Dr. Eileen Callahan, Ph.D.: What to Expect from Therapy

The Structure of Therapy

The First Session

The first session or two of therapy is typically spent gathering information. The therapist will likely have the client fill out some forms that include basic demographic information and insurance information. Some therapists also have the client fill out forms that ask questions about history and presenting problems. Typically, the first session starts with the client discussing what brought them to therapy. The therapist will ask questions about history, medical issues, medications, current life stressors and current symptoms or problems. At the end of this information gathering, oftentimes, the therapist and the client will identify specific goals for treatment. If applicable, other options for treatment will be discussed at this time as well. This is an appropriate time for clients to ask questions as well. It is useful to ask the therapist questions about their training and experience as well as their theoretical approach to therapy.       

Treatment sessions are generally on a regular weekly basis, and last approximately 45 minutes to one hour, depending upon the therapist and the type of therapy.  The length of treatment varies from person to person depending upon the issues they are dealing with and the desired outcome of treatment. After a few sessions, a therapist should be able to give some rough estimate of the probable length of therapy.

Confidentiality

Most of what occurs and is spoken about in therapy is confidential. A therapist cannot reveal what is discussed in therapy to a family member or anyone else who may want to have access to the information. There are, however, some basic limitations to this general rule.  Confidentiality must legally be broken if a client expresses intention to kill themselves or someone else.  In such cases, confidentiality must be broken in order to ensure the safety of the person involved. In addition, if a client reports incidents of child abuse, elder abuse, or abuse of a disabled adult, this information must be reported to the authorities in order to ensure safety. 

If there is court or legal involvement, there could be some limitations to confidentiality as well. This varies from situation to situation and is best addressed directly with the therapist. Finally, if a client uses their health insurance to pay for their visits, there are some limits to confidentially. The insurance company often asks for basic information such as diagnosis, type of therapy conducted, treatment goals, and progress in therapy in order to pay for the sessions. This also varies from insurance company to insurance company and is best addressed directly with the therapist to determine what is true for your insurance coverage.

Confidentiality between minor clients and parents is another issue that may vary from situation to situation.  Most therapists will inform children, adolescents, and parents that what the minor reveals in therapy will remain confidential between the therapist and the minor unless there are safety issues involved or the minor gives consent for the information to be shared with the parents. This is typically done to help build an alliance and trust between the therapist and the minor. Different circumstances will warrant varying degrees of involvement by the parents and thus, should be addressed directly with the therapist.

Difference Between Friendship and Therapeutic Relationship

The therapeutic relationship is a unique one. In some ways it is like a friendship, but in other ways it is very different. The therapist’s role is to listen to and be supportive of the client. In this regard, it is similar to friendship. However, the therapist usually does much more than that.  The therapist will use their education, training, and experience to help the client grow. They will often gently challenge the client’s position or beliefs in order to help the client see things differently and hopefully behave or feel differently. They also often educate the client about situations they are dealing with or positive coping skills they can use to manage their frustrations.

Another difference between friendships and therapeutic relationships is the one-way-nature of the relationship.  Although clients will rely on the therapist for support and will discuss personal details about their life, the therapist will typically not reveal much of themselves or their lives to the client. Different therapists will vary as to how much personal information they discuss with their clients.  Oftentimes when a therapist does reveal personal information it is done with the intent of helping the client in some way. If therapy sessions ever seem as though there is more discussion about the therapist than the client, there is something wrong. This is not what psychotherapy is supposed to look like.

There are more boundaries in a therapeutic relationship than in a friendship. There will be certain rules about when and how a client can contact their therapist. There is not the typical exchange of gifts or gestures that friends would engage in. Additionally, there is rarely in-person contact outside of the office. These are general rules, however, and there are certainly exceptions at times and differences between various therapists.

The reason for all of these rules and boundaries is so that it is always clear that the therapist’s purpose is to help the client and the client does not have to worry about the therapist and his or her issues. The lack of further involvement in the client’s life also helps the therapist remain somewhat objective and therefore, better able to help the client.

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