Initial Consultation
An initial consultation is offered to help you to decide whether therapy is the right step for you and what kind of approach will be most helpful for you.
What can you expect?
During the first session, you will get an opportunity to talk through your reasons for wanting therapy and to think through your overall goals for the work. You will be asked about your experiences and relationships recently, as well as over the last few years and earlier on in your life. Sara understands that for many people discussing these kinds of personal things can be difficult and she takes care to approach things in a sensitive and respectful way. You will be asked if there are any experiences that may be particularly difficult for you to talk about. You will be supported to engage with the conversation in as easy and free flowing a way as possible, which should hopefully enable you to feel secure and in control throughout the session. A second session is often needed to gather enough detail about one’s experiences, in order to enable a shared understanding of how your current difficulties may have developed, how they are being maintained and what therapeutic approach would be most effective in enabling you to move towards lasting change.
Confidentiality
At the beginning of your consultation, you will be given information about how your confidentiality will be protected. This will include information about keeping any records of your sessions and personal details completely secure and private, and the kinds of standards that Clinical Psychologists are expected to adhere to with respect to confidentiality and consent.
What happens after the initial consultation?
Towards the end of the first or second consultation session, an initial formulation will be shared with you related to how your difficulties appear to have developed, what is likely to be maintaining them, or preventing you from making progress, and what may be of help to you in terms of which particular model of psychological therapy. You will have the opportunity to explore these ideas, ask questions and consider whether to begin a course of therapy. In order to help you to decide, a treatment plan will be offered to you along with a recommended length of treatment. Later in therapy, your progress will be reviewed so that the treatment plan can be adjusted if required to ensure that therapy is as effective as possible. At times this may involve further sessions being negotiated to extend treatment if this is required.
What will therapy involve?
The structure and focus of each course of therapy is unique and informed by the psychological formulation, personal therapy goals and treatment plan, which are collaboratively developed during the consultation sessions. A psychological formulation is a way of understanding how your difficulties developed and what has kept them going. Each therapy session will include a brief review of how the your week has gone with a particular focus on the impact of any stressful events and any progress made. Sessions will focus on supporting you to make gradual progress towards understanding your own formulation deeply enough to enable you to work towards meaningful change and take steps towards your goals. Support and guidance is available during sessions to think through stressful experiences or dynamics within your relationships, distressing responses to past memories or challenging experiences during the therapy itself.
How long will therapy be?
In line with best practice guidelines, Sara tends to offer therapy contracts of between 10-12 sessions initially, in order to enable people to work within a time frame that feels as manageable as possible. For some clients, it is beneficial to look at planning therapy to last for a longer period of 16 sessions, particularly if their problems feature relational or interpersonal difficulties or if trauma has been experienced. A lot of progress can be made within these kinds of time frames. The length of therapy depends on a number of factors such as the severity and complexity of the person’s psychological distress, the evidence-based therapy model used and the recommended time frame for their specific difficulties. Alongside these factors, other variables also play a key role in the overall length of therapy, including the social support available to the person during therapy, the person’s willingness to take an active and engaging stance towards therapy, their individual preferences about the length of therapy and their financial situation. The overall length and effectiveness of therapy is continually monitored during treatment with the aim of ensuring the most effective clinical outcome in a time efficient way.
What age groups does Dr Hirst work with?
Sara can offer consultation and therapy sessions to adults as well as children over the age of thirteen. For children, depending on the presenting problem, family or parenting consultations may be offered where appropriate. This would depend on the developmental stage and level of independence that the young person has acquired, the family’s relational style and the young person’s preferences. These options can be discussed and worked out carefully at the consultation stage.
Are there any situations that might prevent therapy from being effective?
Evidence shows that certain issues may obstruct people’s engagement with and progress in therapy to such an extent that they would need to be addressed before psychological intervention is offered. This includes current issues with alcohol or substance misuse, any ongoing risks of harm from others, risky or self harming behaviour, and severe psychological difficulties such as acute psychosis or persistent suicidal urges. These issues may obstruct progress in therapy and would probably need to be addressed to protect the safety and welfare of the individual before therapy is commenced. If these kinds of issues emerge as current problems during the initial consultation, or at a later stage if they have not been fully disclosed during the initial consultation, therapy may need to be placed on hold until these issues can be addressed. Sara would always do her best to support the person during this process and refer on if necessary or signpost to appropriate local services for support.