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What to expect in psychotherapy?

Whether it is your first, or tenth time, starting therapy with a new psychologist can be quite anxiety provoking for most! I hope this article can help by shedding some light into the oh-so-mysterious psychotherapy process.


Note: There are some differences in how different psychologists would conduct their sessions, hence I can only speak for myself. :) At Talking Therapy, I would categorise our psychotherapy journey into 3 broad phases: Assessment, Formulation, and Intervention.


Phase 1 - Assessment - "It sounds way more intimidating than it really is"

In many ways, psychological assessments are similar to medical diagnostic tests; If a patient experiences a persistent fever, a doctor may order for X-rays or blood tests to understand what's causing it. In psychotherapy however, a client's persistent feelings of worthlessness is best understood in context of their lived experiences, including their family background, childhood experiences, interpersonal relationships, coping strategies, how they perceive themselves, others, and the world at large. It may sound like a lot, but I will take the lead in this and guide you through this process. It often feels like a no holds barred conversation with a new friend.


Although baring your heart to a stranger may not sound like the best way to spend an afternoon, many clients have expressed relief at being able to talk openly, for the first time, about their fears, dreams, and experiences in a safe environment with a supportive and non-judgmental professional.


In many ways, I believe this is the first step of healing.


Phase 2 - Formulation - "At some level, it all makes sense"

One of my all-time favourite pictures of psychotherapy


Formulation is a key competence required of psychologists across many jurisdictions. It approaches human distress with the assumption that "at some level, it all makes sense". Simply put, it aims to create meaning of seemingly chaos and despair.


Formulation is defined as the process of co-constructing a hypothesis ("best guess") about the origins of a client's difficulties, in context of their relationships, social circumstances, life events, and the sense that they have made of them. When done well, it weaves my professional knowledge and competence with your story, including the meaning and impact of important relationships and circumstances. This allows us to get beneath the surface to understand the origins of these persistent feelings of worthlessness, how and why it waxed and waned over time, its triggers, what maintains it, and how it has impacted the client's life.


More than an intellectual exercise, formulation often helps make sense and validate the client's pain and suffering. "I'm not crazy/stupid/useless/defective for experiencing these difficulties". Just like how the doctor who can prescribe effective medications once he has identified the underlying cause of the fever, we can now move into an individualised treatment plan consisting of evidence-based therapeutic interventions.

Phase 3 - Interventions - "I am who I choose to become"

In psychology, there are many sub-branches of therapy, each emphasising different targets for treatment: Cognitive Behavioural Therapy. Person Centered Therapy. Psychodynamic Therapy. Psychoanalytic Therapy. Solution Focused Brief Therapy. Schema Therapy. Dialectical Behavioural Therapy. Interpersonal Therapy. and the list goes on...


But how do you know which therapeutic method will work for you?


Psychotherapy is often referred to both an art and a science. The most appropriate therapeutic methods for a client are determined by multiple factors: My clinical experience will help integrate the best available research evidence with my client's personal characteristics to develop an intervention plan that best meet his or her unique needs. Hence, 2 clients with the same presenting issues (psych term for what brought a client into therapy) of worthlessness may benefit from different therapeutic modalities. I will discuss this with you, and regardless of therapeutic modalities, we will work collaboratively towards your goals and desired outcomes.


No two psychotherapeutic journeys are the same. To support you in taking the first step in your therapeutic journey, I offer a complimentary first session for all new clients.


P.S. For more information about how psychotherapy works, I also love this video by the School of Life.


References:

American Psychological Association. (2005). Report of the 2005 presidential task force on evidence-based practice. Washington, DC: Author.


American Psychological Association (2020). Understanding psychological testing and assessment. Retrieved from https://www.apa.org/topics/psychological-testing-assessment


Butler, G. (1998). Clinical Formulation. In Bellack, A. S., Hersen, M. (Eds.), Comprehensive clinical psychology (pp. 1-23). Oxford, England: Pergamon.


Johnstone, L. (2017). Psychological formulation as an alternative to psychiatric diagnosis. Journal of Humanistic Psychology, 58(1), 30-46.

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