ABCs of Mental Health Care

Seeking Help

print The Process of Therapy

While each individual experience of therapy is likely to vary, the following can give you an idea of what to expect as you enter therapy.

Initial contact

Your first contact with a therapist is likely to be with an office staff person. In a private office setting, your first contact will likely be with the therapist himself. This is the time to ask questions about fees, hours (e.g., evening appointment availability) and cancellation policy (e.g., will you be billed for missed appointments?). In the clinic setting, you can get some general information about the therapist (e.g., education, general orientation). However, more detailed information should likely be directed to the practitioner.

The staff person you speak with will ask you a number of questions. After obtaining some general demographic data, he will ask for an overview of your problem, and whether anyone referred you to this particular therapist. You will also discuss any insurance or payment issues.

Based on your needs and the therapist’s schedule, an appointment will be made. Occassionally, due to the nature of your problem and the therapist’s experience or schedule, the therapist may decide that your problem would be better treated by someone else. Such a situation is merely an affirmation by the therapist that you deserve treatment by a therapist best able to meet your particular situation.

First appointment

Upon arriving at your first appointment, you will be given paperwork to fill out. This may include a detailed personal history (e.g., information about you parents, marital situation, physical health, medications) as well as insurance information (your insurance card will likely be copied). There is also likely to be information about the confidentiality of the sessions and any limits to that confidentiality will be presented.

Meeting the therapist

The initial visit can vary considerably and will depend on the practitioner’s professional background and personality. Some practitioners will review your paperwork and start the discussion there. Other professionals will engage in general discussion not related to your problem and work their way into the reason for the visit. Some practitioners may get right to the point. Keep in mind that there is no single “right” way to begin a session.

Most therapy sessions last 45 or 50 minutes, although more time may be taken for the initial interview. Near the end of the session, the therapist might summarize what has taken place and make recommendations for future sessions or additional referrals (e.g., psychological testing, medication evaluation). Do not be surprised if the therapist has questions at the end of the session or is unsure as to your diagnosis. Often, more than one session is needed to obtain this information.

Therapy plan

Early in therapy, you and your therapist will likely develop a treatment plan. Remember, the treatment plan is a joint effort between you and the therapist. It is likely to include structured tasks for you to complete or issues for you to consider between sessions. Your treatment plan may also include goals and criteria for assessing when these goals have been reached. Some therapists will use a written treatment plan, signed by the patient and therapist. Other therapists will use a less formal plan. Either way, you should know the goals of treatment and how you will accomplish them.

Length of therapy

How long a person is in therapy depends on a variety of factors such as the type and severity of problem, therapist’s orientation and affordability. Some therapists practice a brief therapy that targets specific symptoms. Brief therapy can range from six to 25 sessions. Sessions are most often weekly but may be more or less frequent.. Some persons might require additional time, especially if symptoms are severe or their problems are especially complicated (e.g., abuse).

At the beginning of your therapy, you should discuss with your therapist how long he anticipates therapy lasting. While such estimates are subject to change, they can be useful in gauging your progress or your desire to begin the therapeutic process.

Process of therapy

In cognitive-behavioral therapy, the therapeutic relationship goes largely unexamined, but in interpersonal or psychodynamic therapies, the relationship itself is used as an instrument of change. Unlike most social relationships, the therapeutic relationship is examined to enable the patient to gain insight into her attitudes and expectations. Like all relationships, the therapeutic relationship will pass through different stages at different times.

Initially, the patient is likely to feel good about therapy. You may feel a tremendous sense of relief. Much of this comes from talking about your problem with an attentive, caring person. You may also feel relief that you now have an expert who can help you with your problem. Having a plan of action can reduce anxiety and instill hope.

Individuals may experience a range of intense feelings towards the therapist. Such emotions often reflect old feelings originally felt towards a parent, sibling or other important family member. The technical term for this phenomenon is “transference,” and the “working through” of such feelings can help the patient to grow emotionally and to free themselves from emotional blocks and/or inhibitions.

Like most relationships, the therapeutic relationship can have its ups and downs. The initial exuberance felt during the initial stages of therapy may fade. The therapist whom you once saw as supportive and understanding can now seem challenging. This is not unusual or an indication that your therapy is stalled. It is important that you stick to your plan during this time and push ahead. It will help if you share your feelings with your therapist. This process can often uncover uncomfortable emotions that can be addressed.

By Michael Herkov, PhD
© 2000 University of Florida Brain Institute

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