Our first session is a chance for both of us to get to know one another inquiring about your goals, best hopes, challenges, etc.

I encourage all clients to share (or not share) how much you want to with me.

Trust takes time.

I’ll give you my impression of what’s occurring, how I can help you, and what you can expect as we continue meeting.

There’s no pressure to work with me after our first session.

Research indicates that the therapeutic relationship (fit/alliance between therapist and client) is the second most significant factor (30%) for change and positive outcomes in therapy, outranking specific techniques/modalities/approaches (15%) and specific techniques (15%) (Assay & Lambert, 1999). Read more here.

The most important factor for positive outcomes in therapy is related to the client (e.g. biology, personality, resilience, temperament, strengths, areas of growth, belief system) and life factors/circumstances outside of therapy (e.g. environment, family, stable housing, support system, mentorship, relationships, work, community support, health, safety, finances) (40%).

This is why both feeling comfortable with your therapist is very important, and having basic needs met is necessary toward psychological change and growth.

At the end of session, we’ll schedule a regular meeting time if we both decide to work together (weekly or every 2 weeks), or you can self schedule sessions on the client portal as needed.

If not, I’ll provide you referrals and recommendations.

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Read more here (How to Make Therapy Rewarding & Successful).

You’ll receive a written treatment plan after 1-3 sessions, so you have structure, a roadmap, and a sense of what to expect as we work together.

A treatment plan focuses on your goals, barriers/what’s getting in the way, ways to work toward your goals, and when you would know/feel you’d be finished with therapy.

Sample of a treatment plans here.

We’ll work together to reach your goals.

I am a more active therapist, rather than a passive therapist meaning I may interrupt you, challenge you, offer you a different perspective, and ask you to try other ways of thinking or relating.

I may send you resources like articles, videos, podcasts, and/or books you might find relevant in your experiences.

You might cry, laugh, feel better, feel uncomfortable, have more questions, gain insights, approach new challenges, and/or have new goals.

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What's A Typical Session Structure?

• Beginning & Check In

  • 5-10 minutes

  • Saying hello, reviewing past 1-2 weeks.

  • Easing into the discomfort.

  • Updates and logistical items.

• Middle & The Work

  • 40-50 minutes

  • Goal consensus: Focusing on what you want to work on.

• Ending & Review

  • 5-10 minutes

  • Saying goodbye and summarizing.

  • Feedback

  • Compartmentalizing, getting ready for the rest of the day, resourcing, grounding yourself.

  • Assigning optional relational homework.

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What Does This Actually Mean?

A session may include:

• Noticing and interrupting negative self-talk/thoughts/beliefs/stories/narratives

• Provide you education on what may be occurring

• Offer you my observations around patterns and dynamics

• Challenging you at times with compassion and curiosity

• Inquiring about your desires, values, and needs

• Continued challenges, barriers, difficulties

• Learning self management skills

• Facilitating underlying emotions

• Regulating anxiety

• Practicing slowing down and curiosity of your internal world

• Developing more acceptance and compassion

• Exploring your relationships outside of session.

• And more

At most, we’ll meet once weekly.

Most of the work occurs outside of therapy and requires effort, energy, practice, and work from you.

To reap the most benefits from therapy, think of attending therapy like fitness/working out your mind and psychological wellness.

The more you practice your mental and psychological muscles, the stronger these muscles will be. You’ll also want to be careful not to overdo it too.

I will encourage you to practice something in between sessions to strengthen your learning.

It is estimated that clients and factors outside of the therapy account for about 40% of the change that takes place while 30% to the therapeutic relationship, 15% to expectancy (placebo), and 15% to specific techniques (Assay & Lambert, 1999).

Client factors outside of therapy include:

• Client’s level of motivation and engagement

• Perceptions of the therapy

• Commitment to the therapy framework

• Integration of concepts into everyday life

• Hope that therapy will work

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WAYS TO PRACTICE LEARNINGS OUTSIDE OF SESSION

• Completing homework (if assigned)

• Challenging automatic negative thoughts (ANTS) and repetitive automatic negative thoughts (RANTs)

• Practicing skills/tools such as: deep breathing, box breathing, body scan, mindfulness, grounding, etc.

• Sharing thoughts and feelings with a trusted person, friend and/or partner

• Taking relational risks in your friendships and relationships (e.g. being vulnerable, asking for needs/wants, saying no, etc.)

