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  • Caleb Birkhoff

What to expect from counseling, therapy, & psychotherapy in San Francisco

You found a therapist in San Francisco! I know we’ve covered a lot of questions so far in these blog posts about starting therapy, but there’s a chance there’s some we haven’t hit yet. You probably started with a simple step; to type in counselor near me into google, talk to that therapist in San Francisco on the phone, and then schedule your first session. You’re now thinking, so what is therapy in my city all about? What do I need to know about counseling in San Francisco?


-What is all this mountain of paperwork?


There’s no shortage of paperwork to comb through, read, and sign. There are a few things that you will need to complete, or attest to, in order to start therapy in San Francisco. This intake information allows a therapist to know more about you and what is called the “presenting issue,” really what brings you to therapy. Sometimes it feels redundant, some of this has been talked about during your consultation, or your initial inquiry email, it doesn’t hurt to cement it at this point. There are documents also called Informed Consent, which talks about privacy, fees, scheduling, and several other policies. These documents are to ensure your confidentiality is protected and that you understand the agreements with your therapist


-What is the first session about?


The initial session is a get to know you session. Sometimes there is a lot of structure, some therapists have a standardized intake appointment, going through your family history, social history, education, mental health, what you enjoy, your strengths and other areas of your life. Other therapists move through this information more organically, slowly cultivating this information over a course of sessions. One is not better than the other, each therapist in San Francisco might have their own slant on this process. Either way, stick with it, your send session (and subsequent sessions) will shift into “the work,” as therapists call it. The structure of the next sessions might look different, depending on the counselor in your city, they may leave it open-ended, or be direct and say we are talking about some goals. Each therapist’s style is different, and each one has their own way of doing things, even if you’ve been in therapy before you might have a different experience.


-What if I don’t get to everything that I want in that first session(s)?


There will be time! Take your time, sometimes it feels like it’s important to get it all out quickly, so we can get started on the goal setting. Also, taking some time to disclose your life is important, healing takes time and the rush to feel better makes sense; it doesn’t always happen on your timeline. Sometimes your therapist will need to gently cut you off, or “redirect” as we call it. We do want to get to know your whole story, and sometimes 50 minutes isn’t going to be sufficient.


How long are our sessions?


Session length depend on how the provider does them. Counselors in San Francisco may schedule 50, 53, 60, 75, 80, or even 90-minute appointments or even longer than that. This all depends and therapists in California will fill you in regarding times. Counselors keep track of time during the appointments to make sure you are getting what you need that week and to keep things on schedule. It’s a good question to ask, and there is often flexibility. Keep in mind, if you’re going through insurance, that might impact how long your therapy appointments are.


-Therapy is just like talking to a really close friend right?


This is a powerful myth to dispel. Your therapist in San Francisco is not your best friend, your hair dresser, your bartender, that wonderful Uber driver. Counselors, therapists, psychotherapists in California go through years of school, training, supervision, testing to sit across from you. We are professionally trained, diagnose, develop treatment plans, and have incredible ethical and legal standards to maintain. Friends, family, loved ones are a wonderful resource, but are likely invested in you taking their advice, or might just be telling you what you want to hear. We’re not always going to see eye to eye, which can be challenging, we’ll call you on your shit (appropriately) and start exploring what you want to do about these familiar patterns.


-I really like my therapist, can we be friends?


It’s wonderful to like your therapist, and the desire to be friends with them is very normal. Counselors in San Francisco have to maintain boundaries with clients, which can be disappointment, and have professional ethics codes we need to follow. Please don’t take it personally, it’s about maintaining a strong therapeutic relationship and alliance. Being friendly and being a friend are different relationships, despite maybe feeling very similar. If you see us out in public, it’s okay to say hi if you’re comfortable, but do remember it won’t be more than that. Lastly, on that note, a therapist in San Francisco won’t come up and say hi to you, as a way to protect your confidentiality, so be prepared to initiate that hello.


-Is a therapist going to tell me what to do?


Your therapist is not a personal advice column. We will ask you questions, make observations, suggest tools, but telling people what to do is not in the job description. Being told what to do is often the best way to get somebody not to do something. Therapy is looking to empower you to make decisions for yourself, ones that align with your values, beliefs, and goals. Though your therapist in California will get to know you very well, the autonomy, agency, and assertiveness you will gain in taking charge in your own life will be more rewarding than unsolicited, or solicited advice, from your therapist. If you want to be told what to do, you probably already know who you can turn to for that.


-How will I know what to do?


A therapist can help you develop a plan of action that takes into account your strengths and weaknesses, as well as any external factors that may be affecting your ability to make changes. This will be a process that you carry out with your therapist, as noted above they won’t be handing out advice. They can also help you stay accountable and motivated as you work towards your goals. A therapist can provide you with emotional support as you work through it all. They can help you develop healthy coping mechanisms and offer a listening ear when you need it most. By providing you with a safe space to explore your thoughts and feelings, setting realistic goals, creating a plan of action, providing emotional support, and celebrating your successes, a therapist can be an invaluable asset on your journey towards change.


I hope that this list helps you feel more confident about what it means to be in therapy in San Francisco. If after reading all of that, you’re still swirling with questions feel free to call me at 415-990-1452 for a free 15-minute phone consultation, and to get some questions answered. I would be happy to hear what is happening for you, what you’re looking for and provide some direction to finding the right therapist for you.


If you are seeking help with couples therapy, drugs and alcohol, a life transition, discovering yourself, or therapy for men, you can read more about how I can help by clicking here!




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