I want to demystify the process of therapy. Every therapist’s approach is going to be different, but the following are the six stages of therapy involved in my work with clients. This is not a linear process though. It can sometimes be one step forward, two steps back. We might skip steps, or zig zag. Each therapeutic dyad (client and therapist) has its own idiosyncratic way of moving through these phases.
Rapport building is probably the most crucial phase, and one not to be rushed through. Rapport building is where we learn to trust each other. If there is not mutual trust, then little can be accomplished in the other phases. Few of us know what goes into us trusting another person. This is the time to start to understand that. This is also why a regularly attended appointment is so important. The consistency strengthens the rapport. Moments of rapport building can look like discussing the latest book a client is reading, cracking a joke, brief water cooler talk at the beginning of a session, or looking at a picture together on the client’s phone. Therapists are in an inherently powerful position and engaging in such everyday activities helps to share our humanness with clients.
Counseling & Supportive Care
This is the stage in which most therapy takes place and that gets revisited the most. It’s also the phase where many clients often stop. I think of counseling as the management of day to day anxieties and stressors. This is when clients come in talking about everything that’s happened in the last week and give updates about previously discussed topics. It’s easy to fall into a pattern of doing this; the therapist listening and interjecting input along the way. This is an important phase for recognizing patterns clients have and helping them manage their stressors. A lot of time can be spent here depending on whatever a client is currently working through or trying to heal from. Trauma-informed care will spend a lot of time here and the first phase, establishing safety and security. For lasting change we need patterns to show up and play out in therapy, which leads to the next phase.
Interpersonal processing is when the therapeutic relationship comes into play as client-therapist enactments start to happen. Enactments are examples of clients’ behavioral patterns that happen with the therapist. A great example of this is when a client can finally be mad at and express their anger towards their therapist. While this may be uncomfortable to go through, what really matters is how the interaction gets processed; how the therapeutic dyad moves through it together. The counseling phase is mostly a single-person psychology, i.e. focused on the conscious and unconscious of the client. Whereas interpersonal processing is a two-person psychology phase taking into account the interplay of the conscious and unconscious of both client and therapist. The value of this phase is getting to actually practice being in a relationship, which then translates outside of the therapy room with other relationships.
This is the phase where clients start to find themselves in healthy more mutual relationships with others. They may even be repairing familial relationships and moving on from exes. Why? Because this is the phase where we start to accept that other people are different. A lot of internal stress in relationships comes from looking for ourselves in other people and then feeling disappointed when our expectations fall short. This is a stage where a client who usually gets upset if a therapist is running late, may look at the clock and say to themselves, “maybe the therapist is taking care of something else.” The differentiation allows clients to learn how to be alone in relationships. This phase will involve a lot of interpersonal processing and can’t happen without it. Differentiation can occur when the client learns to accept the fallibility of the therapist.
Securing the attachment
All along, the work has been about developing and securing the attachment and at this point there is a well-established therapeutic relationship. Rarely do clients like to admit it, but many of them don’t like when a therapist has to cancel or take time off. By this stage though, clients can accept it, or are able to express that they can’t. The sessions may be happening with less than weekly frequency. The client is able to internalize the work and can tolerate having internalized the therapist to the point that it becomes a natural reflex. Earlier on in the work there may have been an appropriate regression towards allowing the relationship to sink in (it’s hard to feel like you need someone). Now clients are comfortable with it and trust that it is there even when the therapist is not, or in other words, there is object constancy.
See the Breaking Up With Your Therapist post to read about how to end therapy when you’re feeling ready. Ideally, this is a mutually agreed upon and well discussed decision. Coming in one day and saying you’d like that day to be your last session is abrupt. An email or text is even more avoidant. Whatever is causing you to want to end is worth exploring together. It’s very understandable if it’s for financial or other life events. It’s also understandable if you feel like you’re satisfied with how far you’ve gotten. I always fully support anyone’s decision to end, even if it may be premature. I try to make it clear how welcome people are to return and pick up from wherever we left off. Goodbyes are hard, and rarely do we get the opportunity to experience a positive one. Therapy can provide the space for that.