Psychotherapy can facilitate a movement from unconscious reenactment of distressing experiences to becoming consciousness of our unhealthy patterns of behavior. Understanding of our behavioral patterns provides us a choice about how we want to act in the present and future. Awareness is the first step toward positive change. Acceptance and compassion for ourselves is the foundation of being able to love and have compassion for the people in our lives. It is possible to heal our original relational wounds and learn how to better handle repetitive situations in order to put an end to a destructive cycle.
Most of the people I work with are concerned about the quality of their relationships. Some are individuals who seek to improve the relationship with their partner, child, family members, and work colleagues. Others come for couples counseling to heal and change the repetitive and conflictual patterns that threaten to destroy their bond with their partner. Below is an outline of my usual approach to therapy sessions.
DISCUSS GOALS FOR TREATMENT
During the initial assessment phase, it is important to collaborate on the goals of treatment. This helps keep the treatment focused and productive. Without goals, therapy can end up focusing on whatever problem is coming up that week and can interfere with progress of the original presenting problems. Sometimes, the patient may not be able to specifically describe a goal except a vague "I want to be less anxious" or "I want to feel happier". This is fine at the beginning. However, over the first couple of months, you should return to this discussion about goals to see if they can be described in more specific terms.
For example, if someone presents with depression, the goals may include the following: Finding a more fulfilling job, returning to college, exercising three times a week, making two new friends, and stopping the use of marijuana.
START EACH SESSION WITH AN AGENDA
Every session should start with an agenda that is discussed collaboratively between the therapist and the patient. Again, this helps to keep the session focused and more effective. The agenda should include following up on homework from the previous session, a check-in about the mood and week, bridging or reviewing the topics and progress from the previous session, and topics related to discuss in the current session that is related to a specific goal.
DISCUSS WHAT GOALS TO WORK ON
Most therapy goals will have several components including distorted thoughts, beliefs or behaviors. Thus, during the session, collaboratively decide on which level to address the goals. For example, if we are working on distorted thoughts, it is important to elicit what thoughts or images occur that are leading to your distress, such as anxiety, low mood, or blocking a certain behavior. If you are working on certain behaviors such as social skills or relationship issues, it is important to discuss when the skills will be used and how likely it is the skills will be used. Another useful technique for addressing behaviors is role playing and visualizing which helps to practice the skills and address any blocks or anxieties around the behavior.
At the beginning of treatment, goals for therapy are discussed. Sometimes, the therapy session may head in a direction that is unrelated to any of the goals of treatment. This is appropriate at certain times, but if this is happening every session and for the entire duration, then there can be a limit to the progress of therapy. This would be a time to collaborate to discuss whether to continue on the current diversion or issue that is being discussed or go back to what was discussed in the agenda.
Towards the end of each session, a collaborative discussion takes place about homework or "action tasks" to perform between sessions. An action task might be to buy a calendar if one of the issues is time management or recording thoughts and images that occur during stressful periods in a notebook to discuss and address at the following session. Always make sure to follow-up on the homework or action task at the next session or it creates the impression that working on problems or goals in between sessions is not a crucial part of getting better.
Towards the end of the session, I ask what went well during the session, what could have gone better, and what the main take-away messages are. This helps to build the alliance, improve future sessions, and maximize progress.
If I can be of help or you have any questions please feel free to email me at thomkesslertherapist.com or call 415-454-8931.