The scary questions
The initial steps in starting your cooperation with a psychologist can be stressful and somewhat intimidating.  There are a lot of things that come to mind. What do you want to achieve by coming to therapy? Is this the right professional for you? Do they know how to help you? Will you be able to open up to them? How long will therapy last? How do you know it’s actually working? What happens once you enter the therapy room and the door closes? Bearing in mind that some people might be living in small communities how is confidentiality ensured and maintained?

Myriad snowflakes
Mental health professionals are as different as snowflakes. They might appear similar, but if you look closely, they are very different. This blog is a description of how I work, especially in starting therapy with my clients. As you can expect, fellow psychologists handle the initiation to therapy differently, while certain elements of our practice overlap.

The first session: A joint and mutual assessment
As part of starting our cooperation, the first appointment serves as a mutual and joint initial assessment. During this time, you will be sharing with me a summary of why you want to engage in therapy now, what you hope to achieve through therapy, any concerns or any difficulties you expect to meet in the process of doing so.

Fear not! You do not need to know the answers to all of these questions. These will be answered through our dialogue, and through questions that aim to explore what you discuss with me.  Moreover, we will briefly go over a history of physical and other difficulties, medication and habits, so we can both develop an idea of the different elements influencing your wellbeing.

You only need to have an idea of what it is you want to change or develop by coming to therapy. To simplify this for you, imagine you are driving your car. Out of the blue, your car is making a strange noise every time you turn left. Unless you really know cars, you will be taking your car to the mechanic. Your insight was simply that the car is making a strange noise, that isn’t normal. If it was me, I would have mentioned just that to the mechanic, and would have also tried to imitate the noise… “it was a loud clacking noise, which sounded like it was coming from that spot, (while also pointing)”. That level of insight is enough to take your car to the shop to be looked at, and such a level of understanding is also enough to have your first appointment with a therapist of your choice. 

 Exit clause
The first session is always a joint and mutual assessment, as this is our opportunity to discuss whether I am the right professional to accompany you in your journey. Time will be dedicated in discussing my ability to help you and answer any questions you might have regarding the way I work. Moreover, this will give you a chance to see if you feel comfortable working with me, or not. It is important to mention, that if the answer is no, at that or any time during therapy, you can end our cooperation.

The maypole dance that makes you, you
I work with the belief that we do not exist in isolation, thereby our wellbeing is influenced by biological, social and psychological elements in our daily life. I believe that we need to pay attention to all the forces that have an effect on you. This is beneficial in decreasing self-blame regarding your situation, increasing adaptive behaviours, and planning ways forward which are specifically tailored to your circumstances.

Work stress: being overworked vs unemployed
For example, imagine that you are employed in a demanding job post, with long hours and great responsibilities. Our sessions will be extremely different if we are to compare them to interventions used in another therapeutic relationship where, the client is unemployed. Although, both clients might be aiming to deal with work related stress, one is dealing with being overworked. On the other hand, the 2nd client is struggling with the uncertainty of unemployment and their skills and abilities not being used. As such, although the common aim is to work with stress around work, in both cases the methods used to address this, will differ significantly.

The therapy
Following our assessment, if we are both happy to continue our cooperation, we will proceed with booking our following sessions. These run for no longer than 50 minutes. During this time, we will be aiming to foster an environment where you will feel heard, safe and understood. I will be asking you to set the agenda for the session. This helps to make space and time to discuss what is at the forefront of your thinking.  I check in whether I understand what you mean, so we are on the same page throughout our sessions. I appreciate your insight regarding the potential helpfulness of a proposed action, as I strongly believe that you hold valuable insight regarding what might or might not be helpful for you. Moreover, I will be trying to combine your own knowledge with my own, by sharing my insight and asking you to share your opinion regarding the process and tools we will be using in our sessions.

Part of the reasoning behind the 50-minute session time, is that it protects clients’ anonymity and confidentiality. The timing and scheduling of sessions is done in such a way that it helps clients avoid each other. This is especially important if both the client and the psychologist belong in the same small community.

The session needs to end on time, so Client A leaves on the dot, i.e. 4:50pm. They might take their time to exit the premises (i.e. toilet visit to prep for the drive ahead) and leave. Client B, who is informed (like all other clients) that they should arrive as close to their allocated time as possible, enters the building at 4:57pm, for their 5:00pm session.

Other than fixing my appointments in such a way to help avoid bump-ins, I discuss with clients the possibility of a run in, at a social setting. We agree on the etiquette they prefer to keep, and I highlight that it is up to them to greet me. As such, clients have the control of whether they acknowledge me at that given moment, and by extension over their confidentiality.

You have a right to confidentiality, even if you decide not to work with me after our initial assessment. The same principles regarding confidentiality apply to a one of session as well as for ongoing sessions. Confidentiality is only broken in cases of: risk to you, others or property. More on how confidentiality is maintained throughout our work together, is shared with clients through the therapeutic agreement, which is forwarded to clients prior to the first session. This is then discussed during our first appointment.

Onward and upwards
We will be checking on your progress, whether you are happy with the way things have been evolving and our cooperation, every 4-6 sessions.  This is what I call a “mid-therapy review” to explore whether things are working out for you, if there is anything you would like to change etc. Thereby, I urge all my clients to be honest in our sessions, so we can redirect our attention and methods in areas they feel are priorities.