The First Session
Psychotherapy has come a long way in relation to restoring one’s humanity and the overall goal of improving one’s person life. From Freud who emphasized unconscious drives related to sex and death to the mindfulness movement that focuses on the here and now of the patient’s experience. Regardless of a clinician’s theoretical background or way of working with people to relieve symptoms, I have always found that the most important session is the very first meeting. Early studies on attrition and psychotherapy report that about 35% of patients end after a single session (Brandt, 1965) and around 50% drop out by the third session (Hiler, 1958; Rogers, 1956; Affleck & Medwick 1959). In more recent data, Barkham et al., 2006 discovered slightly more than 50% of clients dropped out after one or two sessions due to symptom improvement, i.e. they got what they were looking for or they saw symptom improvement. Overall, When a person decides to take the brave step of seeking out mental health treatment, exploring their anxiety about beginning therapy, what they expect to get out of treatment, understanding why they came in today, and feeling safe are essential to the foundation of successful treatment.
Some patients come for a specific thing such as learning coping skills to manage one’s depression, while others disclose to the therapist, “I just feel empty inside” or “I am stuck and I do not know what to do.” Listening and creating a safe bond between the therapist and patient is ultimate, and most important, work that is done in the first session. I have found on an unconscious level, patients are assessing these common factors: 1) Can I trust you with my secrets? 2) Are you going to judge me? 3) Are you going to be able to understand me and my experiences? 4) Can you help me? This in one way or another is communicated between the patient and the therapist. I would argue that if a person feels that the therapist cannot pass or fails to live up to these four questions, the patient often feels hesitant, nervous, scared, and resentful. When I work with people in therapy, one of the first thing I do is make sure they feel human. I know this may seem simple, but often when people come to therapy they feel “broken” or “damaged” or forget the experience of being connected to others that the love and care so much about. Listening, empathizing, and accurately reflecting makes people feel understood, it makes them feel that you see them. The first session is initially met with anxiety, shame, and nervousness, but as therapists reminding our patients that we care, that we understand, that we see them on such an authentic level creates a feeling of “You are not alone and no matter what you are feeling or going through, I am here for you and we can get thought this.”