Therapy/counselling sessions

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Definitely clients and not patients. "Patient" implies the person is sick, which is a negative.

They likely have some sort of intake form that will cover the basics and suss out the degree and seriousness of the client's difficulties (such as whether someone is experiencing depression or suicidal thoughts). They might start by introducing themselves and sharing a little about their life and career to make a personal connection with the client. They'll ask what the person's goals are and talk about their method of working. They might talk through the responses on the intake form to learn more about the client and their challenges. They might also discuss practical matters, like how insurance forms and payment are handled.

Hope that helps.

What Quickbread said. As an anecdotal example, after we got done with the basics of payment, insurance, and so on, my therapist asked me to explain what I wanted to get out of our sessions.

It was a good way to allow me to give background and what I thought my problems were. Gave us a lot of directions to explore over the next (mumble) weeks.

cat_named_easter said:

Hey everyone,
Just wondering - how might a therapist begin their first session with someone? What might they ask to begin/how would they figure out what issues the client wanted to explore? Would they just ask outright or do some introductory thing to be a bit more subtle?
Also ... would therapists refer to "clients" or "patients" or does it not really matter?
Thank you!

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Uh, the exception to the above being if a therapist/psychologist is working in an inpatient facility. Then they really are patients and often the state is paying so saying "client' is really weird.

Therapists generally begin first sessions by getting money concerns out of the way, taking down insurance information, etc. Then they take a history and try to get the basics of the presenting issues that the client wants to discuss. Therapists are trained to be very direct because being clear with the client is containing (therapist speak for making them feel safe.)

Therapists generally say (my husband is one) that the presenting issue is never actually the issue. There's always the real issue underneath, and that's where the real work of therapy occurs.

If you want a great example that actually gets close to real therapy, check out In Treatment. Also, the "Gloria videos" are short films demonstrating types of therapy, e.g. humanistic/analytical, RBT, gestalt and so with Rogers, Perls, Ellis, respectively. They are a very interesting watch because Gloria was freaking brave to have those recorded and she didn't hold back.

Therapy is terribly represented in most books and movies. They always portray the therapist as asking tons of questions and most therapist rarely ask questions. Instead, they tend to reflect or reframe, and the questions that are asked are often rhetorical.

It's been a number of years since I was seeing a therapist, but quickbread is pretty accurate to my experience, excpet that I've never had a therapist talk about him or her self as an intro. In my experience, it was all client focused and sort of an unspoken rule against discussing the therapist. But the discussion of the client's goals and expectations are defi itely part of it.

In the 1980s and early 1990s, before my first sessions I was made to take the MMPI (Minnesota multiphasic personality inventory), which is a standardized test supposed to identify potential major issues. I think it's fallen out of favor, since there is no possibility of an "all clear" outcome; it will always diagnose something. My daughter never took that when she was getting conselling, which is a relief since it's a long and repetitive test and no fun.

Chris P said:

It's been a number of years since I was seeing a therapist, but quickbread is pretty accurate to my experience, excpet that I've never had a therapist talk about him or her self as an intro. In my experience, it was all client focused and sort of an unspoken rule against discussing the therapist. But the discussion of the client's goals and expectations are definitely part of it.

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A lot of therapists will discuss their school of thought. When I saw my therapist, she explained that after her MSW (Masters in Socialwork - another path to being a therapist in the US) she'd had a fellowship with a focus in psychoanalytical work. A lot of people also seek out RBT therapists for various reasons, so the therapist might explain what that is. Stuff like that.

In the 1980s and early 1990s, before my first sessions I was made to take the MMPI (Minnesota multiphasic personality inventory), which is a standardized test supposed to identify potential major issues. I think it's fallen out of favor, since there is no possibility of an "all clear" outcome; it will always diagnose something. My daughter never took that when she was getting conselling, which is a relief since it's a long and repetitive test and no fun.

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Unfortunately they still teach this, and all PhD students are required to learn it. I am told however that it's improved. Maybe?

I've been referred to therapists for consultations twice. Both times were for specific situations and I was never asked what I wanted to talk about or what I expected to get out of the sessions. Neither time was useful for me though, other than getting the therapist off my back.

