This probably should have been one of my first posts, but it's been interesting to see how this varies in Private Practice as well as the similarities; this post will explore what therapy is like in general, what to expect, and how this happens in my sessions (this will be different for each therapist - thankfully! #diversityisbeautiful). I will be approaching this predominantly from a private practice therapist view, though there will be cross over with free services from NHS, charities, organisations.
I'll be covering:
Initial Contact
Check out my post about how to find the 'right' therapist for expectations on the search aspect.
Once you have found a few therapists you're interested in contacting it's time to actually make that initial contact; The way of contacting a therapist will be personal to them, as to what they offer. Most will have an email and/or phone number to call and enquire about sessions, but there are so many ways to make initial contact nowadays.
It may be that you can book your initial consultation via a website or directory listing. This will normally involve giving some details for contacting and maybe some detail about what you're enquiring about. You can see an example via my booking page here. Alternatively you may be able to email phone, text, DM on Social Media, or WhatsApp the therapist directly.
Regardless, it is important to have some space when making the initial contact as it can be a vulnerable moment. If you're making delayed contact (email, booking system, text, WhatsApp, DM) you can take some time over what you want to include details wise and outline what you're looking for. Be sure to check your spam for replies too, unfortunately this can happen with replies.
Making immediate contact (phone call, live chat) may need you to make space before to note down things you want to ask or get across, time for the conversation with the therapist, and some time afterwards to ground yourself and check in as it can be intense depending on the questions you're asking, but also from any emotional build up the search and contact makes.
I wish I didn't have to type this out, but please also prepare yourself for the potential of no reply from some therapists - though do check your spam folder often as emails can wind up there too. In addition, there is the possibility that the therapist you've contacted isn't able to take you on as a new client, so there can be a chance of not being able to have sessions with your chosen therapist. This 'no' can be for so many reasons (full schedule, conflict of interest, topic being out of competency, no longer practicing etc.), but it may be hard to not take it personally, so do prep yourself for potential feelings around rejection, especially if you know this is something you're sensitive to.
Consultation/Assessment
I can only speak of my own consultation in detail but I will try to give examples of how this might vary for other therapists - hopefully they tell you what to expect before you meet them.
My consultation is a 45 minute session allowing space for us to talk in a little more detail about what you would like to get out of therapy, what might be going on for you at the moment, to talk through the counselling contract and manage expectations around what therapy will look like, and then I also leave space for you to ask any questions you might have. I do ask for payment on this at a reduced rate as it does take time to prep and be with you in the session, but other therapists might offer their consultation as a 'free first session' or a free 15 min phone call. I prefer to have a little more time to have the space to talk and take our time exploring what our sessions might look like before we just jump in - but everyone works different and that's why checking out a few therapists is important to see who you connect with. The consultation is a chance for both of us to get to know the other a little more so that we can make a more informed decision on whether we would like to go forward with sessions.
I don't tend to use any questionnaires or scores but you may find that therapists ask you to complete one for the consultation. This is more used in therapy which is more goal orientate or in organisations where they need to show that the therapy is working in a more tangible way.
First Session
The first session may be filled with a few more questions from your therapist than normal as it is a chance for us to understand and clarify what's going on for you. It can take time for the therapeutic relationship to build up and so the first stage is very much around exploration and understanding.
You may get straight into the content you bring to the sessions in the first session and this can leave people feeling vulnerable once the session is finished. I always try to check in with my clients at the beginning and then at the end of each session as a way to ground you but also to have a routine in keeping the session boundaried. I find this especially important in our first session as it allows you to get a feel for what our sessions will look like going forward but also because a consultation can bring up ALOT of information, feelings, emotions, and thoughts that have to be contained in a short period of time along with the contracting and questions, so it's good for me to check in on how it was for you after our consultation so we can look at how best to manage containing the emotions and feelings in future.
I would recommend giving yourself some space after you first session, and all sessions, so that you have a bit of breathing space before going back into your day to day.
