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ND2012-6The Art of the First Session: Getting It Right From the Start

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.

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11 comments

  • Comment Link Friday, 24 May 2013 14:25 posted by Mildred Stephens

    Since we are working with a short period of time, we need to know as much about the client as possible before we see them. This way when they enter our office, we know how to get them on the right page and keep them there until the goals have been accomplished.

  • Comment Link Tuesday, 21 May 2013 15:47 posted by Terrance Rice

    I feel that the most important thing in a therapy sessions is building a connection with the client. A therapist should be able to have good listen skills and observe client's positioning when they are speaking to therapist in the sessions.

  • Comment Link Tuesday, 05 March 2013 15:52 posted by Jeffrey

    What should the therapist focus on in the first session - or in any session? Whatever the client talks about - and more importantly, how the client talks about what he talks about. If you do indeed track the client's process well enough by staying with his experiencing rather than theoretical speculating about it, you will discover exactly what he is struggling with and what he needs from you. All it takes is patience on your part and the belief that the client is doing the best he can to tell you what he's struggling with. That information is not in any theory because every client has had a unique experience. Don't be afraid to trust your intuition as long as it's not a disguised need of your own or from your own impatience.

  • Comment Link Wednesday, 13 February 2013 14:28 posted by Ashley Martinez

    I found this article to be very informative on the different ways to conduct a therapy session. These are defiantly techniques that I would use when in a session with a client.

  • Comment Link Monday, 11 February 2013 16:01 posted by fanta

    it is not just listen 50 minutes you have to show the clients that process and direction and leadership. you have to get on the right foot. you have to listen. you have to know how to use you time.

  • Comment Link Monday, 11 February 2013 15:09 posted by karen navia

    Taibbi discusses the importance of client's first therapy session and how therapists can make the most of that first meeting; and that is why i agree and like about brief therapy because is letting the clients know a little about your approach during the first contact.

  • Comment Link Monday, 11 February 2013 14:42 posted by fanta

    i have learn that it is not just listen 50 minutes to the clients. you have to show him/her that you have plan for him/her. you can said next week we are going to do something different. you have to show your clients the process and direction and leadership.

  • Comment Link Monday, 04 February 2013 18:22 posted by Johanna Feliz

    I really enjoyed this article. I agree with every point of the article. It made me see things differently. It helped me understand the importance of a therapist role. Trying to help an individual is not an easy task, specially when you do not know the amount of psychological problem this person may have. This is why i feel that every therapist should keep in mind and put in practice all the points clearly explained in the article.

  • Comment Link Monday, 04 February 2013 18:17 posted by RAMONA PEREZ

    "The Art of the First Session: Getting it Right From the Start" I consider it a very interesting article and easy to digest. I agree with the various issues that have been subdivided since that first session covers essential aspects. Starting to get on the same page as the client, so getting your emotional side to surface and so to continue with subsequent steps. This probably will make the customer leaves, but cured of evil that came to such therapy at least feel relieved to stablish the difference between input-output.
    The part does not agree is because if "brief therapy" in some cases according to statistics extend to eight Sessions. I think because it would become a therapy with a higher dimension.

  • Comment Link Monday, 04 February 2013 16:32 posted by Tanya

    It's very interesting to know that"we" are realizing that situational stress plays a major role in how we as people respond and act.

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