Here are some questions that others have asked Dr. Burkham:

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Wednesday, October 12, 2005
Neenah, WI... Looking For Therapy writes:
I am on a Insurance program that only covers therapists that are Medicaid certified. I am having an extremely difficult time locating therapists in the Fox Valley Area (Greater Appleton, WI area) that accept my insurance. Do you have any suggestions as to places that I may want to look for help?

I am sure this is a issue for others as well, since the insurance company does not provide a list of providers, all they will do is verify a provider is covered if you call with the providers name.

Dear Neenah:

You are facing a problem which is very common around the country because Medicaid pays providers so poorly and with such incredible red tape that most private providers do not accept Medicaid. It is sad but true.

I can give you some advice specific to our area (the Fox Cities of Wisconsin) and then give others in the same predicament around the country some advice as well.

I know of three options you can pursue: 1. Contact the United Way information service by dialing 211. 2. Call Information and Referral at 920-954-7200. 3.Contact Clinical Services of Winnebago County at 920-727-4817.

For others around the country, I would recommend calling their local United Way, their county mental health center, and, if you are in a city with a university which has a clinical psychology training program, contact the psychology department of that university and ask if they see clients on a reduced fee basis.

And, Neenah, I wish you the best of luck. Don't give up!

Dr. B

Friday, September 16, 2005
Borderline Help writes:
I am in a relationship with a person that has been formally diagnosed with Borderline Personality Disorder. Until very recently, we have been communicating very well, and everything has been going well.

Recently, she seemed to get upset at me for some reason, and does not want to talk about it. I have not violated her trust in any way that I know. I have reassured her that I am available and I want to talk. She just tells me she doesn't want to talk. She tells me that she wants to stay in the relationship, she loves me, and everything is fine. I don't feel like everything is fine, and I am at a loss as to what I can do next to get the conversation going again.

Borderline's Miserable Boyfriend

Dear Miserable:

You're in a very tough spot. People who have borderline personality disorder have an extremely difficult time with close, emotionally-charged relationships. They can be at times very positive about a person and then turn and be angry, even rageful, and at other times coolly distant. They have a hard time being comfortable being close to others.

From your letter, it seems that you have done what you can do--you have put out an invitation for her to talk which she has declined. If you push her to open up before she's ready to, she is likely to angrily resist that.

I'm guessing that you may be feeling too responsible for this relationship. All you can do is invite her to talk and be open, non-judgmental, and patient. If you do this, you will find out if she can be an emotional partner to you or not. If you try to pressure her to be close and take responsibility for the relationship, you will remain stuck in a frustrating situation.

It might not be a bad idea for you to get some professional help to assist you in dealing with her. Couples counseling will probably not be effective because she does not see a problem.

The best of luck to you.

Dr. B

Friday, July 15, 2005
abc writes:
Doctor, I am in my 10th session. I have bad feelings towards my therapist and iI am not sure if he can help me or not. I am in a country where it is not common to see a therapist and it is not common even to say you see one. I am not sure if I should continue with this is or just try to find another one????????

Dear Abc:

If you have bad feelings after 10 sessions, it is unlikely that your therapist can be helpful to you. The research on therapy says that if the client feels positive about the therapy after a few sessions, that is a good indication that things will go well. If the client has negative feelings, then therapy is likely to be of little benefit. You have given your therapist a good amount of time. I think it's time to find another.

Good luck!

Dr. B

Tuesday, July 05, 2005
Daisy writes:
how does a patient know when she is becoming too emotionally dependent on her doctor?

Dear Daisy: Thanks for such a clear and direct question. It is not an easy question to answer but I would say two things:

1. If you are more concerned with pleasing your therapist than you are with getting better, then you are too dependent. You might stop working on yourself or you might start looking for too much guidance from your therapist. You might lose sight of the fact that the therapy is for your benefit, not your therapist's.

2. If you feel you are becoming too dependent, talk about this with your therapist. Ask him or her what he/she thinks about this. If your therapist refuses to talk about this, that is a bad sign. If your therapist's answer encourages you to become more yourself, then that is a good sign. If his/her answer makes you feel more dependent, then it might be time to find another therapist.

Chapter 4 of my book 'Therapists: the Good, the Bad, and the Overly Helpful' can be helpful to you in sorting this out.

All the best to you in your struggle for growth.

Dr. B

Friday, June 03, 2005
Needy Survivor writes:
Dr. Burkham, what is the "average" length of therapy time for an adult survivor of child sexual abuse? Also, although my therapist has assured me that it is natural to feel dependent on a counselor while in therapy, I fear needing someone so strongly. I don't want to need anyone. I feel that it is too dangerous emotionally. Do these feelings finally subside? I feel like a child dependent on her father. I find myself embarassed by the need.

Dear Needy Survivor:

It is very difficult to give a meaningful answer to your first question because there is so much variation. In my practice, I have worked with survivors of childhood sexual abuse for a few months and they have gotten some help. I have also worked with survivors for over 10 years. Probably an average would be several years but your needs may be different--remember, you are the one who controls how long you want to be in therapy!

The question of dependency on your therapist is a crucial one. Most survivors of childhood sexual abuse have been violated by adults they trusted to care for and protect them. Their abuse teaches them that it is very dangerous to be dependent on an adult, because they will betray you just as your abuser did. So, when you begin to depend on your therapist, your intense fears rise to the surface. Part of therapy can be a healing process of depending on an adult (your therapist) who is worthy of your trust and who helps you to depend on yourself more and more as therapy goes on. Your therapist would need to be very careful and wise to allow you to be dependent but also encourage you to be less and less dependent as time goes on. In my book, I write about "the (relatively) non-anxious therapist"--they are the ones who can handle these issues well.

Therapy can, however, go very wrong if the therapist exploits your dependency thus replicating the trauma which brought you to treatment in the first place. It can also go wrong if your therapist blatantly or subtly undermines your efforts to become your own person. In chapter 4 of my book, I write about abusive therapists, "shame and blame therapists", "overly helpful therapists", and "withdrawn therapists". These types of professionals can all hinder your growth by exploiting your dependency or not helping you to become more independent.

Thanks for your great question--it's one that lots of clients struggle with. The best of luck in therapy.

Dr. Burkham

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