Selecting a therapist who fits and works well with you is very important and may involve investing in a trial session with one or more therapists before choosing one and committing to a reasonable course of therapy. Although most therapy models (e.g., CBT, IPT, PDT) are about the same in terms of their average overall effectiveness, individual therapists can vary substantially in their effectiveness with clients. Ideally, psychotherapy helps people get to the bottom of their symptoms or negative behaviour patterns in a healing manner so that, in the end, they are more emotionally freed up to be themselves with others while retaining their own individuality.
Psychotherapy is a complex interplay of unique client, therapist, and situational factors involved in fostering hope and other internal resources necessary for healing and making meaningful change. Clients and therapists can get tangled up or stuck during therapy in ways that undermine their effectiveness as a team at times. Feedback informed therapy can be very helpful for understanding and navigating common therapy obstacles and maximizing therapy effectiveness for each client. Choosing a therapist who incorporates routine progress and outcome monitoring with clients for ongoing feedback about their work is one way to objectively evaluate the effectiveness of your individual therapy with your therapist.
The first session usually lasts 1.5 to 2 hours. People are asked to come in 10 minutes early to complete consent forms and a brief screen that captures common symptoms, well-being, and functioning for a baseline before we start and to help us monitor our progress and working relationship over time. From here, the initial session requires our best efforts to identify and closely examine your difficulties in depth so we can understand what drives them and how you can resolve them. Major emphasis is placed on how you experience your difficulties, anxiety, thoughts, emotions, and interactional patterns throughout the session while we continually monitor your capacity to engage directly with your emotional system.
Honest feedback is essential to ensure clear understanding, optimal working pace, and to maximize our effectiveness. The previous efforts also function to mobilize your internal resources needed to understand and overcome your difficulties. At the end of the session, we review and consolidate our findings together and map out what therapy will involve going forward to solidify and build on initial progress. By this point, the client has a good sense of the therapy approach and working relationship in order to decide whether or not to pursue a course of therapy.
Course of Therapy
Follow-up sessions are usually 50-minutes and occur on a weekly basis to build on our initial progress and continue working toward your goals. Clients complete a brief screen at each session to help monitor symptoms, functioning, our working relationship, and overall progress. Length of therapy course depends on various factors, such as the complexity of the person’s difficulties, emotional capacity, response to intervention, and client goals. A full course of short-term therapy aimed at the elimination of chronic symptoms and maladaptive coping behaviours involves an average of 40 sessions, but many clients experience a significant drop in symptoms as early as the first session. On average, the majority of my clients report significant improvements in less than 7 sessions, although longer therapy courses are required for complex trauma and more chronic depressive conditions.
Although each course of therapy is uniquely suited to the individual’s concerns and capacity to engage, most therapy usually involves going through some darkness to get back into the light. Follow-up sessions are typically about helping clients make shifts from experiencing symptoms, maladaptive coping responses, and other difficulties towards recognizing and experiencing complex underlying feelings from important relationships in one’s life. Because these intense mixed feelings are usually from painful experiences, they can automatically trigger anxiety, defensiveness, and other difficulties when stirred up in our current relationships.
When clients are able to accept and experience the underlying mixed feelings, they usually report a dramatic drop in anxiety, defensiveness, and other symptoms along with relief and increased self-understanding of their own mixed feelings. Memories, links, and insights often accompany the mixed feelings providing people with deeper understanding of their feelings from current and past relationships. One passage of complex underlying feelings is often enough to have a major impact on client symptoms.
The therapist-client working relationship is the major vehicle to help clients repeatedly gain access to their complex underlying feelings for a healing process aimed at untangling client emotions from anxiety, defensiveness, and other maladaptive responses. At the end of a successful therapy course, clients are more at peace with their complex feelings and freed up emotionally to move forward as themselves and engage fully in relationships and life.