What to expect from Therapy with a Psychologist
Have you ever wondered what is would be like to actually be in therapy? Sure, you can see what the movies show about therapists and everybody knows that Dr. Phil has plenty of experience, but what is it like for everyday people, without a video camera rolling? Well, look no further! In the spirit of easing your mind, here is a basic outline of the structure of therapy and what you can expect from working with me. Each therapist is different, but we have similarities in our structure. Most therapy sessions are 50 minutes in length. Some offer 80 minutes for more in-depth sessions, though you will likely need to ask for that if you prefer more time.
Introduction- Hello, Nice to Meet You!
Clients usually find me through the internet or through a referral from someone. You can contact me via email or phone and I will respond as quickly as I am able to, usually within 24 hours. Remember that therapists are in sessions with clients and will not answer phone and email when in session- that would just be rude- so sometimes we can be a little difficult to reach. Once I receive a message from you, I will offer a free 20 minute consultation. As much as I would love to take credit for being the only psychologist to do this, most psychologists are willing to offer a free phone consultation. I prefer mine in person, since you can get a much better sense of what it would be like to work with me, in person.
The point of the consultation is for us to get a sense of whether we would work well together. You get to give me a synopsis of what you are struggling with and I give you an idea of how I would likely approach it. I share relevant therapeutic perspectives, give examples of the kinds of exercises we might do and the homework you can expect from me. This is also an opportunity for you to ask any questions you might have. Duration of therapy and the costs involved sometimes come up in this session.
- It helps if you come a few minutes early in order to complete the paperwork. The paperwork includes your contact information, your permission to say, "yes" if your insurance carrier calls to check that you actually came when you said you did, and an emergency contact. The second sheet of paper is our agreement of therapy; what you can expect from me, my availability, rules of confidentiality, the risks and benefits of therapy, and what to do in case of emergency or crisis.
- Once we are in the room together, we go over the expectations and legal requirements, so that we are both clear about our agreement to work together.
- I usually give people at least one self-assessment of daily functioning, any depressive symptoms, and what your physical experience of anxiety might look like. If you mentioned any trauma, I will include an assessment of what your symptoms look like for that, as well. This helps me figure out what I need to focus on and which areas I can safely ignore. It also gives us a baseline for comparing. After 10 sessions, I generally like to give the assessments again, in order to see if we've made any progress. If we haven't, we need to figure out why. If we have, we can celebrate your progress.
- Clinical Interview: this is where I get a more complete picture of what you came in for. I ask for details and for the relevant background.
- This is the only session in which I actively take notes. It is a lot of information to gather and I want to remember it all.
- I will ask for other background information, like family, friends, and work/school history, so that I can get a context for the challenges you face
- Basics: how is your sleep, appetite, exercise?
- Substance: do you drink, smoke, take drugs? Which prescription medications do you use, if any?
- Have you ever considered or attempted suicide or homicide?
- What are your Strengths? I use these when we come up with skills for you to practice and when we look for solutions to your difficulties
- What do you do already that helps?
- Social supports
- Family support
- Spiritual beliefs / practices / community
- Things like intelligence, insight, creativity, persistence, or humour
- Creative expression
- Sports and other physical outlets
- After the interview, I like to introduce mindfulness, as I practice it. If we have time, we can go over the handout together and I can give you specific homework from the handout. I don't always have time for this, however, so I will then include this part in the next session.
- We make an appointment for our next session
- I take payment and give you a receipt for you to give your insurance carrier for reimbursement, and for your own records.
- Hugs are to be initiated only by you; not everyone is comfortable with that and many of my clients are uncomfortable being touched, so I will not initiate a hug. If you want one, however, I am happy to give you a hug at the end of the session.
Mindfulness: This is the first step and the basis of the work I do with everyone.
- It gives you ideas for how you can live a more mindful life, as well as helping you determine which forms of mindfulness are more or less effective for you. The more you practice, the better you become at it, and my clients tell me that their minds become quieter.
- Practicing skills mindfully makes them more effective. For example, if you are attempting to self-soothe with a bath, but your mind is going in circles about whatever is upsetting you, the bath will not be very effective. You will likely remain upset - and just be wet at the end of it. You are more likely to benefit from it if you focus on the feel of the warm water, the smell of the soap, the hypnotic flicker of the flame, and the sound of your favourite music in the background.
- Practicing mindfulness at the beginning of the session helps both of us to be present with each other. You can leave your distractions outside the door and I can transition my attention from the prior client, to you. In a "normal" therapy session, it generally takes about 15 minutes for a client to talk about small talk and get settled in to the session. When we do 5 minutes of mindfulness, we are able to jump right in to our session.
- I almost always give clients some kind of homework. In the beginning, it is mindfulness practice. I sometimes give out reading materials or worksheets, other times I give you action items to complete. Sometimes, I just ask you to notice something or to consider your experiences around something.
- After we do our mindfulness practice, you can share your homework results with me. If you did not complete it, I will not judge you, I promise. I'm not grading you. We will discuss what got in the way of completing it and come up with a solution so that you can put into practice the work that we do in our session.
Getting Down to Business:
The majority of the session is spent talking about recent events and issues for you. This is the part that varies from therapist to therapist and client to client, because it is where we get into the actual techniques of therapy styles. My style is to integrate an understanding of past experiences into your current life. This means that we might talk about the past and the present in the same session. I will possibly pop up and draw out an idea on my whiteboard, if we are working with a concept that is best understood visually. We might use mindful techniques during the session if you start to dissociate (space out) or become overwhelmed with talking about painful things. If that happens, I will comfort you and support you through it.
Therapy is about the relationship between therapist and client. As such, the bulk of the therapy is different from person to person. When you feel safe, it gives you an opportunity to get into the painful aspects of life and walk out feeling better. When you can feel safe enough to become emotionally vulnerable, you can make real progress with a therapist who knows how to walk you through it. When you walk through it, you become stronger and more capable. As you become more confident and more capable, I take a less active role and simply make observations or ask questions that will get you to consider something so that you come to your own conclusions.
Your signal that the session is coming to a close is when I sum up the homework you have and pull out my daytimer to schedule our next appointment. Then, taking care of payment and a hug, if you like.
Please note that your therapist will not acknowledge you if you run into each other in a public place. That would constitute a breach of your confidentiality; you must be the one to initiate contact if you wish to say, "hi" when you run into your therapist. I am not being rude, I am respecting your privacy. I am happy to say "hi" if you do make contact when we see each other out and about.
That is all there is to it! If you have any questions or comments about the therapeutic process, I would be happy to discuss them with you.