What happens in a consultation (assessment) for psychoanalytic psychotherapy?

People often assume that when they go see a psychotherapist for the first time, they are already in treatment. However, soon enough the person will learn that before the therapy starts, a consultation takes place in order to assess the needs of the person and help them think, together with the therapist, whether psychotherapy can in fact help them with whatever problems they need to work through.

There are important questions that both therapist and patient need to ask themselves before embarking in the psychotherapeutic process. And this is why an initial consultation for psychotherapy is so important. The consultation is not only for therapist and client to have a sense of each other and to see if empathy and connection springs, but most importantly for the client to have a feeling of how the future therapy will unfold, and if he or she has enough resources to endure mental pain, uncertainty and unsettling feelings and the necessary robustness to face some disturbing aspects we all have within ourselves without breaking down.

A consultation for psychoanalytic psychotherapy happens over a few sessions (normally between 2-4 encounters), and this is so there is enough time for the therapist and client to have a feel of how they work together. It is also an opportunity for the psychotherapist to gauge the mental state of the client and to decide if psychotherapy or counselling is the best approach, if the help the therapist has to offer is enough for the needs of the client.

So I’ve put together a list of elements that are considered in the process of assessment for psychotherapy:

1- Connection. In the consultation stage both patient and therapist will get to know each other a bit better and feel if there is a connection there. This is important so the pair will know if they feel comfortable enough to work together. This connection has to do with empathy and trust. It is normal to be anxious in the beginning though, and it can happen that this connection will take place over time. Nonetheless, the therapeutic relationship is the springboard on where the therapy takes place, and so the connection between psychotherapist and patient is an essential question to be regarded and thought about. It is important though to go through the whole process before making any decision. The consultation is an ideal place to discuss any particular feelings or reactions that the patient might be experiencing in the here-and-now of the meeting, and this will help the pair to think about how it is to work together.

2- Information. During the consultation the patient will be free to share whatever information they feel relevant to help the psychotherapist understand what brought them to seek help. The therapist may ask a few questions to clarify and further explore what the person is sharing. Some of the information gathered throughout the assessment should include: personal history, family history, illnesses (mental or physical) history, current and past relationships, relationship with parents and siblings, work and living circumstances, etc. This list is not exhaustive, and the more information the better. The consultation is also an opportunity to clarify any queries in relation to the psychotherapy process.

3- Mental state. An experienced psychotherapist will be able to gauge the mental state of the person through the consultation stage. It is important to assess if the person has enough mental robustness to dig deep without breaking down or falling apart. If there is a possibility that psychotherapy will harm the patient, it is a golden rule that it should not be pursued. Psychotherapy can be a painful and unsettling process, so if in the assessment the therapist perceives that the person is in risk of fragmenting or becoming too unstable, it is better not to pursue the treatment.

4- The treatment x the needs. Following from point 3, through the consultation the psychotherapist will discern whether what they can offer is enough to contain and meet the needs of the patient. Whilst once or twice-a-week therapy is suitable for many people, sometimes a patient may need not only more intense work, but also the involvement and care of other professionals (i.e. psychiatrists, GP’s). It is important to recognise whether what the therapist can offer is enough to contain the patient, and so this question must be thought about in the consultation process.

5- Trial therapy. A consultation is also a sort of trial therapy. The psychotherapist will make interventions and interpretations and see how the patient reacts to them. This is to gauge the level of insight and see what the client does with the therapist’s interventions. This aspect of an assessment is quite important, as both client and therapist will be able to have a sense of how the future treatment will feel like.

6- Diagnosis. Although psychotherapists will not deliver a medical diagnosis, he/she should be able to identify aspects related to whatever mental illness a client may present. Having said that, some patients will come to therapy without a clear need for it, perhaps pursuing greater self-awareness or because they want to undergo something specific and need some support for that. Nevertheless, in the assessment stage the therapist will be able to see some personality traits and dynamics of the mind, and use that to help the client identify their needs when in therapy.

7- Objectives. It is quite common that the objectives (or needs for therapy) worked on in the assessment stage will change or be lapidated over the course of the therapy. Many times what we think to be the current demand for therapy will happen to be but an expression of a deeper struggle in the mind. Part of the consultation is to talk about objectives and needs, but it is important to keep an open mind for the more unconscious demands of the mind.

It is clear that a good consultation is paramount for a good therapy to develop. I hope the points above helped to clarify what happens in an assessment or consultation for psychoanalytic psychotherapy.

Psychotherapy is a great commitment, but one with great benefits.





Allan Gois – Psychoanalytic Psychotherapist in the London Bloomsbury (WC1)