Friday, May 14, 2010

Finding a Good Therapist: After the First Session


"let the wise listen and add to their learning, and let the discerning get guidance-"

Proverbs 1:5

You have found a good therapist and finished your initial appointment. You felt that your presenting issues were defined; treatment goals were established. Now what? Moving from the initial interview into the actual treatment phase is often an awkward stage of therapy. Your counselor should help you with this transition by telling you what is expected.

My counseling style is insight-oriented therapy. In the first session, I inform my new clients that in future sessions they will have the freedom to talk about whatever comes to their mind or is a concern to them. I have found that no matter the topic, whether upbeat and positive or discouraging, it reveals how clients feel about themselves and the world around them. As a result, I don't lead sessions into a particular direction. I usually start each session with an open-ended question, such as "how are you doing?" or "what would you like to talk about today?"

Not all clinicians work this way since there are several other therapy styles. Some treatment models have a problem-solving focus, and others focus on specific topics. Good therapists, however, will let you know what they expect and will guide you into that direction.

Once you start treatment, don't be surprised if you begin to see the world around you differently. Since you are taking time to focus on how you respond to events, situations, and people, you may find yourself observing yourself throughout each day. This is very normal. I once heard it said that while you are in therapy, all of life becomes about therapy. You may feel like you are examining yourself and your surrounding social environment under a microscope. This experience or sensation is useful since your increased awareness helps you make new observations and conclusions about what works and doesn't work in your life, but it will fade once treatment ends.

How will you know when treatment is finished? Once you begin to feel better and your main issue seems improved or resolved, it may be time to bring up the topic to your counselor. The therapist may also bring it up to you. Sometimes this is an opportunity to re-assess treatment gains and to define new goals. Other times, a termination plan is formed. But the direction---continuing treatment in a new direction or ending----should be a collaborative decision between you and your counselor.

Endings can happen in several ways. Sometimes there is a last appointment and treatment finishes in that session. Other times sessions are scheduled further and further apart until you feel comfortable stopping. Or finally, you can have a "last appointment" as a trial and leave it with the understanding that you can make another appointment sometime in the future, if you need to. It all depends upon the circumstances that brought you into treatment and on your therapist's counseling style. There is no right or wrong way to finish therapy, as long as you feel supported and the termination plan seems appropriate.

It is normal to feel a little nervous about ending treatment and not seeing your therapist again, especially if your therapy has been going on for awhile. This is called "termination anxiety." Your counselor will be able to help process your fears and concerns about termination, and the feelings will go away once therapy has successfully ended.

For the last article in this series, "Finding a Good Therapist," we will look at how to spot when treatment has gone wrong.

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