Frequently Asked Questions

Psychotherapy FAQ

What is psychotherapy?

CA State Law defines psychotherapy performed by a Licensed Clinical Social Worker as:

“The use of psychosocial methods within a professional relationship, to assist the person or persons to achieve a better psychosocial adaptation, to acquire greater human realization of psychosocial potential and adaptation, and to modify internal and external conditions which affect individuals, groups, or communities in respect to behavior, emotions, and thinking, in respect to their intrapersonal and interpersonal processes.”

In plainer language:  Therapy is a non-medical, professional relationship between a clinician and a client.  The goal is to help patients reach their potential, get better at adapting to life’s challenges, and modify the circumstances in their lives–inside and out–that affect how they think, feel, and behave.

What is clinical social work/a Licensed Clinical Social Worker?  How is an LCSW therapist different from a psychiatrist, psychologist, or life coach?

The State of California legally defines clinical social work as:  

“…a service in which a special knowledge of social resources, human capabilities, and the part that unconscious motivation plays in determining behavior, is directed at helping people to achieve more adequate, satisfying, and productive social adjustments.”

tl;dr – Clinical social work is intended to help people get better at coping (feel more adequate at coping, more satisfied with how they are coping, and more productive in their coping.)

In order to become a Licensed Clinical Social Worker (LCSW) in California, therapists must graduate from an accredited Master’s of Social Work/Welfare degree program, complete post-graduate, pre-licensure clinical hours, pass standardized exams, and maintain continuing education.  More information is available at the California Board of Behavioral Sciences.

  • Psychiatrist – A doctor with an MD or DO; went to medical school, can prescribe medicine and/or perform psychotherapy.
  • Psychologist – A person with a doctorate in psychology, most likely with a Ph.D (sometimes PsyD).  Psychologists can administer in-depth psychological tests and/or perform psychotherapy.  California only licenses people with doctorates as psychologists. 
  • Licensed Marriage and Family Therapist – More common in California than in other state; LMFTs have Master’s Degrees (in Counseling Psychology, Marriage and Family Therapy, etc.) and their training has a greater emphasis on providing psychotherapy to couples and families.
  • Psychotherapist – LCSWs, LMFTs, psychologists, and psychiatrists can all provide therapy and accept insurance.
  • Life Coach – Anyone can call themselves a life coach, as the industry is currently unregulated.  Insurance will not cover life coaching, since it isn’t psychotherapy.
  1. You deserve a therapist you can grow to trust.  This may not be the first therapist you meet, or me, or the next one. Trust develops with time, so my hope is that you can find a clinician whom you think you’ll be okay opening up to one day.  Because…
  2. You deserve someone you’re comfortable feeling uncomfortable with.  Growth and self-discovery are awkward processes.  When life gets rough or things get tense, no psychotherapeutic intervention can make you “comfortable.”  My wish is that your therapist is someone who will be able to hang in there with you and make the discomfort a little more bearable.  Because…
  3. You deserve a therapist who will both support you and challenge you.  Our role is to do both.  (This applies to other relationships in your life, too!)  Acceptance and change work in tandem.  Because…
  4. You deserve a therapist who is transparent about your treatment.  While not every client is interested in the rationale behind a treatment intervention or why a therapist is asking the questions they are asking, if you are interested, then it’s totally valid to want to know.  So let’s talk about how a lot of our work is about viewing and thinking with more nuance and balance to reduce your distress.  Let’s ask questions like: Why are we doing what we’re doing?  Is it working?  Where are we getting stuck?  Because…
  5. You deserve to feel better.  By “better,” I don’t mean Happy-Happy-All-the-Time or the complete absence of human (and necessary) experiences like sadness, worry, anger, shame, or angst.  You deserve to experience a balanced and complete diversity of the human emotional experience.  Sometimes this may mean being annoyed or even pissed at a therapist.  It can also mean outgrowing a therapist (not all goodbyes have to be bad ones.)  No matter what, I hope that we can support each other in bringing out your full humanity.  

