Disclaimer: The information provided in this article is for educational purposes only and is not intended to replace personalized professional medical advice, diagnosis, or treatment. If you are experiencing distress, please contact us to see how we can help, or consult your primary healthcare physician.
New Territory
It’s not always easy starting counselling with a new therapist. For someone with no previous experience, therapy might come with some trepidation. Although we’ve come a long way in de-stigmatizing issues related to mental health, some people still feel reluctant to ask for help. They may feel that seeing a therapist means something is wrong with them. These ideas, unfortunately, can prevent people from reaching out. Further, it can be intimidating to sit down with a stranger and begin to discuss difficult issues. It can take some time for us to feel safe enough to expose our vulnerabilities.
This article is a brief overview of what happens in the first counselling session. Other psychotherapists may have their own practices, but here is my own. By sharing the process, I hope to make the first session less intimidating and more transparent.
Building Therapeutic Alliance
The relationship between the therapist and the client is one of the most important factors in therapy. Healing and growth require trust and safety. Therefore, the trusting relationship between therapist and client begins at the phone consultation. This is the first contact where the client gets a sense of the therapist’s personality and clinical approach. During the first session, the therapeutic alliance starts to form in earnest. Through active and empathetic listening, warm and positive regard, and emotional congruence, the therapist and the client begin to form a solidarity, which becomes the basis for deeper inner work.
There’s no recipe or instruction book on how to build therapeutic alliances. For the therapist, listening deeply, feeling the emotions of the client, and making an honest effort to understand the client’s perspective can help to build a therapeutic rapport. For the client, being authentic, honest, and courageous can go a long way in building trust. In the end, there is an organic chemistry that happens when two people meet to discuss matters of great importance. If you are a client who is new to counselling, be yourself, allow yourself to be vulnerable to the extent that you can.
The more you soften into the process, the more rewarding the therapeutic process can be.
Understanding the Client
I start every first session with an intake assessment. This is a brief questionnaire that gives me the landscape of a person’s life. I ask the client about:
- Self-care routine
- Their cultural and racial background
- Sexual orientation
- Current living arrangement
- Family (single, partnered, with or without kids etc.)
- Social support network
- History of mental health challenges
- Previous experience with counselling
- Use of medications and substances
- Risk of suicide and self-harm
- Previous traumatic experiences
This intake interview is usually brief (approximately 10-15 minutes), depending on how clients elaborate on their answers. For some clients, the structured format of the questionnaire can help to ease them into therapy.
Some of these questions can seem intrusive. Sexual orientation? We’ve only just met 5 minutes ago! Yes, I admit this can seem rather abrupt. I ask the question at the beginning because I want to get as accurate a picture of the client as possible. Sexual orientation is part of the fabric of a person’s identity, and keeping this in mind is a vital part of a therapist’s work. I do not want to be in the tenth session with a client only to find out then that they are, say, bisexual. If clients are not comfortable answering the question, or if sexual orientation and identity is part of the reasons they are seeking counselling, I encourage them to answer honestly to the question. “I don’t know” and “I’d rather not say” are both perfectly valid answers to a question about sexual orientation.
Start anywhere!
After the intake assessment, clients have the opportunity to talk about their issues and challenges. Some people jump right in, others hesitate around where to begin. It can be difficult for people to find an entry point, especially if there are many layers to their challenges, or if they struggle to organize their thoughts into coherent themes and narratives. If this is the case, I encourage clients to start anywhere. Start talking! There is no “right” thread, for each thread leads to the larger tapestry of the client’s life. It doesn’t matter if the thoughts and emotions are messy, if the stories digress and intermingle. As a therapist, it’s all helpful in building a picture of the client. If a client really struggles to get started, I can help by providing some prompts like: “What do you find most challenging about your life right now?”
I believe that therapy works best when clients drive the session. If you have something that you have been pondering something difficult, bring it to session.
Forget about the frills and the packaging, drop the hot sloppy mess onto the table and we’ll sort through it together.
When client feel unsure about what to discuss when there isn’t anything pressing, I encourage them to sit silently for a minute until something comes to the surface. Silence and stillness often excavate an emotion or memory that has been buried under the brim and bustle of life. Once something emerges, the session can begin.
I have found that there is a flow to each therapy session. Once the dialogue begins, the session comes to life. Both therapist and client forget themselves in the exchange. This is when something magical can happen. The important thing is to let go, to trust the process, to be authentic and courageous. This is where you get to say the unsayable, to ponder the imponderable, to face what you’ve avoided for so long. The courage to speak openly is the essential fire that illuminates a therapeutic encounter.
Checking in.. .
At the end of the first session, I often ask clients how the session went for them. It’s important for me to hear feedback from clients. Although the first session is only a beginning, something about the chemistry, the tone and tenour of the therapeutic alliance, starts to emerge. I want to know if the client feels comfortable and safe, whether they feel good about our initial rapport. I encourage clients to share honestly about their first impressions, and mention any adjustments we can make to our sessions, or possible topics of discussion that we might explore for the next session. I then work with the client to determine the appropriate time for our next appointment. As with all things in therapy, honesty and courage to say exactly what one is feeling helps a great deal.
Ready to talk?
Therapy can be an insightful way to make sense of your life, whether navigating a tough passage, or entering a quiet period of reflection. The miracle and mystery of therapy is that our words pave a path across a vast inner landscape and we find ourselves on the shores of a new continent.
If you are ready to begin the journey, contact me for a free consultation.
About the Author: David Chang, PhD, RCC, is a Vancouver counsellor and educator. With over 20 years of experience in evidence-based modalities, David helps individuals navigate life’s passages and build strong therapeutic relationships.
