10 Common Mistakes Therapists Make During the First Session
By: Christine Hammond LMHC
Not
everyone who comes into counseling truly wants to get better. Some are present
because a relationship, an employer, or the legal system mandates it.
Unfortunately for the therapist, this is not always transparent initially. Or
is it?
In Galvin
De Becker’s book The Gift of Fear, he
identifies patterns of behavior that can be seen at a first encounter which
help to discern the difference between a safe and unsafe person. The same
concept can be utilized in a therapeutic setting.
While
not every client who doesn’t want to get better cannot be deemed unsafe, there
are some who are. In addition, there are those who are not honest in therapy
for the purposes of continuing to manipulate or control another person. And
then there are those who attempt to gain control of the therapy session and
therefore the therapist for the purpose of not having to accept responsibility
for their issues.
There
are three types of clients who potentially fit this situation: those with a personality
disorder, an abusive person, or an addict.
Within
the definition of a personality disorder is their lack of an accurate
perception of reality so their awareness is already misguided. This affects
their opinions on morality, safety, authority, relationships, and laws. Some
examples include anti-socials, narcissists, borderlines, histrionics, and obsessive-compulsives.
An
abusive person or some addicts go to a therapist to demonstrate to others that
there is nothing wrong with them. They frequently blame their victims by
telling colorful stories of how they are actually the ones being abused. Then
they take the information gleaned and use it to continue to abuse their victims
or justify their use of substances. While the abuser or addict is usually
honest about the reason for therapy (relationship issues), they intentionally
withhold their abusive/addictive nature.
Understanding
these concepts will save hours of frustration during therapy and will
ironically make all of the future sessions far more productive. The book
applies these concepts to an abusive partner or a first-time encounter, but
here it is applied to a therapeutic environment instead.
1.
PINs (pre-incident indicators). Before an
action takes place, a person has to have the thought. Before the therapy
session takes place, the client rehearses it in their head. This type of client
intentionally says something to get a surprise reaction from the therapist. For
instance, they may say, “The last time I heard you speak I almost died,” having
rehearsed in their head what the therapist might say in response. If the
therapist bites and opens with what the client wants, then the client has
gained control of the session.
2.
Charm
and Niceness. This is easy to spot in the beginning because
this client will come in smiling and extending compliments. They will seem very
put together, with little or nothing wrong. But people who come to counseling
usually have some sort of issue that needs to be addressed. Those trying hard
to hide their flaws are the ones that need most revealing.
3.
The
Interview. This is apparent within the first few minutes of
the session. The client responds to the therapist’s opening remarks but then
redirects the conversation to asking the therapist a couple of questions. Some
questions are to be expected and part of the normal initial session, others are
more personal in nature and have little to nothing to do with therapy. A client
who has researched the therapist already has some general information about
them so they usually ask a question that demonstrates this knowledge or goes
beyond it, even to the point of being a bit intimidating. “I see you went to…
(therapist’s university), do you happen to know… (they use the name of
therapist’s roommate).”
4.
Typecasting. The
client makes some personal general statement about the therapist that is
slightly insulting. This is done to engage the therapist and see if they become
defensive. If they do, the client learns an area of vulnerability of the
therapist. This is useful to the client because they can return to the issue
later whenever the therapist starts to notice their abusive tendencies. This
technique was done very well during several of the counseling sessions in the
movie Good Will Hunting.
5.
Forced
Teaming. During the session, the client begins to use the word “we”
in reference to them and the therapist. For example, “I know you agree with me,
we would never act that way. I can tell you and I are alike.” First of all, the
client should have no idea in the first session of what the therapist is
thinking; this is not part of best counseling practices. Next, there is no
united front in therapy. It is not the client and therapist united against
another person.
6.
Loan
Sharking. This technique is precisely why most regulatory boards
strictly limit or prohibit gift-giving from the client to the therapist. The
client offers something to the therapist such as a weekend at their condo on
the beach or a connection to a famous person. If the therapist accepts, they
owethe client on some level and this client intends to collect more than the
offering of the gift. During the first session, the gift offering might be
implied before it is given such as, “I have a lot of friends. If you can help
me, then I will refer them to you.”
7.
The
Unsolicited Promise. While the client is telling an elaborate
story, the therapist through their body language or an expression on their face
reveals disbelief. The client immediately picks up on the signal and says, “I
promise it happened this way.” This should signal back to the therapist that
something is not right about the story. Otherwise, there would be no need to
offer a promise. When trying to convince someone of a hard to believe matter,
offering a promise is an easy way to put someone at ease and question their
judgement.
8.
Discounting
the Word “No.” This is not as difficult to test in a first
session as it might appear. During a story or explanation, politely redirect
the client to another subject. Almost always they will acquiesce initially. But
a person who is unwilling to take “No” for a response will go back to where
they were before. Remember, they are trying to control the session and cannot
accept “No.” Another strategy is to tell the client that the issue they came in
for is not the one that needs immediate attention. If they refuse to accept the
input, they most likely won’t take “No” in other environments.
9.
Too
Many Details. This is easy to hear as the client offers too
many details before getting to the point of the matter. However, some anxious
or obsessive clients naturally do this without having any manipulative intent.
A client whose intent is otherwise offers the details as a distraction, not as
further clarification. The details are more random in nature and have nothing
to do with the story or the person. Asking the client to wrap up the story will
not frustrate the anxious client as this has been said to them before. However,
it will aggravate this type of client.
10.
Rule of
Opposites. Things are sometimes best viewed from their opposite.
For instance it is much easier to distinguish between the colors navy and black
when placed on a white background. Likewise a client who sits on the edge of
their seat in forward position as if trying to get close to the therapist is
very different from one who sits back comfortably in their seat. The same is
true for a client who intently stares at the therapist without looking away
even when answering a question instead of one whose gaze glances off to the
side for a brief moment before returning back to normal eye contact. This type
of client is likely to sit aggressively and have “the stare” down pat.
If any
of these concepts appear during the first session, just take note at the first
instance. But if several emerge, than listen to your instincts that something
might just be off.
To schedule an
appointment with Christine Hammond, please call our office at 407-647-7005.