Yes (with some important exceptions.)   Psychotherapy is most effective when you can be open and honest. 

Therapists (including LCSWs) are bound by our professional ethics to maintain your privacy.  We are also bound by health care privacy and confidentiality laws.  For example, the Health Insurance Portability and Accountability Act (HIPAA) contains a privacy rule that creates national standards to protect individuals’ medical records and personal health information, including information about psychotherapy and mental health.

The most common exceptions to confidentiality include:

  • To protect the patient or the public from serious harm.  If i have reason to believe that you are likely to cause serious harm to yourself or another individual, I may need to break confidentiality to prevent or lessen such harm.  
  • Mandated reporting for child, elder, or dependent abuse.   I am legally required to report ongoing abuse of children, the elderly, or persons with disabilities.  (If you are an adult who was previously abused as a child, I am typically not bound to report unless there are other children continuing to be abused.)
  • To obtain payment for treatment.  In order for insurance to pay for your services, they usually ask therapists to submit a diagnosis as well as information on the date and length of sessions.   
  • Coordination of care.  I am legally permitted to disclose your Protected Health Information to other licensed health care providers involved in your care.  

Please see the privacy practices handout in your intake packet for a complete description.  Also feel free to ask me about these exceptions, I’m glad to explain how they work and  when I would or would not break confidentiality.

Other things to consider regarding confidentiality:

  • This means that if we run into each other outside of therapy (whether in public or on social media, etc.) I cannot acknowledge you as a client as that would be breaking your confidentiality.
  • Employers don’t receive information about the health services a specific employee receives, even if he or she uses company insurance.  They do get access to some information from health insurance companies, such as premiums and costs incurred by the entire company, as part of administering their health benefits plan.
  • If you have a Healthcare Flexible Spending Account, you will likely have to upload the name of your provider and dates of service in order to receive reimbursement.  They would see that I am a mental health professional.
  • If you have apps on your smartphone with microphone or GPS location services enabled, information about what you say or where you go (whenever or wherever you have your phone with you) could be transmitted to tech companies.  You may want to consider disabling those features, leaving your phone at home, or turning it off before arriving at the Counseling Center.
  • Another way to protect your privacy is to call your insurance company to ask that Explanation of Benefits mailings be sent to you via e-mail.  Although these statements do not disclose specific reasons for service, they may list your therapist as the treating provider which could raise questions should someone read your paper mail.

With formal CBT and DBT-informed therapies, progress is tracked on paper or in an app.  You should also see a gradual reduction in unhelpful coping behaviors and lower scores on objective tests and measures.

I also keep notes on our sessions.  If you’re ever curious, we can look back on what you were struggling then and how things are now.  And if you ever have concerns about our progress, let’s talk about it–this is your therapy and there is a lot we can do to make it work for you.

Progress isn’t linear, though–generally–as therapy progresses you should be feeling better, getting more stuff done, and getting more out of life.  

I believe in utilizing the least invasive intervention possible for addressing suicide.  This means utilizing involuntary emergency interventions only as a last resort.

We’ve gotta talk about this stuff.  I want to reassure you that merely talking about the subject of suicide is not enough to trigger an involuntary hospitalization.  I would hate to have someone avoid discussing suicide with me out of fear that they would lose their freedom.

One thing I talk about in therapy (especially CBT) is how thinking about something is not the same as doing something. (Thought-Action Fusion.)

Many people think about dying by suicide as a way to cope, and the vast majority are able to stay safe while managing those thoughts. 

The fact that you even talk to me is evidence that at least a tiny part of you implicitly believes there is a way out of your situation.  I can work with that.  To do our work, you don’t have to want to live.  You do have to want to work towards wanting a life (worth living.)

So when would you hospitalize someone?

When I absolutely have to. 

People who have suicidal thoughts are usually survivors who have borne a lot of pain for a long time.  They are resilient people.  You have stayed alive this long, which is your track record, so I trust that you have quite a bit of self-preserving capacity.   

