This is a brief guide that describes some of the major aspects of our work together.
In general, you can expect the following things to happen. In the first two or three sessions I will gather information from you about your current situation, your symptoms and your reasons for starting therapy. I gather information about important events in your childhood, adolescence, and adulthood. I gather information about your mental health history, your use of substances, your medical history, your job if you are employed, your academic situation if you are a student, and your interests and hobbies. I also ask you about lifestyle factors that affect your wellbeing such as exercise, nutrition, sleep, relationships, stressors, and family life. Also, by the end of the second meeting, we will have worked to clarify several therapy goals—that is, those things you want to be different in your life. A part of the information gathering process includes you filling out some structured measures that help me get a better sense of your symptoms and concerns. Additionally, we shall review the informed consent to treatment form and the financial agreement form.
From there, I usually start each session by assessing how things have been going for you since I last met with you. I believe it is important for me to know how your week has been and if there any things that are stressful to you, as well as how your mood has been. If we are working on safety issues, I will ask in the beginning of the session about how things are going in that regard. From there, we can set an agenda for the session. That agenda might include things we were working on from last time, things that came up over the interim since I last saw you, or something new that you would like to work on. Sometimes there is no set agenda and we discuss what comes to your mind.
In many of the beginning sessions I tend to introduce various skills that I think will be helpful for you in managing different emotions, thoughts, or behaviors. Sometimes, this teaching will be directly related to what you have been talking about and we can move into it more or less seamlessly. Other times, we might take a break from what you have been talking about and start the skill building portion of the meeting. As we continue our work together, we will be able to reference and apply these skills to how you are approaching different things in your life.
The skills we will work on center around three areas—emotion work, thought work, and behavior work. As you become more familiar with the skills through practice in the office and in your life, they will become more helpful and make more sense. You can learn more about the skills as you read further below.
Emotion Work:
The reason people decide to start therapy is usually emotional in nature. They typically feel sad, anxious, confused, regretful, unsettled, and/or angry about something in their life. Our emotions motivate us to do things, including starting therapy. Emotions put things in motion.
This is how we are going to approach emotions in our work together:
- Improving lifestyle factors that impact emotional regulation
- Attending to sleep, nutrition, exercise, work(school)/life balance, relaxation, relationships, enjoyable activities/hobbies, substance misuse and other potentially destabilizing behaviors.
- Learning to work with difficult emotions when they happen in the moment (ITM)
- Approaching difficult emotions mindfully—acknowledging, observing, and describing difficult emotions. This process helps us learn that we can tolerate our challenging emotions. From there, you are in a better position to move towards acceptance of what is happening presently and, at the same time, to consider healthy changes that make sense to you.
- Practicing Distress Tolerance skills.
- When ITM emotional regulation isn’t working for whatever reason at a particular time, learning to use distraction, prayer to your higher power if you have one, self-soothing, and/or breathing to move through difficult emotions until you can begin to approach them mindfully.
Thought Work:
Even though emotions are usually what motivates a person to attend therapy, clients are also almost always experiencing thoughts that are troubling to them. By “troubling”, I mean thoughts that contribute to negative emotions such as sadness, self-doubt, anger, resignation, anxiety, or confusion (to name a few), and that can also lead to unconstructive behaviors.
This is how we are going to approach unconstructive thoughts in our work together:
- Learning that unconstructive thoughts are something thing our mind will do automatically from time to time (and sometimes a lot).
- Learning to detect and observe thoughts that are unsettling or that trigger challenging emotions.
- Learning that we have a choice about what we do with unsettling thoughts when they happen. That is, there are things that we can do to help us manage and respond to these thoughts. We can learn to hear what the thought is telling us (really, what we are telling ourselves) and then develop alternative thoughts that add information and context that the troubling thoughts invariably omit. We can also learn to achieve some distance from the thought so that it less distracting and distressing. We can remember just because we are thinking something does not make it a fact. We can learn to see different perspectives.
Behavior Work:
Behavior change is an extremely powerful tool. Changing behaviors, even in small ways, will impact your emotions and thoughts in a way that emotion and thought work rarely accomplish in isolation. Put simply, when our behaviors are healthier and more closely aligned with our values, the better we are going to feel, and the more openly and accurately we are going to perceive ourselves and our world.
This is how we are going to approach behaviors in our work together:
- Developing healthy habits—finding small steps that move you towards big changes
- Avoiding avoidance
- Managing anger’s influence on behavior
- Behavioral activation to reduce depression
- Empathic responding to others to improve communication and relationships
A final note:
Every client approaches therapy differently. The course of your therapy is fundamentally influenced by who you are as a person, how you approach life, what happens in your life while you are in therapy, what your goals are, and what we agree your needs are at a particular time. Some people use therapy as a place to talk about things they feel they can’t talk about anywhere else. Some people use therapy as a place where they learn and practice new skills or explore new ideas or life goals. Some people use therapy to evaluate the health of important relationships and assess how these relationships can be changed for the better or, perhaps, left behind. Some people use therapy as place to vent hard emotions that they may not feel they can vent elsewhere. Some people use therapy as a place to work on traumatic events that they have experienced in their life. If you are in therapy for a while, you are likely to use therapy for all or most of these things.