Psychiatry & Psychology--General/Client/Therapist ethics


I just started therapy two weeks ago for my anxiety. One reason why I picked the therapist in my area that I did was because on his Psychologytoday bio page he list both Existential and Psychodynamic as two of the orientations that he practices. However he told me that he is going to be treating me with Cognitive therapy, which he doesn't even list on his page. My last meeting (yesterday) when I try to bring up about my past - how one would in psychodynamic - he would simply say, "I know we already talked about your childhood our last meeting.....", and not want to talk about. I like him as a therapist in all other aspects and want to stick with him. The problem lies with my anxiety, I have problems standing up to authority figures and people of power. So I am nervous to ask him if I could have a mix between Existential and Psychodynamic therapy because he is the professional. What should I do? Is it appropriate for the patient to ask the therapist for a certain orientation of treatment?

I also think that part of the reason why he wants to treat me with Cognitive therapy is because I am paying with my insurance, instead of out of pocket, and with cognitive being fewer visits its all what they would cover.   

Hi Joshua, thanks for your question. You asked, "what should I do?"

Well, I always suggest that patients bring up their concerns about their therapy directly with their therapist. There are a number of benefits to doing so, including learning how to solve interpersonal problems, and deepening the trust with one's therapist.

I'm always happy when a patient tells me that they are dissatisfied with their therapy. Therapy, like all relationships, is in perfect. One can only fix problems when they are openly discussed, and it shows remarkable courage on the part of the patient to be able to express themselves in this area, because it leaves the patient in a formidable position. Further, many such conversations in "real life" relationships end up in arguments so it is an opportunity for real progress in therapy.

Now, in regards to therapy for anxiety, research shows that cognitive and/or cognitive behavioral therapy is the treatment of choice for anxiety. It is generally much more effective, for most people. That might be a consideration for your case, especially given that your insurance pays for a limited number of sessions.

Psychiatry & Psychology--General

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Bruce Borkosky, Psy.D.


any related to psychology, especially related to forensic psychology


15 years as a licensed psychologist, 15 years in private practice. My practice began primarily doing individual and group psychotherapy, is now devoted to assessments, but I occasionally do take on clients in therapy.

American Psychological Association

B.A. psychology, B.A., music, Ohio Wesleyan U., 1978 MCS, computer science, University of Dayton, 1984 MA, psychology, Miami Inst. of Psychology, 1991 Psy.D., psychology, Miami Inst. of Psychology, 1993 post doctoral training in Neuropsychology, Fielding Institute, 1995-1997

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