Before Beginning Therapy

Before beginning therapy, it is important to understand the therapeutic process:  i.e. how therapy starts, what happens in the middle, and how it ends.  

When therapy begins, you will be asked to submit consent forms, medical information (such as if you are under psychiatric or medical treatment), and insurance and/or payment information.  These forms and paperwork can seem daunting, but this information confirms your legal consent for treatment and insurance benefits (if you are using insurance).

Your therapist will also request information about your personal and family history.  Providing information about your family of origin and about the people and events that have been important in your life helps your therapist begin to develop a “big picture” of your story - about how you got to be the person you are and possibly about the origins of the problem for which you are seeking help.

The First Few Sessions

The first few sessions of therapy are “intake sessions”.  During these sessions, your counselor will review the consent forms, detail any office policies and procedures (such as cancellation policies), and answer any questions you have.  Your counselor may also share her qualifications and experience, and describe the therapeutic approach, interventions, or modalities she uses.

These first few sessions help both you and your therapist to determine if you are a good fit for each other. It is important for you to know that there are many different kinds of therapeutic approaches and theoretical orientations for therapy.  For example, there are cognitive behavioral therapists, “parts of self” therapists, psychoanalytic therapists, and experiential therapists - just to name a few!  Your therapist should be able to describe her approach and inform you of some of the interventions she will use to assist you in your change process.  

If your therapist thinks someone else will be a better fit for your needs, she may refer you to someone else; and if you feel that what your therapist offers isn’t what you need or that your personalities don’t mesh, you may decide to look for another therapist.

During these sessions, your therapist will also take the time to learn about you: about your family of origin, the people who matter to you, the events that have shaped you, and about your goals for beginning therapy.

After your therapist has a grasp on your personal history and goals for therapy, you and your therapist will develop a treatment plan; in other words, you will together decide what you are working on changing about your life.  This is important because if you don’t know what you want to change about your life, you won’t know when treatment is completed.

The Working Stage

After the initial intake stage, you and your counselor will begin working on the change process in earnest.  You will really begin focusing on the problems that brought you into her office.  

Your therapist may offer you interventions that will help you reprocess difficult events in your life, or assist you in learning new skills. You may practice new behaviors both in and out of the therapeutic setting, you may experiment with new experiences, or even have homework.   Whatever you work on, this stage can last from a few months to a year or two, depending on your needs.

During this stage of treatment, the relationship between the client and therapist intensifies, trust develops, and you may feel safer to talk about things that you have avoided dealing with in the past.  You or your therapist may bring up issues that you have been reluctant to explore, and sometimes that can be painful.  Over time, you may realize that your avoidance of distressing memories or problems is decreasing, and that you are gaining a new level of self-awareness that is necessary for change and growth. 

Sometimes during this stage, there can be difficulties or conflict in the therapeutic relationship.  Your therapist may say something that bothers or offends you, and you may lose trust in the relationship.  This is called a therapeutic breach, and it is a common experience.  When therapy is done well, a therapeutic repair will follow.  This is an important part of the therapy process, because many people have not had the opportunity to practice repairing relationships after a conflict in a healthy way.  Learning how to assertively communicate about a conflict, by asking for what you need or want, is an incredibly healing experience.

If you experience therapeutic breach during your therapeutic process (and you likely will at some point), you are encouraged to confront the problem.  The best outcome is that your therapist will accept responsibility for their part in the problem, and facilitate resolution.  Many people find that after a therapeutic conflict and repair, their trust in the relationship becomes even stronger, because they know that they can confront problems and still remain securely in the relationship.

The Late Stage

The late stage of therapy happens as the client approaches the achievement of their initial goals for seeking help.  They may begin to feel like there isn’t as much to talk about or work on in sessions.  They may also notice that they are feeling more confident in confronting and managing their problems and their interpersonal relationships. 

During this stage, the work often includes celebrating success,  integrating the work that was done during the working stage, and exploring maintenance and prevention strategies. Sessions may be reduced from weekly, or bi-weekly, to monthly or to an as-needed basis.  

Termination Stage: the Ending of the Therapeutic Relationship

As the late stage of therapy comes to a close, goodbyes are in order as the relationship heads toward “termination” (end of therapy).  When therapy ends in an ideal way, it ends because both the client and the therapist feel that the client has achieved the therapeutic goals agreed up in the treatment planning stage.  While this is the ideal outcome, and what you and your therapist are working toward, therapy doesn’t always end that way. 

Sometimes the relationship ends for more practical reasons.  For example, sometimes therapy ends because the client changes insurance companies, or has new hours of work that the therapist cannot accommodate; or, perhaps the client encounters financial strain and can no longer afford therapeutic services.  Sometimes the relationship ends for clinical reasons, like if the client no longer feels that the therapist can provide what they are looking for; or if the therapist feels that problems have been uncovered for which she lacks expertise in treatment. 

In these situations, termination should include an exploration of the client's needs, and a referral should be provided to a therapist who can provide what the client needs.

In any case, termination means saying goodbye.  It is normal for both client and therapist to experience some ambivalence about the termination process. There may be a feeling of sadness or some anxiety about “graduating” from the therapeutic process. Those feelings can be explored and addressed in sessions.

Ultimately, however, termination is an exciting time as goals have been reached and a new sense of confidence has been attained. It is a time to celebrate a chapter in your life. Your therapist may offer some suggestions such as rituals or interventions that help you to recognize how far you have come, or to assist you in embracing what is coming next. 

Termination isn’t just an ending: it is a new beginning and should be approached with some excitement and optimism about the future.