Starting psychotherapy

When people come to see a psychologist/psychotherapist, they have relatively little information as to what to expect, other than what they have picked up incidentally from television dramas and the like.  Some therapists like to provide as little information as possible (a tactic dating back to early psychoanalysis) in order to determine what the assumptions and preconceptions the prospective client may have.
What the patient understands and expects may have little in common with what the therapist understands.  Often patients expect that we will fix something that hurts psychologically, just as they would expect a physician to fix something that is wrong physically.  They may take a passive stance, waiting for the therapist to direct or prescribe just as a physician might.  When the therapist doesn't do that, the client has no clear idea as to what should happen next in their treatment.

Currently I am starting new patients off with a short introduction.  Of course, it begins with some questions intended to get an idea as to what might be wrong.  If the problem is a simple reduction in unpleasant symptoms, such as a recent depression or sudden increase in anxiety, I can tell them what techniques I will be using and about how long it will take.  I can tell them what the financial and personal  costs are likely to be.  I can tell them exactly what I expect them to do and the outcomes they can anticipate.  But if the problem is a more complex one, such as when the symptoms arise from conflicting values and/or a dysfunctional life style, I use a different approach.

I tell them something like the following:  I will work with you to show you how to make changes in your life.  I can't make the changes for you.  You will have to decide what kind of person you wish to become over the years. You are in charge of who you will become, and every choice you make will brings your goal closer or moves it further from you.   Sometimes people make changes quickly;  more often they need more time to make them, so I can't tell you how long this might take.  I believe that is up to you.  My job will be to get you started along that path and show you how to continue it on your own. 

 To help you make those changes, I need to know who and what you are now.  I need to know what you believe and how you behave in accordance with what you believe.   Your part in this process is to demand of yourself uncompromising honesty.  Lies or dishonesty, whether of omission or commision, will stop the process of change.  Begin by telling me about yourself, what is important to you and what doesn't work, and we'll see how it goes. 

Since new patients are frequently uncomfortable with the idea of criticising the therapist, I am hoping that you as a reader will be willing to comment as to how you might respond to this beginning to therapy.