At the beginning of our first initial session, I will plan to go over a few housekeeping rules, make space for initial questions you might have and then begin the intake process.

The goal of the first few sessions is to establish safety and begin to build trust while gathering contextual information necessary for understanding and treating the presenting problem.

FOR COUPLES THERAPY:

For Couples Therapy, I follow the Gottman Method.

During the first session, I will see the couple together to make space for ‘the presenting problem’ (session one).

For sessions two and three, I will meet with each partner one-on-one, separately to gather information mostly focused on the individual’s early childhood development and family dynamics. (The structure of these individual sessions will be very similar to the process of ‘INDIVIDUAL THERAPY’ described below.

For the fourth couple’s therapy session, I will meet with the couple together again to discuss treatment goals and establish a treatment plan.

Steps 2-4 apply for Couple’s Therapy as well as Individual Therapy.

FOR INDIVIDUAL THERAPY:

The intake is a 50-minutes semi-structured interview called a BioPsychoSocial Assessment. The client will be asked basic background information.

If the content is triggering or too activating, the clinician will move at the client’s pace and can revisit certain subjects at a later time. The intake can take up to three sessions depending on the client’s level of comfortability and pace.

The client will be asked to describe each of these categories to the best of their ability:

- History of the Presenting Problem (the reason for seeking treatment)

- Any previous Psychiatric History or Diagnosis

- Trauma History

- Medical History

- Substance Use

- Family Dynamics & History

- Social Dynamics History

- Developmental History

- Educational & Vocational History

- Spirituality & Cultural Factors

- Hobbies & any other relevant information

The goal of this session is to work together to identify and establish specific goals for treatment. This will help guide how to prioritize and focus our time together.

Examples of Goals might sound like:

1. Learn and implement coping skills that result in a reduction of anxiety and worry, and improved daily functioning.

2. Develop a consistent, positive self-image by establishing an inward sense of self-worth, confidence, and competence.

The Treatment Goals are meant to be broad, aren’t fixed and can be changed at any time.

Some clients prefer s lot of structure - a clear beginning, middle and end to session and with homework.

Some clients prefer loose structure, more open ended and less routine or predictable.

These preferences will be explored at this stage and throughout the therapeutic process.

Objectives are the measurable and more specific steps that help support the larger and more over-arching treatment goals. Identifying objectives is meant to be a collaborative process. Objectives do not have to change each week and can remain the same up to 6 months or a year.

Examples of Objectives can sound like:

1. Participate in 1-5 assertive communication behaviors per week.

2. Identify and engage in 1-5 activities per week that are consistent with the client’s values and help improve confidence and self-esteem.

The goal of this stage is to continue to build trust and to adjust treatment goals and objectives as needed.

Change and progress is not always linear. The client will receive psycho-education on The Stages of Change Model to help validate and normalize unreadiness or relapse as parts of the process of change.

These stages include:

1. Pre-contemplation: In this stage, the client may be defensive and is not thinking about changing their unwanted behaviors.

2. Contemplation: The client is aware of the “problem” and is considering making a change by weighing pros and cons of behavior change.

3. Preparation: The client is prepared and ready to make a change and may be researching information about their “problem”.

4. Action: The client is actively making changes and planning to continue with necessary steps.

5. Maintenance: The client is working on sustaining the changes they made during the action stage and may plan for what to do when they feel that their progress is regressing.

6. Relapse: The client may experience a recurrence of previously unwanted behaviors.