By Angélica Pérez-Litwin
New Latina: Psychology Corner
If you’ve never been to psychotherapy (or counseling by a mental health professional), you might be wondering what exactly happens on the first therapy visit. As a licensed, clinical psychologist in private practice, I would like to demystify this process and shed some light into the wonderfulness of going for psychotherapy.
The Referral Call
The process begins with a simple phone call to the therapist. The patient might be referred by a medical doctor, a loved one, an employer or an organization in the community. Many of my patients are self-referred — they have independently made the decision to seek help and find a therapist.
A large percent of my patients find my office after doing an online search for psychologists/psychotherapists with offices near their homes. They review a list of Psychology Today Profiles and choose the one that feel fits their needs.
During the call, we briefly discuss the reason for seeking services, and I make a quick decision as to whether or not this patient is appropriate for my services.
Although most Clinical Psychologists are trained to provide therapeutic services to a range of populations and conditions, most psychologists tend to have expertise or niches they have developed throughout their career.
My expertise is on women’s issues, mood disorders, transitions and family dynamics. I also have a specialty in geriatrics, which means that I can treat and evaluate older adults. I don’t provide services to children under the age of 16. So, depending on the nature of the reason for seeking help, I decide whether or not I am a good fit for that person. If I believe I am, I go ahead and schedule an appointment to meet.
The First Visit
Most psychotherapy sessions are between 45 and 50 minutes long. The first sessions are considered an initial clinical evaluation, which might take an hour. A lot is achieved during this first session. Here is a list of what I normally do when I meet a new patient:
- I introduce myself briefly and welcome them to the session. I also discuss confidentiality and what that means.
- I ask “What brings you here today, and why now?” and what is the most challenging thing or situation in their life right at this moment.
- I listen intensely and pay attention to a number of things: the patient’s mood, facial expression, tone of voice, behaviors, level of comfort/discomfort in the session, judgment, insight about their problems/issues, and level of motivation, among many others.
- We briefly discuss current social/occupational/marital status. Depending on the reason(s) for referral, we may or may not discuss medical/psychiatric/substance abuse history, family history, and history of trauma or difficult experience.
- I ask the patient “What would you like to get out of these sessions? What would you like to achieve?”
- During this time, as a clinician, I am taking mental notes, creating preliminary hypotheses, diagnosing the situation or the problem, and figuring out the best way to intervene.
- One of the most important tasks I have during this session is to build rapport and trust. The foundation of a good therapeutic session is the patient’s trust on the therapist and the patient’s level of comfort with the therapist. If the patient does not feel safe with the therapist, he/she will not feel comfortable opening up and talking about their problems with honesty.
Wrapping Up the First Session
During the last 10 minutes (or so) of the session, I like to briefly discuss my preliminary clinical impressions, offer some genuine words of hope, make some recommendations, and discuss how my sessions can help and what we would need to do. I also remind my patients that psychotherapy is a team process, that we will need to work together to help the patient achieve their goals.
A small number of my patients require a referral to see a psychiatrist, in addition to the therapy session. These are patients who are significantly depressed, anxious, or dealing with a condition that severe. Since psychologists are not trained to prescribe medications (although a few states do allow Psychologists to do prescribe), they are referred to a psychiatrist to evaluate the need and appropriateness of treatment with psychotropic medication.
Once the patient has agreed to continue their sessions, we schedule a regular weekly time. The best practice is to maintain the same day and time every week. This promotes consistency and predictability. Most psychotherapy treatment plans are executed weekly, but there are a number of patients that might require therapy twice per week. These are usually patients who are in crisis, severely depressed, and/or need more close monitoring and treatment.
During follow-up sessions, patients tend to discuss how they’ve been feeling and doing over the past week, and any new problems/challenges. The therapist continues to gather information about the patient’s history (etc., childhood/family) to help better understand the patient’s life journey.
A number of therapeutic tools are employed by the therapist, in a genuine and authentic manner. Depending on the therapist’s clinical approach and training, the therapist may focus on the patient’s cognition (way of thinking and perceiving the world, circumstances, events), childhood traumas and significant events, or the patient’s resiliency and strengths. I am what was is normally referred to as an eclectic psychotherapist, this means that I use a combination of approaches to understand and treat my patients, depending on the problem or condition the patient is presenting at this time in their life.
Some of the tools we normally use to help our patients heal from their conditions are the following:
- Validation: genuinely validating their pain, feelings, thoughts and experiences
- Empathy: understanding the reason(s) for their past or current behaviors/thoughts/feelings
- Mirroring: serving as a mirror to help them see what they cannot see about themselves. Reflecting back “blind spots” about themselves and offering insight.
- Questions: asking powerful questions that might help them understand themselves better
- Clarification: helping them clarify experiences in their lives that they might have mis-perceived or misunderstood
- Review: Reviewing unresolved issues or conflicts
- Empowerment: helping the patient gain an improved sense of empowerment, confidence and strength in her ability to rise above her/his conflicts and challenges
There is much more to psychotherapy and psychotherapy treatment. The goal of this article was to offer a glimpse into the psychotherapy process and demystify psychotherapy treatment. We all need psychotherapy at one point or another in our lives, including psychologists and psychotherapists themselves. When you need the help, pick up the phone and schedule an appointment. It might be one of the best thing you’ll ever do for yourself.