I will make the ethical, legal, and personal choice of initiating lifesaving services for suicide attempts in progress or to secure your immediate safety if you are unwilling or unable to take action to prevent your suicide, and if you remain at imminent risk.  I will initiate active rescue if I am convinced that if I do not act, you will be dead.

If you are willing to talk to me, I will always talk to you first to determine whether or not a hospitalization is warranted.  (So please talk to me.) The purpose of the conversation would be to explore alternative ways of coping to prevent the need for hospitalization.  In most cases, clients may be thinking about suicide, with no intention of following through any time soon.   In that case, I want to try and understand your reasons for wanting to die, figure out how that is affecting your coping, and see if we figure out ways to get you some relief that are not self-murder.

To be real with you, the purpose of a 72 hour hospitalization to prevent suicide is not to help the patient “get better” or “feel better.”  It’s to prevent the suicide–for “protection.”  It’s a last ditch chance to keep you alive long enough to make it through.  

I don’t have the power to keep you from dying.  (I’m not Darth Plagueis.)  You don’t even have that power–not entirely.   (A car could sideswipe you, a rhino could escape from the zoo and trample you, etc. TBH I hope not. That sounds messy and unpleasant.) 

If you did hospitalize me, would I automatically get admitted?

Should I deem hospitalization necessary, the most I could do, legally, would be to work with an LPS designee  to write an application for involuntary admission for a 72 hour hold (aka “5150.”)

The steps for hospitalization typically go like this:

  1. Therapist assesses if hospitalization is absolutely necessary.  Since this decision will impose on the client’s civil rights and freedom,  this is not a decision that should be made lightly or done merely to assuage the therapist’s own anxiety.  If the situation necessitates the initiation of hospitalization, then the therapist brings in an LPS designee (usually a County social worker, or worst case scenario a police officer.)
  2. The LPS designee evaluates the client for probable cause to determine a) if they are a danger to themselves and b) if involuntary hospitalization is actually necessary for the person to be properly served.  If no, the LPS must offer alternate, voluntary services and the client can also decide to go home.
  3. If yes, then the LPS designee will initiate an application for a 5150 hold.  (It’s an actual paper application form.)  The client (and the written application) are taken to a hospital.
  4. At the hospital, a “professional person in charge of the facility or his or her designee” meets with the client face to face to determine whether or not they feel the client is admissible for a 72 hour period of time. If no, the client goes home.  But this is where things get tricky.  Depending on the hospital’s LPS status, they are legally allowed to take up to 1 hour or in some cases 24 hours to find that person to evaluate you (and in Los Angeles County, this does not count as part of the 72 hours.)
  5. If the hospital feels the client is admissible and accepts the application, then the search for a inpatient hospital bed begins.  The wait for this is dependent on availability and can take a long time.  The 72 hours does not start until you are formally admitted for treatment when a bed is found.  [Hours spent waiting in the hospital prior to this do not count(!)]
  6. The client is admitted and the 72 hour hold begins.  A patient admitted to the facility on a 72-hour hold may be released prior to  the 72 hours if it is deemed that further treatment is not required.  After 72 hours the hold expires and the client must be discharged unless the hospital takes more steps to certify them for 14 days of intensive treatment, including going to court.

This process is in place not just because hospitals are busy to the point of being full, but because everyone deserves to have the chance to prove their case before being made to enter a hospital. That way, no one person has the power to hospitalize another person involuntarily.  It’s not a unilateral decision that I get to make.  The LPS designee gets to decide to write an application, and even if they do, the hospital can choose to refuse the application.

I am sharing this information because I feel patients have the right to be informed about how this process works, as well as to highlight how difficult this decision is for psychotherapists.  This is why most psychotherapists avoid initiating this process until the situation is imminently life threatening.  We would much rather work with you to prevent things from getting to this point.  And a lot of this is really about trust–do the therapist and the client both trust each other to keep the client alive?  If not, then how can we get there?

You have rights and there is an entity called the Patients Rights Office at the Dept. of Mental Health that you can contact if you have any questions about involuntary hospitalization.  They can even come out to the ER to meet with you.

