Whether you are seeing a psychologist for the first time, or have received psychological support in the past, you are probably wondering about what your first session with your new psychologist will look like.
The first therapy session/sessions.
It’s really important that we start by getting to know each other. In the first few sessions, a psychologist will strive to understand your background, mental health history, the challenges that you bring to therapy and what you hope to get out of treatment. I usually like to spend the first two thirds of the session learning about you. In remainder of that time, I will ask you about how you would like your sessions to feel going forwards and give you my professional opinion about the best treatment approach.
It’s not so important that we understand everything about you at the beginning - after all there will be time to learn more in the future. What is important is that we build a relationship that will enable a space of trust and safety where you can further explore your challenges and work towards change.
As I learn more about you, together we will build a shared understanding, or in psychological terms, a ‘formulation’ of the challenges that you face. As this formulation develops, I may suggest changes to the treatment plan, or place an emphasis on particular presenting problems and treatment needs.
Therapeutic modalities/approaches.
All therapists work in slightly different ways, but what we all have in common is that we use our training in evidence-based therapeutic approaches (such as Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), Schema therapy or Psychodynamic therapy) as a basis for treatment. The therapeutic approach your therapist takes will depend on what the evidence says is the most effective type of treatment for your presenting problems. Often times there will be several approaches that have a strong evidence-base for treating a certain problem and your therapist may have a personal preference and/or more experience with a particular type of therapy, so this will guide the approach also.
Most psychologists will say that their approach is ‘integrative’. This is a fancy way of saying that they draw on several evidence based therapeutic approaches to design a treatment plan, which meets your needs and preferences.
As therapists, we all differ in the way that we like to deliver treatment. For example, I describe my approach as dynamic. What I mean is that I will flexibly adapt the session to suit what you bring up on that day, while staying true to the chosen therapeutic approach. I will help you to understand your presenting issues in the context of your broader history or ‘formulation’, and together we will work through your presenting issues as well as use it as an example for how to approach similar difficulties you might face in the future. I may also introduce relevant skills or tools when they will be helpful and where appropriate.
Other therapists may prefer to do things differently. For example, some psychologists prefer that both the session and the broader treatment is more structured, with a strong focus on skills-building exercises. They will ask you for real life examples of particular challenges that you want to work on and then teach you how to apply the tools or strategies to address the particular problem. This type of structured approach can produce a real sense of achievement and progress for both the client and therapist.
By no means are these the only two ways of working with a psychologist. You are encouraged to find out about how your therapist likes to work and to negotiate what you would like your sessions to look like with them. For example, if you find a conversational style of therapy unhelpful and would prefer to learn specific skills to practice at home, please let your therapist know and they adapt to your individual needs.
What if I feel like therapy is not working?
Given that research shows the ‘therapeutic alliance’, or the relationship between you and your therapist, is the single most important predictor of therapy outcomes, it really is important that you find the right therapist for you.
Not all humans get along, and even if there is no conflict sometimes there just isn’t a ‘click’ between you and your therapist. As psychologists we understand that really well. We don’t take offence when you decide that you want to work with someone else. After all, we may fit perfectly with the next (or the next) person that sits in the chair across from us.
The one thing that we ask is that you let us know about your decision, as this is a healthy way of ending any relationship. Firstly, and preferably, you could address your feelings with your therapist directly in session. Perhaps there has been a misunderstanding about what your needs and preferences are in therapy and an adjustment in the therapist's approach to your treatment may solve all of the issues! Perhaps not, and we can offer you a referral to another colleague. Lastly, you can send an email explaining that you didn’t find the therapist to be the right fit and let them know that you have chosen to go elsewhere or to take a treatment break if engaging in treatment isn’t the right thing for you right now.
Finishing mental health treatment.
Your progress and ongoing therapeutic needs will be a common topic of discussion throughout the duration of treatment. When you have made sufficient progress, you and your therapist can start to talk about finishing up with your sessions. The last few sessions will usually focus on summary, reflection, and relapse prevention (i.e. helping you to not fall back into unhelpful patterns of thinking, feeling and behaving).
Finishing up your sessions does not need to be a speedy affair. I often offer monthly, three-monthly, or six-monthly sessions to my clients before they finish up altogether. Some clients prefer to book sessions in advance, then cancel the session (while providing sufficient notice) if they feel that they are doing well and don’t need to have the check in.
Finding the right psychologist is key to achieving the desired treatment outcomes. It’s important that both the therapist and their therapeutic approach suits you and your needs. While this can take some time to find, having a read through the psychologists profile can be a really great way to see if you think they could be a good fit, as well as reaching out to the intake team to ask any other questions you might have about which psychologist to see.
