Getting the Most Out of Psychotherapy
Stages of Psychotherapy
Like any relationship, psychotherapy can pass through stages of getting acquainted, becoming more deeply involved, and eventually, ending. I am not the only one to envision the stages of psychotherapy as 1) initial contact, 2) evaluation, 3) early treatment, 4) deepening, 5) working through, and 6) termination. There may be occasional breaks from therapy when either party goes on vacation or some life circumstance necessitates a pause. I describe these stages to help new clients recognize where they may be in the process as it unfolds.
Initial contact is what it sounds like, a phone call, an e-mail or other communication in which the therapist responds, so therapist and potential client start becoming acquainted and can decide whether a first meeting is a good idea.
The evaluation may last a few sessions and includes the first meeting. Here, client and therapist see if they can agree on therapy goals. More importantly, clients determine whether they feel a personal chemistry with the therapist that encourages him or her to speak openly and work collaboratively. During this stage, the therapist conducts an initial assessment of the client’s needs and psychological condition to determine whether the therapist is sufficiently trained in meeting those needs, including any apparent psychopathology. It is the therapist’s ethical responsibility to acknowledge if at least some of the client’s needs lie outside the therapist’s scope of practice. In this case, the therapist provides referrals and may or may not continue treating the client for those aspects that lie within the therapist’s areas of expertise. As evaluation proceeds, the therapist recommends a treatment plan.
During the early treatment stage, client and therapist get to work on the issues at hand and apply the initial treatment plan. Goals and treatment are further specified as both participants experience the results. Re-evaluation and adjustments to treatment can occur throughout the course of therapy.
The deepening phase may not occur in brief therapy. However, in medium- and long-term therapy, the client’s attachment issues come into play as primitive aspects of the mind respond, as described above. If deepening does occur, therapy has the potential to gain power, stall or fail. This is the stage where a person usually feels worse before they feel better. It is here where one realizes that achieving personal change in psychotherapy involves facing more intense emotions than one usually does. The avoidance of such emotions or failure to limit them to appropriate situations is what causes the symptoms that motivate people to seek therapy.
Termination follows a successful course of therapy, with the agreement of client and therapist, and is not the same thing as quitting therapy against the therapist’s recommendation. To be successful, therapy does not need to reach overly ambitious goals, especially in brief therapies where the goal is to alleviate specific symptoms. Therapy that aims at more fundamental change usually takes longer than 5, 10 or even 20 sessions. Even here, the person may be ready at this life stage to achieve a significant change and leave therapy temporarily, resuming later when time, budget, life circumstances and emotional resilience allow.
Sometimes clients will transfer to another therapist with a different type of expertise for the next stage of growth. For example, someone who has undergone successful cognitive therapy for depression may want to do in-depth dreamwork for personal growth that extends beyond controlling depression symptoms. It’s best if such a transfer occurs after successful termination of an earlier course of therapy, and not as an escape from therapy if a client is challenged to undertake significant changes.
“Why Do Therapists Ask Those Types of Questions?”
The types of questions therapists ask have become a cliche in movies and television shows. The most typical one is “tell me about your mother.” Okay, okay. Sometimes we’re guilty of asking such stereotypical questions. But why is this so? And is this our total repertoire?