For new therapists and even experienced veterans, the first session with a new client creates that anxiety buzz in your gut. You feel pressure to do a good job, to "hook" the client, and that pressure is real. Studies show that most folks wind up going to therapy only one time. Is there pressure? Yeah.
But making that first session work, regardless of your clinical orientation, is about salesmanship. Like it not, you need to sell yourself – your personality, your approach – to the client. If you do a lousy job, the client won't be coming back. Here are some tips for closing the deal:
1. Understand their goals.
If you've ever bought a car or refrigerator, you know that the first thing that a good salesman asks you is what you are looking for. Price range, size, manual or stick, side freezer or a bottom one? She then knows what she has to offer, what to zero in on.
The same is true for therapists: What's the problem the client wants fixed? Some clients do a better job of defining their needs than others, but your job is to drill down and get a clear understanding of what the client wants to get out therapy: improve communication in their marriage, reduce their anxiety, know how to help their tantruming child. If you both are on the same page about the goal, you're most likely to work towards accomplishing it and perhaps to reach it. If it's vague or the clinician veers off track for their own reasons, it's too easy to wind up where the client didn't want to be.
2. Understand their expectations.
Clients have some vision of what the therapy process is going to be like. You are going to ask about their childhoods and help them unravel them; you are going to teach them anxiety-reduction skills, you are going to be like Dr. Phil and let them know in 20 minutes what they need to do most. If clients have been in therapy before, ask about that experience, ask why they decided not to go back to that therapist. This gives you instant information about what they didn't like, did like, what you need to do differently.
And if they have not been in therapy before, this is a good time to explain your orientation and how you do therapy – that you are psychodynamic and you explain what this means, that you are a bit like Dr. Phil and behavioral and give homework. This is like the salesman showing you what she has to offer.
3. Stay in lockstep.
One of the things a good salesman does is stay in lockstep with you along the way. She shows you a car that is a bit over your budget but explains that it gets good gas mileage so that you'll quickly make up the price difference in gas savings. Or this refrigerator has a bottom rather than side freezer but explains how you'll be able to easily fit that Thanksgiving turkey inside it. And then she waits to see what you do next: You say you can't afford the extra car cost, that you never would need to freeze a turkey, or you say little but grimace. Depending on your reaction she adjusts – shows you the car in your price range, goes back to the side freezer. What she is doing is staying in lockstep with you. She wants to get solid yesses all along the way towards the close.
You want to do the same. You mention that you do a 3-session evaluation and make sure the client nods his head. You make an interpretation and you see if it hits home and resonated with the client or whether she makes a face or looks confused. Like the salesman, you want to stay in lockstep with your client throughout the session.
4. Watch the clock, control the process.
Unlike the car salesman, you have limited time, and to use that time effectively you want to watch the clock in order to control the process. Here you don't let Henry rant about his wife for 20 minutes, because that leaves you with too little time to hear his partner's side of the story and for you to mop up. Similarly, you don't want to run the clock up the middle of your evaluation questions and have no time for your summary, pitch and feedback.
Here it's helpful to think of the first session in thirds: First third, opening – rapport building, client story; second third, your assessment – what you need to know to confirm your hypothesis; last third, closing – your summary, client feedback, next steps.
5. Make your pitch.
This is about bringing together Parts 1 & 2 – the client's goals and expectations with your own gathered information. Here you provide a summary, you educate them about your approach to anxiety, you provide a preliminary diagnosis and outline of your treatment plan. Think of what your family doctor does after she does after her physical assessment. You do the same, and if the client has been in lockstep with you all along the way, you'll hopefully get a green light to go ahead.
6. Handle objections.
Or not. Your family doctor suggests seeing a specialist and you ask why. The car shopper test drives the car but then says he'll think about it. You lay out your treatment plan and the client says she isn't sure about her schedule or needs to think about it and will get back to you.
It's okay if clients have reservations or objections, but leave time to answer them. Regardless of what they may say, always respond with "That's fine" but then ask if there is anything else they need to know. You are looking to find the problem under the objection and counter with information.
7. Define next steps.
Provide a preview: I'd like to split the next couple session and see you both individually; here's some homework I'd like you to try; I think it would be helpful if you brought your son in with you next time. By laying out next steps, you build momentum and reduce anxiety by letting clients know what to expect and by showing leadership.
Undoubtedly you have your style, your own format for first sessions, but the key to successful first sessions is about avoiding a cookie-cutter-one-size-fits-all, going-on-autopilot approach. Think about what works for you, what doesn't. What do you need to tweak in terms of time management, your assessment, your pitch, so that clients not only have a clear impression of you and your approach but also leave feeling better when they walk out than when they walked in, believing that you're the right person for the right job?