(As you can tell from this wall of text, I’m pretty candid about this subject, so please talk to me if you have any concerns.)

Currently, I work exclusively with individuals.  That’s where the bulk of my training lies and I am happy to leave couples and family work to more experienced therapists.

That being said, I am familiar with both couples and family therapy from my graduate school training.  I frequently bring concepts from Structural Family Therapy (boundaries, enmeshment, subsystems, parentification, etc.) and Emotionally Focused Couples Therapy (adult attachment styles, expression of wants and needs, identifying patterns, building acceptance, etc.) into the therapy room.

I cannot accept appointments made by a third party, especially if the client is over age 18.  Clients are more likely to go to and stay in treatment if they take steps to enroll on their own.  Please encourage your person to reach out to me and make the appointment; if they feel it would help, you can offer to be there for them when they make the call.  

It’s a tough spot to be in; unfortunately there is little you can do to make someone go to therapy if they don’t want to.  You do have some options.  For example, you may choose to arrange a one-time “consultation appointment” for yourself. This is a 50-minute session with a therapist who will attempt to answer your questions about how you might deal more effectively with your loved one.  

Additionally, you may  choose to begin therapy yourself, especially if your life has been adversely affected by the other person and you are looking for ways to change your situation. Sometimes the person in therapy is not the family member who “needs” it most, just the person in the family most willing to seek help.

You, the healthcare consumer, get to make the final call on this. I am not a physician and cannot prescribe medications. 

If your symptoms are significantly interfering with your life, I would always recommend talking to your primary care physician (or get one, if you don’t have one!) and/or a psychiatrist to be fully informed of your treatment options. You have a lot of options and it’s important to rule out any health conditions that might be contributing to how you feel (such as a sleep disorder, thyroid problem, etc.) 

Many doctors are willing–sometimes even very excited–to coordinate treatment with therapists so clients have more resources and ways to approach their mental health.  Before entering private practice I used to work on multidisciplinary treatment teams; I enjoy collaborating with clients and their psychiatrists.

Policies & Payment

I currently accept the following insurance:

  • Lyra Health (Blended Care Program)
  • Anthem Blue Cross of California (In Network Provider)  This includes UC SHIP insurance (with the exception of UC Berkeley.)

I also see clients Out-of-Network.  I can provide a superbill for you to submit to your insurance company for reimbursement.

I am unable to accept new clients at this time.  As my availability opens up, I will update it on my home page.

I only work during weekday business hours. If you absolutely need a evening or weekend therapist, I am unfortunately not available during those times.  

Prior to the COVID-19 shelter-in-place, I was in the process of moving offices to Westwood, Los Angeles near UCLA. At this time, I am not able to open the office for in-person appointments, but I do see clients online through Telehealth.  I do not know when it will be safe to return to in-person appointments.

If you are a Lyra Health EAP member, my availability (Wednesdays and Thursdays) opens up multiple times a month and is available live through the patient portal.  This is because Lyra specializes in short term, highly specialized Cognitive Behavioral Therapy, so people go in and out of therapy pretty rapidly. If you have member benefits through Lyra Health, please search my availability through the care portal. You may also contact Lyra directly (877-505-7147 or and request a link to my profile to book your first appointment. At that appointment, we can discuss further what your needs are, what you are looking for, and what your options for support might be.

I do not have a wait list.  This is because I’m concerned that being on an indefinite wait list might prevent someone from seeking out therapy with another therapist who can start working with them right away.  There are so many great therapists out there and I don’t want to keep anyone waiting, especially since my availability changes from week to week.

Copays and fees are collected at the beginning of session.  If you choose to pay cash and forgo insurance, my rates are $180 for an initial evaluation and $175 for individual psychotherapy sessions.  This is about average for psychotherapy in Los Angeles.

Many people have and would prefer to use their health insurance.  If you have insurance, you may have a co-pay or co-insurance depending on your plan.  For example, if you have the Lyra Health benefit through your employer, sessions are free through the Blended Care Program. Clients with HMO Health insurance usually pay around $5-$40 a session while insurance covers the rest.

