The first few sessions tend to be the most difficult because it can feel awkward and fear provoking to share of yourself with such vulnerability. The initial session is about history gathering, so I'm inclined to ask a bundle of questions and take more notes than usual. With your permission, we will quickly dip in and out of various times of your life, to get a well-rounded picture as if I've known you your entire life.
It's expected that you complete online intake documents prior to the first session which I'll review in my own time. The documents entail office policies, confidentiality, privileged communication, therapy guidelines, expectations, various assessments for mood, anxiety, disordered eating, and overall history. Your questions and honesty are always welcomed.
This is also a time for you to check-in with your gut and ask, "Is this therapist right for me, will she be able to help me, and do I feel comfortable and safe with her?" If your gut says, no, I will be happy to recommend referrals since the goal is to heal, and you might struggle if the relationship feels like oil and water. Also note, if you generally have issues with commitment or safety then that might be what we work through together. You can always schedule a free consultation over phone or telehealth before committing to an intake session.
For many reasons, you might feel emotional during our sessions together; this is quite normal. Some people are afraid to show emotion, some have buried them deeply, and some show emotion more freely and more often. Emotions are welcomed, but the goal isn't to have big, overwhelming emotions, if this happens, I'll help you find your ground - it won't last forever I promise.
I'm afraid to disclose personal information . . .
Your confidentiality is of utmost importance, anything you share stays in the therapy room between you and me unless there is reason to believe you have intentions of hurting yourself, a child, or vulnerable adult. Plenty of individuals have suicidal ideation; a trip to the hospital isn't always warranted, but we will have a thorough discussion to ascertain your safety and establish a safety plan if needed. If a higher level of safety is determined, we'll make that happen together.
If your files are subpoenaed by a court of law, I will notify you immediately and work to provide only a summary statement of your mental health status rather than your entire file, though I can't guarantee this. Sometimes I consult with a professional mentor regarding treatment, however, it's vague and identifying information is not disclosed.
Depending on our work together, you may need to sign a release(s) granting permission to speak with frequented health care provider(s) such as a medical doctor, nurse practitioner, dietitian, diabetes specialist, coach, psychiatrist, a sponsor, basically anyone on your support team. Release authorizations expire one year from signing, or you can rescind the authorization anytime with written notice. You will receive advance notice if I contact a provider or support person to coordinate care or finances.
What happens in my office stays in my office. It's like Vegas but without the gambling, gluttony, and endless buffets.
How does therapy work and how many sessions will I need. . .
For some of us, each day can seem like one big trigger to explode, implode, blame, engage in numbing behaviors, or self-rejecting thoughts and avoidance. In fact, these strategies didn't happen overnight and will take time and commitment to be free from them.
You are unique in your circumstances, up-bringing, biology, strengths, skills, motivation, and stage of change. Therapy encompasses, unites, and considers ALL parts of you so the exact number of sessions is unknown because of our complexity. It's hard to give an exact timeline, however, you get to decide how often you come and for how long. If you are suicidal or in major emotional crisis that disrupts your flow, then you might consider coming more often. Know that eating disorders or other symptoms can take many years to overcome but it is possible if you are willing to change the relationship with yourself and your environment.
I can't afford therapy . . .
Not everyone can truly afford therapy, therefore limited sliding scale and pro-bono sessions are available though not permanent, this way others can receive the gift of therapy too. Typically sliding scale is one-hundred dollars per session for six months, but you can get back on the rotation list if needed, or I can give referrals for lower fee therapists.
There were times when I thought I couldn't afford therapy, and I had to take a hard look at my expenditures and weigh whether my mental health was more important than my daily dose of soy lattes at fancy coffee shops. I choose mental health and cut down on superfluous debt like eating-out, extra buys from target (stuck to the list) and decided on DIY pedicures - you get the picture. Please really consider if you can pay full price to make room for those who cannot.
I'd rather not take medication . . .
I believe self-care in general is good medicine: nutritional food, supplements, proper sleep, frequent movement is a solid start, and decreasing stress, however, sometimes it's not always enough. I'm a fan of whole person wellness and may suggest blood work or other testing, and even adjunct modalities such as acupuncture, TMS therapy, ketamine therapy, massage, functional nutrition, yoga, meditation, among others.
Research suggests that use of medication and psychotherapy together may be the best approach, especially for more severe conditions. Generally, medication is often prescribed for conditions known to have strong biological components such as major depression, schizophrenia, bipolar disorder, OCD, or panic disorder. Medication offers some relief from symptoms and psychotherapy enables the individual to gain knowledge about their condition and how to better cope or strategize for their particular biology. This combined approach offers the fastest, longest-lasting treatment.