What to Expect from Psychotherapy: The Initial Session

When you go to a physician, you probably know what to expect: your vital signs will be taken by a nurse, you will wait on the exam table, perhaps changing into a gown, and then the doctor will come in, ask you questions about your health, and physically examine you. Most people have had this experience many times since childhood and know exactly what to expect.

When they make an appointment with a psychologist or other therapist, however, many people have no idea what to expect. They are usually coming in at a time that is already quite difficult and can be quite apprehensive about the initial appointment. For therapists, on the other hand, the process is so familiar that they forget that not everyone knows it as well as they do and don’t offer much of an explanation.

So, what should you expect?

The initial meeting, or intake session, will be an opportunity for the therapist to learn the reason the client has chosen to come in, which is also call the presenting problem. It is also an opportunity for the therapist and client (or patient) to get to know each other. For human beings, change takes place primarily in relationship with another human being so feeling comfortable in the relationship with the therapist is key.

The initial session is sort of a mutual interview, where both client and therapist get to know each other a little and find out if they feel comfortable with each other, and are a “good fit” to work together. The session may feel uncomfortable because it is difficult to talk about whatever brings you in but the therapist will attempt to empathize with your situation and help you to feel at ease.

After one or two initial sessions you will likely have a good idea whether this therapist is someone with whom you feel comfortable enough to work on the difficulties in your life that prompted you to seek psychotherapy. If you identify discomfort with the therapist that is not related to the distress of discussing your situation, it is perfectly fine to look for someone else.

Before the first appointment, you may be asked to complete some initial paperwork in which you will provide your contact information, describe the reason you’ve come in, and any symptoms related to this issue. You may also be asked for information about your relationships, occupation, medical care, drug and alcohol use, and previous experience with mental health care such as previous psychotherapy, hospitalizations, and medications prescribed. You may also be asked to complete standardized questionnaires to provide further indications of how you’re feeling.

During the first meeting the therapist will ask you to describe the issues verbally and in more detail. She or he will also ask questions to clarify the problem and to understand the wider context of your life. The provider will also inquire about current and past drug/alcohol use, thoughts about death or suicide, including previous attempts, and any traumatic experiences. You may also be asked questions about unusual experiences or beliefs related to delusion and hallucination.

These questions are asked of everyone who presents for psychotherapy and should not be interpreted as an indication that the therapist thinks you are more disturbed than you are. Most people who do have problems related to these issues will not talk about them unless directly asked so these inquiries must be made in every initial interview.

While asking these questions, the therapist will also be making an effort not only to listen and understand your situation but to make an emotional connection with you, communicate understanding and empathy, and to facilitate the discussion of your concerns. At the same time, he or she will also be looking for patterns in your presentation and symptoms to consider possible diagnoses.

Sometimes all these inquiries can be completed in one session; often it takes 2-4 sessions to fully assess a person’s situation and concerns. As this process continues, the client and therapist will begin to set goals for their work together. The therapist may also make referrals to other providers, such as the primary care physician or a psychiatrist. With these preliminaries completed, you and the therapist will begin to work together to resolve your problems and improve your situation.

Nancy R. Soro, Ph.D.

Licensed Clinical Psychologist

The Importance of Positive Support in Coping with Stress

For many people battling with stress, the fight can often feel like a very lonely struggle.  The anxiety and depression that result from struggles at work and in our personal life cause us to feel isolated from others and forget that there are people around us who can help.  These people are our support system, and their presence is vital to reducing stress and helping us maintain a general sense of sanity in our worlds.

The purpose of having a positive support system is to ensure that we are not forced to cope with the pressures of stress alone- they keep us stable.  No matter how successful you may feel at coping with your problems alone, there will always come a time when even the strongest coping skills is not enough.  Stressful situations get worse just as sure as they eventually get better and it is important to have people to lean on when this happens.  Different support persons achieve this in different ways.  Some may help us by lending an ear to listen to us unload our stress.  Others may help take our mind off things by providing a fun afternoon activity to socialize.  No matter how they achieve it, a support person is defined by the end result of helping us reduce stress, anxiety, and depression.

