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 is likely to slow down once therapy really begins. Sometimes the
assessment extends over two or three 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.
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 behavioural 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 behavioural 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 20
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?
