As we enter my workroom I notice their reaction to it, and I wonder if it fits their expectations – based upon the impressions they’ve had of me so far from my website, photo, name, address, voice, my management of their enquiry, and the ease of access to this room – my room that they have been invited into and where they may share some of their most vulnerable emotions and darkest thoughts. They will inevitably have been constructing a ‘me’ as much as I have been constructing a ‘them’ – although perhaps only subconsciously.
The seat they chose to sit in tells me something too – although I will need to check out my guesses later, when it’s safer to question them on something they might not be aware of yet. I don’t want to evoke any shame or to make them feel ‘analysed’. The seat nearest the door might show their need to be close to a means of escape, or they may have mixed feelings about being there. Do they just plop themselves down or wait for me to be seated and to lead the way? How do they sit? Slumped and collapsed? Stiffly and at the edge of the seat? Do they scan the room to avoid eye contact or do they scrutinise me for signs of my courage and integrity, to find out of I am enough like them to understand their pain and to really help them. They may be comparing me to other therapists they’ve known, and if so I wonder what they might now feel towards me.
I become aware of how I feel, here with them, just the two of us alone in a room together with the focus being on their needs, thoughts and feelings – which they might not trust to show to me yet. Perhaps I feel judged, or maybe exposed, challenged to perform and to take the lead for them.
From their voice and non-verbal language I also notice if they seem tight/rigid/closed or loose/open or maybe even chaotic. All this happens underneath our light introductory conversation whilst we establish our boundaries of working together. We confirm the ‘when and how’ of the payment for the session, and the confidentiality both inside the room and outside of sessions if I should bump into them elsewhere.
My own sub-conscious mind is logging all of this information, and maybe a lot more. It sifts it and makes links that may be relevant to us in the present time, and formulates how our new therapeutic relationship might evolve, and what adjustments I might need to make with them to provide the best service I can and to give them what they are paying for – without overfeeding them (which I personally have to be careful not to do as I get very enthusiastic about sharing helpful information with them and they may not be able to swallow or digest more than a few morsels in these early stages). I don’t want to push them too much, and neither do I want to wrongly (to my mind) take their money and time with only superficial toe tapping (instead of our preparing to dance!)
My aim for this first session is to become clear about why they are here, and why ‘now’. I want to establish the foundations for our working relationship – however long that may last (from one session up to several months – depending upon their need, and readiness for insight and change, and of course if they can afford to continue to access my help, although I have seen some teenage clients for free.)
I really want to know what isn’t working for them right now… to clearly identify the reason they’ve sought help and the history of it; and what they’ve already tried to alleviate their problem: and how much it affects their life. By finding out a bit about their story, and offering some factual information into the mix, I can perhaps ‘normalise’ their distress – ‘It’s no wonder you feel……. having had the previous experiences you’ve had’.
I used to complete a full assessment that I’d created myself (and which I now give away to newly graduated integrative counsellors) which cuts through weeks of trying to piece together the chipped and hidden mosaic pieces of their life. I quickly found out about their self-concept and esteem; their self-care (including their sleep pattern/eating/drugs/alcohol intake); any self-harm and suicidal thoughts; their emotional attachments; their family dynamics past and present; the traumas they’d experienced and the present-day effects of these; how they ‘cope’ during life’s challenges; their own personal experience of the highs and lows of life; their public persona/ facade; their early memories and family expectations of them, and what love and supportive relationships they now have around them, if any. I was always saddened when so may people said that they had no-one who genuinely cared about them… a basic human need left raw and unmet.
So by now I’ve identified their present difficulties, where it stems from and how they have tried to make it better – or not – themselves. I wonder too if they can even envisage a life without their difficulties. Many people ‘become’ their problem and it forms a big part of their identity that they’d feel lost without – for instance self-harming or chronic depression – they will need an alternative before they can give up the painful but familiar problem friend.
We both need to find the underlying reason(s) for their difficulties. There is always a reason for everything we experience and do – although we may not be consciously aware of it. What deeper feelings and inner beliefs then underpin those reasons? They may drink/work/gamble too much because they want to temporarily avoid such feelings and beliefs and to escape from their pain and change their mood with a Dopamine buzz in the brain that brings them some pleasure – but which can then drive a dependency or an addiction.
Usually it boils down to a wounded ‘Inner Child’ who still aches and weeps deep inside their soul and whose cries have been ignored for too long. Maybe a recent redundancy or relationship break-up have brought their wounds to the surface where they suddenly feel overwhelming.
If you had a child who felt trapped/abandoned/isolated/rejected/alone/wounded/confused/defective/weird or unlovable, where and how would you start to change that deep pain? One sensitive step at a time is best – but with a clear direction and aim, and an agreement to co-operate together and to be respectful of where we are and of the importance of each step ahead.
This first session sets the scene for the dance…do they want to tentatively commit only to a brief series of meetings, or even one at a time and to see how it goes (which is quite usual as they want to check me out a bit more); or do they want to bulk buy sessions in advance to ensure that I’ll be there for them? I always work sensitively, but still in a focused and purposeful way, with regular check-ins as to the benefits to them of our sessions – which they have exchanged for their time and money).
Some people (usually alpha males) want bullet points and quick relief; other clients are therapy-savvy and want a wise companion along their necessary longer journey (and they know that I have a trusty map and compass); many fear dependency and being exploited (which may have happened elsewhere – either in their own life history, or in the profession as a whole) – and it’s always very clear that my professional boundaries won’t let that happen. That’s not to say that I haven’t found some of my male clients very attractive – but I ask myself… ‘what would your professional adult say and do now?’ and so I have always remained in my own energy space and not merged with or been seduced into theirs.
We end our first session checking how they’re feeling as they leave. It’s vital that they are back in a ‘well-functioning Adult’ state and able to make their way home. (I ask before we meet that we agree a time for our session that allows them to have free time afterwards so that they won’t have to be in a ‘professional role’ after our meeting – and to give them time to re-balance and to process what’s been said and done in the session.) I make it clear that we are not blaming anyone, such as their parents or peers, for the difficulties they’re having; that it is best not to unpick and dilute our session by sharing it with partner/spouse, friends of family; and I may suggest that they make their own notes of any ideas, links or dream snippets that emerge before our next session.
I may ask why they chose me… not from my vanity or ego, but their subconscious inner child will have chosen me for a reason – I’m not the cheapest therapist around. They might say it was because of my qualifications; that I supervise other therapists; or the words I’ve used on my website that resonated with them; or they felt that I knew their pain (the subconscious mind is very wise); or it might even be my name and appearance; or I may be similar in age or appearance to a mother or grandmother either now or when they were growing up. All these reveal hidden aspects of the person’s history and needs.
I am always aware of my own ‘counter-transferential’ feelings (what I’m feeling as a response to being with them)…. which give me more clues about their story and the adaptations they have had to make so far.
How does our session end? Are they keen to arrange our next appointment, or are they hesitant saying they’ll have to let me know about their diary/shifts/availability …but will they? We’ll have to wait and see.
By Maxine Harley (MSc Integrative Psychotherapy www.maxineharley.com www.the-ripple-effect.co.uk www.qpp.uk.com