BLOGGING BEHAVIORAL



LISTEN IN AS AN AUSTIN PSYCHOLOGIST TALKS ABOUT CBT - COGNITIVE BEHAVIORAL THERAPY

May 11, 2009

first session: what to expect

Clinician's differ to some degree, of course, but the first session is generally part "getting to know you" and "getting you to sign paperwork."

After the initial forms are signed, very often therapy begins with me explaining a little bit about my practice, my theoretical orientation, as it's called, which means the type of therapy I use in treating patients. I suggest my clients Google "Cognitive Behavioral Therapy" or CBT to learn more about my approach. A well informed client often has a head start in healing. I encourage questions throughout our meetings.

Then I move on to asking for a brief description of the "presenting complaint." What problem area brings the client into therapy?

The moment we've all been waiting for.

Sometimes I get pieces on the phone but will want to hear about the therapy issues in greater detail. This is where the box of tissues might come in handy.

From there I begin an evaluation that could take one to three full sessions.

I like to get the following, give or take:

- a history of previous therapy, counseling and psychiatric visits; what felt helpful; what didn't

- medical history including prescription medications, over the counter, nutritional supplements

- family of origin including history of mental illness

- education and work history

- relationship history: who have been the most significant romantic relationships and friendships

- trauma history

- current symptoms

- expectations and preferences for treatment; for example, individual (one on one), couples or family therapy; this could also include specific therapy expectations, such as a request for dream analysis or stress management skills

Not all mental health clinicians will begin this way. I cannot speak for all therapists, but most psychologists (who must have a Ph.D. in a psychology field as well as a list of other requirements) have been instructed (or should have been) to be thorough in assessment, diagnosis and treatment planning.

If you are contemplating starting therapy and wonder what you can do to help move things along, thinking about your family history can be a plus. Many people prefer to keep their therapy quest private and that's understandable. But filling in the blank spots of the "who's who" in your family of origin can help the therapist in the diagnostic process. Any parents, grandparents, aunts, uncles, siblings, cousins who have been diagnosed with a mental health condition? Someone who has been prescribed psychiatric medications? Antidepressants? "Nerve pills?" Has anyone had a "nervous breakdown," an unofficial term that can range from a depressive episode to a psychotic break? Blank spots are not uncommon and can be worked around.

The important thing is showing up, being yourself, asking questions, thinking about goals, being willing to consider recommendations, and trusting that this can work, that you can find a caring, listening, non-judgemental ear, and ultimately you can feel better.