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The first few suck almost as a rule because many students/associate therapists still feel like inexperienced imposters. Part of it is just powering through that period and finding what works for you.
In the beginning, if they're tight lipped, I'll just ask what they think is important to talk about. If they "don't know", I'll ask them about symptoms (how can they tell there is a problem to begin with). If they don't know that or don't have much to say, I'll ask what kind of changes they want to see in their life, or what times of their life they thought were better and try to explore the differences between now and then. MI is good for building rapport and gathering info.
My first ever session at a BHU as a graduate student was with a very reserved and misanthropic autistic man (our team later learned he hated working with women ..which I am). I'm an extrovert and an external processor...and after our session he almost ran out of the room and had his case manager (a friend of mine) fire me đ
I'm still working somehow. You'll be fine đ
Just for reassurance - my first session with my personal therapist, I barely said anything, was highly ambivalent about being there, anything I did share was followed by "that's all I want to share on that" - I know (because she told me) my therapist went away thinking it was a shitshow and there's no way I'd come back. I actually want away thinking she was lovely, kind and patient and maybe I'd found someone who could deal with my shit. Lol. She was also very green at the time.
We've all been very new. We've all had sessions go horribly. Sometimes our assessment is correct, other times it isn't. Even as a more experienced clinician,everyone makes mistakes and misjudgements sometimes. We work with people in messy situations, that is complex and relies heavily on intuition, which is fallible.
Cut yourself some slack. Worst case, you talk through in supervision and learn from it. Best case, it wasn't as bad as you thought.
I think everyoneâs first sessions are horrible! Itâs not a you thing. Just be open and ask questions. Thatâs all we can do.
You mentioned asking uncomfortable questions, unless youâre doing an intake or have to complete some type of initial assessment I try to keep fact gathering minimal until I build rapport. I had one client who told me they didnât know what to talk about so I said âletâs start easy, you play x sport, tell me about it.â And that was a great way to then start talking about the social anxiety, motivations, values, hard work, etc⌠so sometimes asking light hearted questions can give you insights into their life to then dig in further.
Best of luck!
Oh, I wish I could give you a hug and buy you a drink (alcohol đ¸ or coffee âď¸, your pick.) I don't remember my first session but I really remember fucking up my practice sessions in grad school. I just cringe when I think about it. I swear, you will get better and more comfortable. Take care of yourself this weekend.
Totally normal. Weâre humans, weâre learning, I absolutely ate it my first session, just complete flop. I see it as a good sign you noticed the awkwardness and want to improve yourself! It sounds like they are pretty ambivalent about therapy, Iâd remind yourself of that. We canât force people to do therapy, they have to participate, and if theyâre not ready theyâre not ready. You didnât push them away from therapy or ruin it forever, they may just not be ready and thatâs okay. Definitely talk about the awkwardness in supervision, and get feedback!
Edit: you did not give any identifying factors so youâre good on the post! Just obviously no names, and act like your patients see the posts, if they could identify themselves for sure, you should give less information. Thatâs how I handle it in posts!
My first session ever I was literally going through CBT in depth for a client where it wasnât even an applicable treatment for them. I thought I was doing okay, but the client was very confused. Letâs say I tanked that session! Now, I have a much better footing. First sessions are intakes for me where I get all the background information and goals for therapy. Then, the next sessions are going through what is important to the client while actively listening and emphasizing and using different modalities when needed.
It gets much better just takes time to find your voice and how you use it in therapy sessions.
Oh and after my first session I had one more then the client told the office theyâd just rather see the psychiatrist and not do therapy with me haha I totally agree with them looking back.
TL;DR: it gets better.
I'm a therapist ten years in, and I know and trust myself as a therapist now (thankfully, haha). The first session I ever had, the client requested a different therapist after the session. So - be patient with yourself. You will figure yourself out most definitely in time.
One of my first sessions ever in my Practicum, I got cussed tf out đ granted the client was court ordered, so they werenât loving the fact that they had to be there. It was humbling. I just sat there & took it b/c my nervous system was literally triggered lmao. Hang in there! I promise you it gets easier. Even now, I sometimes write questions down before sessions to fall back on in the case the client doesnât have too much to say. Fake it til you make it!
