Monday, February 3, 2014

How I Start and End a Counseling Session

Much has been written about how to conduct a counseling session. Less has been written about what should immediately precede and follow one. So I thought I'd share what do.

Before the session

Many client sessions are by phone or Skype so these first few tips don't apply to them.

When the doorbell rings that lets me know the client has let him/herself into the waiting room:

1. I read my notes from the client's previous session(s.)  That way, the client is fresh in my mind.

2. If I'm not in great spirits, as I'm walking downstairs to greet the client, I remind myself to get in gear.

3. In greeting the client, I make clear I'm glad to see him or her: I smile, look them in the eye and say something such as "Good to see you again, Mary," and then a bit of small talk. For example, if during the previous session, s/he had mentioned her dog Woofie," I might ask, "How's Woofie doing?" 

Speaking of dogs, my dog Einstein no doubt greeted the client upon entering. So perhaps my most common small talk is to say something like, "Did Einstein welcome you appropriately?"

I keep my small talk very brief to give the client room to take the small talk in whatever direction s/he likes. That continues as we walk upstairs to my office.

Throughout this pre-session talk, I try to observe and infer the client's state of mind: happy, sad, phlegmatic, excited, etc. That can inform my first substantive question, for example, "You seem happier today. Great. What's up?"

If it's the first session, I note the sort of first impression the client is making on me. That may well be the sort of impression s/he will make at a job interview or on the job. If I sense a problem---for example, poor eye contact, low energy, an angry demeanor, whatever---I usually won't mention it at that point but make a note to raise the issue at an appropriate time.

I'll usually ask the client if s/he wants something to drink. If it's coffee, I'll usually make it fresh right there with the client watching. That's not just so that the coffee is fresh--It allows a few more minutes of informality, which can be revealing. People may be different in that informal setting than in the formal counseling session. I'm more effective if I can see them in that more natural circumstance. 

4. If it's the first session, I point to the sofa and say something like, "Make yourself at home." I try to strike the balance--in word and tone--between being professional yet informal and therefore relaxing. Einstein adds a measure of informality and stress reduction because he'll usually jump on the sofa, sidle up to and even kiss the client. I ask, "Would you like him down?" Most clients say they're happy having him up there. Einstein is a fabulous co-counselor/stress reducer.

5. If it's a first-time client, I start by saying, "I'd like to make a recording of the session for you. Clients find it valuable to listen again to sessions but I didn't want to do that without your permission. Is that okay? And do you want to record it on your smartphone, for me to make an mp3, which I'll email you, or even an old-fashioned audiocassette?"

After starting the recording, if it's the first session, I usually then say something like, "I've just had the pleasure of spending the last hour or so reading and meditating on the new-client questionnaire you sent me. Great, and I have a bunch of questions." They usually say, "Great," and we're off and running.

If it's not the first session, my typical starting statement is something like, "So in light of our last session, what have you been thinking and perhaps doing?"

I take a few notes during sessions so I can devote all my mental energy to listening and thinking what to say rather than to being sure I remember all that's important.

The End of a Session and Afterwards

I usually ask if the client wants to summarize the session or prefers that I summarize. After that summary, I typically ask, "Okay, what homework assignment would you like to give yourself?" I add my input where appropriate. Then I ask, "If we were in Vegas, would you give at least 5-to-1 odds you'd do the assignment?" If the client says no, I ask why. That usually reveals a problem we can usually fix: alter the assignment, explain it better, set a fixed schedule to do the assignment, find someone to be accountable to (including emailing me every night,) what to do if reaching a roadblock, etc.

I'll often ask the client to take notes while listening to the session recording, then print out a copy and keep it on their desk, and to email me a copy of the notes, to be used as a springboard for the next session.

Then, consistent with honesty, I try to end on an upbeat note, for example, "I think we're off to a good start. It'll be interesting to see what you get from doing that homework assignment."

After the client leaves, I immediately take notes on the client.

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