Category: Next Session

Next Session Worksheet/After a while

1. Review all previous worksheets and take note of any changes.

2. If my needs/themes are the same as previous sessions:

• • Have I already dissected the issue to have a general understanding of why I am stuck?
  • Have I used all my tools and done everything suggested between my sessions to help myself move forward?
  • Have I been honest with myself about what I may not be ready to do and honor that I may simply need more time to be in my experience just as it is (at least for now)?

3. If there are no major crises and there are no further changes I am ready to make between sessions, what am I getting out of therapy that is different than what I can get from a loved one/friend or self-work?

CONNECTION: Have I tried to cultivate the level of transparency, depth, and safe space in my conversations with my support system, like I have with Jes?

• • • Next step: Expand my search for connections and spaces that have similar energy as my therapy.
    • Next step: Consider con-joint counseling at this point with a partner, parent/sibling/adult child, friend, colleague, etc.

VALIDATION: Do I need to work on trusting myself more?

• • • Next step: Space out my appointments to practice building my internal muscles and/or to wait until I actually need an appointment.

SELF CARE: Do I need to transfer my energy/time/money that I’ve been putting into therapy appointments into appointments with myself?

• • • Next step: Set a date for self-care that is either calming, devoted to a project/task, joyful, etc

Next Session Worksheet/After a few months

1. Review all previous worksheets and take note of any changes.

2. I would rate my progress from 1-10 (10 = excellent) on feeling better in terms of moving forward with each session (vs staying stuck) at _____.

3. What actions/steps do I want to take, but I’m not ready to work on changing right now?

• • List them
  • What is getting in the way of me taking these actions/steps?
  • Even if I don’t know what’s getting in the way, I know some choices/safeguards/smaller steps could move me in the right direction, such as….

4. What positive benefits (secondary gains) am I getting by not changing right now and the current situation remaining unchanged?

5. What are the full negative impacts of my problem:

• • On myself now? In the future if things continue unchanged?
  • On others now? In the future if things continue unchanged?

6. What solutions have I already tried but didn’t work?

            7. What solutions am I unwilling to consider as an alternative way to feel better?

8. Why exactly do I need this appointment now? What new questions, reflections, motivations am I bringing today that are different from the last session?

Next Session Worksheet/After starting

1. Review the previous worksheet and take note of any changes.

2. Other than reporting/updating Jes on what’s happened since we last spoke- what are my focused questions/intentions for this session?

• • Was there anything in particular from last session that helped? What insights have I had since?
  • After my last session, was there anything that we discussed or Jes said that didn’t feel accurate/bothered me?
  • Where am I still stuck? What do I feel motivated/ready to work on?
  • What specific situational examples can I bring to unpack? What memories connect to what I am presently working on?

3. What are my deeper core issues/fears/beliefs about myself that have been a pattern in my life and/or are surfacing now?

• • What is life trying to teach me?
  • If I were to ask my closest loved ones & friends (those who often interact and/or deeply see/know me the most), what suggestions might they offer about what they consider to be my difficulties? If I don’t know, might it be safe for me to ask them and can I be assured by them that they will only respond in gentle kindness as they try to help me identify areas of growth?

4. What actions am I working on outside my therapy sessions that is directly correlated with insights gained from therapy?

• • What choices are within my control?
  • What choices are not within my control?
  • What plans have I made to tackle a need/task?
  • What routines need to be implemented?
  • What hard conversations need to be had?
  • List concrete action steps (or mini-steps)/time frames necessary for each goal and track my consistency.

Next Session Worksheet/Starting therapy

1. What are my specific goals at this point in therapy? What will have changed in my life when I will feel I no longer need therapy, given that therapy is meant to be time-limited? 

EXAMPLE: instead of “to be happy,” you might more clearly say “to get back into my routine of consistently going to the gym and drinking less wine at night”

2. Am I engaging in basic self-care?

BEHAVIORS THAT DIRECTLY IMPACT YOUR CHEMICAL NATURE

(i.e., affecting serotonin, dopamine, oxytocin, heart rate, temperature, etc.)

