(604) 525-9214 drwilkie@hushmail.com

How do sessions start? What should I talk about?

I take your lead in starting the session. It can feel uncomfortable initially to have the focus on you without a lot of direction or structure, but in this way, I’m more confident that I’m not imposing a focus for the session. If I feel we’re avoiding something important I’ll talk to you about that. Generally, we aim to talk about what brought you to therapy and how the therapy is progressing (are you seeing progress, is there something in the therapy that needs adjustment to make it more effective).

What if I don’t feel like coming to a session?

This feeling is common and often reflects a transition in therapy.

  • You’re not getting better or meeting your goals
  • You’ve run out of money or insurance coverage
  • You’re running out of things to talk about
  • You’re at the point of “the real issue” (and do or don’t want to talk about it)
  • The same pattern that happens in other relationships is happening with the therapist
  • You think you’ve finished your work in therapy but aren’t sure
  • You don’t want to hurt the therapist’s feelings by saying any of the above

If therapy is to be effective we need to have a good working relationship and talk about how I can help you (or help you better – I’m open to feedback!). A large part of my practice is in treating interpersonal difficulties and I expect the same pattern will happen between us that also occurs in other relationships. If we can talk about this as it’s happening, it can provide increased understanding and opportunities to try something different. It’s important to come to a session, particularly when you don’t feel like it, because if we can talk about it then some significant learning usually transpires.

Leaving well

Sometimes people are clear they want short-term therapy: they have a circumscribed problem to address, they have limited finances or insurance coverage, they plan to change work or move. It’s important to discuss this at the beginning of therapy so that we can work within these limitations and aim to successfully complete the work within this frame (like a book chapter).

Another time to consider ending therapy occurs at about 10 sessions. At this point, people often have some relief of their symptoms, have some understanding of their situation, and are feeling more settled and confident.

For others, feeling more settled provides a foundation to explore deeper, to understand how they got to the point of requesting therapy, and to a fuller understanding of themselves in the context of relationships. At this point, we consider long-term therapy and determine treatment goals. Therapy is finished when you feel the issues that brought you to therapy have been resolved and you’re confident in your ability to handle stressors.

Saying good-bye is an important part of therapy and how to leave is important to discuss. We’ll consider what end date is appropriate, whether you’d like to taper off sessions or not, whether you’d like a check-in at a later point. We’ll discuss how you met your treatment goals, consolidate your progress, and plan for relapse prevention. Returning for more therapy or support in the future is also an option.

Are you ready to make a change that counts? I have over 20 years of clinical experience helping people feel better, move forward in their lives, and create more satisfying relationships. Take the first step to get started. Contact me for a short phone call to see if my services are a good fit for what you’re looking for. Generally, I can see new clients 1-2 weeks after this call.

Printable PDF – Getting the most from therapy