What Is It Like to See a Psychologist?
The answer to this question is not as straightforward as you might think. For those who haven’t seen a psychologist before, the picture you may have in your mind’s eye is of a person sitting a chair jotting notes on a clipboard while you lay on a couch and talk about your childhood. There is some truth to this – after all, I do jot notes on a clipboard because it is important to have a record of what happens in a session and because my memory is not perfect. However, I have never asked anyone to lay on a couch (I have never had a couch long enough to fit an adult laying down), and discussing one’s childhood is typically not a large part of treatment. So, it’s safe to say that the reality of seeing a psychologist is not that similar to how it is depicted in movies and on TV. If we stop to think about it, I suppose that is true of most jobs. So what is it actually like to see a psychologist?
Psychologists are different. First, there are different types of psychologists; then, there is a significant variation in how psychologists are trained, depending on their level of education, area of specialisation (if they have one), who supervises them, and where they are trained. Therefore, my answer to this question is really only an answer about what it is like to see me, but it may give some insight into psychological treatment in general.
The first session is an assessment. I meet a person and try to learn as much about that person as possible – what problems concern them, what their symptoms are, how it is affecting this person’s life, and other things that may be going on their lives that impact them. I usually reserve a little bit of time in the second half of the session to ask about the person’s history – their family, their work and educational history, relationship history, what it was like growing up in their household, the events that they think shaped who they became. However, the majority of the session focuses on the present – after all, this person is seeking treatment now, and I need to find out why.
After that first session, I take all of my notes and I try to fit the information together, a bit like a jigsaw puzzle. I look at the symptoms the person has reported and try to decide whether those symptoms fit with a particular diagnosis, like Major Depressive Disorder or Generalised Anxiety Disorder. Often, people do not have a diagnosis – just because a person has a problem for which they are seeking help from a psychologist does not mean the person has any psychological disorder. Sometimes people just need help getting through things that are difficult, like a relationship breakup or grief. To me, a diagnosis is only important insofar as it points me in the direction of a particular treatment model. When I have pieced the person’s information together in what is called a formulation, I basically have a little diagram that shows me how different aspects of the person’s problem impact on one another. For example, if a person comes to see me with social anxiety, I may determine in my formulation that the person’s avoidance of certain types of social situations is making the anxiety worse in the long term.
In the second session, I go through the formulation with the client. I explain everything in detail and give the client opportunities to ask questions. This feedback is critically important, because without it, my treatment plan won’t make sense. I explain what aspects of the person’s thoughts or behaviour I think we need to target in order to have the biggest positive impact, and I give a basic overview of the type of treatment I think is required. I explain to the person how many sessions I think will be required for improvement, and I give information about the structure of a typical session. If there is time, the client and I set some goals for treatment – without these, it is hard to know when we have accomplished what we set out to accomplish, and therefore, when to stop therapy. And, of course, if there is anything about my plan or explanation of the client’s difficulties that the client thinks I’ve gotten wrong, it is important to discuss this, too.
The third session typically is when “active” treatment begins, although going through all of the feedback that we do in the second session is a form of treatment itself. The early sessions (i.e., the third, fourth, etc.) usually include a lot of psychoeducation, which is just a big word that means educating the client about aspects of psychology that are relevant to that person’s problem. For example, if I am seeing a depressed client who is spending a lot of time in bed, I will explain to that person how this may actually be making them feel worse. We talk about strategies that the person can use to change their behaviour and make a plan for how they will implement these strategies outside of the session. We may also start to talk about the person’s thinking and ways for the person to identify their thoughts, to recognise when the thoughts are not rational or helpful, and strategies for thinking more realistically. Whether we work on thoughts, and how, depends on the type of treatment model that I proposed at the start.
Once the strategies that we are using have started to result in positive change in the client’s symptoms and that person seems to be able to use them capably, we typically will then start to discuss any underlying problems that might have made the person vulnerable to their problem in the first place. For example, it may be that a depressed person has always struggled with self worth and, while they may not have been depressed before, it would be important to address their self worth so that the depression does not recur in the future. These “core beliefs” typically emerge in childhood, and discussion of how they arose is important in ultimately changing them. However, not every person who sees a psychologist needs to address core beliefs, and that is up to each individual.
Finally, once the person’s treatment goals have been met, it is time to think about ending therapy. At this point, the person’s sessions have typically become spaced farther apart. The final one or two sessions consist of what I call “relapse prevention”. That is, we do a summary of therapy – what worked, what did not, what it would be important to remember in the future – and we discuss what future problems may crop up and make a plan for how those will be managed.