In addition to receiving stability from your support system, many people find that it helps them to feel grounded and validated.  When we get involved in stressful, anxious, or depressed situations, we often convince ourselves that no one in the world as gone through something like this.  We fool ourselves into believing that no one else could ever understand our pain.  A positive support system will often remind us that being overwhelmed and emotionally drained is normal and expected.  They can help us maintain perspective when our world feels out of control, and a good support system knows what to say to help us take a deep breath and take stock of our lives.

The most important part of creating a positive support system is being able to identify those people in your life that give you stability and validation without the negativity of judgment.  These people could come from any facet of your life: a spouse, a child, a parent or siblings, a co-worker, or just a friend.  If you feel comfortable sharing your feelings with this person and you can expect no judgment back from them, then they are a part of your positive support system.  If they do pass judgment or make you feel negative about the emotions you’re going to, then perhaps it is time to release them from your support system and engage with someone that helps you relieve your stress.

There are times and situations when we may discover that we don’t have the positive support system that we want.  It may be that our supports are too negative for us or that our supports have become warn out.  In these cases, you may want to seek out some new members to add to your support team.  This can be done in a number of different places.  Start by seeking out environments where you can find positive people, including: church groups, community organizations, and even neighbors.  In these groups, you can seek out new friends to create relationships with that can be supportive in the future.

Our positive support groups can be as big or as small as we feel comfortable.  Each person is different and requires a different support network to help us cope with our problems. The most important thing to remember is that, no matte the size, we all need a positive support network of some kind.  If you feel that you don’t have anyone in your life to help you through difficult times, this may be the perfect time to seek out a neighborhood friend, attend a church group meeting, or call a family member.  Reach out to the positive people around us and allow them to help.  You’ve probably already helped someone else- now let them help you!

Bill Knor, LCPC
Licensed Clinical Professional Counselor

Do you have low self- esteem?

Have you ever avoided certain situations and experiences due to fear of what people may think of you? Or does the thought of what other people think of you send you into a flood of anxious thoughts? If either of those questions are a yes for you, you may have low self- esteem.

Self -esteem, which is how one feels about one’s self,  affects almost every aspect of one’s life especially mental health. So as a therapist it is quite common to encounter clients with low self- esteem, though that's not usually why they come in for therapy. Often times clients present with symptoms of  depression and anxiety, with low self -esteem often being a common feature of both.

According to Marilyn Sorensen, PhD, Clinical psychologist and the author of Breaking the Chains of Low Self-Esteem, “low self -esteem occurs  when one believes that they are inadequate (flawed) unworthy and unlovable, and or incompetent”. She posits that all sufferers of low self-esteem experience fear and anxiety stemming from their belief that are inadequate in one or more areas of their life. She also states that “the frequency to which fear drives a person’s reactions reflects the severity of their low self- esteem”. Here are four fears deemed by Dr. Sorensen that accompany low self- esteem:

1. Fear of confirming one’s own inadequacies. Those who experience this fear are afraid of doing something that will prove what they already thinks is true, which is that they are in fact inadequate, unlovable, and inferior to others.

2. Fear of revealing one’s inadequacies to others,  which could result in disapproval, criticism, rejection or blame. Those who experience this fear are vigilant in observing themselves in effort to do what is acceptable, believing that a mistake will result in the criticism or disapproval they so desire to avoid.

3. Fear of losing what one has, fear that success cannot be sustained; fear of abandonment. Those who experience this fear are not only afraid that they will not succeed, they question whether they can keep what they have managed to attain.

4. Fear of re- experiencing humiliation, depression, devastation or despair. Those who experience this fear, are afraid that these strong emotions will return and as a result they may experience extreme anxiety.

According to David Burns MD, psychiatrist and author of Ten Days to Better Self- Esteem and Feeling Good: The New Mood Therapy, “Most bad feelings come from bad thoughts”.  So, if you can relate to any of these fears here are a few affirmations from Glenn Schiraldi’s, The Self - Esteem Workbook to help you replace these fears and  negative thoughts.

