You can read up on the different types of therapy to see if one appeals more than another, but if you like what a therapist says about the way he or she works and if you have a brief phone chat with them, you will have a pretty good idea. Most therapists, especially experienced ones, will use elements from a number of approaches flexibly, as appropriate, always keeping your agreed goals for therapy in mind. And after a couple of sessions, you will know. A therapist should ask what you are hoping to get out of therapy and give you a good idea in a first session what working with them would be like. Don’t hesitate to ask any questions you may have, about the therapist, the approach, your work together, or to specify what you would like – throughout therapy.
It is quite likely that whatever you find difficult in dealing with people sometimes will also show up in the therapy room. That’s ok, even helpful. You can then say, “this is the kind of situation I get into” or “this is the feeling I get when…” Your therapist is on your side, not trying to catch you out: they want to help you and show you that it’s possible to have uncomfortable feelings and still carry on with what you intended to do – inside the therapy room and outside. A lot of people worry before I first session, how on earth am I going to start explaining what’s been going on, how I am feeling, will the therapist “get” me? And it doesn’t matter exactly where you start or how the first words come out – there are lots of ways into the heart of the matter, and you will get there, and your CBT or ACT therapist will guide you with questions if appropriate.
No, it doesn’t mean that. In ACT and CBT therapy, the question is, what you want to be able to do (or stop doing) that you are holding yourself back from because of difficult thoughts and feelings? Whether your issue is hoarding, post-traumatic stress or bipolar disorder you will very likely experience unpleasant emotions if you try to break out of your old habits. Therapy helps you to manage these in new ways so you can act in line with your values (= be who you want to be), no matter what the label, diagnosis or storyline in your head may be. To use a specific example, the strategies and skills that help with an addiction to alcohol are very similar to those for binge eating. A fear of sweating can feel like a random affliction, but it’s probably rooted in a fear of negative judgement, as is spending too much time checking and rechecking your emails before you send them.
No, it doesn’t mean that. People often present for psychotherapy more than once in their lives. In any case, we are always “works in progress”. It may be that you were helped through the aftermath of a specific difficult event in your life but now need other or more general skills, or that you didn’t get to an insight of how important the way you respond to certain feelings is in the process of change. Your therapy may not have been very focused, or you may not have carried any new learnings through into your everyday life. And different people get on better with some types of psychotherapy than others. I specialised in CBT and ACT because I found that clients are more likely to derive lasting change from these – philosophical change, a different outlook and approach to life’s challenges.
Most people ask this, and it’s difficult to answer because everyone is different. If you are motivated and can dedicate some of your time between sessions to following through with what we discuss in therapy, you are highly likely to experience change faster than if you come to each session not having thought about it since the week before. You may find six, twelve or eighteen sessions work for you – but some people have fewer or more than this (and they don’t have to be multiples of six either).
Usually once a week at the same time, though some clients come fortnightly after the first few sessions. It’s good not to have long gaps in between sessions, to keep the momentum of change going and share any observations and concerns in your process with your therapist relatively quickly or your old habits will be harder to shift.
It would help if you had a think about what you are hoping to get out of psychotherapy. If you had a number of sessions and they work really well for you, what would you be doing differently as a result? People often initially say in response to this, “I would not be so anxious any more. I would be happier. I would feel so different!” But think behaviour. What would a camera see you do differently if therapy worked for you? Would you give people more eye contact? Would you pick up a hobby that you love, or get in contact with old friends? Would you be more assertive at work? More patient with your partner or child? These things are more measurable than happiness. If appropriate, you may receive a couple of forms to fill in before your first session, about how you would define the biggest issue or challenge you are facing, what thoughts you get entangled with, some of the background to your life. Some people like preparing a lot before their first session – and it can save time in terms of the number of sessions you have – others would rather turn up and start from there. Either is fine. If you have a referral letter from a doctor, it would help if you brought that.
At least part, in some cases all of a first session can be taken up with assessment. Why are you seeking therapy now, what is your background leading to this, do you feel at risk in any way, what – if anything – have you tried before, what are you hoping to get from the sessions. CBT and ACT therapists aim to have their clients leave each session with a new insight or experience of how something in their life works, and at least one small step in the desired direction, a relevant task to be carried out before the next session. The relevant task could be reading something, observing your reaction to a certain type of situation or behaviour, mindfulness exercises to do, or doing something differently. You may not notice the way you feel changing quickly: feelings tend to change last. The way you view feelings, the way you respond when they show up can change quite fast if you’re willing to try something new!
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