Monday, May 16, 2011

Curious about therapy?

Whether  you know someone that is currently seeking out a therapist or you have always wondered about it and considered seeking therapy yourself, often there are many questions.  Something I learned early in training is that you can never assume that your client knows what therapy really is.  Media paints a picture of an older person (usually a older, white male) sitting in a chair behind a distressed person who is laying on a couch free associating.  While this Freudian picture may still exist, it is very uncommon in today’s therapeutic offices. 

Often times there will be a couch, or two chairs, but in most offices today, the client and the therapist will face each other.  The goal is to feel comfortable.  Emotions (anxiety, sadness, fear, etc) during your first sessions can be slightly eased just by feeling comfortable in the therapy room.  However, there will be certain actions that must be taken to find the therapist that is right for you or someone you know. Depending on what you are looking for in therapy and in a therapist, there are some very important questions you will want to ask as you Shop* for a therapist.

*I say Shop because you are looking for a service provider and you want your needs to match with what they provide.  Searching for a therapist could take several phone calls, referrals, and will require asking questions.

Some of the things you may want to ask as you Shop may be:
What kind of treatment do you usually use (What is your theoretical orientation)?
What are your areas of specialty?
What are your fees?
How long do you expect my treatments to last?
Do you have a sliding scale rate or offer a payment plan?
What types of insurance do you accept?
When do you typically hold sessions? Mornings, Weekdays, Evening, Weekends?
Do you have a website or blog with more information?

And any other questions you are curious about; don’t be shy! 
(Don’t be afraid to do some of your own research.  The American Psychological Association (APA) has more information about all of these topics and can be reached toll free at 1-800-964-2000 or visit their online Consumer Help Center at

During the initial session there are a few points that a therapist will typically cover right away.  The therapist will collect information in an initial clinical interview and then as your therapy begins speak to these points:

An open discussion about maintaining confidentiality, as well as the limits of confidentiality.  It is important to talk with the client about when the limits of confidentiality may no longer apply, such as if the client is in imminent danger of hurting themselves, someone else, or there have been reports of child or elder abuse.  This is a very important subject that will vary based on the needs of the individual client.  Psychologists will follow the American Psychological Associations Code of Ethics  to make sure the client’s best interest is always at the forefront.  A Master’s level clinician follows the Ethical Guidelines of the American Counseling Association  however, the conversations with clients will be similar.

Informed Consent  
         Informs the client that in most situations their personal information will not be shared with an outside source without their written permission.  Additional information about informed consent will be outlined in the Ethical Guideline links above.
        What the First Few Sessions Will Look Like 
         Given that many different life circumstances bring clients to a therapist, it is important to share with them what therapy will be like.  Typically sessions are 50 minutes (known as a therapeutic hour).  The first few sessions will be spent “building rapport,” which basically means, getting to know one another.  Successful therapy is not likely to happen unless the client learns to trust their therapist, and the therapist can help to facilitate this by being genuine, respectful, and empathetic. 
       What Sessions After the First Few Sessions Will Look Like 
         After some initial rapport is built and the client is beginning to feel more comfortable with the therapeutic relationship and expectations sessions will be focused on some sort of symptom relief and goal setting.  The therapist’s theoretical orientation will ultimately guide how sessions move.  For example, if a therapist’s theoretical orientation is Cognitive Behavioral (CBT) then goal setting will likely take place in the first or second session as this is a very goal and behavior driven, short-term therapy.  If a therapist’s theoretical orientation is Psychodynamic or Psychoanalytic, this therapy is traditionally more long-term and much more time in the beginning can be devoted to rapport building and self exploration.  

      Reading recommendation for people interested in therapy and the therapeutic process:

How Psychotherapy Really Works: How It Works When It Works and Why Sometimes It Doesn’t
By  Willard Gaylin, MD

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