top of page
  • Writer's pictureNidhi Trivedi

Psychoeducation about the process of therapy in the intake session: A SAFE approach for therapists!

If only I had a dollar for every time someone casually asked me, “So, how do you do therapy?”  or “how do you cure people?”

Small talk with engineers generally doesn’t involve having these professionals summarize how they work with the laws of physics and thermodynamics. Traders aren’t often asked to summarize the last few years’ worth of Amazon stock trends. Yet, as therapists, we often are asked to summarize our work in a concise elevator speech. Sometimes, we need an explanation to communicate the legitimacy of our profession in social settings. At other times, this explanation plays a crucial role in an initial interaction with a potential patient.

Why is it important to provide accurate and effective psychoeducation about the process of therapy?

Therapists deal with the intimate subjects of people’s emotions and personal experiences. Therefore, it is important to be able to communicate an accurate description of the therapeutic process to a new patient. Many potential patients do not know how therapy works, and they may not be convinced of how it can be beneficial for their symptoms. More often than not, how you introduce them to therapy can make or break their hopes for and faith in the process.

Every individual who decides to go to therapy attends at least one session. Therefore, the therapist has at least one hour to build rapport, gain trust, and communicate effectively about how the process of therapy will play out. Our graduate training and practicum hours teach us a plethora of techniques, theories, and models that are helpful in the therapeutic work itself. However, we do not receive any training on how to provide psychoeducation about the process of therapy.

Who benefits from psychoeducation about therapy?

Every individual who learns more about the process of therapy may be able to benefit from it! The following individuals might benefit most:

  1. Individuals who have considered therapy but who have not gone through with it due to a lack of clarity about the process.

  2. Individuals who have never been in therapy.

  3. Individuals who lack hope.

  4. Individuals who feel stuck.

  5. Individuals who think therapy is a sham.

SAFE: The components of a strong first session

Remember the acronym SAFE to guide you through the psychoeducation process at the beginning of therapy and to put your patients at ease. SAFE stands for:

Space that is safe, confidential, consistent, and judgement free

Assessment and active listening

Formulation and conceptualization of mental health concerns

Effective and efficacious strategies and elements of change

Space that is safe and confidential

Discussion of the limits of confidentiality happens during the first session, but before the intake interview itself. Depending on the organization and the state that is practiced in, the therapist must communicate that the limits of confidentiality include but are not limited to the individuals who will have access to their records, when breach of confidentiality is permitted by the law and the ethics board, and incidents that will be reported to state agencies.

Many therapists neglect having this discussion prior to the initiation of therapy, but a discussion about these limits sets an honest and authentic tone in the therapeutic relationship. After all, the therapeutic space is a safe and confidential environment.

Here’s an example of what this conversation might sound like: “John, before we start the discussion of what brought you here, I wanted to bring to your attention that everything that you discuss with me, both today and in subsequent sessions, is confidential and will not be shared with anybody without your permission. There are a few exceptions: Everyone working at this integrated practice will have access to your records, and we may share relevant clinical information with the insurance companies to obtain compensation for services we provide.

“In addition, if I deem that you are at imminent risk to harm yourself or anyone else, I am able to break confidentiality to communicate to relevant third parties to create a safety plan for you or anyone else in danger. I am also mandated to report child abuse, child neglect, and elderly dependent abuse and neglect. Lastly, if I were court-ordered to release information about you, I may have to share a little bit about our work together. Do you have any questions?”

Assessment and active listening

During the initial intake, therapists obtain detailed information about the individual’s current symptoms, their duration, and their intensity. Apart from that, the therapist may also collect information about the patient’s social, occupational, and educational functioning. It can be beneficial to obtain information about the individual’s medical history, mental health history, substance use history, relationship history, family history, as well as their strengths, weaknesses, and hobbies, to learn more about their barriers and facilitators to change. While assessment and active listening might not seem like a psychoeducational resource, they can be a “preview” of what the therapeutic process looks and feels like.

Here’s an example of what this conversation might sound like: “Because this is our initial session, we will spend most of this time talking about what brought you here. I will ask you to share in-depth information about your relevant life history. It might be hard to paint a comprehensive picture of your life in 30 minutes, so we will try to focus on things that might offer insight into the cause of your current symptoms. Let’s start with you telling me about what brought you here, John.”

Formulation and conceptualization of mental health concerns

Usually, I dedicate the last 10 minutes of the first session to my conceptualization of how I see the patient’s symptoms impacting their current functioning. This involves mirroring, reflecting, and validating the concerns that the individual has voiced. Based on your theoretical orientation, you could summarize how you think their symptoms affect their past or current functioning. This is a time to communicate to the patient that their concerns are valid and provide theoretical and practical conceptualization of their current issues in the way that you understand them.

Here’s an example of what that might sound like: “It seems like it has been really difficult for you to manage work-related stressors. From what you told me about your stress, it sounds as though you have experienced significant anxiety due to previous job-related difficulties, and each time the job becomes unmanageable, one way you have coped with it is by quitting. Avoidance has been your coping strategy so far.

“In therapy, we will explore your anxiety triggers so that they can be recognized and addressed before they begin to feel unmanageable. Also, we will attempt to substitute unhelpful coping skills with adaptive coping skills. In doing so, we will utilize all your strengths and attempt to overcome the barriers that exist to managing your anxiety. What are your thoughts?”

Effective and efficacious strategies and elements of change

Different mental health treatments have different evidence-based interventions. With my patients, I have an honest discussion about their presenting concerns and discuss treatment strategies that can be effective in that particular context. In addition, I also talk about my theoretical orientation and how that might be helpful in the process. I might also discuss my limitations as a therapist for their clinical presentation if I do not feel competent in that clinical area, and I will offer them other options that might be best for them.

Here’s an example of what that conversation might sound like: “Cognitive behavioral therapy techniques are shown to be very effective for anxiety management. These techniques involve cognitive strategies such as the exploration of thoughts and beliefs, as well as  behavioral management techniques such as relaxation and guided imagery. We will also work on finding coping skills that work best for you.

“As a relational therapist, I place emphasis on the therapeutic relationship and encourage you to bring up your feelings throughout therapy, both towards me and towards the process. Occasionally, I might share my feelings with you, as they might help us gain some insight into how your relationships with other people are impacted by stress. Any thoughts?”

Lastly, I encourage clients to ask any questions that they have about me, about mental health symptoms, and about leveraging therapy to empower them. I strongly believe and often tell my clients that knowledge is power. Once people know more about the process of therapy and how it works, they can utilize it to their advantage.

1 view0 comments
bottom of page