Today marks the third week of my Practicum and Professional Orientation class. This is the first opportunity for many of my students to begin live counseling experiences in their Practicum settings. Most seem to be settling in nicely.
If you have been a green counselor in your first session then you know the terror of: “What will they say???? What will I say????” It doesn’t matter if you have a 10 year file on the client or a 1 sentence “presenting problem”, the green counselor cannot predict the outcome of the session–hence the fear.
To alleviate some of the fear, let’s review what makes for a good first session.
1. Introductions. Make sure they know who you are and who is supervising you. Give them a chance to tell you why they are coming for counseling. Sometimes what they say differs from what they wrote on the forms.
2. Help the client tell their story without too much interruption. Don’t be too quick to jump in and direct with too many questions.
3. Gathering the following data (again, without too much interruption):
- content and scope of problem (frequency, duration, intensity)
- solutions attempted, things that help/harm, prior counseling attempts
- current family/community make-up
- other mental illness
- relevant medical history, current meds, sleep quality
- substance abuse
- spiritual dynamics
- supports, strengths
- typical mood, suicidality
- Other important factors (employment, finances, relational conflicts, etc)
- dreams, hopes, goals
4. Summarize (briefly) and discuss possible initial directions or goals as well as alternatives they may wish to consider
5. Counseling model and nuts and bolts of professional care (confidentiality limits, scheduling, contacting you, payment options, etc.)
That will be more than enough for an hour. Most likely, you get great data in some areas and just a tad in others that will require you to follow-up in the next week. The more talkative the client is, the less data you can gather. The less talkative, the more likely you will get the data but the less likely you’ll form a good connection (Q & A leads to very passive clients more often than not).
It is good to have these very general categories in mind as you start that first session. Be wary of either forgetting the categories or obsessively forcing the client to answer all the history questions. You may end up with a wonderful piece of history for a client who never returns.