Lots of beginning mental health providers fear the first counseling session. What do you say? How do you say it? What if you have a reluctant client and they don’t want to be there? The good news is, counselors don’t HAVE to do all the work. 

TCCBB 0106: How do you conduct a first counseling session?

How do you structure the first counseling session?

As you might expect, a first counseling session must include an intake assessment. But what happens after that?

The technique I teach involves giving your client more than just a diagnosis. Offer them a three point wrap up that includes their presenting issue, their life cycle stage, and the impact of stress on their problem solving capabilities.

Then invite them to collaborate on their treatment plan and next steps.

Why collaborate?

As Experiential therapist Dr. Carl Whitaker is famous for saying, “The therapist must win the battle for structure; the client must win the battle for initiative.”

What that means is, you, counselor, don’t have to have all the answers. In fact, collaborating with your client avoids the pursuer-distancer dynamic that leaves so many new counselors feeling stuck.

Instead, clients leave your first session feeling informed, comforted, and part of the process.

Don’t believe me?

Imagine you had to go to the dentist for a toothache. What would you do if your dentist didn’t say a word and she just grabbed the drill and started drilling?

It would be very hard for most of us to cooperate with that treatment plan!

A proper first appointment for a toothache consists of questions, a preliminary diagnosis, further assessment to confirm the preliminary diagnosis (x-rays, physical exam, poke around in your mouth with those little pokey sticks) and THEN a treatment plan is developed in collaboration with you.

• “You need a cavity filled. This will take about an hour. Can you come in next Tuesday?” 
• “It’s going to be $300. I see you don’t have dental insurance but we offer payment plans. How do you want to proceed?” 
• “We can refer you to the dental college downtown and they can do it for free. Would you like their number?”

What do you say?

The first session is basically helping your new client make the decision to DO therapy along with you. I create structure by telling them at the beginning of the intake assessment what to expect.

It sounds something like this:

“I’m going to get to know you by asking a lot of questions. In fact, it’s going to feel like an interview. At the end, I’m going to give you two or three directions we can take. If you agree to go forward, I will give you some homework like something to read, write, or Google. We’ll course correct in the second session based on your feedback. By the third session you’ll have some coping tools and you’ll know better if working with me is going to be a good fit.”

In a very solution-focused way, you are helping your new client collaborate on important questions like:

• What does better look like after three to four sessions?
• How will they know?
• How will you know?
• Who gets to decide?

Inviting your new client to collaborate on their treatment plan and next steps may seem scary at first. And yes counselor, I know you’re the expert. I know that you’re the one with the master’s degree and the expertise to know how many sessions they need. You’re also the expert on the pursuer distancer dynamic and helping new clients understand what better looks like every step of the way.  I challenge you to conduct a first session that informs, comforts, and creates buy-in so that your new client chooses you AND therapy.

Action Steps:

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