Inside the First Assessment Session for Adult Therapy
An initial assessment session is in essence a collaborative exploration. Its purpose is to begin to understand the reasons you feel as you do. This is through finding about what has brought you to therapy and asking about your broader life, both as it is today and over time. This enables an initial understanding of your current difficulties to be formed; how past experiences map onto today’s conflicts.
1. Establishing the Frame
At the outset, the therapist will set the explicit framework of the therapy. This will include explaining the limits of confidentiality, the process of psychodynamic therapy and at the end, if you chose to enter into therapy, establishing a regular day and time. A therapy assessment may take place over two sessions. This allows for enough time for a broad understanding of your life to be conveyed and gives you the opportunity to get a sense of what therapy will be like.
2. The Client’s Story in Their Own Words
Often, you will be invited to talk about what has brought you to seek help. This is usually then extended out into other areas of your life, which includes your work, relationships. The therapist will ask about your history, such as what life was like growing up and your school experiences. This is so that you and the therapist can develop a perspective on your how you relate to others, as well as yourself, together with the type of patterns that may be shaping your current difficulties. It is not only your experiences that are important to attend to, it is how you have responded to and made sense of them.
3. The Client’s Early Life
A central part of the assessment session(s) includes exploring your history, particularly early relationships and significant life events. These moments often provide an indication of learnt ways of relating to others, which might include striving to please others, fearing rejection, or a sense of responsibility for other peoples’ emotions. These patterns are understood as necessary ways that you may have learnt to manage as a child and formed your image of what is likely to happen in relationships. The therapist may ask gentle exploratory or clarifying questions, the intention being to explore and notice patterns that may have felt automatic or have been unseen.
4. Relationship with the Therapist
The therapist also begins to notice how you feel in the room and the nature of your interactions. This is because this can provide an initial indication of how you relate to other people more broadly. This is why the relationship with the therapist is important, not only to begin to feel safe enough, but to also provide insight into the templates you hold in your mind about others and yourself. This is the main reason that the therapist will share very little if anything of their own life.
5. Formulating
By the end of the assessment, the therapist will have begun to conceive of an initial formulation about the reasons that you have come to feel as you do. This may inform the direction of the therapy, but is in no way fixed and are preliminary suggestions, which evolve throughout the therapeutic work. Of central importance is what resonates with and makes sense for you. Its purpose is to help you begin to make sense of what you are experiencing and lays the foundation for the therapeutic work.
6. Discussing Next Steps
The therapist will discuss with you what your goals are for the therapy and if this way of working feels that it will be helpful for you. If so, you will discuss setting up a regular time and think together about how long it will be helpful to meet for. The end of the therapy is not generally thought about at this early stage, but planning the end together will be an important component of the therapy and will emerge over the course of the sessions.
Therefore, an initial assessment is both an introduction and the start of bringing meaning to your distress. It is an opportunity to begin to uncover the emotional patterns that have structured your relational life, which lays the foundations for the therapeutic work and your relationship with the therapist.