Psychotherapy 101

Why Are My Therapy Sessions 50 Minutes?

Why are weekly therapy sessions 50 minutes?

Why not more, why not less? I often get that question from clients. Here’s what I tell them:

Having a set time allows for the client to think about how they want to use that time. Do they want to talk about 10 things or focus on just one or two? Covering 10 things in 50 minutes might feel unproductive, while honing in on a few key issues would mean having to drop the rest and only getting to talk about them in the next session.

Call it a decision-making warm-up: Making choices even before tackling the bigger life decisions that brought them to this session.

The thing is, we won’t know if those choices (to talk or not talk about a topic) were a good one until the client reflects on their experience of the session.

Like other life decisions, we can’t tell if they were right or wrong until we look back on them. We can also decide not to decide, and not making a decision is still a decision. Only by embracing this freedom of choice, confronting our anxieties by making a decision, and taking responsibility for our decisions, can we engage with our choices more consciously and be more authentic with ourselves.

As such, the 50-minute therapy time boundary isn’t just about watching the clock. It makes the therapy space a safe space for clients to practice making decisions, regardless of whether they are the right or wrong ones.

To borrow from Sonke Ahrens in How to Take Smart Notes: “Here, gut feeling is not a mysterious force, but an incorporated history of experience.”

In simpler terms, with all the decisions made and owned up to in that therapy space, clients can gain experience through therapy on how to rely on their intuition (or that gut feeling) to navigate different situations.

by Magdalen Cheng

Therapist Reflection: Am I Doing it Right in my Chemistry Sessions?

I came across this recent study by an existential therapist that sheds light on what effective therapists do in their first client sessions, and it got me reflecting on my own client-therapy approach.

There are two key research findings that deeply resonates with me:

1. Effective therapists see the clients as experts on themselves.
2. Effective therapists promote the expectations of the clients' active involvement in the therapy process.

I recall the time when I was seeking out a paediatrician (Because I gave birth at home, I wasn’t automatically assigned one), and my doula had advised me to actively go out and speak with doctors to find out how they work and, more importantly, if their philosophy of care aligns with my own values.

As someone inclined toward a natural approach, I know I wouldn’t be comfortable with a doctor who would default to taking the most aggressive route, such as prescribing antibiotics for every common ailment. And knowing my expectations had allowed me to narrow down my options, leading me to making a paediatrician choice that I was very happy with.

This “paediatrician-shopping” experience reminds me what it is like to be empowered as a client.

Applying this empowerment to finding the right therapist, it is important for clients to know what their options are before they decide. Clients should have the capacity to interview therapists and ensure their approach aligns with their vision of healing. And it is equally important for therapists to be able to support that.

This is why I call my initial session with a client a “chemistry session” rather than a “consultation”—to introduce the idea that the therapist may not be the only expert in the room and that the clients are also experts themselves.

I hope you too will find these research insights useful. And to my fellow therapist colleagues, feel free to share what are you doing to help your clients feel empowered and actively work with you as a team.

by Magdalen Cheng

Two Helpful Tips to Finding the Right Therapist for You

I don’t know what to ask my therapist to decide if we are a good fit! I don’t even know what my options are!

This is a common feedback I often receive from those who are considering therapy. Choosing the right fit with a therapist can be a daunting experience in itself. This could be especially so if we have had bad therapeutic experiences in the past.

As a client, what are your preferences though?

Clients may be surprised to be asked, and assume that therapy is like other practitioner-led ‘treatments’. Like when you visit the doctors, you do not tell him or her what medications you’d like to take or how you’d wanted to be treated. You tell them your symptoms and they prescribe you what they think is useful for your issues.

Well, sure, many doctors work that way.

But not all doctors have the same philosophy of care.

Philosophy of Care

Philosophy of care. Such big terms. Do not get fazed by it and stay with me a little longer as I explain what it means and how it can help you as you go on your search for a therapist you can click with.

I was introduced to this notion while I went through my pregnancy.

I am a firm believer of how a good birth experience affects how fast I recover and in turn impacts on maternal mother and child bonding. I will need an obstetrician and a paediatrician who can support me to achieve what I want.

Yet, with no experience giving birth, how do I go about even finding the right doctor?

I had the good fortune of a doula accompanying me throughout my pregnancy. As she patiently explained what my options are giving birth in Singapore and what decisions are in my power to make to get the kind of birth experience that I am hoping for, I was given the opportunity to think through my own preferences as we drew up my birth plan.

Go Therapist Shopping

An advise from one of my doula that has stuck with me till today was to go doctor shopping!

Essentially, visit different doctors. Ask them how they work. Look not only at their bedside manners (i.e. managing our anxiety, showing empathy or  building strong rapport with patients) but whether they believe in the same care goals and values as you do.

