What Should I Bring?
A typical psychotherapy session lasts 45 minutes. To make the most of your time, make a list of the points you want to cover in your first session and what you want to work on in psychotherapy. Be prepared to share information about what’s bringing you to the therapist. Even a vague idea of what you want to accomplish can help you and your therapist proceed efficiently and effectively. If you’ve been referred by another professional, such as a physician or attorney, notes about why they did so can be helpful. If a teacher suggested that your child undergo psychotherapy, you might bring in report cards or notes from his or her teacher. Your therapist can also call these professionals for additional information if you give written permission. Records from previous psychotherapy or psychological testing can also help your new therapist get a better sense of you. If you’re on any medications, jot down which medications and what dosage so your therapist can have that information. It can be difficult to remember everything that happens during a psychotherapy session. A notebook can help you capture your therapist’s questions or suggestions and your own questions and ideas. Jotting a few things down during your session can help you stay engaged in the process. Most people have more than a single session of psychotherapy. Bring your calendar so you can schedule your next appointment before you leave your therapist’s office. You’ll also need to bring some form of payment. If you’ll be using your health insurance to cover your psychotherapy, bring along your insurance card so your therapist will be able to bill your insurer. (Some insurers require therapists to check photo IDs, so bring that along, too.) If you’ll be paying for psychotherapy out of pocket, bring along a credit card, checkbook, or cash.
What Should I Expect?
For your first session, your therapist may ask you to come in a little early to fill out paperwork if you haven’t already done so. Don’t worry that you won’t know what to do once the session actually begins. It’s normal to feel a little anxious in the first few sessions. Therapists have experience setting the tone and getting things started. They are trained to guide each session in effective ways to help you get closer to your goals. In fact, the first session might seem like a game of 20 questions. Sitting face to face with you, your therapist could start off by acknowledging the courage it takes to start psychotherapy. He or she may also go over logistical matters, such as fees, how to make or cancel an appointment, and confidentiality, if he or she hasn’t already done so by phone. Then the therapist may ask a question like, “What brought you here today?” or “What made you decide to come in now rather than a month or a year ago?” It helps to identify your problem, even if you’re not sure why you have it or how to handle it. For example, you might feel angry or sad without knowing what’s causing your feelings or how to stop feeling that way. If the problem is too painful to talk about, the therapist shouldn’t push you to say more than you’re comfortable sharing until you get to know each other better. It’s OK for you to say that you are not ready to talk about something just yet. Your therapist will also want to know about your own and your family’s history of psychological problems such as depression, anxiety, or similar issues. You’ll also explore how your problem is affecting your everyday life. Your therapist will ask questions like whether you’ve noticed any changes in your sleeping habits, appetite or other behaviors. A therapist will also want to know what kind of social support you have, so he or she will also ask about your family, friends and coworkers. It’s important not to rush this process, which may take more than one session. While guiding you through the process, your therapist will let you set the pace when it comes to telling your story. As you gain trust in your therapist and the process, you may be willing to share things you didn’t feel comfortable answering at first. Once your therapist has a full history, the two of you will work together to create a treatment plan. This collaborative goal setting is important, because both of you need to be invested in achieving your goals. Your therapist may write down the goals and read them back to you so you’re both clear about what you’ll be working on. Some therapists even create a treatment contract that lays out the purpose of treatment, its expected duration, and goals, with both the individual’s and therapist’s responsibilities outlined. At the end of your first session, the therapist may also have suggestions for immediate action. If you’re depressed, for example, the therapist might suggest seeing a physician to rule out any underlying medical conditions, such as a thyroid disorder. If you have chronic pain, you may need physical therapy, medication, and help for insomnia as well as psychotherapy. By the end of the first few sessions, you should have a new understanding of your problem, a game plan, and a new sense of hope. Psychotherapy is often referred to as talk therapy, and that’s what you’ll be doing as your treatment continues. You and your therapist will engage in a dialogue about your problems and how to fix them. What should I expect as I continue psychotherapy? As your psychotherapy goes on, you’ll