Chai Time Ruminations

Thinking about therapy for yourself or a loved one? Here’s a brief on what to expect from the therapy sessions.

Therapy is a collaborative process where you work with a trained mental health professional to understand your thoughts, emotions, and behaviours. A therapist helps you explore why you may be feeling the way you do and guides you in discovering effective coping mechanisms. If more severe concerns indicate a mental health issue or an ongoing disorder, they will use proven, evidence-based psychotherapeutic techniques to help you recover.

It’s important to remember that not every sign of distress or discomfort is indicative of a mental illness. I like to explain this using a simple example: mental health exists on a continuum, with mental illness at one end and mental wellness on the other. 

Sometimes, you might be somewhere towards the mental illness end but it may not be severe enough for a diagnosis. This means there might be early signs of deteriorating mental health, and you may wish to address them before they worsen and develop into an illness. 

Therapy is a form of treatment aiming to help you address mental health concerns. Beyond treatment, it’s also a space where the therapist uses their knowledge to help you understand yourself or develop coping skills to prevent the development of any severe illness and address present challenges.

So, what happens in a therapy session, especially in individual counseling sessions or 1:1 counseling sessions? (The framework below is what is typically seen within individual counseling, especially with adults. Couple counseling or group therapy may follow a slightly different framework for sessions).

For sessions with children (below 18 years), the outline may be similar, but parental consent is necessary, and the session may include more tools of expressive modalities (play, art, movement etc.), rather than just talk. If necessary, a collaborative approach between different proficient specialists, like a speech therapist or occupational therapist, might also be involved.

The Initial Sessions

Therapy begins only after consent for sessions is provided. Individual therapy sessions involve you and your therapist (If with children, the therapist may require the parents’ inputs or even other stakeholders’-teachers, caregivers’ view of presenting concerns). In the first few sessions, your therapist will gather details about your history and the concerns that brought you to therapy – often referred to as the “presenting problem.” During this phase, with your explicit consent, the therapist may also seek input from someone close to you to gain a fuller picture of how the problem is affecting you.

You and your therapist will then collaborate to define your goals and expectations for therapy. A few immediate strategies to help you cope might also be discussed. Your therapist may also recommend a few psychological assessments or suggest consulting a psychiatrist if they believe it would further help with your presenting concerns.

Privacy and confidentiality are key within the therapy setup. Your sessions are a safe and private space. However, it’s important to understand that in cases where there is potential harm to yourself or someone else, the therapist is legally required to break confidentiality. Your therapist will discuss these limits with you during your initial sessions.

Following Sessions

In the sessions that follow, the therapist may use techniques from different therapy modalities (such as CBT, REBT, Gestalt, Expressive arts etc., as per their expertise) to address your presenting concerns. The therapist may also suggest “homework” (don’t worry, not the school kind!). These are usually reflective exercises or practices to try between sessions, designed to reinforce what you’ve discussed and help you apply new skills in your daily life.

If significant progress isn’t being made as per your goals and expectations, and if the therapist deems that you might benefit from a modality another therapist practices, or you may require further support from different professionals such as a psychiatrist; they could also make a referral. 

This is natural and healthy, as it ensures you get the best and most appropriate treatment for your presenting problem. (It’s natural, remember how sometimes your general physician may treat you for specific problems, but if they sense something more complex, they may recommend you to a specialist.)

Concluding therapy session

Sessions may wind up as significant progress is made, often by tapering off gradually. This means reducing the frequency of sessions as you feel more confident and equipped.

How long does one require therapy for?

Any form of treatment follows a pathway: identifying the issue, exploring treatment options and practices, and checking progress. If it works, you can reach out whenever required; if not, you may need treatment for a longer period.

Similarly, in therapy, the number of sessions depends on the presenting problem, the therapy modality the therapist uses, checkpoints for improvement, and the further plan of treatment. Sessions might range from 4-8; 8 or more, or even extend over the years. If you’re worried about the duration, remember that treatment for any health concern has its own course; sometimes it’s shorter, while in other cases, it might require check-ups and yearly follow-ups, depending on the nature of the challenges a person faces. It’s always best to adhere to the plan that is collaboratively made with your therapist.

If your goals have been met and you feel stable and well-equipped, therapy may begin to taper off. Some clients transition to occasional check-ins, while others might return only when necessary. Therapy is flexible, you don’t need to be in crisis to benefit from it, and you’re always welcome to return if new challenges arise.

P.S– As a client, if you feel your therapist is not the right fit for you, you can, at any point express the same to your therapist and also change your therapist to find the best one that you feel matches with what you are seeking for.