Steps in Therapy (Under Constant Revision)

December 4th, 2012

Steps in Therapy --> to be revised!!

1. Question:  What are you looking to gain from therapy?
2. Joining - Try to create a sense of "us" with client so that they feel more comfortable and are more willing to disclose
3. RESPECTFUL model - This will give a therapist a great look at the client's situation and their part in it
4. Bronfenbrenner's Ecological Theory Model - I think that this is somewhat similar to the RESPECTFUL model in that it shows off the environment around the client

New Step 1:  Talk about confidentiality, roles, and meeting for communicating outside the sessions (as well as Duty to Warn and other limitations on confidentiality)

New Step 1:  Introduce self.  This is amazingly important due to the fact that any first introduction paves the road for future communication.  It teaches them not only more about the therapist, but also gives them a mini lesson in how to communicate.

Last Step (per session):  Document what happened in the session

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December 6th, 2012

Steps in Therapy

1. Introduce self
2. Discuss payment
3. Discuss confidentiality et al.
4. Ask why they are here and what they hope to accomplish
5. Joining
6. Systems models (RESPECTFUL, wellness, Bronfenbrennarian/Ecological)

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January 9th, 2013

     About a month ago, I wrote a more succinct progression of steps when beginning psychotherapy.  To look at some details on these steps, consider the explanations in the first log.  After seeing an abbreviate session in one of my classes, I was told - and later saw the logic in the statement - that a priority in therapy is to understand the client.  I believe that my steps attempt that, but that they lack that word choice.  I think that step six's intent is to understand the greater context of the individual.  But we also need to understand the individual.  So, rather than just ask questions and seek information about his/her environment, seeking information about the person is integral.

     I also think that step five should not be a step in and of itself, but rather the title "joining" hould consist of multiple steps/phases.  I'm not exactly sure what these should be at this time.  I think that the steps should be revised to look like this:

Steps in Therapy

1. Introduce self
2. Discuss payment
3. Discuss ethical considerations in therapy
4. Ask purpose of visit and prospective achievements
5. Discuss number of appointments and method of therapy
6. Rogerian interviewing to understand client
7. Systems models

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January 10th, 2013

     Because I am in my program's ethics course right now, I am sure that some of my future writings will introduce concepts taught or thought up in class.  This is one such entry.  I've been attempting to create steps in the beginning of a successful psychotherapy and I think I've thought of a new step one.  The first step, before formally introducing oneself with credentials and so forth after sitting down in the chairs, would be to give the client pertinent sign-able documents.  These papers would include confidentiality rules and regulations as it pertains to the ACA (or whatever ethical organization is important).  So the steps now are:

1. Disperse and collect paperwork pertaining to ethical and legal issues
2. Introduce self and explain relevant education and licenses
3. Discuss payment
4. Discuss ethical considerations in therapy
5. Ask purpose of visit and prospective therapeutic achievement
6. Discuss number of appointments and method of therapy
7. Commence therapy starting with Rogerian interviewing to understand client
8. Systems models
9. Remember to console client with universality (if applicable)

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January 14th, 2013

     Going off of my previous steps in counseling, I have come to realize more steps and a change in the overall model.  The steps to add include 1) an explanation of counseling, 2) an assertion of more to come, 3) a discussion on client-centered variables in counseling, and 4) the agenda for the first meeting.  Let me elaborate a bit more on each one.

     The first idea stems from misunderstandings in what counseling is and what it entails.  Clients think that counseling is a "quick fix," one that takes a session or two and . . . done!  Instead, it takes work and the ability to change.  This is important for both a resistant client and a client who has been forced into therapy.  Better said, if they don't want to change, therapy will do nothing for them.  

     The second idea is both a phrase meant for comfort and a business practice.  It is very important, first of all, to ensure that a client does not despair in his or her first meeting with the therapist.  The first session is an information-gathering one and can therefore, due to lack of therapeutic merit, be very disconcerting to the client.  To avoid this feeling, it is important to make sure the client realizes that more therapy will commence when information is gathered.

     The third item here is about clients.  A lot depends on the client:  willingness (as previously mentioned), attitude, skills, etc.  Honestly, I jumped the gun on the first point.  Change should have been in this paragraph.