If your philosophy of care is to recover with as few interventions as possible, an aggressive medicalised approach is just not going to cut it.

And as I surrounded myself with care providers of the same philosophy of care, I felt held and supported. Even if I did not experience the birth that I hoped for, I know I will still be empowered to make the right decisions in any birth situation I find myself in.

 I don't not mean going for therapy with different therapists at the same time. That’d not be healthy as different therapists may provide contradicting advises which confuse us more than we probably already are.

Go interview different therapists. Find out their views of mental health struggles and how they’d work with your presenting issue. As you chat with them, you should be able to get a feel of their philosophy of care.

It is one thing to know your therapist’s philosophy of care. It is another to know what your preferences are before you can decide if your philosophy of care even fit your therapist's.

Top 4 areas of Preference for Therapy

Research suggests that clients’ psychotherapy preferences make valuable contribution to outcomes in therapy. It can be a good starting point for a genuine exchange about how you can get the most out of their psychotherapy.

Aside from the usual questions around therapeutic contracts (i.e.g number of sessions, session fees and payment terms etc), I recommend 4 main areas to reflect on as you figure out your therapy preferences.

Do you prefer for your therapist to:

• Therapist Directiveness vs. Client Directiveness
  • focus on specific goals or not?
  • give structure to the therapy or allow it to be unstructured
  • teach you skills to deal with your problems or not?
  • give me homework or not?
  • take a lead in therapy or allow me to take the lead instead?
• Emotional Intensity vs. Emotional Reserve
  • encourage me to go into difficult emotions or not?
  • focus on the therapy relationship or not talk about the therapy relationship?
  • encourage me to express strong feelings or not?
  • focus mainly on my feelings or thoughts?
• Past Orientation vs Present Orientation
  • focus on my life in the past or present?
  • help me reflect on my childhood or on my adulthood?
• Warm Support vs. Focused Challenge
  • be gentle or challenging
  • supportive or confrontational
  • interrupt or keep me focused
  • support me unconditionally or challenge my behaviour if they think it’s wrong.

Adapted from the Cooper-Norcross Inventory of Preferences (C-NIP) developed by John Norcross and Mick Cooper, these 4 areas form part of a standardised instrument which was developed with the goal of stimulating dialogues between therapist and client. You can find a copy of the instrument here.

If you are completing this questionnaire for yourself, please ensure that you have someone whom you can talk to should any of the questions cause any distress. In the unlikely event that you are distressed after completing the questionnaire, you can contact Samaritans or other mental health hotlines.

A doula helped me give birth to life by empowering me with options I never knew I had and walking alongside me as I figure them out. She has since inspired me to think about what philosophy of care Encompassing Therapy and Counselling holds:

It is not only to provide good existential therapy. I strive to be a therapy doula by supporting clients to find the right fit with their therapist.

by Magdalen Cheng

First Session Therapy: I Know I Need Therapy But When Do I Begin?

So you’ve decided that you need therapy. The next question to ask is "when should I begin?"

The fact that we need therapy does not always mean that now is always the right time. 

I like to share this with my clients: therapy is only 50 minutes per week. That’s a very short time to solve anything.  For therapy to be effective, it is important that we are not only able to commit ourselves to working in the therapy room but to also engage with what we have learnt about ourselves in the week before we bring it back to therapy again. It is in the dance of taking our issues into the room, living it out in our lives and bringing newfound meanings, ideas and questions back into the room that often contributes to seeing quicker changes in clients’ lives. Are they ready to take part in this dance? 

Of course, there are many other factors involved that contributes to our readiness for therapy. Finding the right fit with your therapist is one of them (more can be read here). Yet, it is our capacity to commit to working on ourselves on our own and with the help of others that is often overlooked. Below are three areas to consider to help you decide if you are ready for therapy:

Be willing to work on yourself

I’ve worked with many clients who have been brought into therapy by others. Though they have issues that needs to be addressed, they may not often be ready for it now. It may also be the case that they know they have issues to work on themselves but they are not ready yet. 

The most fundamental question to check our readiness is "am I open to committing to doing things differently now?" If the answer is “ no, I’m not", then the time is not ripe. It is ok to wait till you are ready. 

Having the time and energy to work on yourself 

Change takes time. Sometimes, the difficult emotions that we are working on (anxiety, guilt, worry, angst, grief etc) intensifies after sessions. This may not mean therapy is not working. It could mean that emotions underlying our issues are surfacing and it requires time to process them. 

