The Basics of Therapy & Counseling For Associate/New Therapists

Informed Consent

Informed consent in therapy is a crucial process where therapists share essential information with clients, allowing them to make informed decisions about their treatment.

• Limits to confidentiality

• Theoretical orientation and approach

• Fee setting and insurance

• Cancelation policy

• Communication policy in between sessions

• Risks and benefits of therapy

• Alternatives to treatment approach/type

• Endings and terminations

• Affirming client’s choices and agency to say no and yes

• And more

Treatment planning

A treatment plan refers to the specific goals clients have in therapy and interventions a therapist might use to help you reach the goals.

• Assessment

• Diagnosis

• Interventions and skills

• Goals

Diagnoses and assessments

• Completing an assessment

• Providing clients with diagnosis(es) if they ask for it

• Providing clients with a diagnosis(es) if required such as if the client uses insurance

• And more

Documentation and writing notes

• Different styles and ways of writing notes. This can include:

  • DAP

  • SOAP

The Frame

The frame is the context in which psychotherapy occurs and all the arrangements that go with it. Think of the frame as the “rules of engagement” for treatment.

• Fees and insurance

• Communication in between sessions

• Cancelation policy

• Ending sessions on time

• Scheduling appointments

• Boundary management such as dual relationships, seeing clients in public, etc.

• Arrangement of the therapy office

• Waiting room (or virtual waiting room)

• And more

Therapeutic Alliance

• Strength and quality of the relationship between client and therapist

• Important part of therapeutic effectiveness and success

• Approach and modality

• Goal consensus

• And more

The Therapist

Some therapists consistently achieve better outcomes than their peers, and evidence suggests this is due to how they conduct therapy, rather than superior expertise in a specific model.

• Confidence

• Ability to connect to a wide range of clients

• Personality and temperament

• Congruence

• Flexibility

• Stylistic differences

• Empathy

• Communication skills

• Ability to engage and explore areas of differences and diversity

• Ability to integrate skills, knowledge, training into the work organically

• And more

Client Expectations

In therapy, managing client expectations is crucial for a successful therapeutic relationship and positive outcomes.

This involves clearly communicating the process, roles, and boundaries, and addressing both realistic and unrealistic expectations to ensure clients feel understood and supported.

• Providing psychoeducation

• Dispelling myths and misconceptions about therapy and the process

• Engaging the client in a collaborative relationship

• And more

Client Motivation

To effectively motivate clients in therapy, therapists should focus on building a strong therapeutic alliance, setting realistic and achievable goals, exploring client values, and utilizing motivational interviewing techniques to foster intrinsic motivation and address resistance.

• Doing the work outside of session

• Client’s strengths and resilience

• Client’s barriers, challenges, areas of growth

• Assigning optional homework

• If assigning optional homework, understanding why or why not the client does not engage or complete homework (e.g. barriers & challenges)

• Personality and temperament

• Values

• Culture

• And more

Cultural considerations and engaging with difference an diversity

In therapy, acknowledging and respecting cultural differences is crucial for building trust, understanding clients' experiences, and tailoring interventions for better outcomes. Therapists should be culturally competent, continuously learning, and open to diverse perspectives.

• Managing bias

• Managing counter transference

• Engaging with systemic issues in the 1-1 relationship in therapy (racism, sexism, ageism, homophobia, transphobia, etc.)

• And more

Providing Psychoeducation

• Informed consent

• On the process of therapy

• Mental health diagnosis

• Symptoms

• Treatment options

• Providing verbal psychoeducation

• Providing worksheets

• Providing resources

• Helps with:

  • Reducing stigma

  • Promotion of self-efficacy

  • Awareness and understanding

  • Insight

  • Helps improve client treatment compliance/collaboration

Essential Therapeutic Skills

• Empathy

• Active listening

• Flexibility

• Adaptability

• Genuineness

• Communication skills

• Asking open ended questions

• Providing feedback

• Reflection

• Summarizing

• Paraphrasing

• And more

Ruptures, disagreements and repairs

• Providing education ruptures and disagreements are to be expected

• Repairing in the moment when ruptures occur

• Providing a corrective experience for clients

• Modeling imperfection

• Regulating ourselves and taking care of ourselves as therapists if we find conflict, disagreements, ruptures difficult and challenging

• And more

Anticipating obstacles and challenges

• Resistance

• Protectors and defenses

• Impasse and feeling stuck

• Enactments

• And more

Saying goodbye, endings and terminations

• Client’s relationship to endings and goodbyes

• Our own relationship as therapists to endings and goodbye

• How does the client want to say goodbye?

• Reviewing areas of growth and positive changes

• Reviewing continued areas of growth and challenges toward change

• Providing ample space for underlying thoughts and feelings around endings and saying goodbye

• Self disclosing as appropriate our own thoughts and feelings about the work in service of the client and therapy

• Understanding some clients will not want a goodbye session and will “ghost” us or avoid the last session and not take it personally, even though it may feel personal at times

• And more