On-Going Relationship - Crossroads

The First Session
I have reviewed your completed forms, and I may ask you to fill in the blanks for me, if there are any in my mind.  We will discuss any questions or concerns you may have about our previous consultation, the forms you read and signed, or anything that has come up for you since we last spoke.  We will discuss what concerns you, what concerns you most, what you have done to tackle the concerns-challenges, and how I may help you get what you need from yourself and your relationship(s).  Before we end the session, we will both know how we want to proceed together to fulfill your objectives.  Thus begins treatment.  I will ask you to give me your evaluation on how well I've done for you today.  I will incorporate your feedback into my work with you and into the treatment plan.  I will assign a diagnosis, and the diagnosis may change over time as you make steps forward or take steps backwards.    

The Following Sessions
During the first three-four sessions, we discuss issues, challenges, concerns, thoughts, feelings, behaviors.  We brainstorm.  We explore options.  We tap into opportunities, and I present cognitive, communication, relationship, and conflict skills you may want to use with me in therapy and with others outside of therapy to help you achieve your goals.  The goals we set are achievable, realistic, and manageable given your unique situation, strengths, and limitations.  A treatment plan is created, I give you a copy of it, and we make an agreement between us about how the problem is addressed and worked on.  During the course of therapy, changes are made to the treatment plan based on accomplishments and set-backs.  During sessions, we may talk about what we are doing in therapy, how you react to how I come across to you; how I react about how you come across to me; and what challenges you experience in use of the tools in your daily life.  We may role-play how to help you use the tools outside of session, or I may invite you to role play with yourself using, for example, the empty-chair approach.  I will never require you to engage in any intervention or exercise I offer up in therapy.  In session with me, you have the freedom to choose what's best for you.  I am honored to be with you on your therapy journey and I will encourage you, not push you, into interventions that you find unpleasant or uncomfortable.  

It's my goal to create a therapeutic environment where clients have the opportunity to experience themselves authentically and openly.   I strive to listen intently and carefully to the stories of their lives and to respond to their experiences in compassionate, direct, and helpful ways.  I encourage them to reflect on what they're thinking about and feeling in the moment.  The process of change is like water flowing in a stream.  As it flows and meanders, it finds its own way and cuts its own path.

Clients may hear me reflect back my understanding of what they've shared with me to make sure I understand what I've heard.  They may hear me ask a question for information or clarification.  They may hear me challenge their thoughts and assumptions if I believe those thoughts are assumptions are in the way of making positive change.  They will not hear me argue with how they feel.  Feelings are what they are.  Clients may hear me share a personal life experience during a session, if I think it will help them on their journey toward wellness.  I share my personal life experiences with clients, infrequently, and do so only when I think the disclosure may help them in a therapeutic way.  I do not make choices for my clients.  I help my clients make choices for themselves.

Clients and I have frequent discussions about how therapy is working or not working; about how the client thinks and feels about his/her therapeutic relationship with me; and about how the client is seeing change and improvement in his/her life.  I encourage clients to think about what's working in their lives.  I encourage them to do more of what works.  If the client or I think that the client is not making progress in therapy, then we discuss what's happening, what's going on between us, and what the next steps and alternatives look like.