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What Happens in a Therapy Session?
Natalie DeRose • Jul 23, 2020

It’s natural to be curious about what a therapy session entails and to question what goes on during a 50-minute session. The truth is, it depends on you, your reasons for seeking treatment, and/or your mental health needs.



Before Your First Session

Before engaging in a session, most therapists offer brief consultations. These consultations are typically done over the phone, last approximately 15 minutes, and are usually free! Consultations grant you the ability to discuss your mental health concerns, while giving the therapist an opportunity to assess your needs and simultaneously determine whether they are a good fit to assist you. If a therapist does believe that they can be a source of support, they will offer to book an appointment with you. If the therapist does not believe they are equipped to assist you, they will refer you to a therapist who is a better therapeutic fit. The consultation also allows you to determine if you feel comfortable with the therapist and whether you would like to proceed with therapy.



Your First Session

After booking an initial session, it’s completely natural to feel a bit nervous. The first meeting is typically referred to as an intake session or intake assessment. Your therapist will discuss with you everything related to the therapy process, including privacy and confidentiality. Your consent is necessary in order to begin the intake. During an intake session, you and your therapist start to connect and establish rapport. Your therapist will ask you some questions to seek a good understanding of your primary mental health concerns, your goals for therapy, and other important components, in order to develop a general understanding of who you are. This first session typically dabbles into different life domains, some of which consist of mental and physical health, social environment, and family history.



An intake assessment may require up to two or three sessions to complete. At its completion, the therapist will assess your treatment needs and goals. You and your therapist will discuss and agree on a treatment plan to work on your symptoms and/or other therapy goals. Psychologists and psychiatrists have the ability and training to diagnose; therefore, if they determine you meet criteria for a specific psychiatric diagnosis they will communicate that to you. It is common for individuals seeking treatment to not meet criteria for a psychiatric diagnosis.



What’s Next?

After the intake assessment, subsequent sessions will focus on treatment. The type of treatment and interventions used are highly dependent on the therapist's understanding of the patient’s presenting problem(s)/symptom(s) and the modalities they choose to engage with, as well as what type of intervention fits best with your concerns. Some popular, evidence-based therapeutic interventions include: Cognitive Behavioural Therapy (CBT), Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behaviour Therapy (DBT), and Emotion Focused Therapy (EFT).



Although treatment differs from person to person, therapists are constantly revisiting a patient’s previously outlined goals to ensure that the patient’s concerns are being actively addressed. This also creates a space to introduce any new goals that might come up for the patient throughout the therapy process.



Throughout each session, the therapist and the patient create a connection often referred to as the therapeutic alliance. This alliance is key to creating a comfortable and safe environment where you feel you are able to discuss personal matters without judgement from the therapist. This therapeutic relationship may form slowly over time and typically results in a connected and trusting bond between therapist and patient.



Before You Go...

Therapy is a multifaceted process, which each person experiences differently. The most important component to therapy efficacy and prognosis is finding a therapist with whom you connect and feel comfortable with. If you do decide to engage with therapy, please ensure that you find a therapist who best suits your wants, needs, and therapeutic goals. You are your own best advocate, so if you feel you aren’t connecting with your therapist, don’t be afraid to let them know. Many clinics have diverse teams of therapists available for you to work with. If one therapist is not a good fit for you, your therapist will be happy to refer you to someone who may be better suited for you.



Check out our diverse team of therapists here to learn about the various services we provide and how we can help you.



Written by: Natalie DeRose, M. Psy. Candidate, B.A. (Hons)

Edited/Reviewed by: Dr. Stacy Lekkos, C.Psych and Chantal Legere, M.Psy. Candidate, B.A. (Hons)  



