THE ULTIMATE GOAL OF PSYCHOTHERAPY IS TO HELP CLIENTS

ADDRESS AND CHANGE THE PROBLEMS THAT BROUGHT THEM INTO TREATMENT.

The Beginning Of Psychotherap

y By Aoun Ali Institute Of Clinical Psychology Karachi

IntroductionThe process of therapy has many steps, and begins before

the client comes for the first appointment. Below are several steps and some tips on managing them.

First Inquiry

The client's first inquiry is often a phone call or email about the possibility of therapy. You should express interest in working with the

client, and set up a time to meet. 

First Appointment

It is important to realize that the client may be anxious, upset, or in turmoil

when they come for their appointment.

The Start Of Therapy■Therapy begins with a first interview. ■ It is a relational process, where the therapist, as a

person, directs the process and communicates verbally and non-verbally what therapy is like. 

■They "listen" to what is said and not said, what is communicated in verbal and in non-verbal ways.

■ Sullivan notes that many patients become annoyed when the therapist asks "obvious" questions, and suggests that therapists should explain they are interested in the client's unique perceptions. Different people experience "obvious" stresses and make "common sense" choices for a range of different reasons.

■He also recommends constantly assessing whether your questions and the client's answers have alternate meanings.

■For example Where do you live?" based on an assumption that the client has a stable residence,

■Are you married?" based on an assumption that the therapist will not understand the client's problems without some frame of reference,

Interview stages ■ The Inception is the beginning of the interview. The reason for

referral, greeting, previously reviewed information, and ethical concerns of confidentiality and informed consent are discussed during this stage.

■ The Reconnaissance entails gathering information about the problems and stresses that bring the client to therapy.

■ The Detailed Inquiry entails gathering specific and detailed information from the client, separating relevant from irrelevant information, and understanding the balance of problems and stresses compared to resources and strengths. This can include, for example, knowing what the client has tried to resolve problems before, and asking what has been helpful and what has not.

■ The final phase is Termination, the end of the interview

The Initial Interview, Do's And Don'ts■Do not argue with, minimize, or challenge

clients. ■Do not praise clients or give false assurances.■Do not interpret the client's words or actions to

the client, or speculate on the dynamics underlying their personal functioning or the functioning of those around them.

■Do not offer a diagnosis. ■Do not interrogate clients on sensitive areas of

their lives. 

Note TakingNewer therapists may feel taking notes helps them remember the

content of the therapy session, and this is likely true

■ Clients usually do not know what is and is not important to therapists. They may believe some thoughts and feelings are quite normal, or that everyone experiences the same things, and so they may not have the perspective to think otherwise.

■ Clients may not want to reveal certain things until they are sure they can trust their therapists

■ Some things are emotionally painful to face, or require insight and understanding to recognize. As a result, clients may not face these things not as a way to deceive their therapists, but rather as a way to deceive themselves. They may not realize patterns, triggers, or signs and so are not able to report them.

Resistance

Resistance is a way clients protect themselves from painful experiences.

Establishing Rapport■ The need to be dependent and receive sympathy and

understanding (social support)■ The need for unqualified acceptance and validation

(unconditional positive regard)■ The need to reveal painful feelings and ideas; while Freud

called this catharsis and felt it was not therapeutic, others disagree and believe that "lifting" or "sharing" an emotional "burden" is a powerful form of healing in and of itself.

■ The need for education about an illness, which often makes a problem seem less threatening, confusing, and powerful, and offers some hope.

■ The need for transference, or to work out a problem with another person who will set aside their own needs long enough to help clients understand and resolve their conflicts.

The therapist communicates:

■Understanding of the problem■Interest in the person as a person■Tolerance and acceptance■Freedom to experiment with different

values and beliefs, without judgment or pressure

■Objectivity about problems but empathy and understanding for the person experiencing them

Do your best to avoid:

■Exclamations of surprise, over concern, or doubt■Flattery and praise■Moral judgments or criticisms■Expressions that may be interpreted as

punishment, impatience, false promises, bragging, or threatening

■Expressions that maybe interpreted as blaming or rejecting

■Quick interpretations, advice, dream interpretation, and psycho-babble

Reflective Listening

■Open-ended questions (can you tell me more about that?)

■Allowing the client to determine important areas for inquiry and the nature of his problems

■Talking less, listening MORE■Remaining cool, calm, and patient■Remembering that your understanding of

the client may be wrong or incomplete