In my last post, I mentioned a few ideas on how you might go about choosing a therapist. Once you've chosen one...then what? More than once, after our first session together, my clients who were first-timers to therapy have commented "That wasn't what I thought it would be." Thankfully, most felt it was easier, less threatening, not as emotionally difficult as the session they had conjured up in their heads. Again, the mental picture of therapy is fraught with stereotypes that, in many cases, is inaccurate at best. Think: classic New Yorker cartoon: The therapist, almost always male, looks eerily like Freud, with beard, round glasses and notepad poised. The client is almost always in semi-repose on a couch or divan, gazing at the ceiling, and saying (in true New Yorker style) something not only ironic, but chuckle-inducing.
What these cartoons are parodying is called psychoanalysis, pioneered by Freud and built upon, modified and changed as the therapy profession grew, creating a variety of theoretical orientations that are still in use today (my first therapy experience--see my previous blog--was at the hands of a decidedly psychoanalytical therapist, with strong overtones of what has been referred to as the "silent analyst." While he was well-trained and completely competent, we weren't a good fit).
I tend to practice using a blend of cognitive behavioral and reality therapy. But, before I drown you in jargon (more on theories in a later blog), by way of contrast to the psychoanalytical model, I'd like to provide you with a view of how I practice. Remember: no two therapists work exactly alike, so this is just my comment on what you might experience in a first session with me. Equally competent--even more competent and esteemed--therapists may work differently and with wonderful results. This is just one point of view.
My sessions almost always start at the top of the hour. Before you arrive, we will have spoken on the phone and I will always invite you then to share what issues or difficulties bring you to therapy at this time. Because it's really all about invitations, you're free to reveal what you want, when you want, as you feel comfortable.
I recognize that, in many cases, by the time you've made the decision to meet with a therapist, you're ready to talk. But, prior to talking, and only in our initial session together, I do ask you to read a brief statement about how things work, called "Office Policy & Consent To Treat." This usually takes about 5 minutes or so at the most; and while it delays our session briefly, it's important. Because it's designed to inform and protect you. Read on.
I ask every new client to read and sign my "Office Policy and Consent to Treat." It informs you of the things I'm ethically required to disclose about how therapy will be conducted: what it will cost, the limits of my availability (I'm not available for 24-hour crisis counseling), and the limits of confidentiality (e.g., if you tell me you're going to hurt yourself or others, I am obliged to assess the seriousness of your intent and take steps to keep you or others safe, if necessary--more on this future blogs). Also included in this form is also a crisis hot line number you can use in case things get too overwhelming between sessions, how I handle insurance, cancellations, phone calls, and termination of treatment. This constitutes "informed consent," which is a fancy way of saying that you have been told how things are going to work and you consent to these terms. I ask that you sign and date the form, and I give you a copy to refer to as you would like.
I've heard that some therapists aren't as formal about all this as I. I prefer a policy of "no surprises." And I want you to feel comfortable with the process. If everything is written down, there tend to be very few, if any, unpleasant surprises later.
Speaking of later, I'll continue this tomorrow: What I'll ask you in the first 15 minutes of therapy--and why.
Until then, thanks for listening.
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