• Journaling, reflecting, and expressive arts

• Being in nature and natural environments

• Engaging in movement/exercise/physical activity (yoga, qigong, tai chi, walking, stretching, pilates, running, lifting weights, etc.)

• Building and sustaining meaningful friendships and relationships

• Decreasing stress as much as possible and stress management to build resilience

• Decreasing alcohol and other drugs/substances as much as possible

• Engaging in a regular sleep hygiene and getting adequate, high quality sleep (sleep is medicine)

• Eating nutritious, whole-foods

• And more

Healing takes consistent time, work, effort, and repetition. Patience is key.

There is no magical “fix” to long standing and deeply embedded issues.

It can be helpful to remember I am seeing you at one particular moment on your journey of healing for a limited period of time.

You have had many moments of healing and growth before seeing a therapist and will have many future moments of growth.

Try not to rush yourself because rarely does impatience and rushing facilitate positive growth and change.

As Carl Roger states: “The curious paradox is that when I accept myself, just as I am, then I can change.”

We’ll focus our energy on what you want to work on, make sure you feel understood, that you feel comfortable bringing up disagreements, and that my therapy approach is effective for you.

I’ll ask for verbal feedback regularly so I can adjust treatment as needed based on your preferences, personality, values, concerns, and needs.

For those who prefer written feedback, I’ll send feedback forms at regular intervals (3-6, 9-10, and 12 months).

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Signs Therapy is Working/Effective/Helpful 

• You gain insight: you learn why you do what you do 

• You avoid less things you used to avoid because of fear 

• You decrease/stop self sabotaging behaviors 

• You learn to love yourself unconditionally 

• You create a life worth living 

• You feel more hopeful 

• You learn skills/tools to manage overwhelming situations and life stressors (negative thoughts, rumination, guilt, anxiety, fear, emotional pain) 

• You can cope/manage stressors relying less on unhelpful survival strategies (substances, distraction, overworking, avoidance, etc.) and more helpful strategies (asking for help, communicating needs, self soothing, taking care of yourself, feeling emotions, etc.)

• You feel more balanced 

• Your mood has improved

• Your behaviors have changed

• You have more flexible ways of thinking/thoughts

• You feel more confident and competent to handle things on your own 

• You try things outside of therapy and are more able to experiment and take risks

• You are more curious, open, and flexible 

• You practice more compassion 

• You trust your therapist 

• You trust yourself more

• You feel you can be honest with your therapist 

• You feel more empowered 

• You feel more motivated 

• You can identify your values and what’s most important to you

• You feel like your therapist is competent enough to help you with your issues 

• You have a good working relationship with your therapist (personality, common goals, expectations) 

• You feel supported, heard, and validated by your therapist 

• There’s a balance between validation and challenge 

• There’s a balance between gaining insight and learning/building skills

• Conflict, disagreements, and tensions are talked about openly and honestly 

• You feel more satisfied in life (work, relationships, with yourself)

• You have healthier relationships with yourself and others

The Therapist…

• Is licensed in appropriate local and state guidelines 

• Uses evidence based techniques backed by research 

• Is an effective communicator 

• Collaborates with you rather than using their power to tell you what to do/how to be 

• Creates an unique treatment plan for you and your issues 

• Checks in from time to time about how treatment is going (goals being met, taking a break, progress, etc.) 

• Gives you options during treatment (different therapeutic approaches, right to file a complaint, right to end treatment at any time, etc.) 

• Explains the therapeutic process, risks, benefits, answers your questions, does not guarantee success/promises results (you receive, review, and sign a packet of paperwork including informed consent or review it verbally with them) 

• Continually attends lifelong consultation, workshops, trainings, conferences to expand their skills and knowledge 

• Provides you a good faith estimate if you don’t use insurance to avoid surprise bills

• Tells you therapy has a beginning, middle, and end. That therapy will end one day.

