As a Therapist...(Building groundwork towards a therapeutic relationship)
Updated: Sep 22, 2020
As a therapist we can fall prey to our own vulnerability - we may take for granted the power, the impact, of the first therapy session. Something which I will refer to as the “initial therapeutic encounter”...something that isn't always a “therapeutic experience” for many individuals new to therapy. This is scary shit! Especially considering we are still living in a society and culture that perceives therapy as taboo, the stigma is real!
We forget the intensive reality it brings to even the most motivated clients to confront the fear of change, or simply to confront the fear of the unknown. As therapists, there are moments in our career where we can lose sight of this experience for new clients (guilty!). I’ve encountered many clients who tell me about their first therapy experience, they are the clients that seem to be filled with more trepidation than a typical new client, because of a “bad” first experience with a therapist.
Whether you are
a fellow therapist, or
new to therapy, or
giving therapy another chance…
... let’s take into account during our initial session that it’s so important to get the full scope of a client's experience. By doing so, we can better shape our approach. An approach should be tailored to what will work best for a client to explore their vulnerability and increase a greater potential for growth. My effort for this blog is not just to spin the wheel on this topic; but to also provide insight of how the tailored approach means success for the client.
“We and Us” Statements
I had learned since my grad school years, that the framework of a successful treatment lies within the therapeutic relationship. Many clients do not care how many letters we have after our name; it is about the secure environment we create in collaboration with the client, so that they can begin to open up with trust. Normally, we can set the tone with “we and us” statements. Take for example during an initial intake with a client who struggles in social environments:
(After going over the consent for treatment)
Therapist: “So the mic is yours what brings you in today?” (with notepad at hand) “I am just going to write down notes as we go if that is okay?”
Client: “Sure, sorry I don't know how this goes or even where to start.”
Therapist: “Take your time and no worries, I will just start by writing down the date”
Client: “Umm..I've been noticing I get uneasy when I am around people I don't know”
Therapist: “Okay, so I can see us initially becoming anxious in a room full of people?”
Client: “yeah, when someone starts talking to me It's like I freeze and do not know how to answer “
Therapist: “I understand, our hearts pound, possibly sweating palms and we go blank”.
At this point, I have discovered that a flow starts to occur. It involves less about asking questions and more conversing about the client's experience. I believe this approach implies not just “I hear you” but also “You're not alone in this” mitigating the feeling of being judged or put down in any way. This can be described as a feeling of walking into a new space expecting to showcase oneself.
Before the session ends, I often notice a sigh of relief from the client and follow up with a few “you did it!” reaffirmation statements commending them on this positive step. I state my professional opinion on how often we should consider meeting but it is always up to the client. Ultimately, I am there to navigate as they embark on their journey.
Based on a meta-analysis (Results from multiple studies) roughly 20 to 57 percent, new clients do not continue therapy after their first session. This can be for a variety of reasons. However, this may speak to individuals' reporting a bad first impression with the process. It is helpful to know what happened and why it did not work for the client. Oftentimes, individuals are not willing to take another chance at the process believing that the next time will only be more difficult than their last experience. So in this circumstance...ask. With this information, we can get a better sense of what approach to take with the client. What overall experience they have had in being vulnerable and what contributes to the response of shying away from it. We need to pace ourselves and frame questions in a way that creates dialogue. To that end, the client can learn more about themselves in an entirely new way.
As a therapist we are often the initial gatekeepers to a journey of growth. This should not be taken lightly. The decisions that lead an individual to walk through the therapy door can easily be ignored. To be clear, I am not stating this is solely on the therapist, successful treatment involves two people. There are times a client does not come back even if we tried all we could. We all know that therapy is not easy and it takes thoughtful introspection and honest dialogue. Thanks to my fellow professionals. Until next time…...