail.

How do I pick a therapist?

First, get recommendations from any source you can: friends, colleagues, former patients, your family physician, or anyone else you respect. Compile a list of possibilities, research them online or in any way you can, and reduce the list to the two or three who seem best to you. Then, schedule an appointment for an initial evaluation with each of them. Don't feel uncomfortable about this. Be up front with what you are doing: seeing several people and trying to decide with whom you feel you will work best. Good therapists know that this approach is the best way to find a therapist, and are quite comfortable with it. Some will not charge for such a consult. The therapist's location, fee, and availability will all enter into your decision, but your main selection criterion will be your subjective reaction: "Which of these people do I feel most comfortable in working with?" Many empirical studies have shown that the best therapeutic results correlate strongly with the quality of the therapeutic alliance, that is, with how well the therapist and patient work with each other. So, using your personal reaction to the therapist gives you the best chance for a successful therapy.
  
What is therapy like?
 
Because each person has different issues and goals for therapy, therapy will be different depending on the individual.  In general, you can expect to discuss the current events happening in your life, your personal history relevant to your issue, and report progress (or any new insights gained) from the previous therapy session.  Depending on your specific needs, therapy can be short-term, for a specific issue, or longer-term, to deal with more difficult patterns or with your desire for more personal development.  Either way, it is most common to schedule regular sessions with your therapist, at least weekly and often more frequently.
  
What about medication vs. psychotherapy?  
 
The long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of your distress and the behavior patterns that curb your progress.  On the other hand, psychotherapy is hard work, and often stirs up traumatic feelings that can grow to unmanageable proportions. In these situations, medication can be a tremendous help in modulating those feelings and permitting the therapy to move forward. And, there are certain emotional problems (severe clinical depression, for example) in which medication is absolutely essential and is the primary treatment of choice. In short, determining the proper balance between medication and psychotherapy is both an art and a science, in my opinion most efficiently done (forgive me, my psychologist friends) by someone well trained in psychotherapy and experienced with the use of medicine, namely, a psychiatrist. To be fair, most psychotherapies which incluce the use of medication are carried out by psychologists with MDs (usually psychiatrists) as medication consultants. This combination can work very well.
 
Do you take insurance, and how does that work? 
 
I don't take insurance.  I regret not being able to, because it costs my patients money. They're paying for insurance, so shouldn't they be able to use it? But in spite of that regret, I've found the considerations against accepting insurance overwhelming.  Partially, that's because insurance compensation is so low, and I'm unwilling to work for so low a fee. But even more important, I found early in my career that insurance intrudes in many different ways on my patient's therapy. Since the insurance carrier is interested only in the financial aspects of treatment (that is, on not spending money), they request information which should be confidential, limit the length of treatment without regard (in my opinion) to my patient's actual needs, and do everything they can to limit and block treatment, regardless of how essential it seems to both the patient and the therapist.

My fee is $200 for a 45 minute session. I bill at the end of the month, and expect payment during the month I send the bill. I don't have a sliding fee scale, but, since I enjoy doing intensive psychotherapy, I'm sometimes willing to charge less for a patient coming in 3 or more times a week. Ask me about it. 

Does what we talk about in therapy remain confidential?
 
Confidentiality is one of the most important components between a patient and psychotherapist. Successful therapy requires a high degree of trust with highly sensitive subject matter that is usually not discussed anywhere but the therapist's office.   Every therapist should provide a written copy of their confidential disclosure agreement, and you can expect that what you discuss in session will not be shared with anyone.  This is called “Informed Consent”.  Sometimes, however, you may want your therapist to share information or give an update to someone on your healthcare team (you’re your Physician, Naturopath, Attorney), but by law your therapist cannot release this information without obtaining your written permission.
 
However, state law and professional ethics require therapists to maintain confidentiality except for the following situations:
 
* Suspected past or present abuse or neglect of children, adults, and elders to the authorities, including Child Protection and law enforcement, based on information provided by the client or collateral sources.
* If the therapist has reason to suspect the client is seriously in danger of harming him/herself or has threated to harm another person.