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Your first therapy session
Your first psychotherapy session is usually a time for the therapist to gather information about you. The therapist may ask you to fill out forms about your current and past physical and emotional health. All of this information helps the therapist gain a deeper understanding of your situation. It might take a few sessions for your therapist to fully understand your situation and concerns and to determine the best approach or course of action.
The first session is also an opportunity for you to interview your therapist to see if his or her approach and personality are going to work for you. Make sure you understand:
- His or her approach or type of therapy
- What type of therapy is appropriate for you
- The goals of your treatment
- The length of each session
- How many therapy sessions you may need
At any time during therapy, especially in the beginning, don't hesitate to ask the therapist questions.
If you don't feel comfortable with the first psychotherapist you see, try someone else. Having a good "fit" with your therapist is critical for psychotherapy to be effective.
Starting psychotherapy
You'll go to a therapist's office for psychotherapy sessions. A therapist may have an office in a medical clinic, an office building or home office. Psychotherapy can also take place in a hospital if you've been admitted for treatment. You'll probably meet with your therapist once a week for a session that lasts 45 to 60 minutes.
Types of psychotherapy
There are a number of effective types of psychotherapy. Some work better than others in treating certain disorders and conditions. In many cases, therapists use a combination of techniques. Your therapist will consider your particular situation and preferences to determine which approach may be best for you.
Common psychotherapy techniques include:
- Cognitive behavioral therapy, which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. This is the most common type of therapy and is generally set up in a structured, goal-oriented format with a set number of sessions.
- Interpersonal therapy, which focuses on your current relationships with other people to improve your interpersonal skills — how you relate to others, such as family, friends and colleagues.
- Psychodynamic psychotherapy, which focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts to live a happier life.
- Dialectical behavior therapy, a type of cognitive behavioral therapy that teaches behavioral skills to help you tolerate stress, manage your emotions and improve your relationships with others.
- Acceptance and commitment therapy, which helps you identify your thoughts and feelings, learn to accept them, and then commit yourself to the changes you want to make.
- Family therapy, which helps individuals within a family understand and improve the way family members interact with each other and resolve conflicts.
- Group therapy, which brings together a small group of people facing a similar mental illness or situation, with a discussion led by a qualified counselor or mental health provider.
- Marriage counseling, also called couples therapy, which gives partners — married or not — the tools to communicate better, negotiate differences, problem solve and even argue in a healthier way.
- Psychoanalysis, which guides you to examine memories, events and feelings from the past to understand your current feelings and behavior.
- Art therapy, also called creative art therapy, which allows you to express thoughts and feelings through music, dance and movement, drama, drawing, painting, poetry, or other forms of artistic expression.
- Exposure therapy, a form of behavior therapy that deliberately exposes you to what you find upsetting or disturbing in a structured way, which can help you learn to overcome your fears.
- Play therapy, which uses a variety of play techniques to encourage children to more easily express emotions and feelings if they're unable to do so with words.
- Psychoeducation, which teaches you about your illness, including treatments, coping strategies and problem-solving skills.
During psychotherapy
For most types of psychotherapy, you and your therapist sit facing each other during sessions. Your therapist encourages you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort.
Because psychotherapy sometimes involves intense emotional discussions, you may find yourself crying, upset or even having an angry outburst during a session. You may also feel physically exhausted after a session. Your therapist is there to help you cope with such feelings and emotions.
Your therapist may ask you to do "homework" — activities or practices that build on what you learn during your regular therapy sessions. Over time, discussing your concerns can help improve your mood, change the way you think and feel about yourself, and improve your ability to cope with problems.
Confidentiality
Except in very specific circumstances, conversations with your therapist are confidential. However, there are certain situations in which a therapist is required by law to report any concerns to authorities. These include:
- Threatening to harm yourself or commit suicide
- Threatening to harm or take the life of another person
- Admitting to abusing a child or a vulnerable adult — someone over age 18 who is hospitalized or made vulnerable by a disability
Length of psychotherapy
The length of treatment generally depends on why you're being seen. It may take only weeks to help you cope with a short-term situation. Or, treatment may last a year or longer if you have a chronic mental illness or other long-term concerns.
The number of psychotherapy sessions you need- and how frequently you need to see your therapist — depends on such factors as:
- Your particular mental illness or situation
- The severity of your symptoms
- How long you've had symptoms or have been dealing with your situation
- How quickly you make progress
- How much stress you're experiencing
- How much your mental health concerns interfere with day-to-day life
- How much support you receive from family members and others
- Gafford J, et al. Psychological treatment of psychiatric disorders in primary care. http://www.uptodate.com/home/index.html. Accessed June 22, 2010.
- Let's talk facts about psychotherapy. Healtyminds.org. http://www.healthyminds.org/Document-Library/Brochure-Library/Lets-Talk-Facts-Psychotherapy.aspx, Accessed June 22, 2010.
- Barbara Woodward Lips Patient Education Center. Understanding psychotherapy for adults. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2010.
- Practice guideline for the treatment of patients with major depressive disorder. Arlington, Va.: American Psychiatric Association practice guidelines, 2nd ed. http://www.psychiatryonline.com/popup.aspx?aID=49371&print=yes. Accessed June 22, 2010.
- Counselors. Occupational outlook handbook, 2010-11 Edition. http://www.bls.gov/oco/ocos067.htm. Accessed June 29, 2010.
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