     The last item is talking about the agenda for the first meeting.  This is designed to make sure that the client knows what's in store for the session.  This can alleviate anxiety and the possible feelign of being jipped.

     Moving on, I think that putting these steps into "steps" might be a bad idea.  I think to set these into such a format might give them some kind of permanence as a list.  Rather, I think that they are better used as suggestions or points of discussion.  Also . . . I don't want to hampered by so many formal steps.

     I think that some of these points of discussion could be cleared up in a pre-therapy discussion or a pre-therapy paperwork.  Information about ethical and legal issues could be disseminated this way, but should be followed up.  Payment can be easily outlined via paper and may cause the therapist to avoid such a sensitive matter.

     It is possible that some of the other information can be explained via paper, as well.  Information regarding agenda for the first meeting, self information about education, and number of appointments can be presented in a document also, but should be followed-up as well.  

     Let me try to portray this new model again with all the other information:

Pre-therapy documents

• Ethical paperwork
• Payment information
• First meeting agenda
• Short biography including schooling and license(s)
• Policy for number of appointments
• Short description about method

Points of discussion

• Follow-ups
• Ethics paperwork
• Payment information
• Method description
• First meeting agenda
• Self introduction
• Purpose of visit and prospective goals

Beginning of therapy

• Rogerian interviewing and systems models
• these are used in order to understand the client from their point of view and in their context

     It is probably important to cite on-going techniques of merit in therapy also . . .  At this time, I will forego this, but will put it in my agenda for future writings.

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January 28th, 2013

     More points of discussion to add.  They are:

• themes and values in life/family
• developmental thought process location
• introduction of self outside of therapy

     The first point is very much an existential/psychodynamic one (and systems, obviously).  It mentions the important or underlying points in an individual's life.  Through asking the client about their own thoughts about family, life, etc., the therapist might glean at least a small amount of information about the client without their own resistances coming forth.

     The second point is from something I learned from one of my professors.  He talked about thought across the lifespan.  In particular, three of conventional thought (going from moral thought).  The first stage is pre-conventional thought.  It is a stage when a person is mainly concerned with the self.  From a Freudian personality component theoretical model the pre-conventional thought stage is closely related to the id.  The second stage in the model is conventional thought.  In this stage, closely related to the superego, the person harnesses externally-based thought.  While this is an attractive notion, it means that the client thinks of himself/herself in terms of other people's opinion.  This can be potentially harmful.  The third step is post-conventional thought.  It represents the integration of abstract thought into life.  Abstract thought allows the client to form unique ideas and identify both pre-conventional and conventional thought.  This stage is most closely related to the Freudian ego.

     The third point is critical if the therapist might have contact with the client.  If the therapist lives in a small town, the probability of seeing any number of previous or current clients is higher than living in a large city.  It is important to determine means of introduction, complete with proper salutation (Mr., Dr., etc.).  Since multiple relationships are not healthy for the client-therapist relationship, knowing how to act in these situations is important.

     With this line of thought comes obvious paperwork designed to pry information from the client.  I think at least one good piece to have is information about family and friends.  Let's recap the process:

Pre-therapy documents

• Ethical paperwork
• Payment information
• First meeting agenda
• Short biography including schooling and license(s)
• Policy for number of appointments
• Short description about method
• Family/friend information (w/ addresses, contact information, etc.)

Points of discussion

• Follow-ups
• Ethics paperwork
• Payment information
• Method description
• First meeting agenda
• Beginning of therapy
• Rogerian interviewing
• Systems models
• Depth themes
• Lifespan thought process model

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January 27th, 2014

Pre-therapy documents

• Ethical paperwork (consents/confidentiality)
• Payment information (include insurance information)
• First meeting agenda (include demographic and basic information)
• Short biography including schooling and credentials
• Introductory policy as far as number of visits
• Method description
• Family systems information

First Session Points of Discussion

• Brief repeat of:
• Ethics paperwork
• Payment information
• Method description
• First meeting agenda
• Self
• Questions
• Goals of Therapy
• Reasons for entering therapy (what is client's definition of wellness?)
• Mental Status Exam
• Ask about room structure/formation
• Previous therapy experience
• Medication?
• Post-counseling dual relationships