Maximize First Session

This article is written to help individuals and couples, completely new to counselling, to understand how counselling works with All in the Family Counselling’s therapist Tammy Fontana, MS NCC CTRT, Sex Therapist (USA).

Counselling can be pretty intimidating when you don’t understand what is going to happen or how it works. When attending counselling, whether as an individual or in a couple, some people have no idea what is going to happen and thus no expectations. Others may have high expectations, potentially unrealistic, if they’ve never attended counselling, and then risk being disappointed.

One thing to keep in mind is that every counsellor is going to be different. This is because every counsellor will have a different theoretical orientation to run the session as well as their own person style they infuse into theory.  This article reflects the theoretical orientation and style of our mental health counsellor.


Expectation Setting- The client-therapist relationship

When people are completely unfamiliar with counselling they are more at risk for being disappointed with the technology and process of a first time appointment.  It is really important for clients to understand how counselling works. Of course, this is challenging because counselling is so private and individualized that many people have never seen a live counselling session. Another consideration is that no 2 counselling sessions will be exactly the same.


Often they see things on TV (which are completely not realistic to real therapy) or they assume it’s similar to events they are familiar in their real life like talking to friends or family (therapy is very different from this).


One thing to keep in mind with counselling is that when you are meeting the therapist for the very first time, neither the client nor the therapist knows one another. The therapist is learning about the client, the person, the human being sitting in front of them, not just their problem.


Knowing the person is a really important part of helping the client with whatever reason is driving them into therapy. The converse is true as well for the client. The client is about to embark on a journey with a person who starts out as a stranger. Client needs to know a bit about the therapist’s style, ability to help them as well as be able to feel comfortable with the therapist.


Often clients are in a lot of “pain” when they arrive at the therapist’s office and they want to launch into their problem without really meeting the therapist and allowing the therapist to meet the client. In order for a therapist to really help a person, they need to know about the client’s world, relationships, how the person thinks, makes decisions and what is important to the person and what isn’t’.


Another consideration is that how the client defined the problem, may be part of the problem. If a person conceptualizes their “problem” incorrectly, no solution will work. While the client may think they know what is the cause or root of their problem, the therapist may want to evaluate and look at things differently. Again building that relationship is really important to learn how the client’s world works.


Counselling is a very individualized processed. The therapist doesn’t churn out canned solutions. Each client’s situation is unique and therefore to be effective the therapist needs to know about the client. This doesn’t always take a long time, but it is really important for an effective outcome.


Set Your Goals

One way to make sure you can make the most out of your session, even if you only come once, is to think about what you would like to accomplish in the 50 minutes you have with the therapist. Think about how you would like the therapist to help you, what you want her to do with the information you are going to give her so that you can leave the session a little better off.


Many clients don’t know what they want or how they want the therapist to help. If they do not know that, it’s fine, but therapy may require a few more sessions. Sometimes even if the client does know what they want, it still may take a few sessions to work things out. In setting goals, the therapist can definitely help you figure out what is a realistic for the 50 minute session with your help.


Without a clear defined goal or purpose for the meeting, the client risks being disappointed with the session. If a client is only prepared to show up and unload problems without knowing how they want help or to be better, they risk being disappointed unless that is all they wanted to do. Counselling doesn’t hold a magical box of canned solution. Instead, the solution is in the client, and the therapist and client work together to find it. So again, think about what you WANT not only your problem – knowing what you want will help you get more out of your session.


Our Therapist can help across a broad range of Problems and Cultures


As mentioned above, because therapy is leveraging the client’s knowledge of their life, career and culture, the therapist can work across many issues, problems and cultures. Therapy is NOT about telling the client what the therapist would do or what other people have done or churning out canned solutions. No two people’s situations or outcomes are the same, effective or are “right”. Solutions are as unique as the person coming in the therapist’s office. The partnership between client and therapist is leveraged to determine the best outcome for the individual client. The client’s knowledge is used in a new ways with the aid of the therapist.


The therapist isn’t concerned with right or wrong or good or bad – that is the client’s job. Instead together, leveraging each other strengths, the client’s knowledge of their world and the therapist knowledge of mental health, they find a solution.


Don’t get too attached to how you defined the problem


Another key part of therapy, once a relationship is established, is to correctly determining what exactly the problem is. Clients are in “pain” and often have decided what the problem is, but usually are not 100% correct in their “diagnosis. Other times, clients do get the “diagnosis” right, but they are solving it ineffectively due to lack of knowledge or skills.


Together the therapist and client work to understand and clarify what is the problem. This is a process where client and therapist leverage each other strengths. The therapist leverages the knowledge the client has on their own world and can combine it with her understanding of human psychology.


Strength Building, beyond the Problem –What does the client Want!


People come into counselling because they have a problem. A medical model focuses on problem elimination. However counselling is strength based and the reality is sometimes you cannot eliminate the problem and therefore we focus on making the strengths bigger so problem becomes small.


Therapy focuses on what the client WANTS not the problem.  Often the problem is just a symptom or the thing that is in the way of the client getting what they want. Clients often become so blinded by their problems, they never think about what they want. Solutions are rarely found in the problem so we do not need to spend all of our time there. Solutions are found in determining what people WANT.


Counselling spend some time figuring out what is not working but we spend most of our time determining what does the client want? Is what they want realistic? Is what they want good for him/her? Are they effective in trying to get it? We need to work with the client to have them evaluate these things.


Sometimes clients come into counselling wanting things that are not realistic or not good for them. A therapist is not there to grant the wish or unrealistic want of one person. A large part of the reason people are so unhappy is that what they want is not realistic or good for them.


Therapy helps people figure out what they really really want and then find an effective way to get it. If what you want is unrealistic, no therapist in the world will be able to give this to you. For many clients, learning this can be painful, but this is the process of counselling.


Counselling is a Process, rarely a one-time event


As you can see there is a lot to do in the first session and follow up sessions:

·         Building a relationship between client and therapist

·         Orient the client to the counselling process

·         Understand what is the client’s problem

·         Determine what the client wants

·         Start working on the solutions


There are many things to cover in a first session. Often counselling is a process running on average between 6 to 12 sessions. Clients never need to commit up front to any number of sessions, but to get the most out of counselling it is helpful to budget and plan for a few sessions. Counselling is also time limited. This is where setting a goal is very important. Counselling should be able to help clients to get what they want in 10-12 session. Sometimes it is less and sometimes it is more. In the type of therapy we practice whether it is for individual issues or couple issues, couples can start to feel better and have hope after 1 session.


Counselling is a process whereby the therapist and client talk, often about ideas, concepts and process, but then other important part is to translate what is discussed in session to behavioral change of the client. Often clients will have “homework” or activities they need to do in between session that is tied to helping them accomplish what they determined they wanted. So therapy actually occurs in between sessions. Then when the therapist and client meet again they review what happened during the client’s homework and use this to further refine and come up with solutions to help the client meet their goal or their wants.


Effectiveness of Counselling

Counselling is very effective in helping people resolve issues in their life provided clients understand how counselling works and are willing to use the technology of therapy effectively. Counselling is something done WITH the client, not TO the client. Therefore therapy is as effective and fast as the client is prepared to assist the therapist in allowing them to learn about their life, how the client thinks and do the homework assigned between session.


If you would like more information or to speak to our therapist, please call 90307239 or email her here.

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