I’m currently focusing my practice on serving the greater UCLA community.  If you have UC SHIP insurance through Anthem Blue Cross, you will be able to use your insurance to meet with me and be responsible for a modest copay.  

If you have insurance, unfortunately, the insurance company will not allow me to lower your copay.

If you are out-of-network, I can furnish a superbill to help you get reimbursed.  I am unable to offer sliding scale at this time.

If you are on Medi-Cal, please reach out to the Los Angeles County Department of Mental Health to be linked to free services. 

Other local resources for affordable therapy include Southern California Counseling CenterMaple Counseling CenterAirport Marina Counseling Center, and Open Path Psychotherapy Collective.

Appointments that are not cancelled 24 hours beforehand or in which the client arrives more than 15 minutes late are considered to be missed.  This means that if an appointment is scheduled for 3:00 pm on a Tuesday, notice must be given by 3:00 pm on Monday at the absolute latest.  Appointments where a client is running more than 15 minutes late also are counted as missed, as insurance will not pay to cover the appointment.

The Counseling Center will charge the client the Missed Appointment fee.   Please note that this is not the copay, but the full fee set by your insurance carrier or the Counseling Center, which could be up to $175.

If a client no shows or late cancels two appointments in a row, the Counseling Center’s policy is to close out your case.  You will be advised to contact the center Intake line to be re-referred for treatment provided the outstanding balance is paid in full prior to making a new appointment.

Why is there a late/miss fee in place?

Your appointment time has been reserved  specifically for you and it is up to you how you use it.  When you make an appointment, in addition to booking the time slot, you are also booking rent for the room, use of facilities, and administrative services.   If you show up late, we still end on time.  If you are over 15 minutes late or if you don’t show up at all, you still pay for the time and I cannot charge your insurance fraudulently. This is your time.

Man, that’s harsh.  Why not just by a case-by-case basis?

Yeah, I feel you.  Freud said: 

“A given hour is assigned to each patient, and that hour is his and he is responsible for it even if he does not make use of it. This practice, which for the music or language instructor is considered normal in our society, when it involves a physician sometimes appears harsh or unworthy of his role.”  

So it’s actually a thing in the psychotherapy profession that dates back to Sigmund Freud and will probably stick around longer than a lot of his other theory.  From a cognitive-behavioral perspective, missed appointments or chronic lateness could also signify some sort of avoidance, conflict, or self-sabotaging tendencies that we want to be aware of as we proceed in therapy.

I have concerns about a policy that is more “case-by-case” because it puts the therapist in the position of weighing their values against the client’s.  The therapist is being asked to judge whether or not the client’s reason is “good enough” and to punish the client based on that judgement, which undermines the collaborative relationship between the client and the therapist.  Since the fee is about covering overhead costs, I don’t want it to feel like a punishment.

There are also important therapeutic reasons for why the fee is charged.  I know that the existence of this boundary can bring up some pretty strong reactions; if you have any concerns about these policies please talk to me in person so we can explore and work things out.

I do not offer brief phone consultations.  That being said, there are a lot of therapists who do provide 15 minute consults and I completely understand if you’d rather work with someone you can speak to before meeting in person! 

Hopefully, my website can provide answers to some of the things commonly discussed in one of those conversations.  It’s really important for me to spend more than 15 minutes with a client before determining how to proceed.  And after looking at what that would entail ethically, legally, and time-wise, a phone consult is not something that I can make work.   

The initial assessment (about an hour) is covered by insurance, and we will both get a better idea about the fit if we meet in person and spend more time together.  Even if things don’t line up, I am happy to share resources, suggestions, and referrals to help you on your way.  (By the way–it’s totally normal and super common for clients to not want to go back for a second session with a therapist–almost expected depending on your search and the fit you would like.  While I’d encourage folks to be open-minded during their search–give the therapist a chance to get to know you, if you can–please also don’t feel pressured to work with anyone you don’t want to work with.)

