The Sequence of Therapy



Never been to therapy? Here's what to expect from many therapists, including those at Changeways Clinic.

The first appointment


For most therapists, the first appointment is typically designated as an assessment. This means that your therapist will attempt to learn as much as possible about you and about the difficulty for which you are seeking help. Usually the therapist asks a lot of questions, and generally you won't get many recommendations about what to do about the problem. The blizzard of questions will slow down once therapy really begins. Sometimes the assessment extends over two appointments.

The goal of the assessment, from the point of view of the therapist, is to determine:

1. The nature of the problem.
2. The strategies that might be helpful.
3. Whether your requirements are a good match for the skills and style of your therapist.

As well, typically you will be able to ask questions of the therapist. From your own perspective, the assessment can tell you a number of things, including:

1. Whether you feel you can develop a good working relationship with the therapist.
2. The type of approach that your therapist typically uses. Changeways Clinic therapists use a predominantly cognitive behavioural approach emphasizing strategies supported by the research literature.
3. Whether you feel hopeful that your therapist's style and approach are likely to be helpful for your concerns.

Forms and measures


Your therapist may request that you fill out one or more forms or questionnaires early in therapy.
The forms might ask for the usual information: your phone number, address, person to alert in case of emergency, and billing information. Your therapist may also ask you to complete a Release of Information granting permission for your therapist to consult with your physician or others. Feel free to ask questions about any of these forms if you have concerns.

Some forms may ask you to monitor certain aspects of your life or your difficulty. Many therapists, for example, ask their clients to rate their mood on a daily basis, or to make notes about the problem.
Your therapist may use questionnaires designed to assess aspects of your personality or the problem you have been having. These can sometimes help clarify the nature or severity of the problem, or the strategies most likely to prove helpful for you.

Therapy


If you and your therapist agree to work together, your meetings will shift from assessment to therapy. The kinds of things that you will work on depend in large part on the type of therapy your therapist uses.

In cognitive behaviour therapy, for example, the focus is largely on how you think (the cognitive side) and what you do (the behavioural side). Therapy sessions typically involve a structured discussion of the issues on which you have been working.

You might begin a session with a discussion of any therapeutic projects that you have been working on since the previous session. With your therapist you might examine the ways that you have been thinking about the challenges you face -- and, where appropriate, you may explore some alternatives. You might carry out some therapeutic exercises in the session, or you might spend time developing exercises for you to try at home. Each session of cognitive behaviour therapy typically ends with a plan of action (selected and approved by you) for the coming week.

Perhaps the most important thing to realize about cognitive behavioural therapy is that the real work takes place in your everyday life rather than in the therapist's office. Although important insights and decisions can be developed in therapy sessions, these will do little unless you are able to put them into practice in your life.

Appointment length


For most therapists, appointments for therapy are generally 45 to 50 minutes long (the "50-minute hour"). Some forms of therapy and some therapeutic tasks might call for appointments longer or shorter than usual.

Assessment appointments might be scheduled for the usual "hour", or more time might be set aside.

The length of therapy


The number of sessions involved in therapy varies a great deal, depending on the type of therapy, the nature of your concern, the type of clinic, limitations imposed by your insurer, and sometimes your own preferences about the pace of the work.

Cognitive behavioural therapy typically lasts from 6 to 25 sessions, though this is enormously variable depending on the concern being dealt with.

One concern that many people have is the expense. Therapy is an undeniably expensive process, even when the total number of meetings is 12 or less (which is often the case). If you are paying for your therapy yourself, the bill can add up quickly. Some people feel that they would like to cut back on the cost by scheduling less frequent appointments and doing the vast majority of the work on their own. This is sometimes possible, depending on the therapist and the problem at hand, but it can be quite demanding in terms of the self-discipline required. If you would like to explore this option, let your therapist know.

One suggestion: Take your therapist's hourly rate and multiply it by the number of sessions therapy is likely to take. Then ask yourself whether you would be willing to spend that much repairing your car. It's not an entirely fair comparison. After all, in therapy you will be doing most of the hard work, in addition to paying! But if your car is worth it, why not you?