• AscendPsychology

What happens in a therapy session?

Updated: Dec 28, 2020

During a one-on-one therapy session, the therapist and client work collaboratively to achieve a set of goals that have been decided upon by them.

An individual may seek out therapy for several reasons – to learn to cope with grief or trauma, anger, anxiety, depression, etc.

Take for example the brief therapy for Anna (a fictional name)

Anna is 26-year-old and plans to get married in a years’ time. She would be shifting to a different country to start her married life with her husband. But the thought of this impending shift and all the major changes that will follow has started giving her anxiety. This is affecting her sleep and appetite as well. Anna wishes to learn how to handle this anxiety better and has sought out to meet a psychologist to help her achieve these goals.

First the therapist would listen to and understand Anna's subjective world. Then they will assure Anna that a mental health condition does not imply worthlessness and can be seen and treated just like any other physical condition. After an initial collaborative alliance is reached, they will then formulate goals of therapy that are acceptable for Anna and reasonably healthy according to the therapist.

Over the course of the sessions, the therapist will employ a number of Cognitive Behavioral Therapy (CBT) interventions to help Anna identify and challenge her dysfunctional (unhelpful) thoughts. The therapist will also teach Anna a few strategies that may help her when she gets too anxious and overwhelmed. In between sessions, Anna may be assigned homework which would be discussed over the subsequent sessions with her therapist.

Let us now have a closer look at what happens in a therapy session.

The first session:

Prior to commencement of the session, there will be a bit of paperwork that the client is expected to fill out with details pertaining to the presenting concern, contact information, their consent to therapy, contact information of a next-of-kin etc.

An important part of therapy is confidentiality which will be maintained with the strictest standards. A therapist is ethically bound to not share or reveal any information that is shared in the sanctity of the therapy session. The therapist discusses this with the client, as well as the exceptions to this rule- such as if the therapist is privy to information suggesting that the client’s safety or that of others around them is threatened, then they would be obliged to reveal this information to their care-giver or to the person at risk, or to authorities as the case might demand.

During the first therapy session, the therapist builds rapport and gets to know the client and what brings them to therapy. (Of course, rapport building is an ongoing process that will keep happening over the course of the therapeutic relationship.) The therapist will ask a lot of questions so as to gain more clarity about the case history, family background, support systems, employment history, any comorbidity. Sometimes this process may stretch out over two sessions, especially in the event that the client may feel reluctant to share details in the first session itself.

Once the therapist has a better, and clearer picture of the issues at hand, they can go ahead with setting a treatment plan and outlining the therapeutic goals. Sometimes if necessary, the therapist may want to conduct an assessment so as to understand the presenting concern in more depth.

Subsequent sessions

Over the next several sessions, the therapist and client continue building a trusting, therapeutic relationship and unravel the presenting concerns even more, by discussing the symptoms experienced and the negative effects on the client’s life or those around them. The therapist may help the client understand what triggers these symptoms. The therapist will also teach the client to handle them effectively using various evidence-based strategies.

For example, in Anna's case they might be taught strategies to manage anxiety better. They will be taught to use progressive cognitive methods to increase positive feelings. The therapist will also encourage the client to practice the strategies learnt during the session. They would assign homework to further their application of the strategies learnt to real life. They would discuss the experiences (or any challenges faced) over the next session.

As Anna's anxiety reduces, and they are able to cope better with the challenges of the transition to their new life, the client and therapist may discuss reducing the frequency of their sessions. Eventually, the therapist will terminate therapy, after ensuring that Anna can now navigate their concern independently. This is done in collaboration with or after discussion with Anna.

Edited by Supriya Nair

Clinical Psychologist

MD AscendPsychology CogniPsyTech Pvt Ltd


American Psychological Association. (2012). Understanding psychotherapy and how it works. http://www.apa.org/helpcenter/understanding-psychotherapy

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