A Look into the Past as an entry into therapy, or as a standalone experience

“If I come to this session, does that mean I’ve started therapy?” I get this question often, and I almost always hear two things in it at once: curiosity and caution. Someone would like to look into their family story, and at the same time they don’t want to find themselves in a process they haven’t yet agreed to.

The answer is: no, you haven’t. The ninety-minute session “A Look into the Past” is a complete whole in itself. It can be the first step into regular therapy, and it can be the only session we ever have together. Both options are equally valid, and neither is half a thing.

In this piece I set out both paths: what the genogram offers as an introduction to regular work, what it offers as a standalone experience, which criteria help you decide — and, what seems most important to me, what you can honestly expect from a single session and what is unrealistic. The general question of what psychotherapy actually is I covered in my post on psychotherapy; this is about the decision that comes before that.

Two paths that begin in exactly the same way

Let’s clear up one thing first: the session itself is identical in both cases. I don’t do a “shorter” version for people who don’t want to go on, and an “introductory” version for those who do. Ninety minutes, three generations, one sheet of paper, your question.

The difference only appears at the end — and often it’s only then that it becomes clear which path is yours. Plenty of people come intending this to be a one-off and end up saying they’d like to continue. Plenty of people come convinced they’re easing themselves into therapy, and after the session realise they got what they needed and will now live with it for a while.

In practice there’s a third variation too, which I mention because people rarely anticipate it: someone decides to continue, but not straight away. They take a few months, sometimes a year, and come when they’re ready. This isn’t procrastination. Often it’s exactly the right measure — the material from a single session settles during that time, and when the person returns, the work begins from a considerably deeper point than it would have if they’d thrown themselves into the process right after the session.

That’s why I don’t ask for a decision in advance either. It seems unfair to me that you should have to choose a path before you can see where it leads.

The first path: the genogram as an introduction to regular therapy

If you decide on regular work, the genogram is an unusually effective starting point. Let me explain why.

Because it saves time. In a regular process the first hours are often spent getting to know the context — who’s who in your life, what happened, who is where. This is necessary work, but it’s slow, because it arrives in fragments. The genogram does it in one piece. When we begin regular sessions afterwards, we have a shared point of reference from the very first hour.

Because the therapist sees the system, not just the symptom. The clinical literature on case formulation is fairly consistent: a well-drawn initial picture gives the work direction and prevents us from dabbling in a bit of everything. In marriage and family therapy, which is my orientation (I write about it in my post on marriage and family therapy), that picture is necessarily systemic: we understand the individual within the field of relationships they came out of.

Because it gives the work direction. Two or three central patterns almost always emerge from a genogram. That becomes the axis around which the regular process is organised — instead of starting each week with whatever happened in the last seven days. How such a process unfolds over months I described in my post on the regular therapeutic process.

Because it lowers the threshold. This is no small thing. For many people, “I’m coming to one session to look at my family story” is a considerably easier way in than “I’m starting psychotherapy”. The first is concrete and has an end. The second is open-ended and sounds big. If you’re afraid of therapy — I write about that in my post on the fear of therapy — the genogram is often the kindest way through the door.

The second path: the genogram as a standalone experience

And now the path we often underestimate in therapeutic circles, even though for many people it’s the right one.

There are plenty of people who don’t want a long process. Some because their lives are stable and they have no theme they’d want to work on for months. Others because regular sessions don’t suit them in terms of time or money. A third group because they’ve already been in therapy and feel they don’t need another round, but are interested in one particular thing. And a fourth simply because they’re curious about their family — which is a perfectly legitimate reason.

Does a single session give such people anything at all? From a research standpoint: yes. A meta-analysis of single-session interventions showed that well-designed one-off sessions have measurable effects (Schleider and Weisz, 2017). In the nineties Moshe Talmon and his colleagues pointed out a fact that surprised many: the most common number of visits in psychotherapy services is one — and a substantial proportion of those people were satisfied with the outcome. Data on premature termination of therapy fills in the picture: a large share of people finish earlier than the therapist planned (Swift and Greenberg, 2012), which among other things means it’s worth designing every session so that it gives something in its own right.

So what do you take away if this is the only session? The map you’re holding. Language for things you couldn’t name before. A few coincidences you won’t forget. And often a different relationship with your parents — which I write about in my post on aha moments.

Let me add one more thing that seems important to me. The standalone experience is not “therapy for people who don’t dare go into therapy”. It is its own thing, with its own purpose: to understand where you come from. Many people need it not because something has gone wrong, but because they’ve reached a period in which the past suddenly matters — at the birth of a child, at the death of a parent, at a fiftieth birthday. In these transitions people often ask themselves what they were actually given and what they will pass on. For a question like that, one well-conducted hour and a half can be exactly the right measure.