• And more

Signs Therapy Isn’t Working/Isn’t Effective/ Isn’t Helpful 

• You feel judged consistently

• You feel invalidated consistently

• You feel uneasy consistently

• You received unsolicited advice telling you what to do

• You have opinions and judgements imposed on you regarding religion, spirituality, and or other beliefs 

• Your personalities clash and are not a good fit (e.g. you want a direct therapist and they are more passive/says very little or they are too direct/pushy and you want someone more laid back/relaxed)  

• You feel pressured to say the right thing and to please them 

• Insensitivity to your beliefs, identities, background, culture, experiences

• Your experiences are assumed rather than asked about/questioned/practicing curiosity/inquiry

• When conflict and tensions occur, they are not brought up directly and talked about 

• Breaking confidentiality without good reason (e.g. suicidality, safety, elder abuse, child abuse, consultation)

• You feel pushed/rushed to talk about things/topics you don’t want to/are not ready to talk about

• You feel like treatment is going nowhere/very little (not seeing and experiencing changes after several months or getting worse)

The Therapist…

• Avoids admitting mistakes when they occur 

• Seems bored and/or uninterested during session 

• Checks their phone during session regularly

• Gives you unsolicited advice

• Tells you about other clients and reveals personal, identifying information

• Talks about themselves constantly or too much (excessive self disclosure) 

• Is defensive when you give them feedback or criticism 

• Doesn’t listen and respond to your concerns or feedback

• Tries to be your friend 

• Doesn’t give you the time allotted to you (e.g. 45-minutes, 50-minutes, 60-minutes)

• Goes over allotted time regularly in excess of 5-10 minutes (not a 1 or 2 time occurrence, but consistently)

• Touches you without your consent and/or inappropriately 

• Flirts with you

• Compliments you in a sexual or romantic way

• Has sex with you (therapy never includes sex) 

• Pursues a dual relationship with you (hires you to do something, wants to be your friend, dates you, gets you to run errands for them, does personal favors for you) 

• Ends therapy to pursue a business, personal, and/or sexual relationship with you

• Lacks adequate training in your issue, especially if it’s a niche/specialty area (e.g. OCD, ADHD, bipolar, psychosis, PTSD, eating disorders, personality disorders, substance use) and doesn’t let you know and/or refer out to someone who can help you

• Doesn’t use evidence based therapy treatments

• Is consistently unreliable (cancels sessions often repeatedly, often more than 5-10 minutes repeatedly, does not show up to session without notifying you)

• Constantly forgets basic details about your life

• Promises results and/or makes guarantees (there are no guarantee in therapy)

• And more

Read more here.

Is it normal to feel exhausted and fatigued after an emotionally open and vulnerable therapy session? Absolutely.

Therapy is hard work, especially when we unpack stories and experiences we’ve suppressed for years.

Sometimes, you leave a session feeling extra tired, disoriented, and uncomfortable.

This is like the equivalent of moving your body and exercising after a long period of inactivity. Your body is acclimating to the stress and changes now that you are becoming more active.

Similarly, if you’ve been suppressed, avoiding, or holding back parts of yourself or your emotions for years, releasing a bit of your thoughts and feelings may bring about discomfort and exhaustion. Engaging in emotional work and processing is work.

Reasons Why You May Feel Tired & Exhausted After a Therapy Session

• Going to therapy is hard work

• Exhaustion is not just physical, but emotional and psychological

• You are confronting your feelings, experiences, and thoughts rather than avoiding or distracting yourself

• You are processing challenging and uncomfortable material and experiences you tend to internalize or keep inside

• You are feeling a wide range of sensations and emotions rather than thinking about your sensations and emotions

• Being vulnerable and emotionally open is scary and uncomfortable

• Pushing through the pain and discomfort and with yourself to heal quickly (impatience with the healing process)

• And more

Read more here and here.

Feeling stuck could be a sign of many things including:

1. Plateauing in therapy where therapy stalls and sessions feel “meh” and repetitive like you’re just talking to a friend or venting

2. Avoidance/resistance

   1. Such as repeatedly cancelling or arriving late to sessions (a part of me wants to go to therapy, and a part of me gets nervous and anxious)

3. Avoidance/resistance

   1. Such as fear of bringing up honest topics/feedback/issues to your therapist so withholding your true thoughts and feelings.

   2. This can lead to misunderstandings and feelings of hurt/resentment/frustration/anger/etc.

4. New stressors and new goals to work on

5. Feeling worse after sessions

   1. A therapy hangover is normal especially if you have avoided topics/issues since therapy is about confronting what you avoid

6. Not making progress toward goals despite consistent effort

   1. Your therapist has taken you as far as they can take you due to their approach/modality, personality, experience, skills, and/or training

7. Unrealistic expectations of therapy and your therapist (thinking therapy will “fix” or get rid of certain symptoms/issues that cannot be “fixed”).

