The Process of Therapy?

A common question when starting the therapy process is, “What can I expect?” Seeking therapy often carries a bit of mystery, and once started, people frequently wonder if it’s actually working. While every therapist has a unique approach, I’d like to spend some time explaining what the work looks like when we’re in the room together.

Back in therapy school (what my classmates and I affectionately called our grad program), I remember a guest speaker breaking down the therapy process into a three-phase approach. After gathering treatment goals with clients, I tend to follow this model, always understanding that we often float back and forth between phases. 

Phase 1: Insight

Before we jump into any kind of solution, we need to understand where the presenting problem, or the motivation for your goals, is coming from. My therapist and I affectionately call this stage of the process “collecting data.” For example, if the presenting problem is difficulty managing friendships, we’ll explore your history with friendships and how that might be influencing what’s happening now. If you’re turning to substances to cope with this difficulty, we’ll spend time understanding your history with both friendships and substances.

I often draw from Narrative Therapy, which invites clients to tell their stories so we can uncover what’s dominating the current narrative. I’ll also use Internal Family Systems; how we show up in relationships is complex, and we usually have many different parts that affect our interactions. Together, we can get curious about whichever parts are most present.

Phase 2: Awareness

Once we’ve gathered insight and collected our data, the next stage is building awareness. For instance, if we’ve identified that your struggles with friendships stem from being bullied in middle school, we might explore how that history shows up today. Was that bully a friend who turned their back on you during a difficult time? In this phase, we’ll ask challenging questions: What role do substances play in your life now? What need are they helping you meet? How do you know when you’re ready to make a change?

Here, I draw from Emotion-Focused Therapy, which uses emotions to help us understand the patterns we humans often fall into. Additionally, somatic work can be incredibly helpful. Our bodies store these patterns and become comfortable with them. Through somatic work, we can uncover these patterns and ask whether they’re still serving you.

Phase 3: Action

Once we’ve developed insight and grown awareness, we can move into the “final” stage: action. Here, we’ll explore what actions, or inactions, make the most sense for you right now. Maybe we’ve uncovered that your history of being bullied has led you to push away anyone who tries to get close because there’s a perceived threat of being hurt again. In session, we can discuss ways to build safety so that you might feel more comfortable letting a potential friend in a bit closer. Or perhaps you’re not ready yet and that protective part still needs to stay. In that case, we’ll talk about finding a community that feels supportive while holding on to that part.

At this point in therapy, I often return to those initial modalities. Narrative Therapy helps us discover alternative, preferred narratives that can guide you toward your goals. Parts work allows us to find compassion and care for the different parts of ourselves, and that self-compassion gives us the space to make more informed choices. This can often feel like a full-circle moment for clients, but it’s important that it’s never rushed.

When I first meet with a client, we talk about these steps and how they might look in our work together. As therapy progresses, it’s common to feel a bit lost in the sauce at times. Clients (and therapists!) often find themselves asking, “I’m just talking about my week, is this actually effective?” or “What was my initial goal for seeking therapy again?” or “How do I know if I’m ready to stop seeing my therapist or scale back on sessions?” These questions are a natural part of the process; you’d be surprised how valuable they can be when you bring them into the room!