The Biggest Misconception About Mental Health Care (From a Therapist Who Lives It)

Psychologist and Entrepreneur Ariella Soffer, Ph.D. shares how working through problems with a licensed therapist is drastically different from talking to friends or family. 

Ariella Soffer is a licensed clinical psychologist in New York City whose multifaceted career requires her to juggle numerous responsibilities, including running a group practice while being a full-time therapist, freelancing as a data consultant, and being a committed mother - to name just a few. 

Dr. Soffer’s career has given unique insights to the challenges facing the mental healthcare industry today. From the barriers being placed by insurers that make therapy cost prohibitive, to the need to educate the public on what to expect from therapy, Dr. Soffer is committed to the belief that high quality services should be available to everybody. I recently had the pleasure of sitting down with Dr. Soffer to discuss the biggest misconceptions about mental healthcare.

Can you tell me a little bit about your background and what sparked your initial interest in being a therapist?

I’m from New York City. I was born and raised and lived half of my life there. Both of my parents are also therapists, so it wasn’t entirely an off-the-mark trajectory, I suppose. I was initially interested in medicine and thought that was the path I wanted to take. Eventually, I pivoted and decided that the patient relationships that I wanted to have were more akin to being a psychologist rather than a neurologist, which had been my focus up until then.

What was it exactly about therapy that prompted you to make the switch from neurology?

Initially I wasn’t sure whether I wanted to be a researcher, exclusively a therapist in private practice, or an academic. The program I went to at Fordham University was a research-heavy, empirically supported treatment program, so I could have taken my career in a number of different directions. That was one of the key things I liked about psychology versus other degrees in mental health - the fact that there was a lot of diversity in terms of the things you could do. 

What I liked about psychology versus other mental health disciplines was the multifaceted curriculum – I learned how to pursue and conduct research, write grants and publish, teach at a college and graduate level, and also learned to implement various treatment modalities. I was fortunate to have excellent clinical supervision on my externship and internship placements to compliment the mentorship I had at Fordham. Consequently, I felt very prepared for a career that afforded me the opportunity to pursue multiple different domains of psychology (research and consultation alongside clinical practice and supervision).

Where I really started to get interested in therapy was at the intersection of change and the mechanisms of change, and how people got better during therapy. I started to understand how researching small aspects of the therapy process could help my clinical practice, and how important the relationship between a therapist and client, and supervisor and supervisee are in impacting who gets better in therapy. Research began to really support this as well and had a big impact on my clinical practice.

How does this interest in change affect how you provide care for your clients?

It is important to be very intentional about the things I listen for and how I intervene. Above all else, I try very hard to ensure that I am connecting what’s happening in the session to what I am working on with a patient. There are clues in each session that come in the form of words, behaviors and interactions that can help to facilitate a more powerful intervention, whether I am trying to utilize a more behavioral or insight-oriented technique. The more attuned I am to the person in the room, the more of an impact my interventions will make.

Obviously, being well educated and well informed about the treatments that work is very important. But in the end, it comes down to the human connection between a therapist and their client. I think that being attuned to a client’s objective and their goals and being able to listen for that and connect it to the intervention is the most important thing. 

In your opinion, what is the biggest misconception people have about mental health care?

A patient asked me yesterday what’s the difference between talking to a friend and talking to a licensed therapist. I think that’s something that people ask a lot when coming into therapy. “I have people in my life I can talk to already, so what’s the difference? A therapist is just another person I’m talking to but then have to pay.” I think that’s a big misconception because a therapist is a trained professional who is outside of your life, who is listening in a very intentional way, and is intervening in a very specific way, to address a particular problem, or set of problems, or a diagnostic concern.

A therapist is also not a stakeholder in someone’s life in the same way as a confidant. I don’t think people know how important of a distinction that is and how different a conversation that can create. 

This confusion is compounded by the fact that people don’t necessarily understand the mental health industry or comprehend the range of treatment options that are available and what separates one form of mental health care from another. There are so many different people in what we can broadly call the mental health space. I think it obfuscates what therapy actually is or should be. 

Could you explain more about the differences between working with someone who's a licensed therapist and someone who is not?

Therapists strive to help someone achieve a particular objective. That doesn’t necessarily have to be a symptomatic objective. It could be somebody who says “I find it helpful to have a therapist in my life who I’m working through problems with on a weekly basis. That's how I want to use this service.”  So, the therapist should listen and be aligned to that goal. Where someone else may be coming to therapy because they have a spider phobia. They don’t want to be phobic of spiders anymore. So, in this case, the therapist should work on resolving that particular issue. The client could also be a very anxious person, but they’re not interested in working on that because they’re a solitary person who works with computers and don’t need to interface with anybody else – so the therapist can make the person aware of the way in which they could help with the general anxiety, but it’s up to a patient to decide if that is what they would like to work on at that time in their life. A therapist can encourage change, show someone the benefits, but also needs to respect where a person is in their life at the time they come into treatment. Therapy should be informed by someone’s knowledge base in their field and also what kind of care the patient is interested in. 

So it sounds like therapy should be a partnership between a mental health provider and the client to work towards clearly defined outcomes.

Yes, and informed by clinical practice.

Looking at the mental healthcare space, since you had such a great multi-generational experience, what would you like to see change?

I would like insurance companies to stop interfering in people’s ability to have high-quality mental health care. There is such a huge need for high quality mental health care and therapy providers. And not just among people who have good mental health insurance benefits or who are wealthy and can afford it. I think insurance companies have made it very difficult for providers to earn a living wage without seeing back-to-back patients unless they have a business model, like I was fortunate enough to create, where people can afford to pay out of pocket fees for a more curated service. I think there should be a solution for that. High-quality services should be available to everybody. This is where Nirvana Health can really step in, by helping to make the mental health billing process easier for both clients and therapists.

How do you think Nirvana could be most effective in addressing mental health billing difficulties? 

Nirvana is in a unique position as a liaison between mental health insurance companies, practices, providers, and patients. This positions Nirvana to be a valuable resource for disseminating information to the general public while also being an advocate. I think Nirvana's focus on helping therapists get paid appropriately for services while ensuring that clients are having the easiest road possible to mental health services is essential. The more insurance companies and mental health billing issues are removed as barriers, the more people will take advantage of those services.

For example, when I was at a small counseling center at a large public college, we had three therapists on staff and served approximately 26,000 students at the university. We referred a lot of the students out because we didn’t have capacity to serve them on campus. We did a study of the students that were referred and what we learned was that less than 20% of those students followed up with the referral. Why did so few follow up? Because they didn’t understand how therapy would benefit them. I think that is also true of a lot of people. People, in general, don’t understand how therapy can help them with their problems. Nirvana is in a great position to help educate people about the benefits of therapy while explaining to insurance companies how they’re contributing to a mental health care shortage.  

Personally, Nirvana has helped me and the therapists in my practice to focus more on the clinical part of our work and less on the mental health billing and insurance part. During the COVID-19 Pandemic there was such a huge growth in services in my practice. It’s been exciting that so many people have needed services, but it’s also sad to see that this pandemic has had such a negative mental health effect. There’s an explosion of need right now and there are not that many providers who can accommodate it. People are getting pretty creative about how to expand their service, and Nirvana’s mental health billing services have been key in making that possible for my practice. 

This interview has been edited for length and clarity.