Stages of Therapy
I hope this guide will help you understand how the therapeutic process works.
We live in a world of quick fixes, of check lists and goals. Often we come into therapy expecting that it will simply be a matter of saying what’s wrong and then listening as the therapist tells us how to fix it. It doesn’t work that way, though. Psychotherapy and the healing of old and new wounds and traumas is not a linear process. It’s a windy path, with forward and backward motion, good times and hard times, times of great healing and times of where things seem to plateau off until the next breakthrough happens. In this way, it’s rather like the rest of life. But if you are committed to your healing and stick with it you will see progress over time, there will be great healing, and your capacity and resilience will increase. The plateaus are just as important as the big healing moments, because the bodymind knows when it needs to rest, and often there is deep work happening in the deeper parts of the self that our conscious mind is not able to track.There is no way to estimate at the outset how long any of the stages will take, and sometimes the process may even move to a previous stage before going ahead again. So, it’s not as simple as setting goals and checking things off a list. Human beings are complex. Most of us have been through a lot. We need to allow for that complexity and give ourselves the time it takes to heal. There is no doubt that therapy works, if we stick with it, and are patient with ourselves and open to new ways of understanding.
Stage 1: Introduction and Assessment
The therapist and client get to know one another. The foundation for trust is laid. History is gradually taken, and the therapist begins to understand the client’s struggles, needs, early development, family history, relationship history, ways of thinking and feeling. If a diagnosis is being made it often happens during this stage, though it can change later as deeper understanding is build. Please give yourself plenty of time for this initial stage. You have no reason to trust your therapist simply because they exist and you’re in the room with them. It is during this stage that the therapist will assess how easy or hard it is for you to access your body sensations and begin to build a plan for helping you to feel ok doing that, if it’s hard at first -- this cannot be rushed. This stage often takes time, time for you to decide if you want to trust your therapist, and time for your therapist to understand your life and what kind of treatment would help you the most.
Stage 2: Resourcing and Stabilization
During this stage you and the therapist begin to build in resources. This is a very important aspect of healing. It can be difficult to work with traumatic material, and even though in the kind of treatment I do we do not encourage or depend upon going into detail about traumatic events, and in fact are careful to titrate the work so that you do not become overwhelmed, it is still very important to have a good foundation of internal and external resources so that when we do work with difficult material you have good ground to stand on. It’s also important for the therapist to have a clear knowledge of what resources work for you so that they can help you call them up when needed. It is during this stage that we will do pre-EMDR work, including “installing” resources using bilateral stimulation (eye movement or tapping) (these are useful even if we don’t end up doing EMDR). Importantly, the therapeutic relationship is itself a resource. The stronger the therapeutic relationship, the more containment there will be, and the more difficult work will then flow more smoothly and be easier for you. Allowing plenty of time for this stage will greatly enhance to healing later on. In the kind of psychotherapy I practice the body is just as important as the thoughts. Therefore, in addition to talking we will also be noticing what’s present in the body and working with that. It can take time to build this ability. Healing does also happen at this stage, though it may be subtle. And keep in mind, more external resources (financial and economic stability, job satisfaction, supportive relationships, nourishing home environment) equal more room to build internal resources, so if any of those factors have been denied you, are unstable, are difficult, or for whatever other reason are not available at present the more time it can take to build internal resources. The capacity to make change is interwoven with how well we're resourced, externally as well as internally. And each helps feed and grow the other. Please try to be patient with yourself.
Stage 3: Healing, Trauma Release, Insight
During this stage we actively work on healing difficult material, traumatic events, and developmental gaps, as well as continuing to build the therapeutic relationship. This can include deeper somatic psychotherapy work, dream work, and EMDR. Sometimes we may work on more resourcing. New assessments may arise as new things are discovered. This stage can last months or years. As it progresses, new insights appear. It really can be quite amazing and rewarding. Keep in mind also that each of the therapeutic modalities I use (somatic psychotherapy, EMDR, dream and depth work, as well as the talk therapy component) all have their own unique stages, as well.
Stage 4: Ending the Therapeutic Relationship
When it’s time to end therapy it’s best for this to be undertaken with consciousness and intention. We like to take at least a few sessions. This is perhaps a good point to note that, as in any relationship, conflict and strong feelings can arise in the therapeutic one. Your therapist (me!) is only human, and may sometimes misunderstand, make mistakes, or accidentally say something hurtful. When that happens, please let me know, and we will work on it. Transference is a normal part of therapy, and actually beneficial. In transference, the client can safely work with what wasn’t resolved in a parental or other important relationship, using the therapist as a stand-in; this is an entirely unconscious process that is usually not recognized as such until after the fact, and that’s how it’s supposed to be. So, if there is a breach in the therapeutic relationship, whether it is from transference or a mistake on the part of the therapist, please know that you are always invited to work through it in the therapeutic space. Or, if therapy is naturally coming to an end we will endeavor to say goodbye in a way that leaves you with good feelings.
If you have any questions I'm happy to do my best to answer them.