I wanted to create this introduction to therapy for two reasons. One is that starting therapy can feel a little daunting, and knowing some of what to expect going into it can be helpful. The second reason is that over the years, I have noticed some behaviors that support people to get the most out of therapy. You don’t have to do anything but show up to talk to me, but I want to share some things that can be useful to get the most out of the time that you’re putting into this endeavor.
Part of the reason that it can be hard to describe what therapy is like, is that it looks very different depending on both the clinician and the client. Every therapy I do looks different depending on the client I am working with. The therapy hour isn't just created by me, but by you as well. I also do my best to tailor my style and interventions to fit what works best for the person in front of me. Part of the good of this diversity in what therapy can look like is that if you’ve had therapy before that didn’t feel good or helpful, it could be very different with me. Additionally, if you don’t like therapy with me, don’t lose hope or give up on therapy! You can always finish with me, find another therapist, and have a completely different experience that might be more beneficial to you.
That being said, here’s a little of what to expect. The first session is the intake. This is like the “introduction” to a book and is fairly different from what the rest of therapy looks like. It will be a chance for us to start getting to know each other and, yes, for me to ask you a bunch of questions! I will be looking to start to understand you, your life, what brings you in to see me, and the best part: where you want to go! After the intake session, therapy begins.
To start therapy, I typically begin with two things: getting a barometer on how you’re doing in that moment and checking in on the goals set last session. This allows us to measure progress being made and to see if the goal set was a helpful thing or not. The therapy conversation can generally flow out of here, although sometimes we will work to identify something that we’ve been wanting to work on already or something significant from the last week that we can dig from. The bulk of the time is spent here, and whatever it looks like, the goal is to help you to reach your goals that you set with me for therapy. This can look like increasing understanding of yourself or finding new, skillful ways to think and operate. To close up, I like to end with this question, “What is one thing that stood out to you today, felt like a helpful thought, or felt like a new thought?” This is to help you to think back over our conversation and help to remember the things you don’t want to forget. It is a way of working to reinforce therapy gains for you. Feel free to share more than one if we have the time and more than one thing sticks out to you. And then finally, we set goals. Goals generally have something to do with what we talking about in session and represent practicing a new way of doing things out of what you have learned from our time talking.
Less is more, deeper not wider: It is generally helpful to go into one or two topics per week rather than skipping over many topics. This allows us to gain more insight and glean more helpful conclusions rather than having brushed over many different things, but with no fruitful information or changes to show for it. Definitely in the beginning when we’re getting started, fill me in on all of the things from your wee if you'd like, but the goal is to have the bulk of the conversation digging deep into one or a few things.
Brag about yourself: Yes! I’m serious! With me, I want to hear it! I want to know your strengths right from the beginning. And then, tell me about all the ways that you’ve been using coping skills, helpful self-talk, skillful behaviors, etc. that we’ve been working on in therapy. This will give me the opportunity to reinforce growth behaviors with my praise which will in turn help you to grow even more (it’s behaviorism)!
Turn the tables, you take the notes in session: Outside of the first session, I generally do not take too many notes while we are talking. It can take me out of mindfully listening to you and it can distract the person speaking as they may be wondering what I am writing down about them. However, if you feel it would be helpful, I would encourage you to bring in your own notebook and take notes in session of things that feel like an epiphany (or a “starred thought” as I’ve heard someone call it) or things that you want to remember or work on in the coming week. This is very effective and skillful behavior and will help therapy to progress more quickly.
Try to be honest: One of the best indicators of successful therapy is feeling trust in your therapist. I think this may be because it allows for more openness and rawness and dealing with the deep issues. It also allows you to feel seen and unconditionally accepted even in the places you thought you would be rejected. Trust obviously has to be earned, but I’d encourage you to do your best to be brave, give me a chance, and let it all hang out there. If after some time, you feel like I’m not someone that you can trust and completely open up to, please let me know, I can either do my best to work through it with you or help you find someone that feels like a better fit.
Think about the end from the beginning: Give a person a fish and feed them for a day, teach them how to fish and feed them for life. My goal is not to give you a “fish” but to teach you how to fish; in other words, work myself out of a job. I want to help you to have the skills, tools, and healthy relationships that will allow you to feel in-control and peaceful without me. Now, that being said, there is no rush and it is always up to you. But by looking towards the finish line of what you want your life to look like when this is all over, it helps to stay motivated and thoughtful of what needs to change to get there.
Give me feedback: I will periodically check in on how you feel things are going in therapy, but feel free to start this on your own as well. If I do or say something you don’t appreciate or felt wasn’t helpful, tell me! If there was an intervention I used that felt helpful, tell me! That way I can know what does and does not work for you and be a better therapist for you. This also allows you to practice healthy interpersonal behaviors in a safe environment (assertiveness and asking for what you want).
Do your goals!: If there is one of these things that I see the most correlation with quicker therapy gains, it is this one. Fifty minutes talking to someone a week does make a difference, but fifty minutes talking to someone a week, identifying new ways of doing life that will be helpful, and then intentionally integrating it into your life week by week is very, very helpful indeed. Write down your goals and find ways with me to not forget to do them during the week. Rank which ones you saw the most improvement from using. And then keep doing the ones that were really helpful, even if they were not that week’s goal. An added benefit is that if you finish treatment successfully and start to notice some of the old feelings, thoughts, and behaviors that brought you into therapy happening again, you have all of the things that helped you to feel better recorded and can begin to intentionally utilize them again.
*One quick note, I sometimes use the term “skillful behavior” during therapy. This is the use of anything- coping skill, way of speaking, way of thinking, intentional behavior- that is effective to help you reach your goals. For example: a skillful behavior could be going for a walk in the woods instead of lying in bed when you don’t feel like getting up and your goal is to not feel depressed. Or a skillful behavior could be calmly saying, "I want to have a good relationship with you. When you talk the whole time we're together, I feel like you don't care about me." Instead of snapping at that person or pushing down the hurt feelings when the goal might be improving relationships.