The purpose of the first appointment, or intake, is to get a solid understanding of your current issue and history, which helps you and I decide on goals for treatment. It’s helpful to have an idea of what you want to get out of therapy so that we can discuss this and make sure we are on the same page. I will likely ask you to fill out paperwork prior to our first session so that we can spend most of our time on the details of your concerns. This may take more than one session (especially for couples, as there is twice as much information to gather), but the assessment of the problem at the beginning is important because it creates the framework for the treatment that follows. This is also a chance for us to get a feel for each other to make sure we are a good fit.

This is one of the most important aspects of therapy. If you do not feel comfortable with your therapist (some anxiety at the beginning is normal), then you will not want to share things that make you feel vulnerable or talk about issues that can be painful and difficult. Fit refers to the level of comfort, safety, and connection with my style and our interactions. I recommend at least four sessions to bypass the initial anxiety and get a feel for each other. The client-therapist relationship is a real relationship that requires trust, open and ongoing communication, and mutual feedback.

I typically recommend meeting more frequently (once a week) in the beginning so that I develop a thorough understanding of the issues you want to work on and so we can build our relationship. However, work, life, and finances may not always allow for this frequency of meeting, so we can determine if meeting every few weeks is more appropriate. This will also depend on your concerns that you want to address, because meeting less frequently can also make progress slower and may not be as effective for more serious issues. During times of significant stress or crises, meeting twice a week may be necessary until you feel stable. As your issues resolve, we may meet less frequently until you feel comfortable ending the therapy.

I am often asked this, as clients worry that they are taking up time that I could be spending with others who have “more serious issues.” I assure you, I have no measuring stick by which I gauge your problems as deserving of treatment! Different people respond differently to the same problem – some are more troubled by it, some easily cope with it, and those same peoples’ responses may switch in another situation. The most important reason to seek therapy is that the issue is distressing for you, and that is deserving of time and effort (both yours and mine) to make it better.

I don’t give advicefor several reasons. Giving advice assumes I have the answers to everything andmy opinion is infallible, which is clearly not the case!I won’t tell you what decisions to make, but will help you figure out how you feel about possible choices and outcomes, and support you as you implement your choices. I may offer suggestions based on clinical research or share knowledge about the issue. Topics may be related to relationships, identity, transitions, etc. You may come in with an idea of what you want to talk about, and other times you may have nothing specific on your mind and we instead follow the flow naturally as I probe with questions and comments. We may continue on a thread week to week or talk about your experience trying to implement a change. We may talk about anything: nothing is off limits to explore, and there are no “right” or “wrong” things to discuss.

Everything we discuss will be kept completely private, unless you give written permission to share information with another person. Exceptions to this confidentiality occur if there is a risk of you harming yourself, harming someone else, or if you report child or elder abuse. The point is to keep you safe, and keep everyone around you safe, and we would discuss the process if this situation arose. Please see my intake paperwork for additional information on confidentiality.

I do not prescribe medication, but we may discuss a referral to a psychiatrist who can prescribe medication if you or I believe it could be helpful. This may be the case if your symptoms are severe and have significantly impacted your functioning, or if you are not responding to other treatments. I will likely first recommend a physical with your primary care physician to rule out other biological causes of symptoms. Even if you do meet with a psychiatrist and they prescribe medication, it is ultimately your decision whether to take the medication. We can explore any questions or concerns you have about the process and work together to find psychiatrists who will meet your needs.

Everyone responds to treatment differently, and the length of time it takes to see improvement greatly depends on how long you have been experiencing the issue, the severity of your symptoms, how much you are working on your issues outside of sessions, and if areas of life that are related to your issue continue to be distressing. However, research* has shown that half of clients seen in therapy notice some improvement after as little as 8 sessions, and most clients (75%) experience improvement after 26 sessions. Some clients choose to remain in therapy longer because they benefit from the support and having a space to reflect on their concerns and receive feedback. Some also opt to periodically meet as “tune-up” sessions to maintain their progress. If at any point you are not finding sessions helpful, then please discuss it with me and we can either make changes to our treatment plan or perhaps find another therapist who is a better fit.

However, it really is true that you get out what you put in to therapy. Clients who are more active both in and outside of sessions tend to notice the most change. This could mean that you continue to work on what we discuss by writing, thinking and reflecting, reading, talking with others, or changing your behavior in the steps we described together in session. I will check in with you periodically about how the therapy is progressing, to ensure that it is productive and we continue to work towards your goals.

*The dose–effect relationship in psychotherapy. Howard, Kenneth I.; Kopta, S. Mark; Krause, Merton S.; Orlinsky, David E. American Psychologist, Vol 41(2), Feb 1986, 159-164.

For additional information and resources:

http://www.apa.org/helpcenter/understanding-psychotherapy.aspx

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