Jeff

What type of therapy? And for what condition? I had cbt recently and it was all pretty informal - the first session captured my history and outlined my history, and checked I wanted to continue. I think for something clinical it would have been a different process, maybe? But I suspect it depends on more parameters than you've outlined?
Oh, and geographically where? In the UK money isn't discussed, unless private.

Client. Before you start therapy you fill out a contact form, with details like your religion and such. Then before every session (or during if you forget) you fill in a form where you rate your mood over the previous few weeks. In the first session you just talk generally and the therapist tries to get a handle on who you are and what your problems are, and to start establishing a trust relationship.

So they ask about your problems and how long you've had them and when they started and what's your living situation and how do you get on with family. And so on.

Even in the hospital, everyone was referred to as a client, not a patient. In fact, it was called a treatment center rather than a hospital. My first session with the psychiatrist involved going over medical history again, and then discussing the meds I would be started on. My first session with the psychologist was going over what had brought me to that point, and what we would be working on over the first few sessions.

What kind of therapist are you talking about? A psychologist or psychiatrist, or a MSW, marriage counselor, teen therapist, etc. Also, how did the person come to be there? There are kind of vastly different answers to your questions, depending on the above.

Therapists help normal people learn how to deal with the crazy people in their lives. You can quote me on that one;I don't mind.

Hmm, there could definitely be potential for humour then with the kind of background questions therapists ask!

Okay, so I'm in the Uk and had a course of cbt which I accessed privately last year.

First visit I had to complete a questionnaire about how I was feeling and some general paperwork. Then I had to explain why I was there and the history. We covered fees and when to pay in the typical british fashion of mumbling and sliding money into the middle of the table. The process for cbt was explained in some detail and the counsellor checked I was happy to go on and then I was left homework to do for the next week (if it's any form of cognitive/behavioural stuff - and it's becoming used for schizophrenic disorders now, too, so I think possible in your scenario - homework will be set.) that homework was around thought recording and challenging and I think there's some good room for humour in there, maybe?

oh yeah i forgot the homework

One thing I noted from my own counselling sessions is that they don't offer advice. Never. That's not the role of a counsellor or therapist. They can guide you towards your own recovery and support you, but they can't ever advise you on what you should do.

My private CBT therapist often started sessions with a questionnaire designed to gauge how my mood had been lately (after the 'hi/how are you/weather's terrible' beginning small talk). Our very first session began with talking about why I was seeing her/what I wanted out of the sessions and also what I could expect.

shaldna said:

One thing I noted from my own counselling sessions is that they don't offer advice. Never. That's not the role of a counsellor or therapist. They can guide you towards your own recovery and support you, but they can't ever advise you on what you should do.

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That very much depends on the person and the therapeutic or psychological theory they're employing.

Most psychologists don't berate their patients, but a person practicing confrontational therapy can go after someone like you wouldn't believe.

There are those that do offer advice. Many are of the, 'what do you think you should do?' school of thought, but it's not a universal.

Everything starts with an intake. This includes a lot of paperwork: insurance info, psych questionnaires, why the person is there. The intake may or may not be done by the therapist.

The therapist has this info for the first session. They begin by introducing themselves and mentioning that they are just there to listen. They may ask the client/patient where he or she wants to begin or to tell why they are there and whether they feel they need to be there.

It would depend on the client situation. Teens in counseling may be very opposed to the idea. A couple trying to save a marriage may be excited to have found something that may help.

Adding the specifics of the situation you may want could get more nuanced answers.

I had to fill out a huge packet of papers (which the secretary mailed to my house the week before). It was mostly general info about my family, mental health, drug/alcohol intake, relationships, life goals, etc. The first session was mostly introductory, with the the therapist getting to know me and I assume figuring out which direction to take in future sessions. Also, she's always used the terminology 'clients.'

I posted a reply in the other thread before seeing this one. Sorry.

I think it also depends on why the person needs therapy. In this case, the biggest question is "Does the therapist believe in the client?" The whole session will depend on that. The therapist will be treating someone with low self esteem or delusions depending on his beliefs.

I was offered some behavioral suggestions, but very subtly. "I wonder if you realize...?"

The best ways to treat low self esteem involve getting the person to help others and step out of themselves. This could involve a very active therapy - where the therapist accompanies the client into a situation the client is concerned about. It depends very much on the program and people involved.