Seeing a psychologist for the first time can be daunting. For most people, ideas about what happens beyond the closed door of a psychologist's office come from TV and movies. Often, people have an expectation that they will spend a lot of time talking about their feelings. While feelings are certainly important, much more time is devoted to coming up with ways to change problematic thoughts and behaviour that are keeping a problem from improving.

What to expect in your initial session:

Please arrive 10-15 minutes early in order to complete paperwork and an initial questionnaire. 

When you sit down with me, I typically begin a session by discussing the issue of confidentiality with my clients. This issue is so important that I discuss it with all of my clients before any other discussion takes place. It is important that clients understand that the information they provide to me is confidential, and the rare instances in which I would potentially have to disclose personal information to a third party.

The first session (or two) is devoted to gathering information. It is important that I have as much information about the problem(s) as possible in order to devise an appropriate treatment plan. I will ask a lot of questions, and it is important to understand that a client is never pressured to answer any question that they do not wish to answer. Most of my initial questions will deal with the current issue, and later in the session I will ask questions about a client's background, development and upbringing. By the end of the session, I like to provide a brief summary to the client of the problem for which they are seeking help, in order to ensure that I have understood the information correctly.

A word about questionnaires: I administer questionnaires to my clients at every session. I endeavour to keep questionnaires brief; my object is not to torture my clients! However, questionnaires are a valuable tool. Of course, they provide some initial information about the problem and its severity; but more importantly, questionnaires assess the progress of treatment. That is, if what we are doing is working, we expect the numbers on the questionnaires to change. If they do not, that gives us an indication that we may need to change course.

A note about ethics: As a clinical psychologist, I have taken part in extensive training about how to practice in an ethical manner. This means that I have to be careful about who I see, my clients' relationships to me outside of the clinic, and their relationships to one another. There may be times when I cannot take on an individual as a client due to that person's relationship to me outside of the therapy room, or due to that person's relationship with a current or former client of mine. For example, it may not be appropriate for me to see two people individually who are married to each other, particularly if they are seeking treatment to discuss problems in their relationship. In such cases, I must consider the potential harm it could cause to people and this sometimes results in my having to decline to see an individual. At these times, I will work with that person to find another option for treatment. Unfortunately, due to my duty to protect the confidentiality of my clients, I cannot always disclose why I cannot see a person.



The second session is devoted to feedback. This session is often fast-paced, as there is a lot of information to cover. I provide a client with feedback on my understanding of their problem and recommendations for treatment. I endeavour to give a clients an approximate idea of how many sessions may be required. Toward the end of the session, I explain how therapy works, what they can expect from our sessions, and we set goals for treatment.



A typical psychology session with me is 50 minutes in length and keeps to a standard structure:

Setting an agenda: We set agendas for sessions to ensure that each session is used productively to take steps toward meeting your goals. Agendas are set collaboratively, meaning that I will have ideas about what to work on each session, and the client is expected to bring problems to discuss, as well. Without an agenda, it can be very easy to get sidetracked into long discussions about problems that are not necessarily related to a client's goals. While it may feel good to "vent", it ultimately may not help a client to solve the problems for which they ultimately sought treatment. Agendas, however, are flexible. Sometimes, issues arise in therapy that need to be addressed in the moment. When this happens, we can together decide whether it is important enough to add to the agenda for the session.

Brief update: We spend a brief amount of time discussing your symptoms. Are you feeling better, worse or the same since the last session? If anything significant has happened in your life, I will want to know about that, too.

Homework review: When I mention homework, it strikes fear in people's hearts! Yes, there are tasks that people are asked to complete outside of the therapy room. The reason for this is that it is important for a client to take what they have learned and practice using it. If people simply show up to all of their therapy sessions but do not practice what they have learned in the real world, they are unlikely to experience change. Homework tasks are about ensuring that practice takes place. It is important for clients to know, however, that homework is always negotiable. If I ask someone to do something outside of the session and they feel it is not achievable, we can amend the homework task to make it easier.

Skill-building: In early sessions, the bulk of the session is likely to focus on learning new strategies or practising a skill. Later sessions focus more on skill use in the real world.

Setting a new homework task: The final few minutes of any session involves negotiating the homework task to be completed prior to the next session.