   1. Example 1: Wanting to get rid of all painful emotions

   2. Example 2: Expecting immediate results in 1-3 sessions

   3. Example 3: Believing your therapist is perfect and has all the answers to every problem/issue

8. Needing a new type of therapy or therapist that your current therapist does not offer, and

9. Many more reasons.

If you feel stuck, talking directly to your therapist can be helpful as feeling stuck is different for everyone.

While uncomfortable for many clients, having an open and direct conversation with your therapist can be useful because:

1. Your therapist can adjust their treatment approach/modality/interventions

2. Review and modify your treatment plan if needed

3. Provide you psychoeducation on what could be occurring as you feel stuck (e.g. a relational pattern, therapy interfering behavior, misunderstandings, repairing disagreements)

4. Discuss if another type of therapy or treatment type is needed they are not adequately trained in,

5. Discuss if a pause/break is necessary, and

6. Many more reasons

Length of treatment depends on your goals and your ability to invest time and money.

Some clients benefit from brief therapy (1-4 sessions) or short-term therapy (3-6 months) for a single issue.

Other clients benefit from long-term therapy (6-12 months+) for more complex issues.

We’ll end therapy when your goals have been met, your symptoms have decreased, you want space and time to integrate your learning, and/or at anytime you feel therapy isn’t helpful.

You can also pause therapy to metabolize your learnings and see how you are without my guidance and support. I often take 1-2 months off yearly, so this will be weaved into our work.

My goal is for you not to see me anymore eventually and reach out to your social support, utilize self-management skills, and take good care of yourself.

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SIGNS YOU MAY BE READY TO PAUSE AND/OR END THERAPY

1. When You Have Increased Insight Into Patterns & Dynamics

2. When You Achieve/Reach Your Goals

3. When Your Initial Symptoms/Issues Have Decreased

4. When You Don’t Find Sessions Helpful & Ineffective Consistently

5. When You’ve Plateaued

6. Whenever You Want

Read more here.

Some folks come back for check up session due to life changes such as moving, growth, successes, failures, beginning school, starting a new job, starting a new relationship, deaths, and/or births.

This can be helpful to review skills learned, integrate insights, metabolize learnings, and anticipating ways to approach future obstacles and challenges.

Former clients are always welcome to reach back out to resume sessions, though I may not be able to offer a regular scheduled time slot if I am fully booked.

At any time, if we don’t work well together or you need a different type of therapist or treatment, I’ll provide referrals to others who can help you and/or recommendations to other types of treatment/therapy modalities that might be a better fit.

Other options could include attending a higher level of care where you attend therapy more than once a week, assessment with a psychiatrist/nurse practitioner for medication, meeting with an eating disorder specialist, meeting with a substance use specialist, etc.

It’s unethical for me to work with clients I’m unable to help due to lack of specialized education, knowledge, and skill. This would be a waste of time, money, and effort.

Click here for personal therapy referrals and here for general referrals.

You can find free resources on my website below:

FIRST TIME IN THERAPY RESOURCES

1. How To Find A Therapist

2. Types of Therapy

3. Levels of Care

4. What Makes Therapy Effective?

5. Types of Therapists

6. What To Expect From Your Therapist 

7. What Makes Therapy Effective?

8. Your Rights as a Client 

9. Understand Health Insurance 

10. Common Client Questions

11. Therapy Never Includes Sexual Behavior

TRAUMA RESOURCES

1. How To Heal From Trauma Without Therapy (Or In Conjunction To Therapy)

2. Education on Trauma & PTSD

3. Trauma Therapy Modalities/Approaches

4. Complex Trauma Resources

5. Trauma Blog

6. Poems on Grief & Trauma

RELATIONSHIP RESOURCES

1. Relationship & Attachment Modalities

2. How To Work Toward A Secure Attachment Without Therapy (Or In Conjunction To Therapy)

3. Adult Attachment Styles & Questionnaire

4. Attachment & Relationship Blog

5. Poems

6. Quotes & Passages

I often send clients lots of resources like articles, podcasts, videos, book scans, book recommendations, quotes, poems, etc. that are not on my website if I believe it will benefit them on their healing journey.