References



Photo by cottonbro from Pexels

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No matter how complex or simple it is, when you have a reason to do something, you are more likely to actually follow through with it. Remember to remind yourself why you want to focus on this area of your life. This will be particularly important when the going gets tough or if you fall victim of your previous routine way of functioning. Remember, meaningful change (in this case, sleep) does not happen overnight. Limit Blue Light Exposure Cutting out screen time before bed is one of the most effective ways to improve sleep quality. However, I’m fairly confident that most of you reading this will end the last moments of your night on a screen, whether it's a phone, computer, iPad, or the television. Throughout human evolution, humans evolved to be awake when the sun was up and to fall asleep when the sun went down. The problem with blue light specifically is that it has shown to stimulate the brain in areas that are active during alert day hours, disorienting the body’s natural preparation for sleep. Furthermore, blue light suppresses melatonin production (the hormone that makes you sleepy) and elevates cortisol (the hormone associated with stress ). Mariana Figueiro, PhD., found that two hours of screen time before bed displayed a suppression in melatonin levels in the brain (Figeuiro et. al., 2011). In fact, even when our eyes are closed, we have photo-receptors all over our skin that absorb light just as our retinas in our eyes would. Thus, having screens on anywhere around our sleeping areas is problematic. Tips to manage blue light exposure: Setting a screen time curfew Wearing blue light protective glasses Turn on blue light blockers on devices, i.e. phones and computers (f.lux and Nightshift are recommended for iOS users and Twilight for android users) Instead of watching TV, movies, or YouTube before bed, listen to a podcast or audiobook with the screen off or on sleep mode. Ensure your room is completely pitch black at night, with no lights on, curtains closed, and any technology still on should be covered. For those of you who sleep with a light on, it’s recommended to buy a red light for your bedroom. Not only do these look cool but red light on the visible light spectrum has been shown to have little to no effect on both melatonin and cortisol levels. This is hypothesized to be due to the fact that humans have evolved sleeping by fire throughout human history (Stevenson, 2016). Caffeine Consumption Before getting into what you can do to manage your caffeine consumption, let’s take a simplistic look at what caffeine actually does to the brain that impacts our sleep. During normal functioning hours, the brain slowly accumulates a chemical called adenosine that binds to receptors to slow down brain activity and make you feel tired. The longer you are awake, the more tired you feel. Where caffeine comes into play is that it is shaped very similarly to adenosine and it binds to brain receptors. When these receptors are blocked by caffeine instead of adenosine, this tricks the brain into thinking it's not tired. Caffeine has a half-life of about 6-8 hours. A standard cup of coffee has roughly 150g of caffeine in it. What this means is that after about 6-8 hours there is still about 75g of caffeine in your system. Therefore, the timing of your caffeine consumption is just as important as the quantity. With this being said, the best strategy involves setting a caffeine curfew in order to reduce the amount of caffeine in your system by bedtime. It is recommended to cut out all sources of caffeine approximately 8 hours before bed. This includes coffee, caffeinated teas, espresso, or any other source of caffeine. Change Your Mindset in Regards to Sleep Although the other two points mentioned will probably apply to most readers, this one was the most influential point towards improving my sleep. I associated sleep with a negative outlook, specifically with loss of time. I knew through research and extensive thought that if I was going to improve my quality of sleep I was going to have to change my mindset. That isn’t the easiest task, especially when you spend years of your life thinking you dislike something. Some things that I did that helped me with this was reinforcing my why . The more I thought about why I was addressing my sleep, the easier it became to desire wanting sleep. Once I slowly worked towards this, I found that my anxiety associated with loss of time began to reduce and I was able to associate sleep with a positive mindset. Meditate Mindfulness is the act of becoming aware in the present moment, without judgement. The practice of mindfulness through mindful meditation can provide an opportunity to create mental space at bedtime and to help you feel more relaxed. Mindfulness can also help you to cope with negative thoughts surrounding sleep and to help you shift your focus to your body and to be present. This technique is easily accessible by downloading free apps or using beginner guided sleep meditation videos on YouTube. Other Minor Tips to Improve Your Sleep Journaling is an excellent release before bedtime, especially if you are an over thinker. Letting out the thoughts on paper and getting them out of your head will allow you to focus more on sleep and less on what’s on your mind. Invest in a good mattress. As mentioned earlier, we are going to spend about one third of our lives sleeping so why not ensure that we get the best sleep possible? If you are not in an ideal financial situation at the moment, perhaps investing in a proper mattress isn’t realistic. For you, I suggest buying a memory foam topper or just a mattress topper. This is an inexpensive way to improve sleep quality. Sleep and wake at consistent hours. Our super complex yet lazy brain loves to work off of routines so do your brain a favour and go to bed and wake up around the same time. This will make the process easier on yourself and will make you less likely to give up from frustrations of not being able to accomplish what you set out to. Do not, and I repeat do not, do any work or eating or anything in your bed besides sleep. The brain works off of associations so don’t confuse your brain into thinking your mattress is an office, movie theater, or a kitchen table. This is just the beginning when it comes to ways to improve your sleep, as solutions often depend on one’s specific sleep challenges. However, trying any of these tips can be beneficial as improving our sleep is crucial to improving our physical and psychological well-being. Best of luck on your sleep journey and sweet dreams. Written By: Erik Michalik, M. Psy Candidate, BASc, Edited/Reviewed by : Chantal Legere, M. Psy References Figueiro MG, Wood B, Plitnick B, Rea MS. (2011) The impact of light from computer monitors on melatonin levels in college students. Neuro Endocrinol Lett .; 32(2):158-63. PMID: 21552190. Stevenson, S. (2016). Sleep smarter: 21 essential strategies to sleep your way to a better body, better health, and bigger success . New York, NY: Rodale Books. Photo by Andrea Piacquadio from Pexels
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