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Mar 25, 2013

Don’t Put the Cart before the Horse: The Importance of having a solid intake session

First sessions with new clients can be unnerving: it’s often impossible to know in advance exactly how distressed the client will be, how urgent their circumstances are, how much they might be expecting the counselor to guide and direct them.

One of the things I find really useful in guiding a first session is to have a protocol that I follow and then stick to it. There’s a more or less standard set of information that we need to get from every client in the first session: information about the presenting concern, their goals of what they would like to see happen, some information about their jobs, their relationships, their family of origin, their counseling history. Sometimes there may be additions to this: in addictions work we collect some info about the history of substance use, with couples I follow the Gottman protocol (which isn’t too different from what I just described), with adolescents we might also get some school history.

As all of us are aware, this getting-to-know-you is not only important for us to be able to understand and conceptualize all the elements of the problem, it’s also critical in building rapport with clients. And I think most of us would agree that this is of fundamental importance. Where we might start to disagree is about when to begin any intervention or “working stage” of counseling. Does it begin in the first session or would we wait till the second session to start?

There certainly could be arguments for each - when we’re meeting with someone in crisis, wouldn’t it be important to make sure that they’re immediately getting the help they need? And the answer to that question, is of course, yes! But the problem lies in how well they will be able to engage with any intervention in the first session, before they have a chance to know and trust us, at least a little bit. When they’ve taken the step to come back for a second session, Sometimes also, they need the opportunity to verbally organize and understand the problem in the first session before work can begin to be done on it.

This isn’t to say that we don’t do valuable work in the first session - of course the acts of focusing what the main topics of the counseling will be and beginning to relieve some of the distress that the client may have had in feeling alone with their struggles. In fact, I’ve often had clients tell me that the first session felt like a relief, even though I may have had the sense that I’d actually done precious little for them.

Another issue with rushing too quickly into intervention or therapeutic work, the parts that many of us find to be the actual “meat” of the counseling process, is that we risk making the client feel that their pain is being dismissed or their problems “advised” on. In other words, we risk being no different from the stuffy great-aunt who tells them to keep a stiff upper lip or keep their chin up. Part of this might be that without taking the necessary time between sessions to reflect, we may end up taking a wrong turn in our direction or approach with each client. I often find that in writing up the intake, I have important realizations about what will be important elements in the treatment. I may also develop certain hunches of how parts of their life fit together, which can then later be explored collaboratively.

Often the best responses to the tearful “what am I going to do” questions is simply to reassure the client that the two of your will thoroughly examine the possibilities together, that new tools and perspectives will be learned, but that doing so will take some time. If the client really insists on knowing exactly how it will all happen, this can be a great time to orient her to some of the approaches you typically use in counseling, but then reassure her that you will get into a more detailed treatment plan at the beginning of the next session after you’ve had an opportunity to put it together. It can also be important to manage the client’s expectations straight out of the gate on what it is possible to accomplish in a single session. We can empathetically encourage them that while we can understand the impetus to have someone help solve their problems or give them answers right then and there, they might also find that this wouldn’t be helpful to their coping long-term.

Sometimes we also have to check into our own feelings around “I need to give this person more.” Is it really that they need more from us in that moment or are we seeking to fulfill any of our own needs to do some care taking? Anytime I’ve strayed too far from my protocol and into territory of taking responsibility for a client’s suffering I’ve often felt that it made the session less helpful rather than more so. The last thing that we want is that a first session comes to mirror the chaos that may already be swirling in a client’s life.

Christine Forte
is a counselor to the international population in Shanghai, China. You can learn more about her work here:

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