Therapy is a process of exploration, discovery, and change. I think of therapy as an ongoing, dynamic dialogue between therapist and client. During this exchange, insights, new options, and creative solutions can emerge. Clients see themselves, their problems, and their lives differently. They may embrace a new way of being in the world. Letting go of self-doubt, past hurts, or fears, they begin to flower from within.
The duration of therapy varies for each client. Some people attend a few sessions and feel they received what they needed. Others attend for months or years. Specific problem-solving might take a brief amount of time, while healing from trauma might require a longer amount. Sometimes clients seek personal growth and want longer-term therapy.
Many people begin therapy feeling negative about themselves and some aspect(s) of their lives. They often feel helpless and ineffective. Because they haven’t been able to “pull themselves up by their own bootstraps,” they believe something is wrong with them. Perhaps they considered therapy before but put it off because they felt ashamed or embarrassed about asking for help.
Making that first appointment—and keeping it—is a big step. It takes a certain amount of courage, quite frankly. If therapy is a totally new experience, clients can feel uncertain and a little fearful. They wonder what it will be like, what they should talk about, what this therapist will do. Yes, it’s unnerving.
As the therapist, my job is to help make new clients feel comfortable and show them that my office is a safe place. For many, it might be the first place where they can openly share their thoughts and feelings—even the ones they don’t like—and still feel accepted.
In the first session, I ask clients why they have come to therapy—what is wrong in their life and what do they want to be different. I listen attentively and ask questions to make sure I fully understand. I get a sense of what clients are like and what approaches might work best for them in our sessions.
I also find out what they want from me as their therapist. Although I use a collaborative approach, I adjust the level of collaboration according to each client. What do they need? Someone to give them a lot of direction? Structure? Information and teaching? Someone to listen and give them space to sort through their thoughts and feelings?
It is important that I prove myself to be trustworthy. Clients need to know that I respect their thoughts and feelings, and that what they say remains confidential. When clients have been hurt before, it can take a while for them to overcome fears of being in a relationship. Trust builds slowly—especially with some therapist they don’t know. But in order for therapy to work, trust is essential. Hopefully, as we work together, it continues to build.
The beginning of therapy is a time to set goals. What does the client want different? We spend time exploring, clarifying, and defining these goals. A goal can be very specific, such as learning communication skills, or it can be more general, such as wanting to grow. In the therapy, it’s important that we both know where we’re heading.
The Middle Phase
Most of the time spent in therapy is devoted to exploration and experimentation. Exploration of one’s self and life provides the raw materials for problem-solving and making changes. In effective therapy, a lot of learning takes place. For example, if a client’s goal is to overcome depression, we might need to explore other aspects of the client’s life and relationships.
Exploration can involve observing and tracking one’s own internal experience, including thoughts, feelings, physical sensations, and dreams. Sometimes patterns emerge that prove very helpful. Exploration can help clients make sense of things, see themselves and their problems differently, and find new possibilities.
After exploring and learning, clients can try out new ways of thinking and acting, both in sessions and in their lives. They can practice new skills. Although this time can be exciting, it often requires patience. Progress is not always smooth; it consists of trial and error. Learning and changing naturally involve making mistakes. During this phase, it is important for us to hang in there together.
Although they desperately want change, some clients fear self-discovery and learning. This is understandable. Already feeling negative about themselves, they don’t want to risk discovering more flaws and weaknesses. Nor do they want to risk trying new things and failing. They want to protect what little self-esteem they have left. That’s why it is important for me to respect their hesitance and let the therapy unfold at a comfortable pace. Therapy is like getting into a pool: Some people want to dive in, others want to wade in. Either way is OK.
For therapy to be effective, clients must become active in their own healing. This means consistently attending sessions and actively engaging with me as their therapist. I can’t do squat without clients’ input. Sharing their ideas and responses is imperative. Applying what they learn is too. If clients have a hard time becoming involved and active on their own behalf, then together we need to explore what’s holding them back.
The End Phase
Therapy ends when clients reach their goals. Sometimes when goals are met, new ones emerge. It all depends on the client and how long he or she wants to invest in therapy. Ideally, when therapy ends, clients and I have a chance to reflect on the therapy and say goodbye.
For information on how I work with couples, please see "Services."