In ‘Thinking About Therapy? Part 1‘, we explored important factors to consider when choosing a therapist. In Part 2, we will cover everything you need to know about the process of therapy from booking your first appointment to your last session.
Booking Your First Appointment
In this modern age, you have direct and indirect methods of booking your first appointment.
Some therapy practices provide an online booking option that allows you to complete a full or partial intake (more on intake in a moment), but at a minimum requires your name and contact information. Online booking allows an appointment to be booked anytime which is both convenient and, for some, lessens the anxiety around taking this first step.
For organizations providing services exclusively online, typically require you provide the reason for seeking service at the time of booking. Due to the sensitivity of the information being shared during online booking and counselling services, therapist are required to use a secure digital platform that complies with government regulations (see PIPEDA for more details).
Booking By Phone
Most therapist offices provide booking by phone. In this instance, your call may reach the therapist directly or be taken by a receptionist or intake assistant. Booking by phone provides a real-time opportunity to ask any questions you might have on the therapist or processes and help you get a “feel” for the practice or therapist.
The Intake Process
Before you begin service, an intake must be completed. An intake is a questionnaire that provides the therapist or assistant with information about you and the reason your are seeking service.
As mentioned above, an intake may be completed through a secure online form (if booking online) or by the therapist or intake assistant by phone. The length and depth of initial intake processes can vary depending on the organization, however, a basic intake will include:
- Name – Your full legal name as well as a preferred name as an option.
- Age & Date of Birth
- Contact Information – Home Address, Mailing Address (if different from home), Phone, Email.
- Referral Source – As discussed in Part 1 this can be self, another health professional, or third-party.
- Modality of Service – Online, In-Office, or In-Home.
- Billing Information – This includes methods of payment, insurance coverage information, or third-party billing information such as in the case of Employee Assistance or other programs.
- Emergency Contact – This will be the name and contact information of an individual you wish to be contacted in the event of an emergency during a session (eg. medical emergency). This individual will NOT be contacted unless there is an emergency and will not receive or have access to any information regarding your service.
- Reason for Service – A brief description of the struggles you wish to address and/or the goals you wish to achieve.
- Risk Assessment – The therapist or intake assistant will ask questions related to your safety and the safety of others. This will include an inquiry as to any thoughts of suicide or self harm, or any other risk to yourself or others. This assessment is intended to help the therapist understand any safety concerns you might have and, in the event of imminent danger, connect you to the right resources.
Offices and organizations who include a more detailed intake process may ask additional questions regarding your mental health history, medical history, any substance use and treatment history, or any significant current or historical life transitions or changes. These and other inquiries will be covered in the assessment section of this guide.
After your appointment has been booked, the therapist or assistant will review the cost of service and any other fees, provide office location and direction, and answer any questions you might have. Some offices offer text, email, or phone reminders as an option. It is essential that you note the date and time of your appointment as well as the office’s cancellation policy to avoid missed or no show appointment fees.
Attending Your First Appointment
Your first appointment is an opportunity for your therapist to get to know you and understand your goals and struggles. Whether your session is in-person or online, your therapist will first begin with a review of confidentiality and how your privacy is protected. Confidentiality, and the protection of privacy is the cornerstone of the therapeutic process and therapist are required to ensure confidentiality at the highest levels. However, your therapist will explain that confidentiality is limited where there is a risk of harm to yourself or to others. Where it is required to ensure the safety of their clients and the public, a therapist must take the steps required to address the risk regardless of confidentiality.
Following a discussion of confidentiality, your therapist will invite you to share more about yourself, your history, and your goals. This is part of their initial assessment – the collection of information that assists the therapist in understanding the problems to be addressed and forms the foundation of the treatment plan (the plan that details how the problems will be addressed).
Problems don’t exist in a vacuum, so understanding different aspects of your history will allow your therapist to create a treatment plan that is right for you. Your therapist may invite a deeper discussion of struggles you have faced, your personal and family medical history, substance or medication use, previous treatment experiences, significant relationships, etc. Not all of this information may be collected in one appointment. Depending on your comfort level, the complexity of your struggles and other factors, the initial assessment may be developed over multiple sessions.