File under: The Art of Psychotherapy
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But making that first session work, regardless of your clinical orientation, is about salesmanship. Like it not, you need to sell yourself – your personality, your approach – to the client. If you do a lousy job, the client won't be coming back. Here are some tips for closing the deal:
1. Understand their goals.
If you've ever bought a car or refrigerator, you know that the first thing that a good salesman asks you is what you are looking for. Price range, size, manual or stick, side freezer or a bottom one? She then knows what she has to offer, what to zero in on.
The same is true for therapists: What's the problem the client wants fixed? Some clients do a better job of defining their needs than others, but your job is to drill down and get a clear understanding of what the client wants to get out therapy: improve communication in their marriage, reduce their anxiety, know how to help their tantruming child. If you both are on the same page about the goal, you're most likely to work towards accomplishing it and perhaps to reach it. If it's vague or the clinician veers off track for their own reasons, it's too easy to wind up where the client didn't want to be.
2. Understand their expectations.
Clients have some vision of what the therapy process is going to be like. You are going to ask about their childhoods and help them unravel them; you are going to teach them anxiety-reduction skills, you are going to be like Dr. Phil and let them know in 20 minutes what they need to do most. If clients have been in therapy before, ask about that experience, ask why they decided not to go back to that therapist. This gives you instant information about what they didn't like, did like, what you need to do differently.
And if they have not been in therapy before, this is a good time to explain your orientation and how you do therapy – that you are psychodynamic and you explain what this means, that you are a bit like Dr. Phil and behavioral and give homework. This is like the salesman showing you what she has to offer.
3. Stay in lockstep.
One of the things a good salesman does is stay in lockstep with you along the way. She shows you a car that is a bit over your budget but explains that it gets good gas mileage so that you'll quickly make up the price difference in gas savings. Or this refrigerator has a bottom rather than side freezer but explains how you'll be able to easily fit that Thanksgiving turkey inside it. And then she waits to see what you do next: You say you can't afford the extra car cost, that you never would need to freeze a turkey, or you say little but grimace. Depending on your reaction she adjusts – shows you the car in your price range, goes back to the side freezer. What she is doing is staying in lockstep with you. She wants to get solid yesses all along the way towards the close.
You want to do the same. You mention that you do a 3-session evaluation and make sure the client nods his head. You make an interpretation and you see if it hits home and resonated with the client or whether she makes a face or looks confused. Like the salesman, you want to stay in lockstep with your client throughout the session.
4. Watch the clock, control the process.
Unlike the car salesman, you have limited time, and to use that time effectively you want to watch the clock in order to control the process. Here you don't let Henry rant about his wife for 20 minutes, because that leaves you with too little time to hear his partner's side of the story and for you to mop up. Similarly, you don't want to run the clock up the middle of your evaluation questions and have no time for your summary, pitch and feedback.
Here it's helpful to think of the first session in thirds: First third, opening – rapport building, client story; second third, your assessment – what you need to know to confirm your hypothesis; last third, closing – your summary, client feedback, next steps.
5. Make your pitch.
This is about bringing together Parts 1 & 2 – the client's goals and expectations with your own gathered information. Here you provide a summary, you educate them about your approach to anxiety, you provide a preliminary diagnosis and outline of your treatment plan. Think of what your family doctor does after she does after her physical assessment. You do the same, and if the client has been in lockstep with you all along the way, you'll hopefully get a green light to go ahead.
6. Handle objections.
Or not. Your family doctor suggests seeing a specialist and you ask why. The car shopper test drives the car but then says he'll think about it. You lay out your treatment plan and the client says she isn't sure about her schedule or needs to think about it and will get back to you.
It's okay if clients have reservations or objections, but leave time to answer them. Regardless of what they may say, always respond with "That's fine" but then ask if there is anything else they need to know. You are looking to find the problem under the objection and counter with information.
7. Define next steps.
Provide a preview: I'd like to split the next couple session and see you both individually; here's some homework I'd like you to try; I think it would be helpful if you brought your son in with you next time. By laying out next steps, you build momentum and reduce anxiety by letting clients know what to expect and by showing leadership.
Undoubtedly you have your style, your own format for first sessions, but the key to successful first sessions is about avoiding a cookie-cutter-one-size-fits-all, going-on-autopilot approach. Think about what works for you, what doesn't. What do you need to tweak in terms of time management, your assessment, your pitch, so that clients not only have a clear impression of you and your approach but also leave feeling better when they walk out than when they walked in, believing that you're the right person for the right job?
***
So, have I successfully sold you on the idea that therapy is in some ways like selling? That an effective therapist must master not only therapy, but saleswomanship? Have I pitched too hard? Not hard enough? In either event, I hope that I have given you something to think about. Now, what will it be – the side-by-side or freezer-on-the-bottom? The 2-door or 4-door? CBT or, perhaps, something a bit less directive?
File under: The Art of Psychotherapy