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What happens in the therapy room?

Therapy is one of the most private spaces you will ever enter. With all the clinical boundaries, ethical guidelines, and strict rules about confidentiality, you can’t blame the mind for wondering what happens when people “go there”. The fact that the answer to that question is only ever really found through entering the process, and going through the journey yourself, can make most people turn the other way and decide not to do it.

TV and media have tried to depict what happens in the therapy room for years, and while they have some aspects right, I can tell you for free that they have many aspects wrong, and as a therapist watching, I am sure Sigmund Freud would be turning in his grave!

So today, I will give you a quick whistle-stop tour of what happens in the therapy room to help ease some of your nerves and demystify some of the process.


Let’s go!

Whether you are in person, on the phone, or online, the process of what happens in the therapy room has a similar framework.

You might not realise this, but your journey into the therapy room starts waaaay before the therapy door opens, or you have finally managed to connect video and audio! The journey into the therapy room starts even before your first point of contact with the therapist.

It starts with you and whatever your process to therapy has been. Whether you have been pondering for months about "if you should go to therapy or not"; you have been browsing therapy directories, or you have followed a few therapists on IG, all of what happens before the first point of contact will come with you into the therapy room and impact your experience of therapy. Now, so that I don’t turn this into a psychoanalytical paddle down the river Thames, I’ll assume you have already contacted your therapist, and you are either at the point of the door opening or managing the connecting audio stage…

So you are in…

Face to face with this person who you have had pretty minimal contact with, and they are churning out information to you about confidentiality, length and frequency of sessions, and how they work.

This is called the contracting stage. It may happen a few times in your therapeutic journey, but in different ways. Usually, during the first-ever session, the contracting will explain to you how the initial consultation session will go. Your therapist will explain a bit about what will happen in this session (you guys will talk and explore things like your friendships, family history, significant life events, and spirituality). They will also explain how long you have for the session, what confidentiality is, and any limits there are to confidentiality (for example, if you are at risk of harm to yourself or others).

Following the contracting stage, the conversation (the things you guys will talk about) will take up the majority of the rest of the session. The initial consultation is a chance for you to get a sense of the therapist, as well as a chance for them to get a sense of you. So this is a great time for you to get any questions in that you would like to ask too!

At the end of the session, the therapist will sum up and agree with you on how to proceed going forward (if you guys will work together). Now, I want to add here that every therapist works differently, and this is generally how these sessions go, but I have come across therapists who do it completely differently. So, when looking for a therapist, a good question to ask in the initial communication phase is:

“How will the first appointment go”?

As I mentioned, the initial assessment is a chance for you to get to know your therapist a bit, but it is likely to be quite different to your first therapy session (we will get into this later). This is because the initial appointment will usually be very therapist-led. The therapist has specific information and questions they need to ask you, and this tends not to be the way in the sessions going forward where the therapist (depending on their modality) will be less directive.

Okay, so your initial consultation is over and you have agreed to start ongoing sessions together…. What happens then?

This part of the process is a little harder to generalise, because it will depend on the individual therapist’s training. However, I will give you a bit of an insight into how I work in first sessions with clients to give you a feel for the process.

Having had the initial appointment with my client, I will have agreed with them what they would like their goals to be going forward. So, when it comes to the first session, I will have taken some time before the session to reflect on all the information they gave me in the initial appointment, and how this fits in (or doesn’t) with their goals. I will have thought about what other information would be good to explore with the client, and any resources or tools I have in my tool bank that would be useful for them.

I do this so that if my client comes to the session with nothing to say (or not much to say), I can help bring the session to the focus that the client had expressed in their assessment. I will also check in with where the client is at the time of the first session, as a lot can change between an initial appointment and the first session, even if they are only a day apart. Then, I will follow the client where they go in the session, using my knowledge and expertise to guide the client's process.

No one session is the same. Sometimes homework will be set. Sometimes we will do physical exercises. Sometimes we do creative activities. Whatever is needed to help the client process their experiences.

Every so often, I will review the process and progress with the client to check how they are doing. During this time, I will ask the client what they feel is going well and would like to do more of, and what they feel is not going well and would like to do less of or not do again. I always invite my clients to be as honest as possible, especially with what is not going well, because there's no point sitting in therapy doing a bunch of things that aren't working for you and pretending you are happy… You have to do that in your day-to-day life enough - therapy is your space, so the aim is for you to be able to be all that is you!

As a basic whistle-stop tour, that is it. The bulk of what happens in sessions is dependent on what the client brings, so it is hard to give much more detail than I have today. However, if this post sparks any questions for you… let me know in the comments, and I will answer them for you!

How do you feel about therapy now?

Could you see yourself giving it a go?

I hope so!

Next month’s post will be discussing the cost of counselling, how much it costs, and why it costs what it does… If you are interested in this, make sure you are signed up to my mailing list so you are notified when it comes out.

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Until next time!

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