Individual Therapy
Therapy can be an intimidating, stigmatized, and even mythical process – one that’s often dramatized for entertainment in popular culture or talked about in sweeping generalities. For those reasons, and many others, going to therapy can feel overwhelming and scary. While each therapist’s approach varies, my hope is to take some of the mystery out of this process so that clients can develop a felt sense of safety around general expectations of our time together. I always encourage clients to ask questions, pause any interactions they’re not comfortable with, and I try my best to incorporate ongoing informed consent into our activities.
One common fear about starting therapy is the uncertainty of what a therapy will ask of a client in session. But I feel it is counterproductive for me to try to catch a client off-guard or do something in session without their permission. While some our work may include growing their “window of tolerance” for stepping outside of their comfort zone, it is imperative that everyone feels safe enough to take a risk to try something new!
What is individual therapy?
Individual therapy consists of regular, one-on-one sessions between myself and the client that last about 50 minutes. Depending on the age, developmental level, and goals of the client, each session may look a little different.
First session – Intake
No matter what age, the first session will always be an “intake.” This is a time where I’ll get to know the client and identify what brings them into therapy. It’s also a time for the client to get to know me, ask any questions they may have, and get a feel for our dynamic together.
If the client is a minor, this session will happen with both the client and their caregiver so I can get an adequate history of the client’s life from their perspectives. I will also spend some time with caregiver one-on-one so they can disclose any relevant information that may not be appropriate for the client to hear at that time. While I am not the caregiver’s therapist, it’s important for me to know about any of their own history around significant family dynamics, trauma, and diagnoses that could be affecting the client. Caregivers are NOT obligated to disclose any information to me they aren’t comfortable sharing. Our conversations throughout treatment will be ongoing, and I understand we need to build a level of trust in our relationship before sharing personal information. There may also be things that don’t seem relevant until later in treatment that the caregiver discloses as it comes to mind. I am bound to confidentiality, and anything shared in private between myself and the caregiver will not be shared in session with the client or with anyone else, such as another caregiver who may be involved in the therapeutic process. This is also a good time for me to share referrals for the caregiver to seek their own treatment if that's something they are looking for.
My code of ethics also requires me to keep anything a minor client says during our one-on-one time confidential, which means I will never share specifics of what we discussed during session with a parent or caregiver unless I have the permission of the client, or they disclose that they are considering harming themselves, someone else, or that they have experienced neglect or abuse that needs to be reported. However, in those situations, I will always let the client know that I am sharing that information with the appropriate adult(s) who are there to keep them safe.
For all clients, during this session we will identify some initial goals for treatment based on their reason for starting therapy. These goals can and will change throughout our time together!
First few sessions – identifying the threads
As we grow, we are not only person that exists in that present moment, but the sum of all the people we have been over the course of our lives. Depending on the client’s age, we’ll spend a few sessions beginning to identify the threads that have come together to weave the client’s life as it stands in that moment. For me, that often includes creating a genogram (like a family tree) of the client’s family system, as well as any other people or communities that have a significant influence on the client’s life.
Ongoing sessions – untangling and reweaving
As we move forward with treatment, sessions will include a variety of interventions based on each client’s needs. For young children, that may look like incorporating a lot of imaginative play, making art, reading books, or engaging in structured games to process events and learn new skills. It will also include some family sessions with the caregiver(s) and/or siblings. Read more about the process of family therapy here.
No matter what age, we will incorporate psychoeducation, which is just a fancy word for learning about things like conflict resolution, boundaries, how our brains work, emotional regulation skills, emotion identification, relationships, secure attachment and more.
For older clients, we will incorporate more verbal processing (what we think of as traditional “talk therapy”) into our sessions. However, I still find mindfulness, sand tray, art, and other experiential interventions can be helpful.
Therapeutic process and change
It’s important we meet on a regular basis, typically weekly or bi-weekly the first few months, so that we can assess over time what’s working, changes occurring, and any progress or setbacks. Once some initial goals are met, we can reassess the frequency of our sessions.
It’s also important to know that things always seem to get “worse” before they get better. Healing and change are not linear and can often feel painful. I liken it to deep cut within the skin. Most of us are simply putting a band-aid on because the cut might be too scary or overwhelming to look at, especially on our own. But not addressing the wound leaves it vulnerable to infection and significant scarring. Cleaning and tending to the wound day after day is likely going to hurt at first – we're uncovering all the stuff left to fester. It may also feel tedious to clean and change the bandages regularly, maybe utilizing some new skills that aren’t quite second nature yet. But over time, the wound is able to heal. There may still be some scarring, but it no longer has a significant impact on day-to-day life.
For kids, this may look like an increase in “unwanted” behaviors or emotional dysregulation. For all clients, it may show up as a sensed increased in symptoms like anxiety, depression, overwhelm, relationship issues, and more. I ask all clients to remember that it may not be that these things are happening with more frequency and intensity, but that we are now paying attention to them with an increased sense of awareness so they can be addressed.
Wherever you are in your therapy process is the right place to be. Whether you found this post in the discovery phase because you are curious about therapy, or you have experienced therapy before and want to learn more, I congratulate you on your bravery and willingness to take a step, however small, toward healing and growth.
