THE SECOND SESSION: THE FOLLOW-UP
Updated: Jul 14, 2022
This post is one of ten in a series of posts that introduce counselling and psychotherapy. This series covers topics ranging from what to expect from a psychotherapy appointment to signs it might be time to consider seeing a counsellor or psychotherapist.
This post is about the session psychotherapy session: The Follow-Up
With a different format from the first session, the second session will actually be the first follow-up session and will be similar to the other follow-up sessions.
The aim of these sessions is progress. The psychotherapist follows up with the client to see if the client has progressed since they last met.
The client and psychotherapist plan for progress, assess the progress and rework the plan to increase the likelihood of success.
I have said in other posts, but I'll say again that every practitioner has their own methodology. The sessions might not go exactly as described here as they may differ in order or content, but this is to provide a general outline for a general session.
The Beginning
A follow-up session might begin with the question, "How was your week?"
This rather simple question contains much information. What the client chooses to discuss (or not discuss) and their mood/energy as they speak provides the psychotherapist with insights into the client's situation.
Some clients will recount something that stuck with them from the previous session or describe an episode of symptoms they experienced.
Sometimes people come in with a new crisis and need to create a new plan.
Those new to psychotherapy may not know what is relevant and recount their entire week as the psychotherapist guides them to identify priorities or summarize issues. Clients with more experience in counselling may tell how they applied their homework from the previous week and the effect it had.
The psychotherapist should ask about the homework if the client doesn't mention it during their week's review. Homework assignments are central to psychotherapy treatment. Psychotherapy focuses on skill-building, and building skills requires practice.
Reviewing the homework assignments is important to keep sessions effective and motivate the client to continue participating.
The Priority Issue
After reviewing the week and the homework, the client and psychotherapist will collaborate to identify this session's priority issue or event and reflect upon it. This is done to collect information about the event
Even if already covered earlier in the session, the psychotherapist will ask the client to recall a recent event where they experienced symptoms related to their chief complaint. Together they review thoughts and feelings that occurred before, during and after. They discuss the circumstances leading up to the event and the client's reaction to what happened afterward.
Independently or under the guidance of the psychotherapist, the client may imagine how they wished they had reacted or what outcome they hoped had occurred. Over time, the client will internalize these skills of reflecting on an event and reviewing it with rational thought.
The Work
After the priority is identified, the work begins. This is the good part. Challenging, but good. The psychotherapist provides education and guides the client through cognitive and behavioural techniques selected specifically for that client.
If the client has panic attacks and losing control is their priority, the psychotherapist may discuss grounding techniques.
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If the client has panic attacks and their priority is reducing the frequency, their psychotherapist may recommend the client complete a thought record so they can identify their triggers or maintaining behaviours
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The psychotherapist will select topics for education based on the client's special set of circumstances. It could be the physical reaction to stressful situations or the lasting impact of not having childhood needs met. The psychotherapist may challenge the client's perception of a situation or have the client practice saying what they wished they had said.
There is a large repertoire of techniques a therapist can use during the session. And while some of the work occurs in the session, a significant portion occurs between sessions. With new skills and perspectives, the client experiences new events. They bring these experiences back to their next session to repeat the process until the client starts to have reactions and behaviours with which they are satisfied.
The End (of the session)
As the appointment winds down, new homework assignments will be discussed, and if time allows, maybe there will be a small reflective practice on the session that just occurred.
The frequency of appointments usually starts weekly and then tapers off until the sessions come to an end.
As the sessions progress, the psychotherapist will have the client assign themselves self homework. After learning a few skills, the client may conduct a behavioural experiment alone or with the psychotherapist.
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The End (of this post)
Assuming the assessment was completed during the first session, that is the general format of the second session of psychotherapy and other follow-up appointments.
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