This is something I currently determine on a case-by-case basis depending on clinical acuity.  I’ve found that most of my clients do not need to contact me out of session.  For folks who are wondering, I don’t offer email contact between sessions.  Maybe that makes me old school, but my thought is that part of the therapeutic work includes learning to organize one’s thoughts and tolerate the wait between appointments.

Although LCSWs can write letters for an Emotional Support Animal for our clients, I currently do not write these letters.

This is not because I’m against the concept of ESAs, but because doing so is outside of my scope of competence, as well as for legal reasons as I don’t have liability coverage over situations involving ESAs.

There’s a lot of confusion about the distinction between a service animal and an ESA.  There are even predatory companies trying to convince people with disabilities that they need special vests, collars, or expensive ID cards in order to be covered by disability laws (it’s a scam–you don’t!)  I found these resources to be helpful in clarifying what the actual rights for an ESA are:

This is outside my scope of practice and you would be best served by a licensed psychologist who provides psycholgoical testing.

The purpose of meeting with me would be to initiate a course of psychotherapy, which would likely involve a weekly commitment for at least six weeks.

If you are hoping to apply for California State Disability Insurance or Paid Family Leave, unfortunately only psychologists and physicians are able to complete the provider form to qualify a person for benefits.  If your mental health condition is preventing you from performing your usual and customary occupation in the short term, I strongly encourage you to enlist the support of your primary care provider to apply.  If your doctor needs additional support around their section of the application, I’m happy to be a resource for them.

If you plan on applying for permanent disability, such as through Social Security or SSI, I recommend contacting the SOAR program for assistance.

Please note that SSI/SSDI applications hinge on meeting stringent criteria for a mental disorder resulting in extreme or marked limitations in your functioning.  You also need to have two years of evidence that you received treatment and that you are incapable of adapting to changes in your environment or demands that are not already part of your daily life.  (Since the folx applying for these programs are usually arguing that their mental health conditions are severe, chronic, and untreatable, our work together in psychotherapy might work against such an application.)

I am not trained in forensic psychology and therefore do not provide fitness for duty or competency evaluations.  Usually the party requesting these evaluations will recommend an independent, impartial, third-party, licensed health care professional who will perform the evaluation. 

If you are an ongoing therapy client, while it is outside of my scope of practice to provide any certification of fitness, I am able to work with you to provide a summary of treatment, such as the number of sessions we have held, interventions used, the treatment plan, and your progress towards treatment goals.


Pretty indirectly.  I’ve been interested in public health policy from a very young age, and initially I was most interested in and advocated for sexual health and young adult health care rights.  In undergrad, I started to learn more about the field of mental health–including the prevalence of common conditions like anxiety and depression–and the lack of available resources.  I also started to see how access to psychotherapy was helping my loved ones and myself improve our coping skills and ability to deal with life challenges.  As I progressed in my career and continued to participate in policy-making, I began to see a huge disconnect between the clinicians with “boots on the ground” and people who get to set policy.  I realized that I needed to know what it’s like to actually provide mental health services if I wanted to be an effective advocate.

Doing clinical work is definitely outside of my comfort zone.  I don’t consider myself to be a people-person or an amazing listener (seriously, ask my elementary school teachers.)  What keeps me in this field, I think, is that it can be really sustaining to be surrounded by so much resilience.  People who are willing to engage in psychotherapy have this daring and willingness to explore more about themselves, to reach out and connect to others–and to be vulnerable enough to explore changing.  Witnessing that courage has helped me be brave enough to do this work, even if I don’t have a natural affinity for therapizing.

I am not–(but we are legion?  Lee-gion?)

I am Marissa Lee, MSW LCSW.  There was another Marissa Lee operating as a psychotherapist in Los Angeles County from 2012 to 2016, but we have different degrees, licenses, and middle initials.  There are a couple other Marissa Lees out there operating as therapists, but I think I’m the only LCSW at this time.

