The first and all the rest: how a session with a psychologist goes

Psychologist Maria Samotsvetova talks about her first family therapy session.

The first visit to a family psychologist is an exciting and unknown matter. And where there is a lot of uncertainty, there is a lot of fear. Let's look at, in question and answer format, what might worry a couple when they first visit a family psychologist.

What can you say during sessions and what can’t you say?

You can say whatever worries you, whatever you want to say.

The only important limitation is that during individual sessions (if there are any), you should not say anything that you cannot say in front of your partner. A psychologist is not a priest; he will not keep your secrets from your partner. The classic story: in the first two sessions, she cries bitterly and complains, and he is closed and distant. Then, in an individual session, he admits that he has been having relationships on the side for a long time. Thus, the husband seemed to make the psychologist an accomplice in his crime. And what should a psychologist do in such a situation?

A psychologist is not a priest; he will not keep your secrets from your partner.

Let's consider the main stages of seeking help from a psychotherapist, psychiatrist, or psychologist.

The first and most difficult stage is not even choosing a doctor, but deciding to see a doctor. And here many people think: “Am I such a weak person to ask for help?”, “How does a doctor know how to live correctly?”, “I’ll try to cope on my own, and if it doesn’t work out, I’ll ask for help.” " “I myself can tell these specialists for free what and how...”

Psychotherapy is working on yourself.

So, treatment with a psychotherapist is not a passive process, like with a dentist: open your mouth and wait, endure and come out with a finished result. Psychotherapy is work on yourself under the guidance of a specialist who helps you eliminate the pathological mechanisms of the disease and its clinical manifestations as effectively and quickly as possible. You can’t just visit a doctor and expect the doctor to do something for you. Some patients sometimes say: “You’re a doctor, so figure it out.” Both the doctor and the patient participate in psychotherapy; the work does not stop between sessions, but continues daily on oneself.

The psychotherapist simultaneously acts as a doctor, trainer, and assistant. Not a single athlete, without a coach, will achieve outstanding results, and if he does, he will spend an incredible amount of effort than with a coach. A psychotherapist helps you save your time and internal resources to fight an illness or achieve achievements in life. Trying to cope with anxiety on your own without professional help is draining on the body. Many people try to overcome their condition by force of will, to “pull themselves together,” but in doing so they only increase anxiety. The modern world is life in the flow of high speeds and information. Spending precious time unsuccessfully trying to conquer yourself without professional help is an unaffordable luxury.

Seeing a psychotherapist is the behavior of an adult, responsible person.

Patients often say that they have suffered from neurosis for several years. Many conditions can be cured in weeks or months, and sometimes there are conditions where, after even one consultation, the patient begins to move in the “right direction” and is rapidly cured in the shortest possible time. Therefore, seeking psychotherapeutic help is the behavior of a person who takes responsibility for himself and his life, wants to recover as quickly and efficiently as possible, who values ​​his time and considers illness an unaffordable luxury. (Doesn't that sound like a description of a business person, not a weak person?). The psychotherapist does not decide what is better or worse for you, does not evaluate you and your life, and does not give advice. A person is the whole Universe, the task of a psychotherapist is to help the patient understand the laws of this Universe and teach them to use them effectively for the patient. No one will teach you how to live; the task of a specialist is to bring you to harmony by showing you maladaptive patterns of your reaction and behavior, and only you decide whether to change or not.

How many therapy sessions are needed to solve the problem?

Everything is very individual and depends on many factors. The development of events is usually as follows: for the first two or three sessions, the spouses complain, swear and cry. Then small progress and improvements begin. Then - a rollback (the spouses came closer through therapy, and with renewed vigor they presented all their grievances), conflicts return with renewed vigor. This is a turning point: if the spouses can cope, find new meanings for being together and set adequate goals and objectives for therapy, the prognosis is good. Next comes the stage of real work and real changes (the scale is not important here, sometimes the changes seem minimal and insignificant). Then a period of calm and joy from the achieved results.

