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Commentary: What happens in mental health therapy?

Editor's note: This is the first of a series of columns that will address mental health issues.

By Jon Koll, MS, licensed psychologist, Alexandria, MN

Most normal people experience occasions in life during which they feel overwhelmed, unsure, or troubled. Life can be difficult and almost everyone, at some point, will experience at least mild depression or burdensome anxiety. Even the best of relationships go through periods of disconnection or hurt.

Yet, many people who could benefit from help do not make an appointment to see a therapist. Other times, distressed individuals attend their first therapy appointment only with significant anxiety because they are unsure what happens.

In the first session, which therapists call the "Assessment Session," the job of a therapist is to guide his client's efforts to describe the life circumstances that have resulted in the person's current state of distress.

Therapists always want to know about their client's family history, mental health history, and past difficult experiences. Clients do not need to come to their first session prepared to present this information on their own. It is the job of a good therapist to lead a new client through this process in a logical and effective manner.

The therapist knows how to do this as comfortably as possible. In essence, by the end of the first session, the client should feel confident that the therapist understands most of the important information about the client's life and history.

In the second session, therapists typically review the information gathered in the first session to ensure accuracy. Quite commonly, the therapist will use the second session to help the client be more specific about areas of distress.

The therapist helps the client describe how current life stressors or mental health struggles are affecting day-to-day life in areas such as work, school or relationships. During this process the therapist's job is to help the client gradually clarify his or her goals. In other words, when a therapist does his or her job successfully the client will feel confident that the therapist knows what he or she wants to accomplish. Goals are written into a formalized treatment plan which is reviewed in the third session.

On some occasions, the client or therapist may realize the therapist is not the right "fit" for this particular client. In such a case the therapist will ensure that the best possible match of available therapists is found.