Psychodynamic therapy - What to expect

We have all seen TV programmes where characters attend therapy and a version of therapy is portrayed. Often this is far removed from reality. For example, the therapist in the Netflix hit Lucifer became involved in the personal lives of her clients, while the therapist in Ricky Gervais’ sitcom After Life was cynical and appeared bored.

For someone who has never attended therapy, it can be difficult to separate fiction from real life. This article gives an overview of what actually happens in a first session with a psychodynamic therapist and may help you decide if you wish to book an appointment yourself.  

What is psychodynamic therapy?

Psychodynamic therapy is a talking therapy where the aim is to identify unconscious processes and repeated patterns of behaviour. Behavioural patterns and thoughts/feelings often originate in childhood and the psychodynamic therapist will carefully help you to make links between the past and the present. When you understand the origins of why you feel like you do, it is easier to make fresh choices moving forwards.

Purpose of the first session

The first session is often referred to as the ‘initial consultation’. This is the opportunity for you and your therapist to find out more about each other and decide if psychodynamic therapy is the right approach for you. Your therapist will decide if they have the appropriate experience and skills to meet your needs, and you will decide if you feel comfortable talking to them.  Time will be given to explore these factors within the session.

Timing

The therapist will start on time, and will finish on time. Generally, counselling sessions are 50 minutes long and timing is strictly adhered to. If you are late to the session the therapist will still see you, but they are unlikely to make up any missed time at the end of the session.

Clarification of terms and conditions

During the first session, your therapist will want to discuss the terms and conditions of the therapy. They will clarify the time and date you will meet, the format of the session (face-to-face, online or phone), the fee and how you pay, plus the policy regarding missed sessions and holidays. They will make you aware of the confidentiality exclusions and may ask you to give details of your GP and next of kin. It is important that you understand all the terms and conditions, so please ask if you have any questions.

Over to you

In a psychodynamic therapy session, the therapist wants to hear from you. In the first session, the therapist will be interested to find out more about your reasons for attending therapy and what you wish to gain from the process. They will ask you to describe your current situation and will be interested in your family and childhood.

The therapist will recognise that you may feel nervous and self-conscious when talking about yourself for the first time, and this will be understood. Moving forward in psychodynamic therapy, you will lead the discussion and while the therapist may ask clarifying questions, they won’t direct the topic of conversation.

So what does the therapist actually do? 

The therapist will provide a safe and confidential environment which will give you space to explore the content that you bring. They will listen carefully and make observations about any emerging patterns or themes and will be interested in links between childhood and the present day. Your therapist will take particular notice of how the relationship between the two of you develops and will make observations about this too. The therapeutic relationship between therapist and client can often mirror other relationships in your life, and this can provide useful insight to explore.

At the end of the first session, you will talk to your therapist about how the session went, and how you feel about returning. If you both decide it is right for you to continue, you can either enter into ‘open ended’ therapy which will have no clear end date, or you can contract for a specific number of sessions.

I hope that this article has given you some idea about what will happen during your first session of psychodynamic therapy and perhaps made you think more about taking that first step and booking an appointment.