Author Archives: Psychotherapy Networker

Terry Real On Why Leverage Is Key With Men

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Attachment Theory in Practice: NP0028 – Session 5

Join Maggie Phillips as she explores the latest research on the psycho-neurobiology of chronic pain. With this information you’ll be able to help clients realize the connection between past attachment issues and current chronic pain, increase their ability to self-regulate, and access greater inner resiliency.

After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.

Today’s Wisdom: NP0029 – Session 3

Today we’re becoming even more disconnected from one another. Join Tara Brach as she takes us through practices that can help you and your client move beyond the individual identity toward the fuller realization that we are all part of a larger whole.

After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.

Pat Love Talks About Brain Science, Empathy, and Gender

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Welcome to Handling Today’s Hidden Ethical Dilemmas. This practical and thought-provoking series with leading experts on ethical practice will explore current ethical guidelines for therapists. The first session with Mary Jo Barrett will delve into how to reconcile boundary maintenance and will cover why peer supervision and consultation are vital to ethical therapy, plus many issues that are consistently confusing for clinicians.

How has digital technology changed the ethical challenges practitioners face in the consulting room? Join psychologist Ofer Zur in this practical discussion of the new ethical trials that exist due to new technologies such as email, social media platforms, the Internet, cell phones, and more. Zur will break down the new issues and provide suggestions as to what therapists should do in order to best handle these ethical quandaries.

Join Clifton Mitchell for a practical discussion on the latest legal developments on therapists’ responsibility to handle self-injurious behavior in clients, report abuse or rape, and handle right-to-die issues. Mitchell will delve into significant legal and ethical situations and discuss practical case studies that’ll help you better understand the best ways to deal with these important issues—ethically and legally speaking—in the consulting room.

Learn from veteran therapist William Doherty as he’ll delve into complicated ethical situations by showing video clips from the popular HBO series, “The Sopranos” and “In Treatment” to lead discussions on useful and unbeneficial ways to bring up terminations when clients are no longer benefiting from therapy. Doherty will explain the most common scenarios when termination is—or should be broached—and will go over strategies for initiating termination topic at the right time and in the right way.

During this session you’ll have the opportunity to hear from Steven Frankel, who’s a certified clinical and forensic psychologist as well as an attorney at law. Frankel will discuss the best ways to deliberately avoid the most common ethical dilemmas in order to protect your clients and yourself.

As the final session, Marlene Maheu, a leader and pioneer in telehealth, will discuss how to effectively provide online therapy while maintaining ethical boundaries. She’ll explore such tools as Skype, Google, virtual self-help products, and more.

After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.

Rich Simon

By Rich Simon Two years ago, when we put out an issue about digital technology and how it was revolutionizing the way we experienced our relationships, I was having a little revolution of my own.  A long-time Luddite who’d been dragged into the Computer Age, I had just acquired my first iPod and was in a state of deep infatuation, entranced by the possibilities for connection and entertainment promised by that little digital baby. Read more

Coach #21

By Rich Simon Like a lot of us in this field, I’ve had boatloads of therapy over the years, but never a coach. At least not until recently, when Andrew—my 26-year-old basketball coach—came into my life to school me in the fine art of the crossover dribble and how to slide my feet on defense. At no extra charge, he’s also begun providing me with some of the best therapy I’ve ever received. Read more

Attachment Theory in Practice: NP0028 – Session 4

As a parent are you overstressed or burned-out? As a therapist is your client’s child shutdown? Learn how to apply PACE (play, acceptance, curiosity, and empathy) to reestablish a more empathic conversation. Join Daniel Hughes as he teaches how to apply these skills and reunite parents and children through dialogue.

After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.

Today’s Wisdom: NP0029 – Session 2

Learn how to bring freshness and novelty to your life and practice by moving beyond habitual patterns. Join Eugene Gendlin as he shows how to use our “Felt Sense.”

After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.

The Art of the First Session

By Robert Taibbi


Q: I know that the first session with new clients is crucial, especially when doing brief therapy. How can I make the most of it?

