Therapy is a transformative process that can bring profound changes to one's life. For many Kenyans, understanding how therapy works can demystify the process and encourage those in need to seek help. My name is Joan Kamere-MA Marriage and Family Therapy and in this post, I will walk you through the stages of therapy at JK Therapy: the intake interview, goal setting, case conceptualization, treatment, and close-out. 

1. Intake Form 

The journey of therapy at JK Therapy begins with an intake form. After booking your first appointment, I’ll use the intake form to get a general idea of you as my client beforehand. Most people are reserved when it comes to completing the intake form and are hesitant to include all relevant information. However, the information collected from the form serves as a general starting point that will aid in the process of therapy. 

It's important to consider Dorris' situation. Dorris has been suffering with symptoms of depression for the past few months, yet she feels like she has no valid reason to be depressed. She has a job that caters to her basic needs, a roof over her head, and even some money left to send home after she's taken care of all her responsibilities. Despite this, Dorris has trouble sleeping nearly every night, her chest always feels tight even when she's lying in bed watching her favorite show. Most of the time, she lacks the appetite to finish her food, and she's almost always so exhausted.  

Dorris is at a loss as to why she's experiencing all these things when she seems to be exactly where she needs to be at this stage of her life. Dorris is 27 years old, the eldest of four children. Her father has been in and out of her life for as long as she can remember. Dorris was raised by a single mother who worked day and night to put food on the table while in and out of the hospital with high blood pressure and low blood sugar from her diabetes. From the age of 12, Dorris has been in charge of her younger siblings. She sprained her ankle two years ago while alighting from a matatu on the way to visit her sister in boarding school. The injury flares up occasionally when she stands or walks for long periods. Her boss seems understanding, but work can sometimes be stressful for Dorris as her coworkers aren't very friendly and being an introvert, she has struggled to fit in for some time.  

In this example, Dorris is looking at things linearly instead of holistically. Her mental health is suffering yet everything seems as it should be in her life. If Dorris decided to start therapy, I would need to have a full picture of her life experiences in order to make an accurate diagnosis and create a working treatment plan that addresses all the factors contributing to her previously mentioned symptoms. 

That’s why the intake form at JK Therapy was carefully created to span across five themes: 

• Mental Health History: Understanding past and current mental health issues. 

• Medical History: Gathering information about physical health and medical conditions. These may be contributing factors to current psychological challenges. 

• Substance Use: Exploring any use of alcohol, drugs, or other substances. 

• Family History: Learning about family dynamics and history of mental health issues. 

• Background Information: Collecting general information about the client's life, such as education, work, and personal experiences.  

Note: In addition to talk therapy, I may refer you to a physician if a biological issue seems to be perpetuating the mental health symptoms, or to a psychiatrist if you present with symptoms that can only be medically treated, such as schizophrenia and BPD. 

After completing the intake form, this is the first session where we'll meet one-on-one to see if we’re a good fit for each other. I’ve found that this initial session is crucial as it sets the stage for the therapeutic relationship. During the intake interview, we will: 

• Discuss your background: I will ask about your personal history, including your family, education, work, and any previous experiences with therapy. 

• Identify your concerns: You will talk about the issues that brought you to therapy, such as anxiety, depression, relationship/family problems, or other mental health concerns. 

• Understand your expectations: I will inquire about what you hope to achieve through therapy. We will then collaboratively explore your desired outcomes and set goals for therapy.  

Back to Dorris, if Dorris made it to the intake interview she would probably share her struggles with symptoms of depression that have plagued her for the past few months. She’d let me know that despite her efforts to rationalize her emotions, she feels lost, unable to pinpoint a valid reason for her symptoms. 

I would encourage Dorris to expound on her daily struggle: the sleepless nights, the persistent tightness in her chest, the loss of appetite, and the exhaustion that seems to follow her everywhere.  

I would use probing questions as we delved deeper into her story, Dorris would eventually reveal the complexities of her upbringing. Raised by a single mother who battled health issues, how she took on the role of caregiver for her three younger siblings from a young age, and her father's sporadic presence. 

Recounting her responsibilities as a parentified child would lead to an explanation of the injury to her ankle two years ago. As she copes with the occasional flare-ups, the demands of her job and the strained relationship with her coworkers weigh heavily on her shoulders. How despite her best efforts to blend in, her introverted nature leaves her feeling isolated and out of place. 

As Dorris opens up, I would listen with empathy, recognizing the resilience that lies beneath her pain. Together, we would explore the intricate web of factors (past and present) contributing to her depressive symptoms and explore some of the outcomes she would like to see in her life.  

As the session continues, I would make note of any symptoms—whether observed or mentioned—that could be part of a larger issue. During the next session, I would administer assessments to accurately diagnose the problem and include interventions for said problem(s) in the treatment plan. 

The intake interview is a time for you to ask questions as well, ensuring you feel comfortable and understood. It's an opportunity to build rapport and trust with your therapist. 

After the intake interview, the next step is goal setting. This stage involves: 

• Clarifying objectives: Together, we will define clear, achievable goals based on the concerns discussed during the intake interview. 

• Prioritizing issues: We’ll then determine which issues to address first, focusing on those that have the most immediate impact on your well-being. 

• Creating a plan: Using all the information gathered up to this point, I will outline a plan that includes specific strategies and interventions to help you reach your goals.  

Goal setting provides a roadmap for therapy, giving you direction and a sense of purpose as you work through your challenges. Goals serve as benchmarks to track progress and ensure we are working towards a successful therapeutic outcome. 

4. Case Conceptualization: Understanding the Bigger Picture 

Case conceptualization is a process where I synthesize the information gathered during the intake and goal-setting stages to develop a deeper understanding of your situation, using your contextual background, my theoretical knowledge, and professional experience. This involves: 

• Identifying patterns: I will look for recurring themes or patterns in your thoughts, emotions, and behaviors. 

• Considering influences: I will take into account various factors such as your past experiences, current circumstances, and cultural context. 

• Formulating a hypothesis: Based on my observations, I will develop a working hypothesis about what might be contributing to your issues. 

Case conceptualization helps to tailor the treatment plan to your unique needs, ensuring that the interventions are relevant and effective. 

5. Treatment: Working Towards Change 

The treatment phase is the core of the therapeutic process, where you actively work on the issues identified. This stage involves: 

•  Therapeutic interventions: Depending on your needs, I may use different techniques such as narrative therapy, solution-focused therapy, trauma-focused cognitive-behavioral therapy, mindfulness, or other evidence-based approaches. 

• Regular sessions: You will attend regular therapy sessions, typically once a week, where you will discuss your progress, challenges, and insights. 

• Homework assignments: I may give you tasks to complete between sessions to reinforce what you've learned and help you apply new skills in your daily life. I encourage you to take these assignments seriously if you would like to see real and long-lasting change. 

Consistency and active participation are key during the treatment phase, as they significantly contribute to your progress. 

 The close-out stage is a time to celebrate your achievements and ensure you feel equipped to continue your journey independently. 

Conclusion 

My hope is that understanding the stages of therapy can help demystify the process and encourage those in need to seek help. Therapy is a structured, yet flexible process designed to support you in overcoming challenges and achieving personal growth. If you're considering therapy, remember that it's a collaborative journey towards a healthier, more fulfilling life. 

By educating ourselves and others about how therapy works, we can break down the stigma surrounding mental health and create a supportive environment for everyone in our community. If you or someone you know is struggling, don't hesitate to reach out to me and take the first step towards healing.