What Happens in Sessions?

If you have never thought of seeking therapeutic help before, you probably don’t know what to expect and may feel a little anxious. I hope I can help to put any concerns to rest by describing what may happen in sessions. Different therapists will vary in their specific approach, often depending on the issues being addressed, but most will be quite similar.

Each session will normally fixed at 50 minute, but sometimes longer, depending on the nature of the treatment. This 50 minute session length has been found to be practical for both the client and the therapist. It is long enough to achieve progress, but also short enough to avoid exhaustion and confusion from working too long and on too much in one go.

There will, as a very general rule, be one session per week, fortnight, or sometimes longer in cases where that would be practical, such as at the end of therapy. Time between sessions allows time to process what has been worked on. There can sometimes be more sessions per week where additional support is needed, but during therapy any less than one session every two weeks is probably not going to be helpful, the only exception being at the end of treatment.

At the beginning, in the first session (maybe on the phone), the therapist will discuss what is most concerning for you. While talking they will take down details such as name, age, address, name of partner(s) and children (if you want to give them). This is so that whenever you refer to them, the therapist will have an understanding of how they relate to you.

They will also need to discuss any medical concerns or treatments that you are undergoing as prescribed (and other) drugs can have an influence on an issue or what you are experiencing. It will help if you write the names of any medication down and take this along with you.

There may be a Client-Therapist Agreement to sign. This simply ensures that both you and the therapist have some mutually agreed boundaries and expectations. For example, the confidentiality of therapeutic meetings, your rights to access your data and read session notes, what happens if an appointment is cancelled at very short notice, and so on. You should also find details of how to contact professional societies that the therapist is a member of when you have a concerns.

The agreement will also include concise details regarding the cost of your treatment.

It is important to have a suitably private time for your treatment sessions, but this is not always practical if you have small children or elderly dependent relatives, pets etc, but having uninterrupted time is desirable and at times essential.

The number of sessions will initially be between 6 to 8, but the actual number of sessions can vary wildly. Sometimes just a couple of sessions will be enough, and at other times therapy may extend over a significant time.

There will often be a short assessment every fourth session. An assessment is not assessing you, it is assessing the treatment direction, how you feel the treatment is progressing. Assessments ensure that the therapist is paying proper attention to your needs, and they are a way to ensure that you are provided with an opportunity to raise any concerns that you may have. Do not be shy about requesting and having an assessment whenever you wish.

During sessions the things that are concerning you will be unravelled, with you and the therapist working together on understanding them as fully as possible, and then finding ways to bring about changes. Sometimes you may be given things to do in-between sessions, “homework” such as writing down what has happened to you and how you feel at certain times of the day, dreams, intrusive thoughts, things that feel important. This will almost certainly help a great deal with the progress of your treatment and I would encourage you to think in terms of therapy taking place both within and between sessions.

In sessions, you can explore your feelings very openly and frankly, and say whatever is on your mind in complete confidentiality and safety. It is the trust and safety that you feel in the therapeutic relationship, something that naturally develops, that enables the healing processes of psychotherapy to take place.

When nearing the end of treatment, you will find yourself working toward having a final session. This is to bring proper closure to the treatment. It can feel like something of a wrench to suddenly stop sessions because of sharing so many private things and getting to know each other.

In the final “winding down” sessions, you will review your therapeutic journey together, the changes that you have felt, what has been shared, and you will review the treatment more generally. You may like to discuss which aspects and events within the treatment were the most helpful. This will also indirectly assist the therapist to become even more skilled.

The final sessions are used to tie up any “loose ends”, to say whatever you feel needs to be said so that the feelings you go away with are that the treatment is properly complete, and that you have “closure”.

During therapy you may find that when dealing with difficult feelings, that they may feel like they are getting worse before they start to get better. Try to remember that this is a very positive sign, and that it indicates that necessary work is taking place, that deeper issues are being addressed. It is very important that you see your therapy through.

Hopefully, I have managed to de-mystify psychotherapeutic sessions and what you can generally expect. Therapists may vary in their methods but the above is a good guideline of what to expect from an Integrative style therapist (a therapist who is trained in and able to use several therapeutic approaches simultaneously).

I’ll finish with a word of encouragement. Therapy sessions can feel very challenging. Working on things that have been getting in our way and impeding us for much of our life you from having a more fulfilling life are, by their nature, not generally going to be straight forward. You may well feel like giving up because of how difficult it sometimes feels, but please try to remember that the difficult and challenging moments are signals that you are doing some vital work, that you are touching on amazing opportunities to grow, to change. Your therapist will be there with you to help keep you anchored and safe, to help you unravel those knots and to understand them and how they formed. Allow yourself to be brave in the knowledge that you are changing your life for the better.

I wish you well. Have a peaceful and fulfilling life.

David