by Tony Vasquez, MSW, edited by Laura Morrison, June 2014
For individuals interested in becoming a counselor or therapist it may be useful to understand the typical phases involved in the process of providing counseling to clients.
A graduate program in counseling and therapy might help prepare students for a wide variety of potential careers in which practitioners may have to opportunity to work with a diverse client population. However; regardless of setting, and population served, there are often fundamental similarities in the therapeutic process.
For every stage in life there is always a beginning, middle, and ending. This includes education, employment, relationships, etc. There is no difference in the therapeutic process. Although, there are many steps in and phases throughout the process of therapy, you will most likely be familiar with three major phases, the beginning, middle and termination phase. Therapy can be a very complex procedure but it can also be very effective for those who have chosen to seek therapy as a tool to facilitate change, understanding and support. The phases of therapy each have a distinct and specific function with many parts working together.
This phase starts even before the initiation of the actual therapy with a client. This introductory phase may often include someone inquiring about therapy. Many times a therapist will field questions from a prospective client via telephone or email. This first step is important as clients have reached a “breaking point” and are often looking for immediate relief. A therapist can use this first consultation, usually 20 minutes or so, to explore the client’s issues and to answer questions that the client will ask. It is important to note that the rapport building has already started. This is also the period to begin to assess the client’s problem (s) to see if it is an appropriate referral or match depending on your expertise and specialization. It is important to note that you will be explaining expectations of therapy, and providing the client a better understanding of who you are and what to expect. The therapist will set up the first appointment (face to face) with the client as quickly as possible. The initial contact with a client is an opportunity to begin to build rapport. This is very important as rapport building is paramount into a successful therapeutic relationship.
During the first appointment the therapist will usually explain the privacy and confidentiality protocols that have to be followed throughout therapy process. These include reasons you may need to break confidentiality. You will also start to set the professional boundaries and explain the parameters of your services. Should your client accept the therapy services you will also set up the schedule to meet with your client and also address insurance benefits or set up a payment schedule. You will be securing a lot of psychosocial history, coping strategies, and the client’s definition of his or her problem (s) throughout this first interview. For some this assessment can be completed in two or three subsequent sessions. The beginning phase is also where we will have to do more listening and less talking. Our duty is to accept what client is saying (unconditional positive regard) and start to understand their issues through their perspective. We will have ongoing assessment during this part of the interviewing and also starting to formulate and develop treatment intervention.
Once we have set the “ground rules” of therapy we will be continuing into the middle phase. For all intents and purposes this is where we often begin preparation for the termination phase as well. This middle phase represents where the “meat “of therapy happens. Although, we are constantly assessing the client’s insight, coping strategies, and signs of improvements, we are also being cognizant of transition from addressing some of the external issues and how it affects our client’s thoughts and feelings to helping our client internalize those thoughts and feelings. We are helping our client explore deeper feelings and negative thoughts and help them build appropriate coping strategies. Many therapists also utilize tasks or homework during this phase to facilitate this process. This allows the client to work on some of the therapeutic interventions through exercises between therapy sessions. This also assist the therapist with assessing the clients understanding of what is being discussed in therapy (usually reviewed in the beginning of next session) and also helps build better insight for the client in addressing his or her issues. Remember therapy has to be more introspective and active among client and therapist in this phase and not didactic. As always the therapist is assessing the ongoing need of therapy in order to justify the client’s participation in therapy. With this understanding we are starting to prepare for the final stage of therapy, the termination phase.
As with any healthy relationship saying goodbye can be a very hard thing to do. During the termination phase we will help the client understand this process. We will help the client understand how this closure process is important as it relates to many important stages of life and transitions through the processes. It is important to review and discuss the client’s progress toward short and long term goals and review coping mechanisms that can be used in the future. The termination phase is you will be formulating an after care plan to help client with maintenance. This will include assisting clients to build support networks in order to identify alternative resources and areas for support in the event future issues should occur.
Termination also represents the closure of the professional relationship between client and therapist. For some patients longer term therapy may be necessary, and in some instances the therapist may need to make a referral to another source if appropriate. As therapist we have to use our professional judgment to determine if ongoing therapy is necessary or if some of the issues have fallen outside of our area of expertise. Also, we must accept that although we want to help, therapy may not work for everyone, therefore it is helpful to be familiar with additional community resources that could be helpful for the patient.
So as you can see there are many steps throughout the process of therapy. All stages are essential to the successful completion through the therapeutic process. As therapist we must be skilled in facilitating smooth transitions from phase to phase as we complete therapy. With experience your ability to recognize your client’s cues for change and appropriateness to transition through each phase will become a very valuable skill.
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