I always offer a no-obligation assessment session in the first instance. I think it’s essential. Amongst many possible conversations in the assessment we will talk about your history as well as your present circumstances, what you are looking for in a therapy and whether that can be achieved in a therapy with me. Such conversations lead to the question of whether we are looking at what is classified as a “brief” or “time limited” therapy, or whether it’s more appropriate to begin a longer term, “open ended” therapy. It’s a decision we make together, and one that we don’t take lightly.
Both forms of therapy can be effective, but each requires a different approach. The brief form must, by necessity, be more specific in its focus. There are particular techniques which make most effective use of the time available; cognitive behavioural therapy (CBT) is useful, and very often the associated technique of mindfulness is useful in bringing down anxiety and anger levels in the earliest stages. Sometimes learning that such emotional regulation can be achieved is all the therapy that’s needed, and such therapy is certainly possible in the short format.
I recommend the longer, “open ended” format when it seems that the focus cannot be brought down to one or two issues alone. A childhood marked by neglect, for instance, isn’t going to be fully remedied in the typical six sessions of the short format. The complexities of the relationships and reflections that may be found when looking at such a damaging childhood requires patience and, importantly, the building of trust between therapist and client. It will very likely be necessary to re-encounter some of the pain from that childhood, and you will only feel ready to do that when you feel assured that our relationship can withstand such high emotion; that I will not buckle under weight of your anger or hurt, and that you will not be embarrassed or ashamed of sharing such feelings.
Where I have delivered therapy in schools or colleges, for charities, or for companies via their Employee Assistance provisions, it has often been mandated that the therapy will be only of the short term format. As said, brief therapy can be effective, but we lose the luxury of choosing our timescale and, inevitably, some I’ve met in this prescribed short term format have been frustrated with the six sessions, left wondering as to “what more could we have achieved if there was more time?”.
Onward referral is key here. The short term therapy can still be valuable even if viewed as just a “triage” therapy; we can better identify the issues at hand and then decide together the type of therapy, and even the best therapist going forward.
The decision over short or long term therapy is only one aspect to consider before the therapy proper can begin. In future posts I aim to demystify the therapy process further. Of course, when entering your first therapy, the road in front of you may seem unknowable and intimidating; I hope this and further posts help you make the most of your therapy.