What to Expect in a Therapy (Treatment) Session
I’ve spoken to friends and clients over the years about what stops them accessing therapy for their problems. One topic that’s come up again and again is, unsurprisingly, fear of the unknown. Like with any new experience, if you’ve never experienced therapy before, there can be a degree of apprehension about what goes on behind the closed door of a therapist’s room.
Stereotypical media portrayals of old-fashioned asylums and therapeutic techniques do modern therapists, like myself, no favours! Obviously, every therapist is different and brings their own personality characteristics, therapeutic approach and training into the therapy room but there are some common themes. This article addresses some of the most common questions I get asked about a therapy session, with reference to how a typical session with me might look like.
What happens in a therapy session?
The beginning
The content of every therapy session varies, but there are some similarities in terms of the structure. A session will usually start with a quick check in about how you’ve been since the last session. We’ll then briefly set a short agenda, highlighting the key things you want to cover in the session. Typically these points follow on from things discussed in the previous session or revolve around anything significant which has occurred since we last spoke.
The middle
The majority of the session is focused on whatever items we’ve put on the agenda. If any ‘homework’ was set at the end of the previous session we usually start by reviewing how you’ve got on with this, before moving onto other agenda items. Our conversation may incorporate some or all of the following (not an exhaustive list!):
collaborative hypothesising (usually called ‘formulation’ in therapist language) about what has triggered your problem/s and what keeps the problem/s going
reference to appropriate and helpful psychological theory, information, facts and statistics
teaching and in-session practice of appropriate therapeutic strategies tailored to your specific problem/s.
the processing of distressing emotions, thoughts and/or memories.
You will be supported and guided to continually work towards your specific therapy goals (which we outline at the start of therapy) so that you feel you’re making consistent, meaningful progress. I will also support you in overcoming and learning from any setbacks that may arise.
The ending
Towards the end, we’ll summarise the key ‘take home’ messages or insights you’ve learned from the session, before discussing any ‘homework’ which could help you consolidate these. Homework might include:
monitoring your mood, thoughts, memories or behaviours
practising therapeutic strategies you learned in the session
making modifications to your behaviours or routine
anything which we agree could move you closer to your therapy goals
Then we agree a time to meet again (typically the same time each week) and say goodbye!
“Sometimes you just need to talk about something - not to get sympathy or help, but just to kill its power by allowing the truth of things to hit the air”
- Karen Salmansohn
Is the first therapy session different?
Yes. The first time we meet the structure is a little different. The initial session is what we therapists call an ‘assessment’ session. It’s a chance for us to get to know each other and to check we are a good ‘fit’. It’s also an opportunity for me to obtain a clear understanding of what the problem/s you want to work on are, when and how they begun and also obtain any relevant background and personal history. I’ll deep dive further into what an ‘assessment’ session looks like in a future journal post.
How long does a therapy session last?
Sessions usually last 50 minutes. This is known as a standard ‘therapeutic hour’. There are various theories about the origins of the 50 minute therapeutic hour but no consensus on exactly when and why it was established. However, it has remained the typical industry standard, and for good reason. These include psychological reasons (research has shown a 50 minute session is more containing, and less fatiguing for the client than a 60 minute session), as well as practical reasons (it’s easier for people to schedule into their busy timetable or lunch hour. It also enables a short break for therapists to make notes or prepare between clients).
In specific circumstances, such as trauma focused work, a longer session of 75-90 minutes may be recommended.
How many sessions will I need? How frequently should I come?
The answers to these questions vary. They depend upon your unique clinical circumstances (such as your specific problem/s and goals) as well as practical considerations (such as your availability and finances or insurance coverage). Typically though, people get the most from therapy if they regularly attend weekly and for a minimum of six therapy sessions (following the initial assessment session). We’ll discuss your specific circumstances and clinical needs following the assessment session.
Is my therapy session confidential?
Yes, except for a few important exceptions. Anything you discuss in a therapy session is kept between you and me. I, like all therapists, receive clinical supervision with another therapist, in line with professional regulatory guidance. Although clinical work is discussed within these supervision sessions, all discussions are anonymous. The main situation where confidentiality may need to be compromised is if I was concerned regarding risk; to or from others, or to yourself. This, fortunately, is rare. But it’s important you understand that from the outset. You’ll be provided with written information regarding confidentiality, and it’s limitations, before you commence therapy. This will be discussed and your consent obtained in the initial assessment session.
A couple of IMPORTANT caveats
This article discusses what a typical session of cognitive behavioural therapy (CBT) might look like, the approach I most commonly use in my clinical work. Therapy sessions entailing other therapeutic approaches (such as EMDR or psychodynamic therapy) will likely look a little different. Also, as every human is different, and every problem unique, the exact structure and format of therapy will differ from person to person.
Want to learn more about therapy sessions?
This journal article is part of a series of posts called Therapy 101. The series is a beginners guide to different aspects of psychological therapy and addresses some of the most common queries people have about it. If you’re interested in learning more, these articles might be useful:
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