It is important to consider how much time you can commit to working on yourself each week. Aside from considering the frequency of therapy (weekly, biweekly, multiple sessions in one week or as-needed sessions), one should consider their capacity to engage with themselves outside of therapy. Are there other priorities in life (e.g. work, family, studies, physical health etc) that will come in the way of working on myself outside of therapy?

Evaluate financial commitment to therapy 

Let’s face it. Therapy can be expensive. You’ll want to consider the treatment costs and whether it’s sustainable financially. Individual therapy sessions are not typically impactful in and of themselves. Therapy is a cumulative process, and we can't predict when growth will come. It is important to weigh the costs of therapy in the context of an ongoing process instead of the cost of a single session. Am I ready to pay for therapy or would the money be more wisely spent on other areas of my life? 

In the event that therapy does not fit your budget at the moment, there are lower costs options to consider. First, check if your insurance covers mental health services. You can also ask your therapist for sliding scale, discounted rates or shorter sessions options. Alternatively, check if your company offers Employee Assistance Programs (EAP). Read up more here on what to do when therapy is not financially possible. 

Therapy can be incredibly useful for lots of things including depression, anxiety, phobia, grief, trauma etc. It can also lead us into becoming better people even if we do not have serious issues to cope with. Yet, therapy is not helpful when we are not ready to do the work ourselves. At Encompassing Therapy and Counselling, we believe in supporting our clients to help them discern whether they are ready for therapy. Book a First Session Therapy with us today to discuss if you are ready for therapy. 

by Magdalen Cheng

First Session Therapy: Owning Therapy for Ourselves

Many clients who come into the therapy room voice out a common struggle: they feel incapable of making the right choices for themselves, whether it is not knowing what they want, not having the power to make decisions for themselves or feeling afraid of making the wrong choice in life.

This happens a lot to new clients looking for the right therapist too. Coming into therapy may already be a big step. If they cannot “click” with the therapist, they may find therapy a disempowering experience.

Healing begins when we know owning our decisions is now a possibility.

It is empowering when we know that we are capable of making choices freely, and even when wrong choices are made, we can be responsible for them.

To feel empowered and be active agents in our lives does not begin when we start therapy. It starts from the time we are considering seeing one and going through the process of choosing the right therapist for ourselves.

Here are some tips to consider when choosing a therapist:

1. Know the different types of therapies available. Not all therapies work the same way. Some are more solution focused while others are more exploratory. They cater to different client needs and preferences. Educating ourselves on the different modalities and how they work will help us begin on the quest of asking what is right for us. Read here to learn more about how different therapists work. To find out what therapies are available in Singapore, click here.

• Explore the self. Before embarking on therapy, it is important to ask oneself these questions:
  • Is it the right time for me to have therapy now? Although we may need or want therapy, it may not be the right time. And that's alright! Sometimes, work, family commitments or studies are in the way and it is not the right time.For therapy to work, we need it to make it a priority to work on ourselves. It is a good idea to discuss with your therapist about the commitment level within therapy to help you answer this question.
  • What are my expectations and goals of therapy?
  • How would I like my therapist to work with me? We are all different and may have different preferences. To help you consider, you can start considering from these 4 areas:
    • Therapist Directiveness vs. Client Directiveness
    • Emotional Intensity vs. Emotional Reserve
    • Past Orientation vs Present Orientation
    • Warm Support vs. Focused Challenge

• Get a sense of how the therapist works. Most therapists these days offer an assessment. This session allows the therapist to get to know the client and his or her needs better. However, just as much as a therapist has the know how to assess the client, it is important that the client chooses the therapist as well. Not all therapists have the same style even if they work with the same modality. We are persons after all and our own personalities and preferences come into play in the therapeutic work.

I often tell my clients in our first meeting that it is important for them to get a feel of me in the room, go home and reflect on the session before deciding if they feel comfortable enough for me to support them. Clients are also encouraged to ask their therapists questions on how they work.

Some useful areas to ask include:

1. Therapeutic contract: this includes areas like number of sessions, where and when will sessions be held, session fees and payment terms, cancellation and session rescheduling terms. This will help you get a sense of the commitment level therapy requires from you.
2. Philosophy of care: It is important that the client feels safe with the therapist. Equally, it is essential that the client agrees with the therapist’s philosophy of care. If we are advocates for natural healing, we are not going to see a doctor who pushes for us to take medication each time we see them. This is the same when we choose a therapist. Thus, it is important that clients have some idea of their goals, expectations and preferences before going into their first meeting with the therapist.
3. Therapist's training and experience: Are they a licensed therapist? Licensed by which licensing body? What do they specialise in? How long have they been working as a therapist?