The pace of this journey is different for all couples. The first results, on average, appear after the fifth or sixth session.

Why you shouldn't be afraid

It's normal to be afraid. Fear is an important psychological mechanism that protects us from danger. He mobilizes resources in a threat situation - “fight or flight”. It’s not for nothing that they say that you can live without fear, but not for long. Evolutionarily, it was given to humans for survival.

Another thing is when fear causes restrictive behavior. For example, a person is afraid to fly and refuses travel, work and relationships that involve flying. Or he puts off going to a psychologist because “only crazy people come to him,” “everyone will know about my problems,” or “this is just a simple money grab.”

Such fears, as a rule, disappear when the client learns that the psychologist complies with three important conditions - safety, confidentiality, and scientificity. This means that the consultant will not tell anyone anything, even if he is “tortured” by your close relatives. Confidentiality is a law enshrined in the international standard of psychological care.

As for the scientific or evidence-based approach, you need to know that a psychologist’s session excludes occult practices. A psychologist relies on science, that is, knowledge, and works within the framework of professional ethics, while psychics, fortune tellers and astrologers use the client’s faith and the effect of the “impression of a miracle” as a fulcrum.

I hope that the psychologist will open his/her eyes and he/she will change.

A psychologist is not an arbitrator. If you are wondering what a family psychologist does, keep in mind that his task is not to find the culprit and punish him, but to feel sorry for the victim. Ideally, the psychologist should not join either partner, but join in their pain about the problems in the relationship.

A psychologist is not an arbitrator; his task is not to find the culprit and punish him, or to feel sorry for the victim. Ideally, the psychologist should not join either partner, but join in their pain about the problems in the relationship.

Fears and concerns associated with seeing a mental health professional.

So, you have decided to seek professional help. And here you immediately have numerous questions, fears, concerns:

• Who should I contact a psychiatrist, psychotherapist, psychologist?
• Should I contact a government agency, a private clinic or a private practitioner?
• How to behave at the reception?
• What should I say?
• What will they ask?
• Do I need to answer questions honestly?
• What should I do if I don’t want to answer some questions?
• What should I do if I'm afraid of the doctor?
• What happens if I am found to have a mental disorder?
• How will the diagnosis affect your future life?

Who to contact?

If you are seeking help in the field of mental health for the first time in your life, it is best to consult a psychotherapist. In Russia, not only doctors, but also psychologists, as well as specialists with a humanities education, call themselves psychotherapists.

There are no only mental illnesses and no only somatic ones.

Absolutely every mental disorder has a somatic manifestation, and every somatic disorder has a mental manifestation. For example, anxiety is manifested by a rapid heartbeat and rapid breathing. For example, any cold. influenza is necessarily accompanied by asthenic syndrome (which refers to mental pathology).

Therefore, knowledge in the field of medicine is essential so that a specialist can separate gross somatic pathology from manifestations of a mental disorder. Psychologists with a humanitarian education are generally unable to assess the state of a person’s health, and while they know little about mental symptoms, they have absolutely no knowledge of somatic pathology. Therefore, it is better to consult a doctor.

Next, choose between a psychotherapist and psychiatrist and a public clinic, a private clinic and a private practitioner. A psychiatrist deals exclusively with medicinal relief and supportive therapy of mental disorders. This treatment is symptomatic. The psychiatrist’s task is to prescribe medications, but medications are not able to change thoughts, feelings, emotions, or understand the mechanism of mental disorders. Psychiatry helps a person survive. Based on the fact that medications cannot change thoughts, the psychiatrist’s questioning comes down to identifying the syndrome (depressive, anxious-depressive, hallucinatory-delusional, etc.). The psychiatrist doesn’t really need a detailed questioning.