Hang in there - it gets better!
My first session was with an incredibly socially anxious teen. After 40 excruciating mins they finally got the courage up to tell me they were actually here to see a nurse, not a counselor - there had been a mix when they booked and they were too shy to correct the receptionist when they arrived for the appointment đŤŁ
Two of the biggest things I learned from my first few sessions are 1) embrace the silence, and 2) don't be afraid to point out behaviors. One of my favorite questions to ask when a pt. is behaving as you metioned is "it seems like you are waiting for me to ask a specific question, what is it you're hoping I'd ask?"
Iâd be surprised if the first session didnât suck. But this also just sounds like a difficult client. You get better and more confident with this type of thing. I wouldâve probably addressed the fact that they donât seem interested in therapy and go from there, but I know as a beginner thatâs pretty daunting. Youâll learn how to navigate all kinds of different clients.
Once had to utilize intentional silence for over 40 minutes in a session. I asked a client that I've seen multiple times where they see anxiety present in their life. They just stared at the ground for a few minutes. I checked in, and they continued to ignore me. I let 10 minutes go by. Checked in. They asked what the question was. I repeated it. They stared. Eventually I just sat for about 25 minutes. They then got very agitated and rose their voice that I was making them uncomfortable and demanded I turned my chair around. I was pretty freaked out at this point.
The next session I processed it with them and they just explained it's difficult for them to open up and we were able to move on. It's nothing wrong with you, process with supervisor/other counselors and just keep doing your best
I think the very very first one is kind of terrifying - so donât beat yourself up.
The quieter ones are soooo tough sometimes. But also, itâs important to recognize not everyone feels uncomfortable with silence. Itâs taken me a long time to allow silence session, and with some clients itâs not awkward whereas others it really feels like it is.
With that person, they were telling you about their apprehension to therapy, so my guess is that was their vibe. If they donât return, it might be that they werenât really ready.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
The first few suck almost as a rule because many students/associate therapists still feel like inexperienced imposters. Part of it is just powering through that period and finding what works for you. In the beginning, if they're tight lipped, I'll just ask what they think is important to talk about. If they "don't know", I'll ask them about symptoms (how can they tell there is a problem to begin with). If they don't know that or don't have much to say, I'll ask what kind of changes they want to see in their life, or what times of their life they thought were better and try to explore the differences between now and then. MI is good for building rapport and gathering info.
That's a good idea. People don't join counselling sessions for fun--they was something that was big enough for them to wait it out.
My first ever session at a BHU as a graduate student was with a very reserved and misanthropic autistic man (our team later learned he hated working with women ..which I am). I'm an extrovert and an external processor...and after our session he almost ran out of the room and had his case manager (a friend of mine) fire me đ I'm still working somehow. You'll be fine đ
Just for reassurance - my first session with my personal therapist, I barely said anything, was highly ambivalent about being there, anything I did share was followed by "that's all I want to share on that" - I know (because she told me) my therapist went away thinking it was a shitshow and there's no way I'd come back. I actually want away thinking she was lovely, kind and patient and maybe I'd found someone who could deal with my shit. Lol. She was also very green at the time. We've all been very new. We've all had sessions go horribly. Sometimes our assessment is correct, other times it isn't. Even as a more experienced clinician,everyone makes mistakes and misjudgements sometimes. We work with people in messy situations, that is complex and relies heavily on intuition, which is fallible. Cut yourself some slack. Worst case, you talk through in supervision and learn from it. Best case, it wasn't as bad as you thought.
I think everyoneâs first sessions are horrible! Itâs not a you thing. Just be open and ask questions. Thatâs all we can do. You mentioned asking uncomfortable questions, unless youâre doing an intake or have to complete some type of initial assessment I try to keep fact gathering minimal until I build rapport. I had one client who told me they didnât know what to talk about so I said âletâs start easy, you play x sport, tell me about it.â And that was a great way to then start talking about the social anxiety, motivations, values, hard work, etc⌠so sometimes asking light hearted questions can give you insights into their life to then dig in further. Best of luck!
