FAQ

Therapy is an endeavor of growth. Anytime we try something new, it is natural to feel nervousness or trepidation. That’s one way our hearts and minds inform us that we are genuinely turning towards change. It’s also natural to feel nervous to let a stranger so close to our fears, insecurities, fantasies, and emotions. The therapy relationship is unlike any other relationship in modern society. We sometimes let therapists closer to our inner emotions than we let our partners, spouses, parents and our friends! Once we make a decision to begin this endeavor it is imperative that we find a therapist who we feel genuinely can meet us where we are. Someone that we get the sense can actually hear us, can give us reflections, and can engage with us honestly - while also having our best interests in mind.

How do I choose a therapist?

Research suggests that despite the increase in available number of modalities, the effectiveness of psychotherapy as been consistent over the last 40 years (Miller et. al, 2020). In other words, just because there are more modalities does not mean therapy has become more effective. Furthermore, research consistently shows that a strong therapeutic alliance is associated with better treatment outcomes, regardless of the specific therapeutic approach used (Prusinski, 2022), So what does that mean for you, the client? Your experience of the connection with your therapist is the most important part of the therapy process and it is the greatest predictor of success in therapy.

Therefore, what do your insides say when you are talking with a potential therapist? Do you feel a possibility for connection? An openness with them? What are the “vibes?” I know that may be hard to quantify, but your experience is the guide.

If we must talk about modalities…

There are many different theories of psychology applied under the umbrella of therapy. It is not essential that you know all about all of them (unless you want to investigate). Many therapy methods overlap in function, while using different terms. Some therapy methods repurpose older therapy methods in new words and simply have good marketing or public exposure.

CBT is the most widely practiced form of psychotherapy in the US. It focuses on the relationship between our thinking, our emotions, and our behavior. Other therapy approaches definitely focus on these things, however CBT tends to do so in a highly structured way. I think CBT is useful at times for some people, but I find that it can too easily reinforce the suppression of our internal states; bringing short-term relief but in the long-term not really supporting deep change. It is also too dry and conceptual for my liking. Of course there are many excellent and skilled clinicians who practice CBT; choice of modality doesn’t equal clinical skill or competence.

My orientation…

My approach to therapy is integrative and grounded in a neurodevelopmental perspective. I am primarily a relational therapist; meaning I observe emotional and behavioral patterns that unfold in relationship experiences and help clients develop insight into them. I draw from psychodynamic, developmental, behavioral and neuroaffective theories. I help clients connect with their bodies as a source of wisdom, which is often called somatic work. I believe that our default patterns have served a purpose that we want to understand. If we try to just push past them without developing insight into their role, most often we get stuck. As understand these patterns more and more, we develop new pathways for both self-expression and self soothing. I see our emotional patterns as systems, and I help my clients learn the signals of these systems.

How do I know if you are the right therapist for me?

Take your time to read through my website. If you sense that I may be a good fit based on what you are reading, you can email me or sign up for a consultation.

During a free phone consultation, you can ask me what a typical session with me is like, ask how I work as a therapist, or any other questions you may have that are specific-to-you. You’ll also be able to share what’s going on for you and I can share my ideas around how I can help you.

The most important factor is feeling comfortable with your therapist, which can take time to develop. During sessions, you'll gauge how you feel working together. My approach may not suit everyone, and it's crucial to find someone who feels like the right fit for you.

Does what we talk about in therapy remain confidential?

Confidentiality is a cornerstone of the therapeutic relationship. What you discuss in therapy sessions remains private and protected by strict ethical and legal standards. Therapists are bound by confidentiality rules, meaning they cannot share your information without your explicit consent. There are, however, a few exceptions to this rule, such as situations involving imminent harm to yourself or others, or cases of abuse. These exceptions are in place to ensure safety and well-being. Understanding these boundaries can help you feel more secure in sharing openly during your sessions. Confidentiality fosters a trusting environment where you can explore your thoughts and feelings without fear of judgment or exposure.

How long will therapy take?

The duration of therapy varies greatly depending on individual needs and goals. Some people may find relief and achieve their objectives in a few sessions, while others might require months or even years of ongoing support. Factors such as the complexity of the issues being addressed, the frequency of sessions, and the therapeutic approach used can all influence the length of therapy. It's important to have open discussions with your therapist about your progress and any adjustments needed in your treatment plan. Remember, therapy is a personalized journey, and the time it takes is unique to each individual. The ultimate goal is to achieve meaningful and lasting change at a pace that feels right for you.

Very often, however, progress is non-linear. This is what I have come to expect in therapy. We may take two steps forward and one step back. Sometimes we take several back. However, each time we learn something new about ourselves that we can apply in the future. We deepen our awareness into our emotional patterns giving us more freedom and flexibility.

What can I expect during the first session?

Overall, you can think of the first session as a structured assessment that helps me get to know you and the challenges that brought you into treatment. I’ll invite you to share more about yourself and we can also talk about what’s worked or not worked for your mental health in the past.

Some questions that I like to ask during a first session include:

What brought you to therapy?

What’s present for you in your life right now?

Have you gone to therapy before? How did that go?

You can ask me questions as well. You might be curious about about why I'm a therapist or how I've helped other clients like you.

The most important part of a first session is that you see if you feel I’m a good fit for you. If you feel supported, seen, and at-ease with me, we can discuss if you’d like to meet again.

How can I get started?

I'm here to talk during a free phone consultation where you can share what’s going on for you and I can share my ideas around how I can help you.

Email me today to get your free phone consultation at scott@scottmenasco.com.

or sign up through the calendar below!

References

Miller, S. et. al. (2020). Better results: Using deliberate practice to improve therapeutic effectiveness. Washington, DC: American Psychological Association.

Prusiński T. The Strength of Alliance in Individual Psychotherapy and Patient's Wellbeing: The Relationships of the Therapeutic Alliance to Psychological Wellbeing, Satisfaction With Life, and Flourishing in Adult Patients Attending Individual Psychotherapy. Front Psychiatry. 2022 Jan 31;13:827321. doi: 10.3389/fpsyt.2022.827321. PMID: 35173642; PMCID: PMC8842997.