But the field of mental health is a very unusual area of ​​medicine: mental disorders of a non-psychotic level (i.e. when we are not talking about hallucinations, delusions) are not treated with medications! They are treated by special work with the patient to analyze the mechanism of the occurrence of experiences, building a scenario for exiting the disease to health. The path from health to illness and work along this entire path is psychotherapy. Medicines have only a supporting role. There are disorders for which they are needed (psychosis and epilepsy), and in milder conditions it is often possible to do without them altogether. Psychotherapy is always individual work with the patient’s personality, which is important to evaluate through a history examination and the use of various psychological tests. Therefore, a psychotherapist, who necessarily has a primary specialization in psychiatry, has enormous capabilities in his capabilities compared to a psychiatrist.

Related article: What does a psychotherapist treat?

Where to go?

We decided that we need a psychotherapist, we choose between PND, a private clinic, or a private practitioner.

In modern Russia, in most regions, including Moscow, state psychotherapy is not included in the list of services guaranteed by the compulsory health insurance program (CHI). According to the medical policy, psychotherapeutic assistance is provided in the clinic. You can seek free help from a state psychiatric institution: PND (psychoneurological dispensary), where a psychotherapist can meet. However, when entering the IPA, a person immediately faces several problems:

1) The enormous workload of a psychotherapist in an intensive care unit or a day hospital, where, due to his busy schedule, he cannot devote sufficient time to the patient and treatment is reduced either to group work or to short and very superficial conversations with the patient without real individual, long-term in-depth work.

2) There are no anonymous services in the PND , the request for consultation is recorded in the medical documentation with a psychiatric diagnosis, which naturally entails further difficulties in obtaining certificates (for driving, owning a weapon, getting a job), this medical record will not go anywhere. Many mental disorders are treatable, but the medical record of a diagnosed mental illness will remain forever. Not everyone wants to have a psychiatric diagnosis in their biography.

Private clinic?

Next, the choice may fall on a multidisciplinary private clinic. It depends on your luck: everything depends on the management of the clinic. If they are interested in generating income, then before they can see a psychotherapist they will have to undergo a huge number of tests and examinations, sometimes completely unrelated to mental health. However, there are also decent clinics and doctors who perform only psychotherapeutic work. To do this, you must first look for information about the clinic and find out patient reviews about the doctor.

The third option is to contact a private practitioner. In my opinion, this is the best option. Private medicine has appeared since the times of division of labor and existed in Russia until the 1917 revolution. Contacting a private practitioner always means complete anonymity. No one will ask you for documents; you can introduce yourself with a fictitious name. A private practitioner works for himself, so he is maximally interested in the quality of his work. In public medicine, the quality of services is not included in the assessment of a doctor’s performance. There, it is only important to fulfill certain statistical indicators. In a competitive market environment, a private psychotherapist strives to provide services as efficiently and effectively as possible. And also a specialist must constantly improve his professional level. so as not to lag behind others.

How to behave at a doctor's appointment? What to talk about?

The psychotherapist’s task is to explain to you what is happening to you, how it happened and what to do about it. A practicing doctor does not need much effort to understand what is happening to you, but conveying this to the patient is much more difficult. When patients come for help, they have their own explanation for their condition. I often blame others or myself. Due to the existence of psychological defense - a psychological phenomenon that consists in the fact that the human brain seeks to avoid awareness of information that is unpleasant for it. Therefore, patients usually do not realize the real picture of what is happening to them. The psychotherapist must explain, interpret events from the patient’s life, show and teach to recognize reality.

Behavior patterns are established in early childhood. Therefore, it is necessary to trace a person’s life, from childhood to the present moment. Therefore, the specialist asks numerous questions. Again, I repeat, he is doing this not for himself, but for you. The doctor’s questions must be answered as they are, and not lie or fantasize. There is no need to try to show your best side. Naturally, you always have the right to say which questions you do not want to talk about. It is your right. The doctor will not ask questions that are not related to your condition, and will not “extort” from you any professional knowledge, reports on financial affairs, names and surnames.