It is common and understandable for you to feel anxious or agitated during your first session. You may be unsure of what to say or feel like you are talking too much or too little. Therapists understand this discomfort and are there to guide you through in a supportive, non-judgmental way. If you have questions, ask. It’s OK to take your time. Focus on sharing what you wish to accomplish and why, and trust that your therapist has the tools to guide you through the rest.
The Treatment Plan
When you and your therapist have a good understanding of your goals and the obstacles you are facing, you will work together to set out a treatment plan. This plan will include the following:
- Presenting Issue – The problems or struggles being addressed.
- Goals of Therapy – The outcomes you intend to achieve with therapy.
- Methods – The type of therapy or interventions that will be used to support you in achieving your goals.
- Duration – The estimated number of sessions expected to achieve the goals identified.
The treatment plan provides the guide for your therapeutic service. It will be reviewed and, if necessary, modified as you progress throughout service. It helps both you and your therapist track your progress and remained focused on your goals.
The Therapeutic Relationship
If the treatment plan is the guide for your therapeutic service, the relationship between you and your therapist is the foundation. To ensure a solid foundation, a therapeutic relationship requires trust and clear expectations.
Building trust provides a feeling of safety in therapy. It requires a willingness to be vulnerable that is developed over time. Trust in a therapeutic relationship is best built by establishing open communication – the freedom to ask questions and seek clarification regarding your sessions or progress. The ability to provide feedback to your therapist can be essential to their ability to effectively support your needs.
While a therapist can feel like a friend, it is important to understand the professional boundary inherent in the relationship between therapist and client. Professional distance helps therapists maintain the objectivity that is essential to their work and for this reason, it is important to understand and be clear about what you can and cannot expect from your therapist including:
- Contact – Many therapists will restrict their contact to appointment times only. They are unlikely to provide their personal contact information or set out restrictions around when/how they can be contacted.
- Social Media Policy – In the age of social media, many therapists do not communicate or connect with clients over social media, or have policies in place to limit such communications.
- Non-Therapeutic or “Duel” Relationships – Therapists must adhere to strict guidelines and limitations around contact with clients that is not rooted in the client’s therapeutic goals. These restrictions extend to and beyond the development of personal or social relationships, business or financial transactions, and other non-therapeutic relationships.
In some cases, such as in rural areas, you may have a non-therapeutic relationship or connection with your therapist (eg. work at a place they do business). In this case, you and your therapist must work together to ensure the therapeutic relationship takes priority and place any necessary limitations on the secondary or duel relationship.
When you have trust and clear expectations, you and your therapist are free to develop the professional and supportive connection that can help you reach your goals.
Therapy can come to an end in 3 ways. It can be ended by the client (Client Initiated), by the therapist (Clinical Initiated), or mutually terminated as a result of the client achieving the goals of the treatment plan (Service Completion). Let’s take a look at each:
Client Initiated – A client may discontinue therapy at any time. It is ideal to provide a therapist with notice of your intention not to continue, however, in the event you do not provide notice the therapist is likely to attempt to follow up prior to closing your file.
Therapist Initiated – A therapist also has the ability to discontinue sessions, however, they must have sufficient reason for doing so (such as a conflict of interest, or safety concern). Where possible, the therapist must make attempts to support the client in connecting to supportive resources and/or transitioning to a new service provider.
Service Completion – The service completion is the natural ending of the therapeutic process and occurs when a client achieves the goals set out in the treatment plan and no new goals are to be set. Reaching this stage typically means you have overcome old obstacles and developed effective strategies to overcome new ones. In your last sessions, your therapist will review your goals and the progress you have made and identify any resources and supports available to help you continue your success after therapy has ended.
Are You Ready to Reach Out?
Therapy can be truly life changing. It provides the kind of supportive guidance that clients can use to empower themselves and create positive and lasting change. It can be interesting. It can be enlightening. And yes, at times, it can be hard. But when you commit to the process, and push through the discomfort, it can be worth it.