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What clients might expect to happen in therapy depends on the nature, severity and duration of their problem and on the goals that the client wants to achieve from therapy. Pactical limitations such as how many sessions a third party, eg, Medicare or Workcover, are willing to provide, or how much money an individual has available to invest in therapy can also affect the course of sessions.
Some clients may just wish to discuss a problem or a major life decision that they currently face. In such an instance, this can be commenced almost immediately in the first session, and may require no more than two or three sessions before sufficient progress is established. .
Others may present with sufficient daily distress and unpleasant emotions (e.g., low mood, anxiety) that a formal psychiatric diagnosis may be present (e.g., major depressive disorder, generalised anxiety disorder). In which case the first one or two sessions are spent undertaking a comprehensive biopsychosocial assessment that looks at the biological, psychological and social aspects of the complaint before deciding what diagnosis or diagnoses may apply. Making the correct diagnosis is vital as this affects the selection of the best treatment approach to follow.
As part of this assessment process, you may be asked to fill out some questionnaires either in-session or as homework tasks to be handed in at the next session. Some questionnaires may be repeated at a later date to help your therapist monitor how you are responding to therapy and to guide what topics future sessions might focus upon.
The assessment process also includes the therapist determining if a psychological approach might be of benefit for the patient's presenting complaint, and also the patient deciding if they feel comfortable and safe enough with the therapist to continue working on their problem(s) at subsequent sessions.
Sometimes people wonder whether therapy will be beneficial for them. One option is to take part in a trial of four or five sessions and then make a more informed decision as to whether to proceed further with therapy.
At the start of each session clients are invited to put onto the agenda for the session any issues they may wish to discuss or work on. The therapist will also make some suggestions too.
The first step of treatment is often educational in nature. Psychologists call this process psycho-education. This educates clients about the nature of mental health problems. This may include providing clients with certain reading materials to be read between sessions. Often a model or step-by-step diagram is developed to demonstrate the various parts of the problem and how they interact to cause - and maintain - the client's problem in their life. Such models also act as a guideline for planning treatment sessions.
The real work of therapy begins, by teaching the client to become more aware - to observe - their thinking patterns and the effect this has on their subsequent moods and behaviours (or lack of behaviours). This is achieved in sessions by exploring recent examples of occurences in the client's life that were associated with unpleasant emotions. Learning to record such instances methodically is demonstrated and clients are then encouraged to complete as homework a few examples from their daily life before their next session.
It is strongly recommended that clients will need to undertake homework or practice tasks between sessions as changing unhelpful thinking and harmful behaviours is not easy and that learning new patterns of thinking requires considerable practice before it becomes natural and automatic. In this way, therapy is an active process (as opposed to passive therapies that are largely confined to talking only). As learning any new skill takes time and practice, difficulties and the need for refinements are to be expected, and can be discussed in subsequent sessions with your therapist. Clients are asked to bring their homework sheets along to all sessions.
Then begins the process of clients learning to identify their thoughts and associated moods and behaviours. As therapy progresses, clients are taught to re-evaluate - to challenge or reality check - their thoughts to help them reduce their experience of inappropriate negative unpleasant emotions.
Towards the end of therapy, when clients believe they have made significant progress towards their goals, relapse prevention is covered. Relapse prevention helps clients recognise their early warning signs which indicate clients mental state is slipping back towards their old complaint.
When clients have reached their goals, a time will come when they start to consider no further need for therapy, in which case they may sack their therapist - that is you chose to cease therapy.
Understandably, clients may feel vulnerable at the conclusion of therapy. Consequently, clients have the opportunity to take occassional booster or maintenance sessions if they wish.
As a rough guide, many established psychological interventions involve between six to tweleve sessions (e.g., for anxiety and depression), while therapy for personality issues takes considerably longer. Sessions are best spaced about a week apart to ensure both therapist and client stay focused on the treatment goals and maintain sufficient forward momentum between sessions. Clients on a tight budget my find sessions spaced fortnightly are sufficient. Sessions typically last 50 to 60 minutes.
Note, it is your right as a client to end therapy at any time if you wish - although it is requested you give a minimum of 24 hours notice of any intention not to attend an appointment, otherwise a cancellation fee may apply.
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