If you live in a place where there aren't many mental health practitioners, or simply haven't been able to afford it, you might wonder what happens when you go for talk therapy. There is no standard approach, but if you work with me, here's what we do.
Before We Start
You contact me (firstname.lastname@example.org) to say you want to schedule an appointment. Maybe you tell me all about yourself, perhaps you don't say anything. I write back and we schedule a free 15 minute session.
The free 15 minute session
I work online via various systems including WhatsApp, Skype, Telegram, Messenger and Meet. Each has pros and cons, and some work better in some countries than others. So the first thing is to make sure the technology works for us.
Then we have a brief chat about what you want from sessions.
I work with stress, depression and anxiety which covers a lot of situations. However, should you have an issue that is outside of my scope, we talk about where you might find another person to help you. If I can recommend someone, I will. If you want, I will also ask in my groups for you.
If we can work together, I explain how confidentiality works, about the notes I send you, what we do if there is a lightening strike or other interruption, how billing works and more.
After our 15 minutes, if you want to have sessions, we make an appointment. I then email you the confidentiality agreement.
Note: There are no rules about what first sessions are like. But if you tell me you're maybe anxious or depressed or stressed but you're not sure what's going on, then the first session may go something like this.
The focus on the first session is to get deep background so that we know more about how stress and depression are affecting you, and what exactly you want to manage. Basically, you do a lot of talking!
Structured Conversation #1: Your Overall Health
I am not a doctor. But as some physical issues can have a big effect on your mental health, I will ask you to tell me a little bit about your health status. Like, have you had any accidents recently, have you suffered from a lot of pain, been very ill, are you on medication of any kind, and when you last saw your family doctor.
Depending on your answers, I might suggest you talk to your doctor. In fact, if you are depressed and you can't think of a reason why you might be so, I strongly recommend that you have a checkup, just to make sure there's nothing physically wrong, like a wonky thyroid. The checkup doesn't have to be fancy. Just go and see your family doctor. You can read more on that here.
Structured Conversation #2: The Stress In Your Life Over The Last Year
Life stress can have a big effect on mental health, but sometimes we lose track of how much stress we're under. This conversation is about figuring out what's going on your life.
In this conversation, I ask you questions about your personal life, your relationships, and your work life. You may recognize parts of it because it is inspired by Holmes & Rahe's social readjustment rating scale that was published in 1967. I will also explain what their intention was, and why my conversation with you has no scientific value.
Why do it if it's not 'scientific'? Well, if I ask you what's been going on, you might forget things or draw a complete blank. With this structured conversation, we cover a lot of ground easily and quickly.
Structured Conversation #3: Your Support Network and Primary Relationships
We talk about how you get along with your immediate family, your work colleagues, and your best friends.
I want to know partly because early learning and the way your parents raised you have an impact on the attitudes, beliefs and behaviour on the adult you. The other reason is that positive relationships are important for good mental health. If you feel you need to strengthen ties, we add that to our list of goals.
Structured Conversation #4 Your Sleep
How well you sleep has a direct impact on your mental health. It's very important, so we talk in detail over when you sleep, how well you sleep, whether you're getting enough or too much sleep, and more. If sleep is an issue, we talk about ways to improve your sleep.
Structured Conversation #5 How Exactly Does Your Stress and Depression Affect You?
As everyone is different, we discuss common signs of depression and see whether they apply to you. We talk about your appetite, energy level, concentration and your mood and emotions, including guilt, fear, sadness and anger.
You will recognize some of the questions because ask about the nine criteria described in the Diagnostic and Statistical Manual of Mental Disorders used by doctors. Although my Master's training included methods and techniques for helping manage depression, I am not a doctor and I do not diagnose. The purpose of this part of the conversation is purely to see how your stress and depression affect you.
Part #6 Putting It Together
At the end of the session, we put everything together so that we have a good picture of what's going on. Then we discuss how we can get into a happier space. During this part, I will make suggestions about various approaches and techniques that may be useful. It's all about fitting the right methods to your needs.
At this point, we'll both be tired, so we make an appointment for the next session where we kick off with getting in the effective change.
After Our First Session
I send you the notes, highlighting the most important parts with an outline of how we're going to work. Also, an invoice!
I hope you found this interesting.