Considering the demands of modern living and the difficulty with maintaining balance in our lives, it is not unsurprising we are faced with several mental and stress-related disorders. For our mental wellness, it is imperative we improve our capacity to cope with the many life stressors. Importantly, recognize the impact of psychological distress on our well-being.
Sitting with a stranger to discuss your personal problems may seem nerve-racking, so you delay seeking care due to concerns about divulging your deeply held secrets. After much deliberation, you decide you are ready to seek help from a therapist. But you remain skeptical about therapy and if another person can understand your situation without judgment.
The work of a therapist is guided by a code of ethics. For example, the American Counseling Association (ACA) code of ethics lays out best practices for the therapist to follow honestly, ethically, and professionally. Section A.1. of the ACA code of ethics addresses client welfare. Specifically, subsection, A.1.a. states, "the primary responsibility of counselors is to respect the dignity and promote the welfare of clients."
The initial appointment:
Depending on the counseling practice, your initial appointment is like a visit with a new primary care physician. You arrive at the office while in the lobby; the front desk staff will likely present you with paperwork to be completed and signed before the start of your session.
The paperwork may include a request for your demographic data, consent to treatment, confidentiality agreement, the privacy of your counseling record, insurance information, the release of information, and a brief screening questionnaire of your mental health history. The paperwork is completed and returned to the front desk staff.
You are now sitting with the therapist. There is an introduction, the therapist reviews the consent to treatment and your confidentiality agreement. In addition, the therapist should inform you of the limitations to confidentiality and the situations in which confidentiality might be broken. For example, if you are an imminent danger to yourself and others, the therapist has legal "duty to warn" the potential victim.
Per the ACA code of ethics, clinicians should inform you of the following:
Their qualifications, credentials, relevant work experience, and approach to counseling.
How your records will be safeguarded.
Explain the nature of all services to the client.
You have the right to review your counseling records.
Once the therapist begins the initial interview, the aim is to understand from you:
What is your presenting problem? The reason you are seeking therapy.
What are your symptoms?
How frequently do you experience these symptoms?
What is the duration of your symptoms?
What are the precipitants to your symptoms (recent life changes)?
As stated previously, the therapist will share the specific theoretical orientation and technique to be used in therapy. For example, the therapist may have extensive training in cognitive-behavioral therapy (CBT). Or, the therapist may have training in several theoretical orientations and use an eclectic theoretical approach to include concepts from CBT, Solution-Focused Brief Therapy (SFBT), Narrative Therapy, Rational Emotive Behavioral Therapy (REBT), or Reality Therapy among others to work with you. The purpose of therapy is to assist you with developing a repertoire of behaviors to cope with your stressors, restore your mental health, and functioning.
Based on the therapist's theoretical orientation, you may have homework. The assignments will apply to your symptom presentation. For instance, you are being treated for anxiety, you may be assigned a worksheet to practice identifying your anxiety-producing thoughts and an alternate rational counterstatement for your anxious thoughts. Or a Thought Log that documents:
The event that produces anxiety,
Thoughts that follow the anxiety-producing situation,
The consequence of the thought, and
What is an alternate response for the thought associated with the anxiety-producing event?
The initial session is an opportunity for you and the therapist to develop a therapeutic alliance and collaborate on meeting your treatment goal. The therapist will not be doing therapy on you. Instead, the therapist will be working with you to address your presenting problem.
In the follow-up sessions, the therapeutic work begins the opportunity to improve your functioning and reduce your stressors. Specifically, get you closer to your preferred future. For instance, the therapist will begin the follow-up sessions by asking "what's gone well since the last session" or some variation to track your progress. This question is particularly crucial as you learn to adopt a problem-free narrative on your journey to personal growth.
If you find you are having difficulty connecting with the therapist, you have a right to terminate the counseling relationship and seek another therapist you think is a better match.
This is an overview of what to expect as you begin therapy or think about seeking therapy. However, if you are already in treatment, this may not have been the approach your therapist employed, but it does not mean your therapist is not using best practices. It could mean the therapist's practice is not streamlined in the manner expressed in this post.
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