Therapeutic Relationship
The therapeutic relationship is not like other relationships in life. Whilst it is two way to some extent, most therapists won't bring their own 'stuff' to your sessions in terms of self disclosure. Some approaches mean that your therapist won't even answer "how are you?" as they want to be a complete blank slate in the relationship, meaning you won't know anything about them. Other approaches are a bit more relaxed on this and so your therapist may disclose information about themselves - this is done with you in mind, i.e. self-disclosure should be for the benefit of the client.
You will have your own preference on this, so this may be a question to ask in your consultation with the therapist. I tend to do some self-disclosure where it feels appropriate. I do also share a fair bit of myself on my therapy socials, but again, I do this with my follower in mind - what I share is within the context of being for the followers benefit.
The therapeutic relationship takes time to build, and it will be used within your sessions too. The relationship is there to be a consistent safe connection to model how you want to be in the 'real world' out of the therapy room. Your therapist will be empathetic, non judgemental, actively listen, and hold you with unconditional positive regard in order to let you explore what relationships mean to you, how you relate, and have a chance to practice how you want to be with others in your life. It is your chance to practice a healthy relationship!
As you can see, the therapeutic relationship is important.Having a good therapeutic relationship has been found to be the biggest factor in having a positive outcome from therapy. We have supervision in order to make sure we are keeping this relationship boundaried, professional, and working in your best interest, because if we stray from this as a therapist it can have a negative impact.
The relationship built should allow you to voice if you feel your therapist is wrong or if something said doesn't sit right with you. Ruptures can happen, as therapists are human and mistakes can be made, but if the relationship has a strong base, these ruptures can be a great chance to experience resolving conflict in a healthy way.
With all this in mind, if you find your therapist isn't holding you safely, you feel like your feedback isn't being taken on board, or you feel your therapist is acting inappropriately please do look to raise these concerns with their Professional Membership Body, PMB, (currently counselling isn't regulated in the UK which can cause problems if you're looking to complain and your therapist isn't part of an organisation/PMB - check out my post here for more info).
Themes/Focus
You may chose to have a theme or focus for sessions. This will be different for the approach of therapy your Therapist follows.
More solution focused approaches (CBT, SFT, ACT, DBT) will have a focus for your sessions. You might find that you have a structure to the sessions with a clear path of what you'll be doing. When I had CBT for my pain management I was given a handout which explained what we'd be doing in our 6 sessions. I had homework to do in-between each session to put what we talked through into practice. The sessions were very much about guiding me through the handbook, gaining understanding on what the process meant for me, and then putting it all into practice. This can be really useful and productive for those looking for ways of coping with a specific 'problem', however for ongoing deeper work it isn't always as effective.
More client led approaches (Person Centered, Humanistic, Existential, Psychodynamic) might ask you what it is you'd like to get out of therapy, but it is then very much in your autonomy to get there. You will bring the topics to each session, your therapist will then help you explore this in the session.
Integrative approaches tend to find there way somewhere in between these on the spectrum of client led or solution focused. I love being integrative, whilst it means I'm not a 'specialist' in any one approach, I am able to adapt to my clients preference of how to work and gives more flexibility on the timeline of sessions. I have found that most sessions tend to be client led to begin with as the rapport is building up, and then as more has been explored and understood there is a process of 'moving forward' which then brings in some of the practices used in the solution focused approaches.
Structure, Consistency, & Boundaries
Structure, consistency, and boundaries are important for therapy.
We've already talked about boundaries in this post so far. Boundaries should be outlines from the offset of any therapeutic relationship. Therapists who are part of a PMB will have an ethical framework to follow which outlines the boundaries, so if you're ever unsure on if something is okay in therapy, you can ask your therapist or check out the framework yourself.
Consistency is part of the ethical framework in terms of modelling the health relationship, and this goes both ways. It is important for you to be attending your sessions consistently as well as the therapist being able to be consistent in the space which is offered. As mentioned before, we are human, so there will be nuances to this as well as modern life not always allowing for weekly sessions.
