Whenever I am contacted by someone exploring the possibility of beginning therapy or counselling, I am aware that a question that will be on their minds, whether or not they articulate it, will be ‘What can I expect from a first assessment session?’ and ‘What will come after it?’
In the hope that if you are thinking about coming to therapy it would help you to begin to answer that question, I thought it might be helpful if I spelt out how I, and many other psychodynamically trained couple therapists frame our work with couples who come to see us. At Coupleworks our original training was psychodynamic, but we have all gone on to undertake further training and developed additional approaches so we might more accurately be described now as integrative couple therapists.
Clients want change and answers and sometimes to be told what to do to make it better. There are different ways of getting to the point of change. From the outset let me stress that the work we do is genuinely collaborative. Unlike some forms of ‘problem-solving’ or ‘skills based’ couples therapy – both of which have their rightful place in the world of therapy – I like to focus less in the first instance on immediate solutions and more on understanding the emotional dynamics between partners and especially unconscious patterns that are being repeated and are often rooted in a person’s background. As a therapist my aim is to provide a secure space in which these things can be explored.
So, what will happen in that first ‘assessment’ session?
Well obviously, we will need to begin by explaining some very practical things to do with the process. What the length of each session will be – usually 50 minutes – and how often they will happen – mostly on a weekly basis. Then there is the question of fees, cancellation policy and how many sessions are typically needed. We will also discuss the boundaries of confidentiality. After that first session if I and the couple decide to go ahead with some sessions, I often suggest that we review things in 6-8 weeks to see how things are going and if the couple are finding it helpful or not.
Then I will invite them to talk a bit about what has brought them to seek therapy for their relationship and how long the issue has been going on. For instance are there arguments that repeat themselves falling into well-worn tracks time and again. Or have there been significant issues or life transitions that have triggered a set of different responses in their relationship.
I usually take the couple back to the beginning of their relationship and ask them about what they liked about each other in the first place – this is usually a moment of relief when they can think about happier times but it also gives a clue about what might be going on in the dynamics of their couple relationship.
Within the first session I will also begin to be looking for patterns that seem to be repeating themselves – patterns that often reflect the past experiences of the family lives and upbringings of the couple long before they met each other. To this end, I will ask each partner in turn to describe their early upbringing. To prompt their thinking, I ask about the structure of their family – how they experienced their parents’ marriage (or partnership), their early relationships with each of their parents and their siblings. I am beginning to look at what their early attachment patterns were like – were they close to their parents – who did they go to for comfort, how were emotional issues of love and conflict dealt with. How were anger and vulnerability expressed?
Obviously at that point in a first session things will usually only be touched on at a superficial level but the fact that they are beginning to be named can be very important not just for each person but also for their partner listening to the story. I will be noticing if the one who is not speaking is attentive or listening empathetically or if their body language shows a significant level of disengagement. How the couple behave in the room, even if it is inevitably early on in an artificial situation will be a window into the dynamics of their relationship which we will be thinking about together in the weeks to come.
I ask the couple what they are hoping to achieve by coming for therapy and towards the end of the first session will check in to find out how they have found it.
My goal is to help the couple to increase their understanding of themselves individually and as a couple to help both partners to see what deeper emotional meanings and patterns lie beneath the conflicts, creating the space they will need for new ways of relating together.
As the therapy process continues it may be that we may also incorporate other approaches including more skills or behavioural interventions to enhance the deeper understanding that is developing between the couple.
Of course, whilst I have related all of this to a first session, in practice what I have described may easily take longer than that. As with building a house there are no short cuts and establishing solid foundations matters enormously for allowing the therapy to move ahead helpfully.
Finally, I am conscious with Christmas approaching, the long break, and the amount of time couples spend together both with their families and friends, that this is a time which can trigger couples to approach us at Coupleworks for therapy. Please do contact us if you feel this is something that might be helpful – it is better to come sooner than to let the problems become too entrenched.
Sarah Fletcher