What To Expect In Psychotherapy

As a psychotherapist, I find it troubling that there are so many badly dramatized depictions of therapy in TV and film. (One *good* one is the show In Treatment). I imagine it’s better than being a lawyer and having to deal with the negative stereotypes and jokes, but the state of affairs leaves most people pretty misinformed or clueless about what to expect when they first go to see a therapist. So let me give you a broad-strokes idea of how therapy goes, and some clearer view of how I operate.

Two tasks any therapist wants to work on when you first meet is 1) to learn about what symptoms have brought you into the office, and 2) to begin building an alliance with you. Most therapists will also want to work on getting a history of your presenting problem and of yourself in general.

When someone visits me, I try to create a relationship that helps them work for change. The process will not be identical with every person, but the key ingredients are very similar: I need to start to see the world as you see it, and I need to help you believe that I do. As I learn about you, I can get a picture of how to apply my strengths to help you, and we can discern together if there may be some reason I am not a good fit for you. If we can build an authentic connection, we’ll have a wide-ranging discussion over the first session or two, delving into the presenting problem, current stressors, important relationships, and family history.

I typically find that the patient gives me all the information we need to really get going by the end of the first session, so I can usually quickly offer a (revisable) map for the path ahead. The tools I most often use to conceptualize treatment include Adlerian Therapy, Existentialist Therapy, Ancient Greek philosophy, and REBT. How much we work with any tool will depend on my patient’s presenting problem, goals, and temperament.

I also use my ability to break down complicated ideas, provide a wide-ranging knowledge base, and an open-minded stance to problem solving and treatment planning, to help us make progress. Most importantly, I want to make sure that you feel the treatment plan makes sense and sounds promising. If I can’t explain how and why I’m pursuing a topic, suggesting a treatment plan, or assigning homework then I am not doing my job.

Many therapists prefer to be significantly geared to listening and reassuring, and provide little if any direction. This is often called ‘person-centered’ or ‘Rogerian’ therapy, and it is highly useful. Others will have little desire to get a thorough history and simply want to focus on symptom abatement as quickly as possible. This is at the core of CBT and REBT, which are also highly useful. I try to foster a sense of safety and empathy, as well as a can-do spirit, but I am more directive than the average person-centered therapist, and more exploratory than the typical CBT/REBT therapist.

I find that I can use my natural inquisitiveness and ability to frame questions to spur conversations rather than to simply coax or force my patients to do all the talking. My patients still talk probably over 80% of the time in a session, but I find that sometimes psychoeducation and philosophical exploration require me to do a bit of the heavy lifting. I am continually asking myself “Where is this person?”; “What do they want?”; “Where are they stuck?”; “What is getting in the way of getting where they want to go?” But of course, it isn’t usually very useful to just bluntly ask such questions.

So I engage with you to help you uncover who you fundamentally are, how you frame the world, what you see as threats and aides, and really suss out the beliefs you have about what is valuable in you and the world. Based on your presenting concerns, we work to understand what beliefs and goals are helping and hurting you, begin the process of reconsidering them, and determine which we may need to change.

From there, any particular session may vary in theme or topic from ‘putting out a fire’ that roared in the past week, to going deeper into understanding the map of the world you’re unconsciously operating on, or to putting into practice techniques for symptom management, elimination, or improvement. No topic is out of bounds, and everything said in the room is good info for our work, so please be encouraged to talk!

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