Criteria: how you know which path is yours

If someone were to help you decide with a few questions, these would be them:

• Do you have a theme or a question? A question can be answered in one session. A theme — “I don’t know how to be close”, “I always exhaust myself”, “I can’t bear conflict” — is the subject of a process. If your formulation is long and has repeated itself over the years, we’re probably talking about a theme.
• How long has it been going on? Something that has troubled you for a month carries a different weight than something that has troubled you for twenty years. Long-standing patterns need a repeated experience of something different, not a one-off realisation.
• What do you want to take away — understanding or change? This is the most useful question. One session can manage understanding. Changing your behaviour in relationships takes time, repetition and someone who is there when it doesn’t go well.
• How solid is the ground under you right now? If you’re in the middle of a crisis, what you need first is stabilisation. If you’re stable, a one-off experience is a perfectly safe choice.
• How much support do you have outside therapy? Anyone who has a partner, friends or a sibling to talk to will find it easier to work through on their own whatever opens up.

These criteria aren’t an exam and nobody checks them. They’re an aid to making your decision deliberately rather than by accident — because in practice most people don’t decide wrongly, they simply don’t decide at all. You come to the session, you leave with a sheet of paper, and you never take a moment to ask yourself what you’ll do with it. Fifteen minutes of reflection on what you actually want is often worth more than three additional sessions.

And one criterion that isn’t in the books: how do you feel at the thought of coming every week? If something tightens in your chest at that thought, it isn’t necessarily resistance — it may simply be information that now is not your time.

What you can expect from one session — honestly

And now the part I consider the most important, because it’s the one marketing likes to overstate.

You can realistically expect: a map of three generations; two or three insights you’ll still be able to put into words a year from now; language for a pattern you couldn’t name before; a noticeable easing of personal guilt; often a softening of your relationship with your parents; and a clearer sense of whether you’d like to carry on working.

You realistically cannot expect: that a pattern three generations in the making will disappear; that after the session you’ll know how to act differently in situations that have thrown you off course for decades; that relationships in the family will be different because you’ve now understood something; that anxiety, depression or a sleep problem will be resolved; that everything will be told to the end — an hour and a half holds some stories, not all of them.

This difference comes from something I described in my post on insight: insight contributes to change, but it isn’t a sufficient condition for it. A meta-analysis of the link between insight and therapy outcome shows a moderate, not a complete, association (Jennissen and colleagues, 2018). Anyone promising transformation in ninety minutes is selling something other than psychotherapy.

That’s why I don’t promise transformation either. I promise a look — and a look is more than it sounds, because a great deal in life can’t be changed until it’s seen.

Signs that I’ll suggest continuing after the session

Sometimes something happens at the end of a session that tells me one session won’t be enough. When it does, I say so — not as a sales tactic, but as a professional assessment. What are those signs?

• More has opened up than you can carry alone. If a loss, violence or a secret you’ve never had anyone to work through it with came to light during the session, continuing makes sense. The map has then opened the door to a room it wouldn’t be good to stay in alone.
• The pattern has serious consequences in the present. When it becomes clear that something is directly eroding your relationship, your parenting or your health, a one-off understanding isn’t enough.
• A lot of absence showed up during the session. When a genogram is full of gaps, silence and broken contact, slow work is often needed. I address a related theme in my post on family secrets.
• Signs I notice in the body. If a strong response appeared during our conversation — numbness, trembling, shutting down — it makes sense to work more slowly and for longer.
• You said so yourself. The simplest sign of all: someone says at the end, “I’d like to go further here.” I always believe that.

If you decide to continue, it doesn’t have to be with me. I am a marriage and family therapist in training under supervision, and whenever I judge that someone with a different orientation or more experience would serve you better, I say so and, where I can, suggest where to look. What really matters when choosing a therapist I gathered in my post on choosing a therapist.

The time in between: two or three weeks that say a lot

If you can’t decide after the session, I suggest something simple: don’t decide straight away. Let two or three weeks pass, and watch what happens.

That in-between time is a surprisingly reliable indicator. If things settle, if the map sits down and you look at it now and then with interest rather than unease — one session was probably enough. But if more and more keeps opening up over those weeks, if the theme won’t let go of you, if scenes keep coming back, or if you notice your sleep or mood getting worse — that’s a fairly clear sign it would be good to have someone alongside you.

The same holds in the other direction: if something in your relationships starts shifting of its own accord after the session, if you talk to your mother differently for the first time in a long while, if you dare to say something you never have — that’s an answer too. It means you can work the material through yourself and that you have enough support.

Some people write things down during that in-between time. Not long journals, just the sentences that come to mind. When you look back at those ten sentences three weeks later, it’s usually quite clear whether this is a finished story or a beginning.

The door stays open

One more thing that often puts people at ease: the decision isn’t final. Plenty of people come to a genogram session, spend a year working with it on their own and then come back — sometimes with the same sheet of paper, wanting to add new things they’ve learned in the meantime. Sometimes people return after three years, because a new stage of life has brought them a new question.

I find that the most natural rhythm of all. A family story isn’t read in one sitting; over the years layers open up that you couldn’t see before, because you yourself were at a different point on that same path. I write about this in my post on life after insight.

The session “A Look into the Past” is described among my services, and we arrange it through contact. If you’d like to know how it unfolds stage by stage, read my post on how the 90-minute session goes; and if you’d like to know how to prepare, my post on preparing.

And if you can’t decide: come to the session and decide afterwards. That is precisely the great advantage of this format — you don’t have to choose the path before you’ve seen where it leads.