The process of individual psychological treatment, commonly termed psychotherapy, begins with a consultation. The consultation usually is completed within one meeting but under some circumstances may require extended time. During the consultation, legal and ethical boundaries of confidentiality are reviewed. Information regarding the reason for referral, background, general health, and treatment history is obtained. This is followed by a thorough clinical evaluation about psychological, behavioral, and social factors. Treatment goals are specified and agreed upon. There is also an assessment of any risk factors that could compromise care or safety. Based upon these variables, a case formulation including diagnostic specification is made. This is the time when initial recommendations or a treatment plan are offered. Prognosis as well as possible length of treatment and intensity of sessions is discussed at this time. Before ending the consultation process there will be opportunity to ask questions or verbalize any concerns. If there is need for further assessment, or treatment at NBI is not indicated, a referral for psychological testing, psychiatric, medical, or other health evaluations may be made.
During the course of psychotherapy there is an ongoing attempt to develop more effective coping strategies, improve functioning, lessen emotional distress, and resolve symptoms and problems. As with any process involving change, there may be times of discomfort, resistance, and uncertainty. It is a part of the therapeutic process to address these issues in an understanding, effective yet straightforward and honest manner. Psychotherapy may be considered unlike most life situations in that open communication and discussion of difficult, even embarrassing material is not only encouraged but also often necessary for progress. Challenging the thoughts, behaviors, and relationship patterns that create and maintain the difficulties that led to the need for treatment is essential for the best outcome possible.
Sessions are tailored to balance present needs with long-term objectives. Treatment will usually take place in a private office unless another setting is deemed appropriate. For example, there are some symptoms and problems that are most effectively dealt with in the home environment. Of course, this would only take place with permission granted previously.
Deciding when to end treatment can be a complex matter. Certainly, the ultimate choice is the patient’s or their guardian’s. However, generally speaking this decision a part of the therapeutic process. There are times when terminating treatment is not for the best reasons or reflects resistance to change or outright self-sabotage. For acute or situational matters, it is more likely that intervention stops when the presenting symptoms or problems have significantly decreased and/or psychological distress is no longer marked. For some with chronic or particularly complex issues, treatment and follow-up may take place for an indeterminate length of time. It should be understood that questions about any subject pertaining to the therapeutic process are appropriate to discuss with the treating clinician at any time. In most instances, however, questions about scheduling, financial matters and records that are not clinically relevant will be directed to administrative personnel.
The overwhelming evidence from available scientific research is that treatment works. While it is not possible to predict improvement on an individual basis, current methods appear likely to benefit many. This seems especially the case when treatment is timely and well focused on the presenting issues.