The Intimate Hour (Part II)

What is a patient looking for when he or she comes to therapy? My experience is that, in general, he has tried everything he knows to do in dealing with an issue. He has exhausted his own personal resources. But making that initial call can be fraught with anxiety. The patient has delayed it and delayed it, while he struggles along with the situation. Admitting that you're unable to resolve a life problem on your own, that you'll have to address it with a stranger, can be a daunting prospect.

A patient is seeking first and foremost understanding. Whether in therapy or not, each of us ultimately wants our life narrative to be heard. Whether it's someone wanting to share her rage at her husband's infidelity; a person isolated and in the throes of hopelessness who writes a suicide note; or a serial killer who eventually feels compelled to describe his horrific crimes; we all desire for at least one other fellow human being to hear our story and understand our motivations.

A patient is seeking acceptance. The slightest whiff of judgment will taint a therapeutic relationship. The therapist must have a very high tolerance for dealing with attitudes, behaviors, even lifestyles that he does not personally endorse. If he struggles with this, it behooves him--and is in his patient's best interest--to either do some work in therapy himself regarding his discomfort, or to make a referral to another therapist.

Most patients are seeking some specific means for effecting change in their lives. For all but a few, gone are the days when an individual can spend an hour a day, four to five days a week, on a therapist's couch. The vast majority of today's patients come in with a specific problem or problems. Pursuing self-actualization in therapy is a luxury that few can afford. To that end, as a new patient and I wrap up our intake session, I help them formulate and prioritize their goals for therapy. The question might be something like, "What would you like to be different in your life as a result of coming here?"

Finally, patients frequently need what I call a "takeaway". This can be something as specific as an "assignment" to journal, to chart behavior (e.g., eating, exercise), to take turns planning special events with a spouse, to read certain portions of a book or listen to a podcast, to contact an estranged family member, to think about their goals at work. You get the point. A small task or bit of information at the end of a session can reinforce the work done in the session and enhance the patient's sense that she has gained something positive and concrete from her work in therapy.