To help demystify the process of psychotherapy, I have provided a thorough explanation of some of the major components of therapy.
The first session will be used as an initial consultation. During the consultation, I will gather specific information about what brings you into therapy. We will try to identify the triggers, thoughts, physical feelings, and behaviors associated with the distress you are experiencing. I will also ask general questions regarding your social relationships, psychological and physical health history, and social/occupational functioning in that these areas can impact emotional functioning. Reducing emotional distress often includes addressing any problems that may exist in relationships, at work or school, in physical health, with sleep, with nutrition, or in finding meaning to life in general.
During the initial session, we will also have to go over forms that explain treatment, payment, and privacy and that release necessary information. The information I gather during the initial evaluation will be used to develop a treatment plan. The treatment plan will include explanations of the treatment approach and expectations for treatment. The particular treatment approach will be tailored to your own individual needs and will vary depending on your presenting issues and concerns.
Any questions and concerns regarding treatment will be answered fully at this time. In the case that you would benefit most from a treatment approach that I do not provide, I can assist you in finding more appropriate treatment providers. You are under no obligation to continue in therapy at any time.
EXPLANATION OF THE GENERAL PROCESS
In my work, therapy is a collaborative venture where you and I work together to identify your unique coping styles, understand how you came to develop these particular styles of coping, and understand ways in which certain coping styles may no longer be useful. Once you understand your past and current styles of coping, we would then work together to develop a more effective and constructive path towards improving your quality of life. As the therapist, I would provide expertise in psychological strategies whereas, as the client, you would provide expertise regarding your own psychological functioning, life experiences, and what types of strategies have worked for you in the past. The strategies that I use are cognitive behavioral.
Cognitive Behavioral Therapy (CBT)
I use an insight-guided cognitive-behavioral therapy. The therapy is insight-guided in that treatment involves the development of self-awareness regarding the sources of distress. The sources may be early childhood experiences, unresolved emotional issues, biological vulnerabilities, family relationships, personality styles, or early learning experiences, to name a few. The therapy is also cognitive behavioral in that it involves identifying and shifting unhelpful patterns of thoughts and behaviors. The belief is that though our brain generates automatic thoughts and reactive responses to anxiety, we are also able to train our brain by changing neural connections or bfain activity to generate new patterns of thoughts and behaviors.
There are usually four parts to the cognitive behavioral treatment of anxiety disorders: education, cognitive skills training, behavioral strategies, and somatic management skills. Education regarding the causes and treatments for anxiety can provide peace of mind, a sense of control, and motivation for treatment. There should be no mystery or complexity in the explanations and treatment. Cognitive skills training involves identifying and challenging the thoughts that increase anxiety and can include self-monitoring thoughts and developing an alternative perspective regarding feared outcomes. This technique has been referred to as cognitive restructuring. Another cognitive skill is being able to engage in effective problem solving. Behavioral strategies include exposing you to situations that induce anxiety in a controlled manner allowing you to face your fears and develop confidence in your coping skills. Other common strategies include adding more enjoyable or relaxing activites into your life or engaging in exercise. Somatic management skills refers to relaxation, breathing, and mindfulness meditation strategies that are used to calm general physiological arousal or to help you tolerate and "sit with" the discomfort of the situation. The strategies used will depend on your own individual needs.
The section on Anxiety Disorders and Treatment describes the specific strategies that have been found to be most effective for certain anxiety disorders.
Beause there are specific strategies to be taught and practiced, therapy tends to be active. This means that I take an active role in shaping each session and will come to each session with a plan based on our last meeting while also taking into consideration your needs for the session. This also means that there is a strong educational component where you will gain knowledge to make you an expert on anxiety, its causes, and its treatment. There will also be strategies that are practiced in session and between sessions. At the beginning of each session we will review how practice went between sessions and at the end of each session, we will spend a few minutes reviewing what we have covered that day and what you might want to work on between sessions. Such an active approach may lead to a temporary increase in anxiety at the beginning but you will find that with time, knowledge, and practice your anxiety will begin to subside in the long run.
As you can see, therapy can be quite a challenge but my job is to motivate, support, and coach you through the process. If at any time, you find that therapy is not progessing to your satisfaction or I feel that I am not the best therapist to meet your needs, I will do my best to provide you with referrals to other providers.
After we have identified the blocks in your path, and you have started to develop effective coping strategies and have begun to experience a decrease in your distress, we will discuss the next step in therapy. Some clients find that the initial course of therapy is sufficient and are comfortable ending therapy at this time. Part of ending therapy would be coaching you to be able to identify your unique vulnerabilities so that when you see yourself falling back into old maladaptive patterns, you can readily utilize the strategies you learned in therapy. By the end of treatment, you will have developed a sense of independence and confidence to be able to continue to implement on your own the strategies you have learned. If at a future time, you find that old problems resurface or when life events present new obstacles, then all you need to do is call me to set up another appointment and continue to use therapy “as needed.”
If you find that you are having difficulty consistently implementing strategies learned in therapy, therapy can be continued for several more sessions. In this situation, therapy sessions can be spread out to once every other week to help generalize the treatment to day-to-day life. Some clients find that after the immediate crisis is resolved, there are other issues in their life that they would like to address (relationships, communication, life goals, self-esteem, fitness, assertiveness, family issues, etc.) If a good relationship with the therapist has been established, it makes it a natural decision to continue working with the same therapist on different issues that will help one achieve an optimal quality of life. If therapy is continued in this fashion, reevaluation of treatment objectives will occur on a consistent basis.
I do not see therapy as providing an easy “cure” for “sick” folks, but rather as motivating and coaching individuals on how to use their own resources to the best of their abilities to grow, gain insight, and solve specific problems.