• Enough sleep/Consistent sleep routine
• Healthy foods/Following dietary needs
• Reduce or eliminate depressants/sedatives (i.e., alcohol, sugar, excessive sleep/pain aides, etc.)
• Reduce or eliminate activators (i.e., caffeine, inflammatory foods, trigger foods, etc.)
• Consistent aerobic exercise 5x’s a week/Physical therapy if needed
• Touch (i.e. cuddling, hugs, pets, massage)/Orgasms (i.e. masturbation, sex)
• Breathwork/Meditation/Prayer/Yoga
• Time in nature/Sunshine/Cold shower-plunges/Steam room
• Informative medical tests/Routine medical care
• If applicable, evaluations & taking medications consistently and as prescribed (see your: PCP, ARNP, psychiatrist)

MEANING-INTENTION

• Go inward and check-in with yourself often (i.e. taking time to be alone, journaling, asking what you want before asking others what they want, etc)
• Care for your physical body & physical living spaces (i.e., tracking your cycle, taking showers/brushing teeth, getting dressed/making your bed, going grocery shopping, cleaning/removing excessive clutter, personalizing/decorating, tending to repairs, etc.)
• Balanced self care-play/work-tasks/caregiving-partnership
• Responsible finances
• Getting off mindless screens
• Engaging nature & connection 
• Creating or participating in a hobby/interest
• Honest with yourself about people/choices that are counter-productive to your mental health
• Living in integrity & with boundaries (i.e., speaking up, saying “no”, not apologizing for your needs, identifying first and then not betraying your core values, holding consequences/accepting there will be disappointment/loss/change/transition, etc)
• Asking for help
• Attuning or giving back to something bigger than yourself (i.e., prayer/meditation, being in flow-art/hobby, volunteering/service, etc.)
• Remaining gentle with yourself and your mistakes, forever beginning again by doing the next right thing or the next thing right, with infinite-unconditional mercy and grace

Next Session/ Introduction

to Focused Therapy

Focused Therapy Only 

• My practice is geared towards focused therapy and our work will reflect this.
• Focused therapy is like physical therapy to fix an injury: some difficult feelings, requires active efforts during yoursession AND active efforts on your own between your sessions.
• On the other hand, supportive therapy is more like a massage at a spa: pleasant feelings, passive participation onlyduring your session, and no work is expected between sessions. Supportive therapy would include simply reporting on/updating about events between sessions without any new insights or actions, venting about things outside your control, coming to sessions not prepared with an agenda for why you booked the appointment, repeating the same concerns in therapy while also refusing the suggestions and steps offered, or simply attending therapy out of habit but not being ready to make further changes right now.
• Insurance requires that our time be focused- just like physical therapy.
• I’ve found that the more conscious/intentional (focused) you are about each and every session, the more you will getout of therapy.

Insurance Requirement for “Medical Necessity”

Insurance contracts don’t allow general, supportive counseling. Instead, they require that there be a: 

• Medical diagnosis from the Diagnostic Statistical Manual-5
• Formal treatment plan with objective/measurable goals that are routinely updated
• Acute symptoms documented for every session’s progress note
• Professional/skilled therapeutic interventions for every session’s progress note- not just supportive listening
• Some form of resolution (i.e. progress towards goals, decrease in session frequency, discharge).

Your Job & Homework 

• Take notes between sessions to process your feelings, track your progress and identify your stuck points.
• Complete a “Next Session Worksheet” before each and every session to organize your thoughts and set your intentions.
• Do not send me your Next Session Worksheet- just keep it with you to refer to during our next session.
• You will lead every session by telling me where you’d like to focus during our limited time together.

Therapy with an Endpoint

• To decide what you need to feel better- but then to get very clear about what you are actually ready to work on right now.
• To identify what you can and cannot control, your morals, your belief system, and to bolster your sense of self.
• To better understand how your choices and beliefs affect your happiness – even more so than external circumstances.
• To utilize all the suggestions discussed in therapy that you agree would be helpful.
• To internalize the unconditional positive regard that therapy fosters.
• To problem solve, build internal muscles, and self-soothe more and more without therapy.
• To build a support system for yourself that you practice connecting to the same way you connect to me.
• To reduce the frequency of your sessions over time.
• To return only as needed for booster sessions

Therapy for Loneliness & Connection

• If you enjoy therapy mostly because it gives you a chance to share yourself unconditionally and have time dedicated just to you, that is wonderful- and that is more like supportive therapy, not focused therapy.
• Being seen and heard unconditionally is an essential need, but my practice is geared towards insurance regulations and having time in my limited schedule to be available to help those in crisis to get professional help.
• If you find that therapy has become more about your connection to me and not the work you doing on yourself, then we should talk about what kinds of closeness and intimacy you may need to nurture in your life outside of therapy.
• I cannot act in a friend capacity due to the ethics of my profession and, therefore, enabling you to rely on me would be a deep disservice to you and the relationships in your life that may need deepening.

Scheduling Expectations

• Appointments are generally scheduled approximately every 2 weeks, then drop to every 3 weeks, and so on. Therapy is not meant to continue for years at the same frequency.
• Because we are a focused therapy practice and not a supportive therapy practice, clients in most need (e.g. safety issues or acute crises) will get priority scheduling.
• Our practice does not take on new clients if we don’t have enough spots for current clients. However, appointment needs ebb and flow, and predicting this is sometimes out of our control.