Thoughts of Self-Esteem from The Self-Esteem Workbook

• I think well of myself.
• I accept myself because I know that I am more than my mistakes, foibles or any other externals.
• Criticism is external. I examine it for ways to improve, without concluding that the criticism makes me less a worthwhile person.
• I can criticize my own behavior without questioning my own worth.
• I am aware of my strengths and I respect them.
• I can laugh at some of the ridiculous things I do sometimes.

Ariane Allen, Psy.D

Psychologist

Orland Park, Il

aallen@anxiety-stresscenter.com

The Platinum Rule to Reduce Stress

The Golden Rule- We all know it. Most of us have grown up with it. “Do unto others as you would have others do unto you.” Or, more commonly, “Treat others how you want to be treated”. It’s a pretty simple concept. If you want to be loved, love others. If you want to be accepted, accept others. If you want patience bestowed upon you, be patient with others. If you want to be cared for, care for others. If you want to be forgiven, forgive others.   

However, this rule can only account for so much. While we may treat others according to the Golden Rule, it does not account for everything.  Many who follow the golden rule put the needs of others far above their own wants and needs. And, this can be praiseworthy at times. However, could there be more to this?

I propose the “Platinum Rule.” This is not meant to replace the golden rule. More so, to give us something more to aspire to in our actions and choices. A complimentary rule. And here is what I propose: “We must learn to treat ourselves how we want to be treated.” Sounds simple enough. Or does it?

What is it that we truly seek from others?  Love, acceptance, patience, and care. Moreso, unconditional love, patience, acceptance.  Even forgiveness may be added to this list. How often do you practice loving yourself?  Accepting yourself fully? How often are you patient with yourself? With your own struggles? Patient with your mistakes or progress? Most importantly, how often do we forgive ourselves? Fully and freely and allow ourselves to move forward without shame and regret? How easily do we offer these gifts to others, yet not to ourselves.

So, I implore you, incorporate the platinum rule, as well as the golden rule. Treat yourself how you want others to treat you. Love yourself. Accept yourself. Be patient with yourself. Take care of yourself.  Forgive yourself.

Karen Rosian, Psy.D.

Licensed Clinical Psychologist

Disagree Better: Avoiding Conflict to Reduce Stress

Some of the most common causes of stress living in a social world are the disagreements that we can have with others throughout the day.  Whether it is with a spouse, a coworker, a family member, or a child, disagreements are a natural part of communicating our individual opinions.  Stress enters into this world when disagreements turn into fights.  As our conversations decline to conflict, most of us feel the anxiety that comes from having to defend ourselves and the anger that often accompanies it.  We can avoid these feelings if we learn to disagree better!

In order to avoid fights, we first have to identify some of the pitfalls that get us from civil disagreements to all out brawls.  Being dismissive of others is a common complaint that often heats up a conversation.  If we don’t take the time to listen to the other person and at least consider their perspective, then it is natural for them to get angry and not afford us the same luxury.  This pitfall is a sign of disrespect that no one appreciates.  Another trap that people fall into is letting the focus of the disagreement get away from them.  We often begin a discord on one topic, but end up fighting about every little thing that has every annoyed us about the other person.  We need to learn to stay on topic and not bring up any previous slight that we’re hanging on to- those are best discussed at a separate time.  A third pitfall is when we attack every argument with the same energy and gusto no matter what the topic.  It is important to learn to pick our battles.  Knowing that we’re trying to avoid fighting, we need to ask ourselves “is this fight really worth the stress that it will bring me”.  If the answer is no, then we need to have the strength and courage to move on.

When we get involved in an argument, we are often so wrapped up in our own feelings that we forget that the other party in the discord is feeling similarly.  Empathy can be your biggest weapon in defusing fights before they occur.  While we cling to our own perspectives, it is helpful to consider the perspective of your sparring partner.  Are they as passionate about the topic as you are?  Do they have some emotional connection to this topic?  If we try to understand the perspective of the other person, it often leads us to a better grasp on why this fight is occurring.  Even if we continue to disagree, empathetic disagreements often avoid some of those pitfalls that lead to fights.

