Once you’ve interviewed therapists and selected someone with whom you feel compatible, you may have a few questions about what is involved with the therapy process itself. There are many different approaches to therapy, based on theoretical orientations (schools of thought) and the therapist’s individual style. Much of the content below reflects a cognitive-behavioral approach to therapy, though the general elements are likely to be similar to those of other therapeutic approaches. Be sure to ask your therapist for more specifics as to what will occur in the course of your therapy. It is reasonable to expect that elements of the therapy will be customized and adapted to your individual needs.
How frequently would we meet? The usual frequency of appointments is once a week to start. Then, as the need for therapy decreases, so does the frequency of the appointments, transitioning to every other week, then to monthly to as needed. Alternatively, it could be appropriate to have appointments more often if the situation is severe enough to warrant a more intensive course of action.
It is helpful to compare therapy to learning a foreign language. Laying the foundation often requires greater intensity or immersion. As you become more fluent in the language, you need fewer classes to build or maintain your skills. Even if you have finished working with a therapist (“terminated” or “discharged” are the professional jargon), it is sometimes useful to come back for a “booster” session to remind yourself of the skills you learned. Never assume that a therapist is closed off to you. While the ultimate goal of therapy is for you not to need therapeutic services any longer, you can always ask your therapist if it is possible to come back and resume your work together. If your therapist is not able to work with you at that time, for whatever reason, you can ask for referrals to other therapists who would be good matches.
How long does the therapy process take? There is no set rule for how long it will take for you to successfully meet your identified goals. While the average length of therapy is between 12 to 15 sessions, this may not be what your personal issues require. Some clients attain their therapeutic goals within a month or two, while others have a life-long relationship with therapy. The duration will depend greatly on your specific goals, the severity of your issues, and your investment in the therapeutic work. It is not uncommon for someone to come to therapy with a single identified goal only to uncover additional goals and issues that are subsequently addressed. Additionally, there are some people who start therapy and then decide to discontinue after only a few meetings. This may be for any number of reasons – financial limitations, a poor relationship with the therapist, an unreadiness to engage in therapy, or outside life circumstances. Rather than the number of sessions, it is more relevant to consider whether or not you and your therapist agree that you are benefitting from the therapy and are continuing to progress toward your goals.
What should I expect to happen during therapy? The goings-on behind closed doors can feel quite secretive and almost mystical but there are no special handshakes or symbols associated with therapy. The first few sessions are going to focus more on assessment – what are the reasons for seeking therapy, what is your particular background as it relates to these reasons, and what are the possible ways of addressing these reasons. These initial meetings also are an opportunity for you and the therapist to get to know each other. This is particularly important as you are likely going to be sharing some personal and sensitive information with this individual sitting across from you.
As therapy progresses, the focus is working toward the therapy goals as you and your therapist have outlined them. This treatment plan should be reassessed to make sure that the goals are still relevant and that you are continuing to make progress toward them. While the treatment plan and its evaluation may not be formal, it’s a good idea to have conversations with your therapist regarding the direction of your work together. This could be done every two to three months, depending on the details of your situation.
The “nitty gritty” of each session will vary based on your therapist’s style and the rhythm that the two of you get into. The start of each appointment often consists of a review of events since the previous session. This will hopefully tie in with larger themes that brought you to therapy in the first place. While it may feel as though you and your therapist are “just talking” for the whole appointment, you are actually doing clinical work – learning to reframe the way in which you view a situation, developing coping skills for managing stressors, role-playing effective communication skills, and exploring emotional responses and the situations that trigger them.
Toward the end of your appointment, you and your therapist may review the main points that were touched on and then identify ways to build on them through the up-coming week. This “homework” takes ideas and concepts out of the therapy appointment and incorporates them to your daily life. You may have a specific task or exercise to complete – making a phone call, facing a long-avoided interaction, completing a worksheet, reading a chapter in a book. As the goal of therapy is to create change in your life, it is only fitting that the bulk of the therapeutic work actually happen while you’re living your life. Therapy appointments can help structure and direct you in making these changes, but an isolated hour each week by itself is insufficient to create change in the remaining 167 hours. Homework is an effective way to help generalize the therapeutic work that you and your therapist are doing.
How do I know when I’ve completed therapy? In an ideal world, you and your therapist will agree that you have accomplished your therapeutic goals and that it is time to consider wrapping up your work together. At this point there would be one to two sessions dedicated to reviewing the issues that were covered in the course of the therapeutic relationship. There also would be attention paid to planning ahead – ways in which you can maintain the therapeutic gains that you’ve made, how to recognize the signs that some of these issues may be resurfacing, and when to consider returning to therapy if necessary.
Therapy may end for reasons other than the mutually agreed-upon. Whatever the reason may be, it is often a good idea to discuss it with your therapist. This is not so that your therapist can convince you to continue; rather, it’s an opportunity to review the decision to terminate and to make sure you are getting support and guidance through the process. If there are financial concerns, the therapist may be able to offer you a sliding scale fee or refer you to another therapist whose fees you can afford. If you are moving out of the area, you and your therapist can consider therapeutic options in your new locale. If there has been some sort of disagreement or falling-out, it may be beneficial (while admittedly uncomfortable) to openly give voice to the trigger that upset or angered you. You and your therapist may have simply misunderstood each other – bringing it to light can allow for potential resolution. If you prefer, leave a detailed voicemail message or send a written explanation instead. The therapist likely would benefit from, and appreciate, the feedback as opposed to having you simply disappear. It creates an opportunity for the therapist to redress the situation, offer alternatives, and even provide referrals to other service providers.
Hopefully, after going through the steps of identifying and screening potential therapists, you will find yourself building a stronger and more positive relationship with your therapist. Together, you and your therapist will identify your individual goals and the strategies for getting there. Therapy is not a passive process. It is an intense and interactive relationship that is focused solely on you. Given the level of investment and commitment that therapy can require, it is important that you find the therapy and the therapist that are best suited to you. By following the advice and suggestions outlined in this series of articles, you will be better prepared to begin the search and connect with a therapist who can help you address the challenges that you are facing.
– Elspeth Bell, Ph.D.