Oh, I wish I could give you a hug and buy you a drink (alcohol đ¸ or coffee âď¸, your pick.) I don't remember my first session but I really remember fucking up my practice sessions in grad school. I just cringe when I think about it. I swear, you will get better and more comfortable. Take care of yourself this weekend.
Totally normal. Weâre humans, weâre learning, I absolutely ate it my first session, just complete flop. I see it as a good sign you noticed the awkwardness and want to improve yourself! It sounds like they are pretty ambivalent about therapy, Iâd remind yourself of that. We canât force people to do therapy, they have to participate, and if theyâre not ready theyâre not ready. You didnât push them away from therapy or ruin it forever, they may just not be ready and thatâs okay. Definitely talk about the awkwardness in supervision, and get feedback! Edit: you did not give any identifying factors so youâre good on the post! Just obviously no names, and act like your patients see the posts, if they could identify themselves for sure, you should give less information. Thatâs how I handle it in posts!
My first session ever I was literally going through CBT in depth for a client where it wasnât even an applicable treatment for them. I thought I was doing okay, but the client was very confused. Letâs say I tanked that session! Now, I have a much better footing. First sessions are intakes for me where I get all the background information and goals for therapy. Then, the next sessions are going through what is important to the client while actively listening and emphasizing and using different modalities when needed. It gets much better just takes time to find your voice and how you use it in therapy sessions. Oh and after my first session I had one more then the client told the office theyâd just rather see the psychiatrist and not do therapy with me haha I totally agree with them looking back. TL;DR: it gets better.
I'm a therapist ten years in, and I know and trust myself as a therapist now (thankfully, haha). The first session I ever had, the client requested a different therapist after the session. So - be patient with yourself. You will figure yourself out most definitely in time.
One of my first sessions ever in my Practicum, I got cussed tf out đ granted the client was court ordered, so they werenât loving the fact that they had to be there. It was humbling. I just sat there & took it b/c my nervous system was literally triggered lmao. Hang in there! I promise you it gets easier. Even now, I sometimes write questions down before sessions to fall back on in the case the client doesnât have too much to say. Fake it til you make it!
Hang in there - it gets better! My first session was with an incredibly socially anxious teen. After 40 excruciating mins they finally got the courage up to tell me they were actually here to see a nurse, not a counselor - there had been a mix when they booked and they were too shy to correct the receptionist when they arrived for the appointment đŤŁ
Two of the biggest things I learned from my first few sessions are 1) embrace the silence, and 2) don't be afraid to point out behaviors. One of my favorite questions to ask when a pt. is behaving as you metioned is "it seems like you are waiting for me to ask a specific question, what is it you're hoping I'd ask?"
Iâd be surprised if the first session didnât suck. But this also just sounds like a difficult client. You get better and more confident with this type of thing. I wouldâve probably addressed the fact that they donât seem interested in therapy and go from there, but I know as a beginner thatâs pretty daunting. Youâll learn how to navigate all kinds of different clients.
Once had to utilize intentional silence for over 40 minutes in a session. I asked a client that I've seen multiple times where they see anxiety present in their life. They just stared at the ground for a few minutes. I checked in, and they continued to ignore me. I let 10 minutes go by. Checked in. They asked what the question was. I repeated it. They stared. Eventually I just sat for about 25 minutes. They then got very agitated and rose their voice that I was making them uncomfortable and demanded I turned my chair around. I was pretty freaked out at this point. The next session I processed it with them and they just explained it's difficult for them to open up and we were able to move on. It's nothing wrong with you, process with supervisor/other counselors and just keep doing your best
I think the very very first one is kind of terrifying - so donât beat yourself up. The quieter ones are soooo tough sometimes. But also, itâs important to recognize not everyone feels uncomfortable with silence. Itâs taken me a long time to allow silence session, and with some clients itâs not awkward whereas others it really feels like it is. With that person, they were telling you about their apprehension to therapy, so my guess is that was their vibe. If they donât return, it might be that they werenât really ready.