Learner therapist (44)…… A first session strategy

Torrey Orton

May 28, 2014

Making contact – aims and methods of the first therapy session

My objectives in Session One: to provide my patients with …

…experience of recognition and acceptance                                                                             

…increased understanding of presenting issue(s)

…hope that change is possible and that some directions towards it exist

…relief of pressure(s) by live exposure and containment of them

…a live model of the therapy experience which will follow

…an appreciation of their existing competences relevant to handling presenting issue(s)

…a sense of personal wholeness

Stages in Session One (and most others) – a collection of conscious processes

Coming into our ‘house ‘– arrival ritual(s)

·         Arriving, paying, waiting, being called up

·         Hello’s, handshakes, seating, name checking?

Opening

·         Blank slate assumption – getting them to start ASAP (prompted by questions like What are you here for? What do you need? What can I do for you? if necessary)

·         Listening for key players, key feeling(s), key theme(s)

·         Initial validations - ‘Noticing’ feelings, themes and players; remarking these as they emerge.

• Initial feedback – summaries of story chunks for disconfirmation, capturing themes, feelings and players; relevant therapist self-disclosure(s).

Engagement - Joining their story

·         Perspectives – framing their story, similar stories, psych facts conceptualising the ‘problem’

·         Implications – extending their story – how it affects whole life?

·         Objectives – what outcomes wanted; sharpen the focus

·         Work processes – through feelings to truths and new actions, as we are doing here now

·         “Am I crazy?” – a common question to be grasped directly as early as possible.

Closing

·         Summary of overall session tone, topics and tendencies

·         Check fit of my style with their needs

·         Therapeutic prediction – time and labour to ‘recovery’

·         Home works

Leaving our ‘house’ – departure ritual(s)

·         Walk to gate

·         Encouraging word(s)

·         Handshake

·          C u next week…

(Some of) my therapeutic assumptions…

·         Feeling is the pathway to resolutions

·         The pathway to feeling is non-verbal, assisted by feeling language and concrete expression

·         Resolution requires acceptance of the injured self

·         Skills for resolution are mostly present in non-injured self, but inaccessible to the injured at the moment

·         Change emerges from the unconscious and reveals itself in little steps of which a first is starting therapy

·         Many issues arise from misshapen or over-developed life habits based on normal functions and needs.

·         Awareness is the key tool for shifting ineffective habits

·         Getting back own power and defending against others’ power is usually a major covert outcome in depression /anxiety spectrum disorders

·         Our times are net stressors for everyone

·         Sharing secrets w/ significant others reduces internal stressors

·         Families matter cultures matter gender matters age/life-stage matters…

·         Therapeutic progress must occur at thought, feeling and action levels to be resilient and resistant to backsliding.