The Beginning Of Therapy
What Happens During The Beginning of Therapy?
Commitment and agreement between patient and clinician (boundaries, the frame, attendance, cancellations, sick policy, etc.)
Education client about treatment and therapy (risks and benefits, what to expect, etc.)
Orient client to therapy (what to expect, what therapy is, what therapy is not, the role of the therapist, role of client, etc.)
Elicit potential barriers to therapy (unintended consequences, money, time, commuting, etc.)
Answering questions and concerns client may have
Informed consent
Discussing when to terminate/end therapy
And more
Remember
We are trained and experienced, but the client is the expert of their lives and have choice and agency to do what they’d like
This means they can end session/treatment with us at any time
We know theories, but clients do not fit neatly into a theory/box/category
Change is hard, challenging, and difficult
Ambivalence is normal and to be expected
Most clients, though not all, come into session with conflicts
Address ambivalence and apprehension early on
Relapse is normal and part of the healing process
Normalize this
Normalize and validate the client moreso during the first part/beginning of treatment
We hold hope for clients even when they are hopeless
Collaborative and work with clients (therapy is a two-way street)
Ask for feedback and respond accordingly
Display empathy, warmth, and compassion
Hold flexible, yet firm boundaries based on your own personal and professional boundaries
And more
Goal of an Effective and Useful First Session
Helps reduced drop out
Increases hope
Increased motivation to achieve goals
Client is educated and aware of process and treatment of therapy
Helps set expectations, agreements, etc.
Helps with client ambivalence and uncertainty
Provides them with a roadmap of what to expect vs. being overwhelmed and confused
Provides client notice/awareness that there will be an ending to therapy eventually
And more
Questions To Reflect On
What is my goal/are my goals for a client during a first session?
How can I instill hope for change and growth during the first session?
What are the challenges/barrier for me personally as a therapist during the first session?
As a client in therapy personally, how do I/would I want to feel and what do I want to get out of a first session?