Therapy/Counselling

When someone comes in to see me and it is their first time in a psychologist’s office, I often reassure them that it is weird at the beginning but gets easier over time.  And it is weird – telling a complete stranger things that you would perhaps rather keep to yourself!  I find that there is also often anxiety around the experience because people have a lot of preconceived notions about what the experience will entail (I blame the media).  There is a fear that it will be painful or difficult or ‘oddball.’  Typically, those fears do seem to resolve at least somewhat by the end of the first session. 

In my experience, people seem to have two reactions to an initial session.  Sometimes they are relieved, because they have opened up (often just talking about something helps), they have made a start on finding a solution, or because they have gained something specific that is helpful.  Sometimes this is a way of understanding the problem, sometimes it is a homework assignment, and sometimes it is the simple recognition that they are NORMAL (funny how often this is in doubt!).  Other folks are disappointed, because they don’t feel better at the end.   The first session is often a lot of assessment and stage setting, and sometimes that is not enough.  And often the disappointment comes from the recognition that there is no ‘silver bullet’ that is going to make everything go away.  I often think people expect (even if unconsciously) that I will be able to push the emotional button that will unlock all of their problems. 

These are some of my thoughts on different parts of the therapy experience:

Number of sessions.  I am often asked how long it will be necessary to come and see me.  What I typically will say is that my orientation is to see the person or couple as little as possible.  That means that we will work together to find solutions to what they are dealing with in the most efficient way.  This typically ranges between 3 and 6 sessions, although some people I only see once or twice, and some I see for much longer.
 
Regularity of sessions.  The issue of timing of sessions is a difficult one, and one that needs to be addressed with each individual.  I typically like to get some momentum going at the beginning, so meeting once a week for a couple of times can be helpful.  Often, once a week seems like too much of a rush – no time to do homework, no time to reflect on what has already been discussed.  Therapy shouldn’t stress you out!  It can also be quite helpful to have ‘maintenance’ sessions – there are a lot of individuals and couples I see once every couple of months just so they can stay on track. 

Confidentiality.  This is something that is a basic part of our Code of Ethics as psychologists. 

We are required to keep confidential any information that arises in the session, or a client’s attendance, with the following exceptions:

• Danger to self or others
• Child Abuse
• Court Subpoena

This means that we will be asking for your written consent if there is ever a time that it would be helpful to discuss your situation with someone else (for example, your family physician).  It also means that when you are a part of an EAP (Employee Assistance Program), your billing goes out under a number, and never your name.

Type of therapy.  There are quite a variety of different approaches to therapy. We all know of the “lie on the couch and say whatever you want to” approach (Freudian Psychoanalysis), but there are also Rogerian, Interpersonal, Cognitive-Behavioural and Solution-focused etc.

Most psychologists in Calgary will use a number of different techniques from a number of different schools of thought, depending on the issue (the word “eclectic” comes up a lot).  Most would also say that they are short-term and solution-focused.

Therapy vs. Counselling.  This is a tricky one, in the sense that the two terms are often used interchangeably.  From my perspective, I tend to distinguish between counselling as being a focused effort towards a specific, short-term issue, and therapy as involving a broader approach to the individual’s “self.”  We do much more counselling than therapy. 

Picking a psychologist.  The match between a therapist and a client is really an important one.  It is unlikely that you will accomplish much if you feel that you can’t relate or that you don’t respect each other.  That being said, there are a lot of variables to be considered.  Certainly approach makes a difference (see above), but so can experience (although I have also met some excellent new therapists). Gender tends to be less of an issue than most people might expect.  The minimum that I would suggest is that the individual be trained at the Master’s level and be registered.  Also, unless you have a very strong reaction, I would encourage to try a therapist more than once, and to bring up issues that you are concerned about.  A therapist who can address your feedback and work towards a better fit, is one probably worth hanging on to.