To me, the main part of consistency is to be engaged - this includes being in contact with your therapist if you're unable to attend, as well as your therapist being consistent in there engagement too. I am transparent with my clients from the start in having chronic illnesses which can lead to cancellations on short notice, however I always try to offer an alternative to meet each week where possible.
As for structure, this goes hand in hand with consistency and boundaries. My prefered structure for sessions is to have them weekly at the same time and day, however this isn't always possible, and so a flexible structure is still just as valid.
The theme throughout all of this, is collaboration with your therapist on what works for both of you.
Confidentiality
Confidentiality is one of the biggest factors in therapy. As a therapist we do what we can to offer you confidentiality in sessions, this means checking our software is as confidential as can be within the limits of our competencies, making sure our sessions are held where others can't over hear, keeping any data we collect secured and anonymised, etc. Every session should be held in a confidential space where all of what is said is kept between the two of you.
The biggest section of my contract is around confidentiality, this is to explain what I do to keep sessions confidential, but also to explain where confidentiality may be broken. Sometimes we may need to break confidentiality in compliance with the law. This isn't always straight forward and can be a judgement call on the therapists side as to whether a break in confidentiality is the right move going forward for those involved. The overview of this is if someone is in immediate harm - whether that's the client themselves or someone else (abuse, terrorism).
My take on breaking confidentiality is to do this in as much collaboration with my clients as possible. I will always try to talk to my clients about what breaking confidentiality might look like and what the next steps will be.
It is never easy to break confidentiality on either side of this relationship! If you're ever worried about what you want to talk about leading to a break in confidentiality it is always worth talking about what this might look like with your therapist. A general rule I've seen in organisations is if you have a plan to end your life within the next 24 hours and intend to act on it then this would be a time to break confidentiality and raise the support for the client to crisis services, however your therapist may have a different take on this.
In Between Sessions
Following on from confidentiality, if you were to meet your therapist in a public space (online or in person) the general take is that your therapist won't acknowledge you to keep confidentiality in tact, however if you want to say hi then you can. I have a section in my contract to cover this as well as a digital policy for online spaces.
Other types of contact in between sessions will vary from therapist to therapist. Some therapists may set 'homework' that you are able to send to them inbetween sessions ready to discuss in the next session. Some therapists allow you to text/email/message them with different things that come to you as part of the ongoing relationship.
Generally speaking, I don't contact my clients outside of sessions unless it is to rearrange sessions, notify of holiday, or for something important. But as with everything there are nuances to this where I may know of a resource that would be useful to a client that they are happy for me to send to them outside of sessions.
In order for confidentiality and boundaries to be kept in tact, it is advised that any contact outside of sessions is discussed with your therapist so that you are both on the same page and it can be contained within the therapeutic relationship.
Endings
Endings can happen for many reasons in therapy. Hopefully the ending is because you feel your work is done and you're ready to go on without sessions, however this isn't always the case.
How you end therapy is up to you, as part of therapy is empowering you in your autonomy. Therapists may outline what they expect in regards to an ending - for me I ask for 2 weeks notice so that we are able to wrap up the work we're doing, the client can experience a 'good' ending, and we can review the work done too. You have every right to end sessions with your therapist and you can do for whatever reason it is (not connecting, complaint not acknowledged, feeling unsafe, feeling you've got all you can out of the sessions, feeling ready to end sessions etc.)
Sometimes though, it may be that your therapist needs to end the sessions. This can be for an unlimited amount of reasons and will very much be up to your therapist to explain where they feel able. The most common reasons (I've seen) are health related, change of circumstances, or due to a conflict of interest that has arisen.
Endings are delicate, the hope is that we can offer you a 'good' ending as most endings in the world can be painful (break ups, bereavement, ghosting). Your therapist will be as congruent and transparent with you as they can with the ending on their side, and we ask the same of you when you finally feel ready to end.
Summary
Therapy is different for everyone. It is a relationship between you and your therapist which is what works for you. Your relationship with your therapist will be different to their relationship to their other clients.
Therapy is YOUR space. It is to support, empower, and heal you. It helps you explore your past and move forward into the present, preparing you for your future.
