Blog 1 (Part 5 of 8): Starting therapy

This blog post will not cover what happens in specific types of therapy – e.g. CBT, schema therapy, etc – that’s for another day!  It focuses more on what to expect at different stages of therapy in general.

Getting to know each other

Your first few therapy sessions might be referred to as the ‘assessment phase’.  This is standard to all therapy treatments and is designed to help you and your Psychologist get to know each other, understand your difficulties and begin to build an effective therapeutic relationship, which is key to successful treatment. 

At the beginning of therapy, the Therapist invites you to openly share what is going on in your life, touching on what your main difficulties are and how these are impacting you on a daily basis.  You will then discuss what goals you have for therapy and make a plan for going forward.

How you might feel

Some people cry when they start therapy – it can feel hard voicing things for the first time.  Some people feel emotional because it feels like such a relief to finally share their difficulties with someone.  Some people feel numb / detached from their emotions, and this is ok too.  There is no right or wrong way to feel in therapy.  One thing I always warn my clients about is that they may feel tired and emotionally drained following their first therapy session – this is completely natural!  We cover a lot of ground in the first few sessions and starting therapy can be emotionally hard work.

What to share

There is absolutely no pressure on you to share everything during the first few therapy sessions – you don’t have to talk about anything you don’t want to or don’t feel comfortable with. Your Psychologist will encourage you to open up as much as you want, whilst going completely at your own pace.  They will be there for you and provide you with the tools to cope with the difficult things that may come up.

Some Psychologists have their own therapy as part of their training and choose to dip in and out of therapy through their careers - I for one have been to therapy myself.  Psychologists often choose to go to therapy to do the deep work themselves (so they know what this feels like), be in the best place they can be for their clients and to learn from other Psychologists.  We therefore get it.  We know it takes a lot of courage to arrange and show up for that first session.  We also don’t expect you to be able to share everything in one go.

Over the assessment sessions, you may be asked about past experiences and you may work together to understand how these have shaped you or contributed to any current problems.  However, depending on your goals, you may not actually talk about your past much.  Instead, the focus of your therapy may be on the here and now, and the future you wish to create.  It all depends on your unique situation and experiences.  Equally, if you are adamant that you definitely do not want to talk about anything from childhood, this can be a sign that it might be helpful to – either way, you can discuss this with your Psychologist.  Many clients find that working through things from the past can help with strong negative emotions that they may have been holding on to for many years.

Confidentiality

Your conversations with a Psychologist will be kept in the strictest privacy, and confidentiality is always discussed at the beginning of therapy.  When you are seeing a private Psychologist, it is even rare for your information to be passed on to your GP (all therapists differ, e.g in the NHS, an assessment letter is usually sent to your doctor, but this is not routine in private therapy).  The only time we may breach confidentiality is if we hear anything from our clients that may concern us about their safety or anyone else’s safety.  In this instance, we would always try to discuss things with you first, before we share it with any other professionals who may need to know.  All Therapists and Psychologists are also required by their professional body to discuss their clients with a Clinical Supervisor, to ensure we are providing good quality care and to be supported ourselves.  This is again kept in the strictest confidence between the Psychologist and their supervisor.  Additionally, notes are kept for every client seen by a Psychologist.  These are usually kept within a confidential, online secure clinical platform that no one else can access.  Information will never be shared with family or friends (unless you ask for a joint session, e.g. with your partner/parent/any other family member).  We also do not routinely see people from the same family as this would be a conflict of interest.

Psychological mapping

Psychologists are highly trained and experienced in what we call “psychological formulation”:  a “psychological map” that helps us to understand and explain a client’s problem.  This is where we apply the psychological theory, which we have specialist expertise in, to your unique experiences to help you.  This helps clients to see how/why their difficulties have developed, what is now keeping the problem going and what they need to do break any vicious cycles or “stuck patterns” they now find themselves in.  Most clients find the formulation extremely powerful, as they often enter therapy not understanding what they are going through, or feeling as though their difficulties are complex, chaotic and confusing.  The formulation turns their problems into something which finally makes sense.

The psychological map also provides a guide for therapy and informs the treatment plan.  Once we have an understanding of the processes causing and maintaining a client’s problems, we can more easily see what interventions might be useful to overcome these.  Having this map therefore allows us both to have a shared understanding of the problem and where we are going in therapy. 

This map can even be useful if the client wants other people in their life to better understand what they are going through and I often have clients who share the formulation with their loved ones.  Overall, the psychological map can help to make more sense of your difficulties by “looking at it from a new angle” and providing a “new route” in life, which becomes the focus of treatment.  The assessment and formulation phase can take around 4-6 sessions to complete.

Practicalities of therapy

The practicalities of therapy are also discussed at the beginning of therapy, so you know what to expect, e.g.

-          Details around how long sessions are (sessions usually last around 50-60 minutes).

-          How often you will see your psychologist – clients normally attend psychology sessions once per week to begin with (for at least 6 sessions, so a good assessment and formulation can be made).  They often continue weekly or fortnightly with the view to spread sessions out towards the end of therapy.  Depending on what clients can afford, some prefer fortnightly sessions or 3 sessions per month with one week off where they can consolidate everything they learn in therapy each month – this can be discussed with your Psychologist.

-          What to expect from therapy and each session moving forward and how payments are made. 

-          How long you will be attending therapy for / how many sessions you are hoping to have.  This may not be known at this point and may depend on your needs / type of therapy you are having.   Our goal is not to keep you in therapy forever though – we will work with you to get you to where you want to be as quickly as possible, whilst also taking the time you need to work through everything.  

Join the dots:

(1) Assessment phase - getting to know each other

(2) Psychological “mapping” phase - understanding your difficulties, treatment planning and reaching your destination

(3) Ongoing therapy - working towards your goals and keeping the end in mind

What happens after therapy has started and I’ve been attending sessions for a while?  …Go to Blog 1, Part 6.