At Encompassing Therapy and Counselling, all new clients go through the First Session Therapy where the above considerations will be explored. Take your time to find the right therapist. If you feel you are ready to come for a first session, book a session with us. 

by Magdalen Cheng

Do All Therapists Work in the Same Way? How Do I Choose My Therapist?

How do I choose my therapist? Do All Therapists Work in the Same Way?

People have frequently asked me how psychotherapy and counselling work, especially more so my clients who are new to this way of working. Through our interactions, I realise how much our preconceptions of this talk therapy are still deeply influenced by what media portrays: the client lying on the couch with the therapist sitting across or behind, writing notes on a clipboard. It sure feels impersonal and detached.

I’m learning to explain what therapy is. Admittedly, it was hard at first, putting concepts into simple language that most of us can relate to. Funny how, even, as a counsellor, I experience my own struggles in communicating my thoughts and ideas to others. All I can say is that this ability to connect is a skill and an art that I myself am still learning.

On the topic of how different therapists work, I have found the analogy of falling into a well the easiest and most relatable thus far. If someone out there reading this article has a better one, do share with me.

The Metaphor of the Well

Here is the analogy: we all fall into a deep dark well once in a while. When I say “we”, this includes myself. We all react/respond to falling into our own, unique wells differently. Some of us might see it as an opportunity for making changes in life, while others perceive it as a depressing and hopeless place to be. Sometimes, we find ourselves climbing back out with the help of our families, friends, or self-help resources.

Yet, there are also times when this well is deeper and shadier than we expected. After exhausting our optimism and resources, we may still find ourselves stuck. It is here when some of us may turn to some form of professional help.

In psychotherapy and counselling, there are two common ways of working. Here, I am boldly making generalisations. As some of you may have learned through your own research, there are numerous modalities of therapies out there. Cognitive-Behaviour Therapy (CBT), Psychodynamic, and humanistic or person-centered therapy are just the tip of the iceberg when it comes to talk therapy. However, here, I’ll simplify it into the following two ways.

One way of working is where the therapist stands at the mouth of our well. Looking down, he or she explores how clients ended up down there and tries to give them concrete tools that will help get them out. After all, despite no two wells looking the same, there are commonalities and tools that have been clinically proven to help clients experiencing similar issues to climb out of their suffering.

Another way of working is having the therapist jump into this hole with us. A caveat here: your therapist may just be as lost as you in finding the best way to exit this hole. Some of you may be wondering, what is the point of seeing a therapist, then, if I feel like I’m dragging someone else down into this hopeless dark hole with me?

A simple but experientially profound answer is knowing that you’re not alone. As Irvin Yalom, an existential therapist said, “it’s the relationship that heals”. Knowing that we have someone by and on our side as we go through this emotionally exhausting and mentally draining journey out of this dark hole can, at times, be just what we need.

How is this different from turning to support from our families and friends?

Good question. A short answer is that the therapist, in this second instance, sees themselves as first: a human being, just like all of us. However, we are also professionally trained to have certain therapeutic tools that are useful. We see our role as a guide who is kindly invited to journey with our clients in the current chapter of their life. This guide happens to be someone who is trained to know where and how to shine a light on the dark areas of your well; your blind spots. By illuminating these areas, hopefully, clients can start seeing areas they never considered before, appreciating better the ugly and possibly recognising the uniqueness of their suffering. Through this, choices are expanded and difficult emotions are better coped with.

Sometimes, therapy helps us realize what we are looking for may not be a way out of our suffering but to make sense of the pain which helps us live our lives more purposefully.

Most importantly, therapists who work in this way are grounded firmly in their belief that the clients are the experts of their own life. The therapist could empower clients with certain resources and skills but ultimately, the clients are the ones who are in the best position to make the right choices for themselves.

How Do We Work at Encompassing?

At Encompassing, we see the value of both these ways of working. Neither is better than the other; it all depends on several considerations:

• client issues
• how quickly one wants to get along
• expectations from therapy
• preference of the style of therapist. 

However, as a therapist, I prefer working long term with clients. I can help my clients best when I jump into the well with them, experiencing the same uncertainty and anxiety of not knowing. It excites me to be in a room where two people are seeking ways to relate genuinely to one another as we figure out together what is personally meaningful to them and exploring new ways of being that is authentic to both themselves and to others.

At the end of the day, it is not so much finding the way out of the well that defines the success of therapy. Of course, that would be ideal! However, what makes therapy successful, in my opinion, is when clients leave the room with more self-awareness and insights. At the same time, they relearn how to become the agents of their own life in the midst of having a fuller appreciation of the human condition:uncertainty, anxiety and freedom that comes along with the beauty of life. This way, when life throws them into another well, they find themselves more equipped to stay in their uncomfortable emotions as they figure out how to extract themselves.

by Magdalen Cheng