The first few psychotherapy sessions are generally considered “getting-to-know-you” sessions:  you and your therapist will explore what feelings or problems have brought you to psychotherapy.  While your therapist helps you express your feelings, you will want to think about how comfortable you feel with her.  Do you feel understood? Do you feel safe in her presence?  Are you comfortable talking to her?  Most importantly, do you trust her?

Therapists may take the occasional note or ask for clarification, but generally, they say very little at the outset of psychotherapy.  Following these early sessions, you and your therapist decide if you can work collaboratively to address the concerns you have brought to therapy.  If you are comfortable with the process, the therapist introduces what is known as the “therapeutic frame”   and then together you establish the frequency and time of your sessions, you confirm the fee for each session, and you affirm the therapeutic goals you wish to achieve.  As you work with your therapist, you develop what is known as a therapeutic alliance.

What is a therapeutic alliance?

In psychotherapy, the therapeutic alliance consists in the trust that develops between you the patient, and the therapist.  A successful therapy allows you to express all your feelings and emotions without fear of being judged or misunderstood.  Your best interests are always the focus of the relationship. Part of the psychotherapeutic process involves developing, maintaining and nurturing that alliance. 

Are my sessions going to be confidential?

Confidentiality is the cornerstone of psychotherapy.  Nothing you share with your therapist may be conveyed to another person without your explicit consent; nothing that transpires in a therapeutic session may be used for research purposes or publication without your explicit, written consent.  The limits of confidentiality are laid out by the College of Registered Psychotherapists of Ontario (https://www.crpo.ca/standard-3-1-confidentiality/).

What happens if suddenly I have nothing more to say?

There are times during psychotherapy when you might feel you have “nothing to say.”  Perhaps your week has gone well, or you haven’t been plagued by habitual problems.  Don’t be surprised if this “nothing to say” feeling emerges.  You probably have had a good week; the ongoing source of stress has momentarily dissipated.  So, what’s to be done?

Patients often wonder what the “value” of therapy is on a day when there’s no crisis to contend with. Your therapist may invite you to consider the feelings you are experiencing right then.  What does it feel like to be momentarily liberated from a particular anxiety or worry? Can you remember when you last felt like this?  Moments such as this allow you to enter into a much deeper relationship with your emotional world; you will be able to take hold of threads that lead back to important earlier experiences.  Such sessions are often very rich in material and advance your therapy considerably.  As one patient once said, these are the “aha” opportunities that therapy provides.