Our first meeting is used to gather as much information as possible about your history, problems and strengths, as well as things that are important to you. You are likely going to be given some tests or monitoring sheets to complete before the next appointment. This is necessary for us to better understand the mechanisms that maintain your difficulties and to create a working model of what is happening in your life. Obviously, each person is different, with different life philosophies and aspirations. Yet many of us get stuck in self-reinforcing cycles of triggers, thoughts, emotions, actions and outcomes that add up to create our lived reality. Your goals and values are your own. It is the job of a therapist to find out and treat the processes that make it very difficult for you to live a life that your desire. In short, therapy will make your mind works for you and not against you.

 

If your situation is very complex, we might need more than one appointment to gather the necessary information – some of that information might not be available unless you complete the monitoring forms. While we are working on building a model of your difficulties, we are also starting to introduce coping strategies and working on bringing more clarity to your thoughts and goals.

 

Once the assessment phase is completed, typical appointment starts with agenda setting. It consists of a very fast review of important events that might have happened between the sessions, review of your progress with skill practice and then setting specific goals for the meeting. These goals might include more detailed discussion of observations reported during the initial review, discussion of deeper underlying mechanisms or crisis management. A therapist is accountable to you on how your therapeutic hour is used. Agenda setting allows us to catch points of concern early on and to ensure that we allocate enough time to discuss what is truly important. It should be highly collaborative but brief.

 

Towards the end of the session, we summarize what was covered and develop a plan of action for you to follow before the next appointment. The tasks to be completed between the sessions might include skill practice, information gathering or an experiment that asks you to do something that might still be difficult but necessary to help you move closer to your desired objectives.  

 

Since we need to ensure that therapeutic interventions match your reality, we cannot act based on hunches or assumptions. Unfortunately, our job is not done once we build understanding of mechanisms that maintain your pain. Insight is not enough, and a therapist needs to coach you to facilitate changes in the way you deal with your difficulties. That change might be the most difficult part of the process. It is true that life might have hurt you more than others. But it is equally true that you might be the only person with enough vested interest to do what is necessary to undo that harm and simply can’t afford to wait for others to make the first step.

 

The initial part of treatment centers on data gathering and learning of new skills. This stage of therapy lasts for 4 to 5 weeks and might require you to come to therapy at least once per week. After that, appointments are spaced further apart to ensure that you are able to maintain your gains more and more independently. We always refer back to treatment plan and outcome measures to determine how you are progressing along.

 

We stop therapy once we reach our agreed upon goals. Some clients are able to do so in less than 10 appointments, others need significantly longer depending on complexity and severity of issues that need addressing. Sometimes it makes sense to divide your therapy into segments – for example you can use one set of meetings to learn how to manage panic, take a break, and then return for another set of appointments to address poor motivation or relationship concerns.  

 

Therapy is meant to facilitate life, not interfere with it. Yet it is not likely to be effective if we do not follow evidence-based processes. You might be in therapy for years if you book your appointments only when you need to discuss painful crises that occur over time or you might build resilience to handle such difficulties independently if you commit yourself to making changes in a systematic manner. Although therapy will not protect you from vagaries of life, it will certainly teach you not to make your life worse than it absolutely has to be. Commitment to regular appointments and skill practice pays off in the long term as your new way of interacting with the world becomes self-reinforcing. Then, simply, you might no longer need therapy and life worth living starts to happen.