Phases of therapy and adherence to treatment

Psychotherapy bases its success and usefulness on the fact that it can adapt to the person's objectives throughout the entire therapeutic process.

It is a work in harmony between psychologist and person in which various stages can be identified.

The stages of psychotherapy

Below is a general overview of some of the main stages of the therapeutic process:

1. Commitment and Evaluation

This initial stage consists of the agreement between the psychologist and the consultant to invest time, energy and capacity in establishing a therapeutic relationship aimed at achieving the therapeutic objectives. At this stage , the demand of the person who attends the session must also be evaluated ; taking into account, as far as possible, both objective measures and those offered by the different empirically validated tests as subjective measures. The subjective measures are those that are collected both in the sessions and between sessions in different self-records or tasks.

At this stage, the professional may come across barriers that do not allow him or her to continue and must refer the person. Likewise, the person can commit from the first moment or do it a little later, after a period of exploration and framing.

There are certain variables that influence when the person decides to start the therapeutic process: a) their expectations and perception of the psychologist, if they perceive him/her as competent, empathetic and experienced, b) motivation, if they need therapy just to let off steam, for personal growth, to cope with a duel... and c) the personal characteristics (education, culture, learning history) fit with the methodology proposed by the professional.

2. Process

It is the most complex and central stage of all psychotherapy. This stage can be divided, in turn, into other sub-stages. The most common are search for patterns in the person, information gathering and consolidation .

Similar to the evaluation phase, since it is necessary to continue collecting information on the person's progress. Each period depends on the characteristics of the person and the reason for consultation. It is essential that, at this stage, the person realizes and is aware of what is happening to him and in this way changes and progress can be produced.

3. End of therapy

The person has learned to know their own functioning and way of being in the world . The person knows his weaknesses and strengths and assumes responsibility for him when making vital decisions.

4. Tracking

Adequate follow-up over time is important to ensure that the positive changes achieved continue to be maintained . This follow-up can be bi-monthly, quarterly or even yearly.

The importance of therapy not being interrupted

Although different stages in psychotherapy can be identified that proceed more or less linearly, these are not rigid and strictly delimited. You can start intervening from the first moment and you can go through each period throughout the entire therapy.

In this sense, it is important that the therapeutic process be continued . In other words, weekly sessions are recommended until they can be spaced out more as the objectives are achieved. The circumstances of each person must be taken into account, such as the scarcity of economic resources, lack of time or not being prepared at this moment in their lives to begin a therapeutic process.

Here the flexibility and empathy of the professional comes into play when adjusting to the needs of each person who comes to the consultation, although it is necessary to make a good setting of the therapy. It is essential to emphasize the importance of not abandoning the therapeutic process if the final stage has not been reached.

The fact of leaving a therapy halfway can mean that the person does not feel satisfied with the process, does not achieve the objectives that were programmed and considers that psychology "is useless". It may be that more than a therapeutic work process has found a space for relief, which may work in the first sessions, but in the long run it stops working for the person.

When the process is interrupted before reaching the end of therapy, it is known as therapeutic abandonment. It is something common in clinical practice and has consequences both for the person who comes to therapy and for the psychologist. Therapeutic abandonment occurs when the treatment ends unilaterally by the person. It is necessary to take into account the different psychosocial, clinical and institutional variables associated with the abandonment of the consultants and to see the abandonment within the context of the person.

How is therapeutic adherence improved?

On the other hand, there is the concept of therapeutic adherence . Unlike abandonment, in this case the therapeutic process ends by mutual agreement between the psychologist and the person.

Some techniques that can help reduce dropouts are:

• Create a good therapeutic alliance between the person and the professional, based on empathy, honesty and care.
• Convey security and experience, have a decisive attitude and not get caught up in the problems that the person brings to the consultation.
• Validate the person's emotions and not judge them. It is necessary for the person to see and feel that it is a safe space in which to work together with the therapist.
• Provide psychoeducation when appropriate to motivate and educate the person to commit to therapy.
• Have frequent contact with the person and the family, whenever necessary, in the form of calls or emails.