continue the process of building a trusting, therapeutic relationship with your therapist. As part of the ongoing getting-to-know-you process, your therapist may want to do some assessment. Therapists are trained to administer and interpret tests that can help to determine the depth of your depression, identify important personality characteristics, uncover unhealthy coping strategies such as drinking problems, or identify learning disabilities. You and your therapist will also keep exploring your problems through talking. For some people, just being able to talk freely about a problem brings relief. In the early stages, your therapist will help you clarify what’s troubling you. You’ll then move into a problem-solving phase, working together to find alternative ways of thinking, behaving, and managing your feelings. You might role-play new behaviors during your sessions and do homework to practice new skills in between. As you go along, you and your therapist will assess your progress and determine whether your original goals need to be reformulated or expanded. In some cases, your therapist may suggest involving others. If you’re having relationship problems, for instance, having a spouse or partner join you in a session can be helpful. Similarly, an individual having parenting problems might want to bring his or her child in. And someone who has trouble interacting with others may benefit from group psychotherapy. As you begin to resolve the problem that brought you to psychotherapy, you’ll also be learning new skills that will help you see yourself and the world differently. You’ll learn how to distinguish between situations you can change and those you can’t and how to focus on improving the things within your control. You’ll also learn resilience, which will help you better cope with future challenges. A 2006 study of treatment or depression and anxiety, for example, found that the cognitive and behavioral approaches used in psychotherapy have an enduring effect that reduces the risk of symptoms returning even after treatment ends. Another study found a similar result when evaluating the long-term effects of psychodynamic psychotherapy. Soon you’ll have a new perspective and new ways of thinking and behaving.
How can I make the most of psychotherapy?
Psychotherapy is different from medical or dental treatments, where patients typically sit passively while professionals work on them and tell them their diagnosis and treatment plans. Psychotherapy isn’t about a therapist telling you what to do. It’s an active collaboration between you and the therapist. In fact, hundreds of studies have found that a very important part of what makes psychotherapy work is the collaborative relationship between therapist and patient, also known as a therapeutic alliance. The therapeutic alliance is what happens when the therapist and patient work together to achieve the patient’s goals. So be an active, engaged participant in psychotherapy. Help set goals for treatment. Work with your therapist to come up with a timeline. Ask questions about your treatment plan. If you don’t think a session went well, share that feedback and have a dialogue so that the therapist can respond and tailor your treatment more effectively. Ask your therapist for suggestions about books or websites with useful information about your problems. And because behavior change is difficult, practice is also key. It’s easy to fall back into old patterns of thought and behavior, so stay mindful between sessions. Notice how you’re reacting to things and take what you learn in sessions with your therapist and apply it to real-life situations. When you bring what you’ve learned between sessions back to your therapist, that information can inform what happens in his or her office to further help you. Through regular practice, you’ll consolidate the gains you’ve made, get through psychotherapy quicker, and maintain your progress after you’re done.
Should I worry about confidentiality?
Therapists consider maintaining your privacy extremely important. It is a part of their professional code of ethics. More importantly, it is a condition of their professional license. Therapists who violate patient confidentiality risk losing their ability to practice psychology in the future. To make your psychotherapy as effective as possible, you need to be open and honest about your most private thoughts and behaviors. That can be nerve-wracking, but you don’t have to worry about your therapist sharing your secrets with anyone except in the most extreme situations. If you reveal that you plan to hurt yourself or others, for example, your therapist is duty-bound to report that to authorities for your own protection and the safety of others. Therapists must also report abuse, exploitation, or neglect of children, the elderly, or people with disabilities. Your therapist may also have to provide some information in court cases. Of course, you can always give your therapist written permission to share all or part of your discussions with your physician, teachers, or anyone else if you desire. Therapists take confidentiality so seriously that they may not even acknowledge that they know you if they bump into you at the supermarket or anywhere else. And it’s OK for you to not say hello either. Your therapist won’t feel bad; he or she will understand that you’re protecting your privacy.