A: Like it or not, many of us are brief therapists by default. Stats tell us that clients go to an average of five to eight therapy sessions, but most of them go only to one, making it essential that we hit the ground running.

We all know the essential tasks of the first session in any kind of therapy: building rapport and a sense of collaboration, assessing and diagnosing, and formulating and offering a preliminary treatment plan. The tasks in brief therapy aren’t different, but they’re done in less time–meaning that therapists need to get to work immediately, and there’s little leeway for mistakes.

I find it useful to think of the first session the way a family physician might when a client shows up with an ailment. Basically, there are four goals to meet: getting on the same page, changing the emotional climate, clarifying the link between problems and personality, and offering a clear treatment plan–and if you miss any one of them, the client probably won’t return.

Getting on the Same Page

It’s useful to set the stage for brief therapy by letting clients know a little about your approach during the first contact–that you think brief, that you focus more on the present than the past, and that you give behavioral homework. You may tell them a little about your experience to convey a sense of your competence. Once they come to the session, like any therapist, you help them feel welcomed and safe. You can do this by listening carefully to their story and being empathic, subtly mirroring their body position or language to help foster rapport, and clarifying their expectations, either to reinforce them or to suggest alternatives.

But you can’t just listen for 50 minutes and then thank them for coming, take out your appointment book, and say, “Same time next week?” Not in the age of Dr. Phil. You must shape the process by offering direction and leadership, not just responses. This gives clients the crucial sense that you know what you’re doing and where you’re going with them.

However, the most important part of getting off on the right foot is what I call “tracking the process like a bloodhound.” This is where it’s easy to get lazy and lose focus. Clients instinctively want to talk content–to dig through their pile of stories and sort through the heap of facts. Of course, to some extent, that’s important, but you want to focus on what you see that clients usually don’t: what’s happening moment-to-moment in the room. Whether you make a comment or an interpretation or provide education, you need to watch closely how the client responds. Make sure you notice the nod of the head or other indicators of solid agreement. If you hear a “Yes, but . . .” or a lukewarm “That makes sense,” or observe eyes glazing over or a frown, don’t move ahead. Stop and address the problem that’s right there in the room: “Hmmm, you’re making a face. It seems like you may see it differently.”

Gently clarify your thinking, connect your thoughts to the clients’ most pressing concern, and make sure they’re in sync with you throughout the session. If they are and you can offer a clear treatment plan, you’re off to a good start. But if not, they’ll balk or seem uncertain about setting up another appointment. Then and there, you need to realize that, somewhere along the line, you fell out of step.


Changing the Emotional Climate

In a first session, clients are expecting something for their time and money: when they walk out, they want to feel differently from how they felt when they walked in. This is what I call changing the emotional climate. Simply listening and being empathic, allowing clients to vent, goes a long way toward accomplishing this. So does education. Talking to clients about the brain physiology of anxiety, for example, or typical family patterns can help normalize their distress and place it in a larger, fixable context. This is what your family doc does when she tells you that you have an infection or that your rash is simple contact dermatitis caused by the new cream you put on your face. You feel better having a label, an explanation, and a palpable sense of your physician’s educated concern.

In brief therapy, though, you need to ramp it up experientially. One of the most effective ways of changing the emotional climate is, again, zeroing in on the ongoing process with the client. You want to pay extremely close attention to the nonverbal communication, to tap the subtle feelings that are just below the surface. When Sara looks hurt, stop the story and focus: “Hold on, Sara, what just happened? You’re looking sad.” If you say this gently, with real sincerity, Sara may be able to drop her defenses and actually begin to tear up or cry. This open and shared vulnerability will help her emotionally bond with you. You can also do this by asking directly about these often softer and less obvious emotions: “What causes you to feel sad? What worries you the most?” Or ask about positive feelings to offset all the focus on negative ones: “When do you feel your best? What are you most proud of?” By asking, you move to a different level in your relationship with a client and change the climate in the room. Even if Sara seems to push your questions away, you’re still letting her know that you’re noticing how she feels and that this is a safe place to talk about difficult things when she’s ready.

