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.