pavel blagov, phd, licensed psychologist

Psychotherapy

What is psychotherapy? Psychotherapy is a relationship between a psychologist and a client who have agreed on certain rights and responsibilities. The process requires regular meetings between the therapist and the client, during which the client brings up problems or goals and the therapist responds, based on the client's personality and needs. Therapy is likely to succeed if the client engages during sessions and works on his or her goals between sessions.

Therapy can have benefits as well as discomforts. For example, it may involve discussing unpleasant experiences and feelings. Therapy has been shown to lead to benefits, including improvement in relationships, solutions to specific problems, and significant reduction in distress. There is no guarantee what a given client will experience.

In general, the first 1 to 4 session involve an evaluation of the client's needs. By the end of the evaluation, the therapist offers an initial impressions of what may be helpful. The client should evaluate the information along with his or her impressions of the therapist. Because therapy costs time, money, and energy, the client should pick a therapist with whom the client feels comfortable.

If you begin therapy, you and the therapist will usually schedule one 45 or 50-min. session (one appointment hour) per week at a time you agree on. The therapist will expect you to come regularly and on time. If you cannot attend a session, then, with advance notice, the therapist may try to reschedule. If and only if clinically indicated, the therapist may ask the client to commit to attending a given number of sessions. Psychotherapy usually ends when the client decides so or when external circumstances require it.

The course of therapy. Active treatment may start as early as the first session, although it usually starts after the evaluation. Treatment sessions often take the following form. I ask you how you have been doing since the last time, and I ask what goals you wish to work on. You might choose to focus on a recent or past event that is linked to your difficulties. I may then ask questions about what happened and what you thought and felt, and I may offer my feedback. This may involve focusing on key thoughts or feelings, challenging your way of thinking, coming up with new skills to try out in real life, or understanding and changing relationship patterns. Not all sessions will follow the same format, as it will depend on your current needs. You may stick to your original goals, you may change your goals, or new goals may emerge. We will review the treatment goals periodically to make sure that we are on the same page.

Treatment may last a few sessions for mild problems, a few months for moderate problems, or a couple of years for more serious problems. Long-lasting changes to personality or serious relationship problems may require more than a year of treatment. Chronic mental illness may require longer treatment; in many such cases, clients are often able to eventually reduce the frequency of sessions.

An important part of treatment is ending. When to end treatment is almost always the client's decision. I may bring up the question of whether ending has been on your mind or whether it may be time to end. Preparing for ending may involve reviewing what treatment goals were accomplished and what goals may remain. It may involve learning how to prevent old problems from happening again in the future, and it may involve focusing on positive personal growth. It is important to prepare for ending, so that it is a positive experience for you.

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