It is also important to realize this simply fact: you can’t have a fight with only one person.  We often feel like we need to defend our position and fight when challenged, but the reality is that this is not the case.  If we are working to avoid the stress caused by fights, then the best weapon we have is the ability to avoid fighting altogether.  Learn to avoid hot button topics that you know usually lead to fighting.  Make efforts to eliminate people from your life who thrive on consistent conflict.  Most importantly, remember that you don’t have to participate in an argument just because someone else wants to fight with you.  This technique is particularly important for parents of teenagers who often seek out conflict as they search for their own identify.

If an argument seems inevitable, there are methods to assert your feelings in a way that can disarm your partner and reduce the stress involved.  First off, try to use “I statements” as much as possible.  “I statements” are a way of taking ownership of our feelings and problems and avoid throwing blame at others.  Instead of saying, “You make me so angry when you don’t listen” why not try, “I feel like we’re not communicating well together”.  The new statement feels less like a jab and more like an issue that we can solve together.  Secondly, make sure you identify the change that you want to happen.  Going into an argument with no clear plan of solution puts added stress on both parties.  If you don’t know what change you want, perhaps that’s something you should consider before addressing the issue. Finally, try not to generalize your thoughts with words like “never”, “always”, or “only”.  It's much more effective to say, "I rarely get to go to parties, and I'd really like to go to this one." than to shout about how "You NEVER let me go ANYWHERE! I'm going to be the ONLY person not there!"

By learning to disagree better, we can reduce a great deal of stress from our daily lives.  If we can be empathetic, avoid common pitfalls of arguments, utilize “I statements”, and be clear about the change we want to see then we can live happier lives with less conflict and more pleasant communication.

Bill Knor, LCPC
Licensed Clinical Professional Counselor

Meditation Followed by Aerobic Exercise Reduces Depressive Symptoms

I recently stumbled upon a brief article that offers a evidence of how aerobic exercise helps to reduce depressive symptoms.  Take a look...


Thirty minutes of meditation followed by 30 minutes of aerobic exercise twice a week significantly decreased depressive symptoms in patients with major depressive disorder, according to a study in the online Translational Psychiatry. 
“The effects were robust, as evident by the nearly 40% reduction in depressive symptoms after only 8 weeks of training,” wrote researchers from Rutgers University, New Brunswick, NJ. “Interestingly, individuals without a clinical diagnosis of major depressive disorder also reported significant reductions in depressive symptoms.” 
The study investigated the effects of a mental and physical training intervention that consisted of 30 minutes of focused-attention meditation followed by 30 minutes of moderate-intensity aerobic exercise twice a week over 8 weeks. Twenty-two college students with major depressive disorder and 30 healthy students participated in the investigation. 
At the study’s end, all participants reported fewer depressive symptoms and ruminative thoughts, researchers found. 
“By learning to focus their attention, the participants acquire new cognitive skills that reduce interference from negatively biased recollections,” researchers wrote. “These neuronal mechanisms activated during mental training with meditation are perhaps further strengthened and even ‘consolidated’ by the physical training with aerobic exercise that occurs immediately afterwards in this neurobehavioral intervention.” 
A previous study involving 8 young mothers who were homeless and living at a residential treatment facility also found decreases in depression as well as reductions in anxiety and gains in motivation after the 8-week mental and physical training intervention, researchers noted. 
The findings suggest the mental and physical training intervention may offer an accessible alternative to psychotropic medications and psychotherapy in the treatment of depression. 
“There are two behavioral therapies, aerobic exercise and meditation, which have demonstrated benefits for individuals suffering with depression, are not accompanied by profound side effects and can be practiced across the lifespan,” researchers concluded. “Here, we provide evidence that demonstrates the effectiveness of a combined behavioral approach in improving mental and cognitive health outcomes in individuals with major depressive disorder and otherwise healthy individuals.” 


 —Jolynn Tumolo 




References
1. Alderman BL, Olson RL, Brush CJ, Shors TJ. MAP training: combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity. Translational Psychiatry. 2016 Feb. 2;6:e726.
2. Exercise and meditation — together — help beat depression [press release]. EurekAlert!: Washington, DC; Feb. 10, 2016.


Lauren F. White, LCPC
Psychotherapist
Anxiety and Stress Center
Orland Park, Illinois
lwhite-johnson@anxiety-stresscenter.com