While these points may seem fundamental to being a therapist, I’m always surprised when I see clinicians failing to create this powerful shift. They get too caught up in gathering history for assessment to notice these emotional subtleties, or they rationalize that it’s too soon to tap them. But that’s a mistake.

Linking Problems to Personality

The first question I always ask myself is: What keeps this person from solving this problem on his own? Sometimes it’s because clients have situational stress: they just got fired from their job, they have a medical crisis, their kid got busted for drugs. Normally, they can cope, but now there’s just too much on their plate. They need support and help to be able to zero in on the problem. Other times, it’s a matter of skill or lack of it: they have continual financial problems because they really don’t know how to set up a budget, or can’t talk with their partner without triggering conflict or disengagement. Once you help them understand and implement a budget or master the keys to good communication, the problem begins to fade.

Other problems persist, not because they’re rooted in stress or lack of skill, but are intrinsically linked to their personality and coping style. I think of this from the Buddhist standpoint: How you do anything is how you do everything. In fact, this is where some clients are stuck. While they’re worried about the what–the content of their problems–the real source and solution to their current problem, and many of the problems in their lives, lies in the how, their overall response to problems. This is what I call their core dynamic–an expression of their primary childhood ways of coping, such as accommodation, anger, or withdrawal. While these ways may have helped them survive the challenges of their early environment, now, like outdated software, they’re no longer helping them negotiate the more-complex demands of an adult world.

To move out of the 10-year-old’s perspective and better handle the problems in their lives, they need to update their inner software. More traditional approaches might track this down by a long march through the past, but in a brief approach, you can tackle it in the first session by asking how they concretely and specifically cope with current problems on the job or at home. Of course, you may even detect their coping style during the session itself, through their responses to you.

Once I’ve defined their coping style, I often try to link it to their current problem, helping them see the latest manifestation of the same outmoded response. By doing that, I set the stage for their attempt to challenge their early wiring: instead of being good and accommodating, as they’ve always done, the might push back and say what they need; or, instead of spraying anger around the room, they might self-regulate and use their anger as information. I let them know that they can update the software, which will not only fix their current problem, but prevent future ones.

This focus on defining, understanding, and challenging the core dynamic is empowering for clients. The message is that you can help them map out new ways of taking acceptable risks, breaking old patterns, and acting more like the adult they are than the 10-year-old they often feel like.

Offering a Clear Treatment Plan

Finally, like the physician, you need to leave clients with a clear set of next steps. If you decide the client is stuck because of situational stress, talk about ways of navigating this challenge in the scope of their broader lives. If it’s about coping skills, map out what skills you feel would be important for them to learn. If it’s about their core dynamic and ineffective approaches to problems, or a combination of all of the above, let them know what you’re thinking and what they concretely need to do.

Then, as always, track the process and see what happens next. Does this make sense to them? Do they agree? Do they understand how this is all related to their presenting concern? If there’s a sincere and congruent yes, you may give them concrete behavioral homework to help develop new skills or reduce their stress. If there’s hesitation, ambivalence, or accommodation, stop, clarify, or ask questions until you’re clear about what’s going on. Just remember that their resistance isn’t the problem, but a source of valuable, additional information about what the solution might be. As in any other phase of psychotherapy, it’s hard to go wrong if you bear in mind the clinician’s most useful mantra: track the process like a bloodhound!

Robert Taibbi, L.C.S.W., trains nationally and is the author of more than 200 articles and five books, including the forthcoming Therapy Boot Camp: Brief, Action-Oriented Approaches to Anxiety, Anger & Depression. Contact: bobtaibbi@ntelos.net. Tell us what you think about this article by e-mail at letters@psychnetworker.org, or at www.psychotherapynetworker.org. Log in and you’ll find the comment section on every page of the online Magazine.