Many 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. Let’s talk about counseling techniques and skills for that awkward first counseling session. 

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

What is the First Step in a Counseling Session?

As counseling professionals, we understand that the cornerstone of any effective counseling session, particularly the first, is the intake assessment. 

However, the journey doesn't end there. Once the formalities of the intake are completed and some of the awkwardness is over, it's crucial to transition into a process that not only identifies what’s going on but also empowers the client. 

The technique I advocate for takes a step beyond merely getting to know the client and their presenting issues. This three-step process involves a comprehensive wrap-up that serves as a bridge between clinical assessment and therapeutic engagement. 

This three-point summary involves addressing 1) the client's presenting issues,, 2) their current life cycle stage, and 3) the different ways in which stress influences their problem-solving abilities. Let’s get into it!

The Three Step Summary Process

Let’s break this process down a little: 

1. Presenting Issue: Begin with a concise summary of the presenting issue as described by the client. This not only acknowledges the client's immediate concerns but also validates their experience. By taking this first step, you're laying the groundwork for a trusting relationship.
2. Life Cycle Stage: Integrating the client's life cycle stage into the discussion provides context by helping both the counselor and the client understand the issue within the broader narrative of the client's life. To do so, consider factors like developmental tasks, transitions, and potential stressors relevant to their current life stage. This provides context and clarity. 
3. Impact of Stress: Discussing the impact of stress on the client's problem-solving capabilities shifts the conversation from one where you’re seen as trying to identify a problem to one that considers the client's strengths and challenges. It highlights how external pressures can make any challenges they have feel much worse. This builds empathy on your part and provides a segway into talking about resilience and coping strategies.

What Are the Common Goals of a First Counseling Session? 

After presenting this wrap-up, the next critical step is to invite the client to collaborate on their treatment plan and next steps. This is not just about informing them of your clinical impressions or proposed interventions. 

It's about engaging them in a dialogue, where their input, concerns, and goals are paramount. Think of it as giving them agency or buy-in in their own treatment.

This collaborative approach demystifies the therapeutic process, making it a shared journey rather than a prescribed path.

Encouraging client participation in devising the treatment plan does more than just outline the direction of therapy; it empowers the client and fosters investment in the therapeutic process. 

Once you have involved the client in their own therapeutic process, you can discuss potential therapeutic modalities, set realistic goals, and establish the frequency of sessions, always ensuring that the client's voice is heard and valued.

Structure Vs Initiative in The First Counseling Session

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 the first counseling 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, poking around in your mouth with those little pokey sticks), and THEN a treatment plan is developed in collaboration with you.

Your dentist appointment would go something like this:

• “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?”

You can see from this short script that a dentist uses the three-step summary process. They diagnose the issue, talk with you about how to proceed so that YOU are involved in the process, and then they form a plan to help you get the problem fixed. 

Counseling Tips and Skills 101: Have a First Counseling Session Script

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 of this first counseling session, 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 “feeling better” look like after three to four sessions?
• How will they know if they are feeling better after three to four sessions?
• How will you know if the client is feeling better?
• Who gets to decide?

Collaboration is Key to a Successful First Counseling Session

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 in the field of “what does therapy actually do.” 

Trust me, I know that you’re the one with the master's degree and the expertise to know how many sessions they need. 

However, you’re also the expert on the pursuer-distancer dynamic and helping new clients understand what better looks like every step of the way. And that’s probably why you’re on this page looking for counselor tips and skills!

With that in mind, I challenge you to conduct a first counseling session that informs, comforts, and creates buy-in so that your new client chooses you AND therapy.

Action Steps

• How can you work to create more client buy-in for the first counseling session? Have you tried the three-step summary in a first counseling session? How did it go??
• If you liked this episode of Texas Counselors Creating Badass Businesses,  please subscribe and leave a fabulous review!