What is the typical structure of a therapy session?

1. You fill out a brief symptom checklist about the previous week in the lobby.
2. We start the session at the appointment time, and welcome you in the office and we handle the payment, scheduling, and any other administrative issues. This process takes up to 5 minutes.
3. We start the session and give you feedback about the checklist, your current progress, and note any issues on which we may wish to focus in the session.
4. We also discuss any issues and/or lessons from the previous session.
5. We go over homework from the previous session.
6. Together we set the agenda about what to work on for the current session.
7. We work on those agenda items for the majority of the session.
8. Approximately 5 minutes before the ending time, we wrap up the session, elicit feedback about the session, and assign homework to do over the next week. We will end promptly at the conclusion of 50 minutes.

How long is a "therapy hour?"

Most psychotherapy sessions last 45 minutes, commonly called a "therapy hour." This is reinforced by the medical insurance industry which reimburses individual therapy sessions for a 45 minute psychotherapy procedure. It has more to do with the business aspects of therapy rather than any magic in the time-frame.

In my practice, I add on an additional 5 minutes at the start of the hour to handle administrative issues, increasing our meeting time to up to 50 minutes. But most people wonder what I (and other therapists) do in that 10 minute break between sessions. What most clients don't realize is that this is not the kind of break where one relaxes and, perhaps, has a cigarette. It is the busiest time of the therapist's hour!

Speaking for myself, during that 10 minutes, I furiously write down notes of the previous session while they are fresh and I am actively thinking about my previous client and their issues. I then put the file back into my file drawer and prepare the next file for the upcoming session. I also read the notes from the previous session so that I may refresh my memory about issues we are working on, homework assignments, and any other business or therapy items that may need to be considered or discussed. I also straighten up the office from the previous session, remove trash and paperwork, get a bottle of fresh water for my upcoming client, and put the space back to a starting position. But, that isn't all!

This 10 minutes is also the only time I have to use the restroom, have a quick bite to eat, and/or return phone calls, emails, or texts. Because this time is so limited, it is rare that I can actually get to return all phone calls, emails, and texts. Often times these communications are put off until much later that day, or the following day, as my treatment days do not end until after 9:30 p.m. And this is just the routine stuff.

Sometimes a complication may arise that throws the schedule off, but this is very rare. I do everything possible to start my sessions promptly at the start of the appointment time, create a welcoming physical space, and give my full attention to my clients and their issues.

How will I know if I am getting results?

YOU WILL KNOW IF YOU ARE GETTING RESULTS. Most therapists rely on their own intuition and personal observations about whether your life is improving as a result of the therapy. Though this helpful, it does not give the full picture.

It's not a guessing game with me and I don't want to be for you either. I do three key things that help us now where you are starting from and how much progress you are making along the way:

1) I do a full baseline diagnostic interview, get baseline measures, and get an objective personality evaluation and other background information. It is like getting a full physical at the beginning of therapy to determine your starting point. I share all of my impressions with you and use this information to help us determine the treatment plan.

2) I measure progress over time. I use a 23-item DASS (Depression-Anxiety-Stress Survey) to track individual clients and a 7-item Relationship Survey to track the progress of Relationship and Couple Clients. These brief questionnaire's take 2-3 minutes to fill out and give us progress data that I share with you to help us know if our work is on the right track.

3) I evaluate our relationship both through a brief measure and informally by talking about it. That way if there are any issues that are getting in the way of our therapy, we can deal with them as soon as possible so that we can effectively continue our work.

I can't promise you'll get better, but I can promise you will know if you are and be able to change course more quickly if you aren't. Basically, I want you to get results too.

If you want to know why this approach is so important, check out the following article: http://www.psychotherapy.net/article/successful-psychotherapists

Do you get results?

YES, I GET RESULTS! Part of my secret to getting good results with my clients is that I continue to evaluate my work on an individual client basis and as a collective whole. I use checklists and surveys as well as other markers to help us both know if we are on the right track.

In one self-study of 73 of my clients using the Symptom Survey-77, I was able to show an overall reduction at the end of therapy in every category being evaluated (Somatization, Depression, Alcohol Use, Anxiety, OCD Symptoms, Panic, Agoraphobia, and Trauma Symptoms). See below if you want the details:

Following is a report of 73 clients for whom I had both intake and discharge data over three years. The instrument used to measure progress (SS-77) is a listing of 77 symptoms related to various mental health conditions. Below is a listing of the scores, a graph of the scores, and a written explanation of what each category indicates. Clients had varying lengths of therapy and presented for a wide variety of problems.

The individual numbers of the scores are less meaningful than the difference of the intake scores versus the discharge scores. For the statistical experts out there, the scores are based on T-scores which use a mean of 50 and a standard deviation of 10. If you do not know what that means, 50 is the average of most people who took the survey and a difference of 10 (up or down) is a big change in the score.

In sum, if you look at my intake scores versus my discharge scores for various symptom clusters, it appears that overall and in individual areas, the therapy worked.

Summary Report for the Symptom Survey-77 (SS-77)

Description:

The SS-77 is a brief measure for establishing baseline functioning, documenting the necessity for psychotherapy and other treatments, assessing the effectiveness of treatment and monitoring progress or improvement. The SS-77 is not a psychological or diagnostic test and should not be used for determining a diagnosis.

SS-77 Scales (Intake Score; Discharge Score)

Somatic Complaints: 48; 39

Depression: 58; 38

Alcohol and Other Drugs: 42; 41

Anxiety: 53; 43

Obsessive-Compulsive Symptoms: 52; 44

Panic, including Agoraphobia: 50; 41

Agoraphobia Alone: 43; 40

Traumatic Stress: 46; 40

Minimization: 47; 41

Magnification: 34; 28

Total patients included in analysis: 73

SYMPTOM SURVEY-77 (SS-77) Scale Explanation

SOM = Somatic Complaints. The items are generally descriptive of major physical symptoms frequently endorsed by pain, neurologic, and other medical patients and disproportionately endorsed by persons with psychological problems.

DEP = Depression. Scores on this scale essentially establish the extent and nature of dysphoria, hopelessness, and general feelings of unhappiness, associated with the general construct of depression.

ALC = Alcohol and Other Drug Abuse. This measures whether drinking alcohol or using drugs to the point of self-admitted symptom expression has occurred within the past week.

ANX = Anxiety. This scale includes items designed to measure autonomic arousal.

OCD = Obsessive-Compulsive Symptoms. This scale measure the degree to which a person is bothered by symptoms classically associated with obsessive-compulsive disorder.

PAN = Panic Symptoms. This scale measures the physical and cognitive features of panic, including autonomic nervous system arousal, apprehension, and sense of loss of control.

AGO = Agoraphobia Alone. This scale measures fears of being in a place where help may not be available in the absence of reported panic symptoms.

TRA = Traumatic Stress (related to a traumatic event). This scale measures a variety of symptoms related to trauma, including anxiety, agitation, depression, obsessive-compulsive symptoms, and somatic complaints.

MIN = Minimization of Symptoms. This scale reflects the degree to which a person is likely to "deny" or minimize their presenting symptoms in the desire to appear well..

MAG = Magnification of Symptoms Scale. This scale reflects the degree to which a person is likely to exaggerate or magnify their presenting symptoms.

SS-77 Computer Report: ©Copyright 1995 DocuTrac,Inc. All Rights Reserved.

SS-77: ©Copyright 1995 Judith Johnson, Ph.D. All Rights Reserved