Have you thought through the key components in how to start a therapy session as a therapist? I find that it’s one of those aspects of therapy that is so ingrained or innate that you often don’t hear people talking about it that much.
But, today I want to take a moment to discuss those first few minutes when you meet with a client.
I want to make it clear that I am just sharing my own personal reflections about what I think is important to consider when you start a therapy session as a therapist.
And also, your individual licensure jurisdiction may have its own legislation and ethical guidelines for how you are expected to conduct the beginning of your sessions. So make sure you are also brushing up on those things as well.
Tips For How To Begin A Therapy Session
1) Be Prepared
This happens before the session even starts.
I take 1 to 2 minutes of my time per client to revisit my notes from the last session.
This reminds me of what the treatment goals were that were being focused on, how we focused on them last time, and deciding if we should continue that same thread today.
In my particular therapeutic approach, I’m always happy to deviate from the thread we were on last time to something new that has come up.
But, it’s also really helpful to hold the frame of what we have been working on, and help the client decide to either dig in further to the thread from last session or to go in a new direction.
2) Start On Time
Obviously, we all have our moments (including me!) when we start sessions a few minutes late.
But, if you are consistently showing up late for most of your sessions, then that is going to wear on the therapeutic relationship.
3) Have A Consistent Structure
Every therapist structures things differently. I believe it’s helpful to have some elements of your structure at the beginning that feel predictable.
Consistency breeds a sense of routine, which creates a type of safety for your clients.
Consistency also creates helpful cues. It helps the client transition into the therapy session.
4) Polite Remarks
Consider what niceties or polite remarks you might offer at the beginning of your session.
This is particularly important for in-person sessions when you are walking with your client from the waiting area into your office.
Personally, I feel most comfortable offering some kind of polite commentary that is not related to what we are working on in therapy.
I may say something like: “It is so good to see you!” or “Did you make it here okay in the rain?”
You can tailor this to your own style and therapeutic approach.
This does play out a little differently in virtual therapy. It can be worth thinking about if you want to start with any niceties at the beginning of your session.
5) Incorporate Hospitality
Consider what avenues of hospitality you might like to lean into at the beginning of your session.
I have a video with some ideas of how to incorporate hospitable touches into your therapeutic practice.
You can do little things. For example, offering water or coffee at the start, or checking to make sure the temperature is okay. This can make your clients feel comfortable and cared for.
6) Virtual Therapy Specifics
It can be helpful to do a check-in about technology, confidentiality and location.
I almost always start off the virtual therapy session by asking, “Can you hear me okay?” “Good, I can hear you also.”
We are also expected to know where our client is located, just in case of an emergency. It may not always be therapeutically advantageous to ask for our client’s address every time.
I notice that my clients will often sit in the same spot each time. That way I can tell where they are located. But, if they are noticeably in a different place, I find a casual way to check-in and learn where they are.
Of course, for virtual therapy sessions, the confidentiality piece is so much more challenging to hold consistent. If there are any clues that you can see that maybe confidentiality may be compromised, you will want to check-in on that. Try to ensure confidentiality to the best of your ability.
7) Safety and Symptom Check-In
Of course, it wouldn’t be appropriate to do a safety check with everyone.
But, for folks you’re working with who have a recent history of thoughts of harm, problematic substance use, or significant mental health symptoms disrupting their lives, it’s good to check in on that before diving into anything else you’re working on.
Having this check-in right at the beginning of your session ensures that you don’t miss anything important that might be going on.
Tact is invaluable. Rather than saying, “Did you use this week?” or “Have you thought about hurting yourself since we last met?” I like to cushion these questions in a context of care and concern: “I”ve been thinking about what we talked about last week when you said you had some passing thoughts of hurting yourself and I’m concerned about that. How has that been going?”
8) Begin Your Session
You can now kick off the formal structure of your session.
Fit this to your therapeutic approach and style.
But, it can be helpful to keep it relatively consistent with each client you see. This helps clients know what to expect.
Personally, I start by saying kinda same thing each time.
For example, I often say something like: “We can pick up where we left off last time, or do you have any new updates that have come up since then? Do you have a preference for where we start today?”
This is where the preparations I suggested you do earlier come in handy. I like to be prepared with a short synopsis that can be used to remind my clients of what we worked on last time.
It All Happens In Minutes
Although this feels like a long list of items to include in how you start a therapy session as a therapist, in practice it only takes a few minutes to run through all of these. The remainder of the session is for your client to work through their work.
The Importance of Setting The Tone
Having the same steps at the beginning of every single session creates a sense of consistency. This helps foster routine, which helps foster safety. That way clients know what they are stepping into every single session. They will also feel like you’re prepared because you showed up on time, considered how to make them comfortable and remembered what they talked about last time. All the little things add up.
If you want to think through how you begin the very first session with a client, I have a blog post that gives you some tips!
And of course, when you are planning out how to start a therapy session as a therapist, it makes you think about how you would end. Check out my YouTube video about things to remember when ending a therapy session.
And until next time, from one therapist to another: I wish you well!
Photo by Timur Weber on Pexels
Photo by Marius Mann on Pexels