Habits and rules

Photo by cottonbro: Pexels
Such a decision in itself is already stressful: after all, you will have to talk about the most intimate things, about what you very rarely admit to yourself with a complete stranger. The rules and norms of behavior in society do not welcome the open manifestation of emotions and feelings, and this develops the habit of psychological closeness.

It is very difficult to overcome something that you have cultivated within yourself for a long time. And yet, what to expect from a visit to a psychotherapist?

Three tips for working effectively with a psychologist

Don't be afraid to change.

An initial consultation is not an obligation to spend your entire life with a specific psychologist. If you feel the feeling “he had a free session, it’s inconvenient to refuse now,” this is wrong. If something goes wrong, tell the psychologist and contact our support service. We will select another consultant for a free session. You can stop at any time if you feel that you don’t trust, things haven’t worked out, there’s no improvement.

Don't wait for advice

It would, of course, be nice to receive instructions on how to live correctly. But, unfortunately, a world where people live according to universal rules exists only on the pages of dystopias. Yes, you will be “tormented” with questions. Yes, they will try to find out what you want. Yes, they will force you to find answers to your own questions. And if something different happens during the session - for example, a psychologist recommends that you get a divorce and go to India to look for yourself - you probably need to change the psychologist.

Keep records

The therapeutic session lasts on average 50 minutes and takes place once a week. To consolidate its results, keep short notes during the session or after it - what you understood, what you felt, what you experienced. During the week, continue to do this useful activity - reflect on paper or electronic media. And then you won’t have to start all over again every time.

Specialist education

Before making an appointment with a psychotherapist, the education of the future doctor is taken into account. Studying even at the most reputable higher educational institution is not enough, so it is important to pay attention to the doctor’s activity after receiving a diploma: participation in seminars and courses, consulting experience (from three years), recommendation from a senior colleague, practice of intervision and supervision. The experience of your own therapy is equally important.

How does a psychiatrist work in a private clinic?

Non-state medicine offers patients various types of care. In most clinics, psychiatrist services are limited to outpatient appointments by appointment. Often specialists work in different centers because they do not have a full-time job at their main workplace. This is due to the small flow of patients and a limited list of treatment tasks.

This organization of work leads to the fact that patients consider private medical centers as a temporary alternative to state psychiatric dispensaries and visit them in order to:

• get several specialist consultations;
• confirm or refute the diagnosis;
• write a prescription, a certificate, get a conclusion.

A limited list of medical services, the inability to receive a full course of treatment - from an acute condition to remission or recovery, and the lack of personal interest of the doctor as a result undermine the trust of patients and force them to constantly look for “their specialist.”

A psychiatrist in Moscow working in a specialized private clinic works only with patients of one medical institution. He bears personal responsibility for them. His job is as follows:

• receiving patients by appointment in the outpatient department;
• urgent home visits to primary patients;
• home visits to persons receiving course treatment;
• organization of hospitalization and escort to the clinic;
• management of patients in the 24-hour department;
• Conducting labor examinations with issuing certificates and sick leave certificates;
• registration of examination reports and therapy carried out with delivery;
• conducting commission inspections and consultations;
• referral of the patient to other specialists.

Work within the framework of the program of biopsychosocial rehabilitation of patients involves the joint management of one patient by a whole team of specialists. The absence of colleagues in related professions makes it difficult to conduct additional examinations and introduce additional assistance. In this case, the patient has to look for specialists in other institutions, wasting time and money.

First consultation

A meeting with a doctor is not an ordinary conversation. There are two options for what an appointment with a psychotherapist looks like:

• The first is diagnosing the client's condition or specific problem for future therapy. This is relevant if the person who asked for help is in crisis. The doctor analyzes the client’s life history, looks for the reasons for what is happening, selects treatment methods and prescribes the required number of sessions.
• The second option is a consultation on a specific request. Selected if the client has a problem that worries him and the need to get answers about its solution. The appointment may be one-time or consist of several meetings. The result of the consultation is an analysis and assessment of the problem, as well as recommendations for getting rid of it, new useful skills. On average, a visit takes about an hour.