Beginnings can be quite difficult. If things happen too fast at the start, it may scare us away. If it’s too slow, we may run out of patience. If it’s too big, we may become suspicious. Too small might feel insignificant. But life is made of a succession of beginnings, coming in all shapes and sizes. The more experienced we become, the more we realise that every beginning has its own timing, and however small or slow we should learn never to despise them.
This is no different in relation to the psychotherapy process. So in this post I’ll list a few key aspects that are important to think about at the start of a psychotherapy journey. There are important considerations to be made, from how it feels to how a person can make the most of the beginning of the treatment. So here are a few tips to help with the therapy experience from the onset.
1- Realising you need help: This is the first step towards seeking the help of a psychotherapist. However, it is not an easy one. It does take time for us to be able to see the extent of our circumstances, and even more to accept that at times we can’t solve all our problems on our own. It may be that you realise it through the people close to you, i.e., how your difficulties are affecting your loved ones. It may also be that you have come to the conclusion that you simply feel hopeless and helpless. Maybe other people have pointed out the things you need help with. However you came to this difficult and painful realisation, it is an important step towards change. No therapy will be truly effective without the person realising and accepting that he/she does indeed need help.
2- Choosing the right type of therapy: There are many types of therapies available: Cognitive-Behavioural Therapy (CBT), Psychodynamic/Psychoanalytic, Gestalt, Integrative, Humanistic, etc. There are also group or individual therapy, couples therapy, family therapy, brief or open-ended, etc. The effectiveness of each is determined by many different factors, so it is very important to assess what type of therapy will be more suitable in relation to your personality and your particular issues, depending also on the severity of your problem. An experienced psychotherapist will help you think about it during the consultation stage (first few sessions). The therapist should be able to determine if the particular treatment provided will be beneficial for you. Your GP also may be able to help you choose the right approach.
3- Choosing the right psychotherapist: Alongside finding a suitable type of therapy, it is very important to find the right therapist. It’s tricky though to say the ‘right’ therapist, because this is based in very particular and subjective factors. But generally, try to seek psychotherapists who are registered or accredited members of reputable professional bodies. Some of the UK professional bodies that you can rely on are: BACP, UKCP, BPC, BPS, HPC. Being a member of a professional regulatory organisation means that the therapist has enough experience and training to practice independently and responsibly. A professional body will also be ‘on top’ of the therapist, requiring him/her to abide by clear ethical guidelines and to maintain their standards of practice (i.e. participating in continuing professional development programs).
4- The first sessions: when you have decided what type of therapy to pursue, and have found and made contact with a suitable therapist, you will then be invited to attend an initial consultation. This can be anxiety provoking, as it is not easy to open up to someone you just met. The therapist won’t expect you tell him/her about out your whole life in the first session, but it will be a good opportunity for you to tell your therapist the things you want help with. The psychotherapist will invite you to unpack the circumstances that brought you to seek help, which can sometimes be linked to past experiences, recurrent patterns, past or present relationships or feelings that are too difficult to bear. It is important that you are as honest as possible. It may be anxiety provoking, but psychotherapy is about sharing and being listened to in a confidential and non-judgmental way. Believe me, an experienced therapist has heard a good share of things in his practice. Although your problem is unique, it shouldn’t be enough to shock the life out of an experienced psychotherapist.
5- Pay attention to how you feel: The first few meetings are a good opportunity to have a sense of how you would feel working with your therapist, to know if the two of you connect. This is very subjective, but yet very important. The therapeutic relationship, although being professional, can be a very strong one, and so it should be if the therapy is to work. See how you feel in the first sessions. You are probably the best person to judge if the therapist you are seeing is the right person to help you.
6- Go all the way. Having just said that you can judge if a therapist can help you or not, don’t pull the plug too soon if you feel like stopping in the first few meetings. Think about it first: are you protecting yourself? Are you afraid? If so, of what? The mind will try to defend against anything too painful when probed. It is like when we are touched near a wound, we will naturally pull the part that hurts away, to protect from pain. Your mind will try to do the same, and that might result in you dropping out too soon without both you and your therapist knowing whether psychotherapy can help you. So it is important to go all the way, to go through the whole of the consultation stage and then with the help of the psychotherapist decide what the best way forward is. So can these initial feelings be understood and worked through?
7- Be honest: This links to the previous point. If you are too anxious or afraid to carry on with the first few sessions, be honest with your therapist. He/she should be able to help you understand and work through your initial fears, and that might result in you finding the help you need. In the same way, be very honest about the things you want help with.
8- It is ok not to know. In my experience as a psychotherapist in London, I have come across several people who seek therapy but can’t actually pinpoint what they want or need help with in their lives. Perhaps it is too difficult even to be put into words. Whatever it is, throughout the consultation stage the psychotherapist will help you lapidate your demand, your need for therapy. It may not be clear to you at the moment, but it will become clearer to you as time goes by. In addition to that, many times the initial complaint will turn out to be secondary in relation to the true need for psychotherapy, and this is also an interesting and important discovery.
These are a few points to have in mind in the beginning of a psychotherapy process, from realising the need for help through to concluding the consultation and embarking in the treatment. A consultation for psychotherapy normally takes 2 to 4 sessions, and this is so the person has enough time to explore the things they want help with and think about how psychotherapy can help them. This beginning is important and can even determine the success or failure of the therapeutic process. I hope this post was helpful to clarify a few anxieties or questions in relation to the beginning of psychotherapy.
Allan Gois – Psychotherapist EC1