I mean, yes.  It absolutely does.  Psychotherapy is a “western” (as in European, not cowboy boots)* and patriarchical social construction…and one of many resources people use to help cope with life.  The fact that access to these commodified resources is determined by access to, well, money and health care?  Don’t even get me started on how the way we diagnose in mental health pathologizes people for “functioning” poorly in inherently oppressive and increasingly complex social systems, or how “health” is seemingly measured by your adaptation to a system that is designed to grind people down. Kai Cheng Thom talks about this more eloquently than I ever could in the Asian American Literary Journal’s issue on mental health.

There are many ways to address mental health or life concerns and this is only one of them.  I’m down for interrogating the problems with psychotherapy even as we utilize it to improve your life.  Given all that is going on in the world right now, I believe self compassion is an act of resistance.  It can be liberating to gain a better understanding of oneself.

* Also, although there is this perception that social work and psychotherapy are “white person things” it’s important to note that you can trace it’s roots to people on the margins (namely the Viennese Jewish community circa 1890, queer women like Jane Addams, disability rights activists throughout history, and shout out to Hellenistic stoic philosophers, too.)

I’d like to believe I’m “conversationally fluent” in Mandarin, but don’t use it as often as I would like. I’m definitely not a native speaker, but can get by in conversation.  During graduate school I briefly worked as an interpreter for a domestic violence shelter.

To get technical about it, my CEFR level would be somewhere between A2 and B1, or between Level II and III of the  汉语水平考试 Chinese Language Proficiency Scales for Speakers of other languages.  I haven’t been formally tested, but this is my best guess.

AKA the “So are you a friend that I pay to listen to me or what?” or the  “Um, can we be friends?” question.

The relationship between a therapist and a client is not a friendship (or at least not how I personally hope a friendship would go.)  The distinctions I’ve found include this:

  • It’s a professional relationship that is limited to the therapy office.  Friends get to hang out lots of different places, with no time limits or other structures.
  • The time we spend together is focused on your concerns and goals.  Your insurance company is not paying me to vent to you about how Starbucks always misspells my name or to share how much acrid contempt I have for the ending of Game of Thrones.  On the other hand, this also means there is a power dynamic where–since the focus is on you–you are also more emotionally exposed than the therapist.  Friendships are usually (hopefully) more mutual.
  • I can be sanctioned/disciplined by licensing boards for stepping over professional boundaries and limits.  There is no licensing board that can revoke someone’s license to practice friendship.
  • In summary, to be friends with a client would constitute a dual relationship. This is unethical and in extreme cases could even be straight up abusive.

I certainly hope we will be “friendly” to teach other, and we also cannot be friends.  I would like to demonstrate to you that you are worthy of respect and cheerleading.  I would like to demonstrate what it’s like to have a relationship (even if it is a professional one) with healthy limits and caring. 

Therapist/Client is a unique type of relationship and to me, a kind of challenge.  Gauntlet thrown down: can you be vulnerable with someone knowing they won’t be vulnerable back?  Can you tolerate knowing that this is a relationship with walls and an endpoint? 

My hope is that by working together we can help you strengthen your ability to make lasting healthy, friendships. It is important to me, both professionally and personally, that I don’t sabotage that.  This means I cannot aspire to be a permanent fixture in your life.

There are so many people out there in the world whom you have yet to meet.  I’m tempted to say that befriending your therapist would be really limiting, since our role is to broaden your horizons and to show you possibilities.  If you can build a working relationship with someone who– right out the gate–can’t be friends with you, then you are also learning how to build healthy relationships with people who can.

For me, this flower has always represented freedom, resilience, and hope.  (Also, they smell nice and I like that Tom Petty song.)

No, my dude.  (How negligent and hateful would I have to be, as a mental health clinician, to say anything else but that?)

The fact that you feel like dying does not mean we can reasonably conclude that you should die.

As Marsha Linehan put it:  We do not have any data indicating that people who are dead lead better lives.

Also: Therapy doesn’t work on dead people.  

The fact that you feel this way and are still here means you have a lot of courage.

If you’re feeling miserable, please reach out to your loved ones, your care team, or the National Suicide Prevention Lifeline at 1800-273-8255.


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