How to Start a Counselling Session: A Practical Guide for Therapists

Ken Kelly: Start a counselling session with a client. Now, I just wanna understand this, Rory, are you saying how to start a very first counselling session with a client? You’ve never seen this client before, or is it third time they’re visiting and how you begin the counselling session?

Rory Lees-Oakes: I think it’s how we start. How we start would be the first session, but it could be a follow on sessions as well. And what I’m coming to is that when we are thinking about how to start our session off, client walks in, sits down, we’ve done our contracting. How do we start, what do we say to clients, do we say anything at all?

And I think the best thing to think about is thinking about this from the client’s frame of reference. If you’re a student, your client will have had to go to an agency, will have had to sit in front of someone, be assessed, talk about the very difficult things in their lives. Then they’ll be told they’ll get a counselling session, but it could be in the future.

So then they have to sit and wait and what’s going on in their lives will be playing out around them or what’s troubling them will still be with them. And then eventually they’ll get a text or an email or a letter or a phone call to say, come in and see you. And here’s the thing, generally speaking, they’ve not done a counselling course, they’re seeing a counsellor. And it doesn’t matter if you’re a student counsellor, you are their counsellor. So when they come in, they may be unsure or unsettled or not quite understanding what happens next.

How do you start? Client sits down, you’ve done your contract, what do you say to them? And it’s a question I asked one of my tutors many years ago when I was studying. Because I wanted to be respectful and thoughtful and not get it wrong. And it was quite interesting what my tutor said to me.

She said you’ve got a number of paths, you can say, how can I help you today? Where do we start? Or sometimes you’ll just sit up and take a breath and your clients will just start telling you their story. They’re so eager to get all this pain out and to have someone hear them that they might start without any kind of prompts.

But I think it’s very different to skills practice. The transition from using skills as a student with your peers in a classroom, it’s a massive step change to sitting in front of a client who doesn’t know the rules of therapy, who’s not studied to be a therapist, who has real pain and real difficulty. So it’s really a bit of a chat about how we start therapy.

What do we say Ken?

Ken Kelly: Yes. I like it, I think it’s a really good topic. Doing your skills is so different to when you are in a real therapeutic contact and the client doesn’t have the rules of engagement. In your simulated skill sessions when you break out and you’ve got 20 minutes to practice skills, you sit down and you say to the person, what do you wanna bring today? And bam, they’re off and they’ll bring a narrative.

With clients it is not always that way. Your first sessions with clients are gonna be as different and as unique as the clients that you see. And I think that’s a really good starting point, to not have any expectations of what the beginning may be like.

Because it can vary, and it can be vary from, I don’t really know what to bring, and a client being at a loss of how to describe what’s going on for them. To the other side of the coin, which you mentioned, Rory, and that’s that immediate sharing, almost like a champagne cork coming off, and you just have this narrative that flows at you.

And you would handle both situations differently. And we’ll maybe get to how we might handle those in a moment. But the place I go with this is, I think about what you mentioned, Rory, the frame of reference, the mindset, how it is for the client coming in.

So I think of it this way, if you’re going through some trouble in your life and it’s really difficult, very often, and this is doesn’t apply to everyone, but very often it’s hidden away inside. We don’t tell people about it, we don’t tell our work colleagues about it. It affects our day to day, but it’s something that we keep internally.

And it can often be that when a client sits in front of you, they’re speaking about this for the very first time. And not only that, they’re speaking about it for the very first time with someone they’ve never met before, someone that they are viewing maybe as someone that can help. So they’re going through this process, which is a painful process. Thinking about what the mindset of that person may be before going in, the night before when they’re considering, oh, I’m gonna be seeing my counsellor tomorrow, and they might be reviewing what material they’re bringing in, and I just see it as a privileged position to be there to receive that information. But also we need to recognise that.

We need to perhaps allow time to build up trust and not rush a client into a narrative. So if a client does come and say, I’m really nervous, I don’t really know what to say, we can be kind, understanding, and just there for the client in a warm way. Sometimes people will need a relationship to develop first before they feel that they can share.

And then, like I started with on the other side of the coin, there is that instant narrative where, I guess as a placement counsellor, you might feel, ooh, I better stop them so that I can get some skills in here, and a quick reflection, yes, and oh, I did this. And sometimes it’s just about letting the client vent, letting them vent and get the whole story out.

So from my side it is always different, and the clients will teach us. But gently, not expecting. And when I say not expecting, you can have a referral through, and I remember this and taking it to my supervisor back in the day when I was in placement. I was in a GP practice, and the doctor would make the referrals and would give me an indication of what the referral was for.

This person wants to see you for this reason. And thanks to my supervisor, I stopped looking at this reason after a while because I didn’t want to have the expectation, when are they gonna start talking about this? I was almost maybe wanting them to rush to something they’d shared with the doctor where they weren’t ready.

Because they maybe had a relationship with the doctor and I was this stranger that they just met. So there’s just some thoughts, Rory, from my side.

Rory Lees-Oakes: Yes. Thank you for that, Ken. And I think it’s interesting you touched on referrals and in my early career I was very much, I don’t want to read the referral unless there’s an element of risk, harm to self or harm to others,I want to hear this from the client.

And as I matured in my practice, I took a slightly different view. And my view is that I always read the referrals, because if a client came to you and they had maybe a history of sexual abuse, maybe a history of domestic violence, they may say do you know my background?

And if you say no, they may have to tell you all over again and recount that pain. So in my later career, I would say yes I’ve read the referral, and is it about that, is that why you’re here?And they may say no, actually I’ve come about something else. But nine times out of 10 it was, yes.

So I think being thoughtful of saving the client the trauma of retelling another professional, because they may have had to tell their story a number of times. People forget this, but the times someone sees a counsellor, they may have had to go through a number of professionals.

In cases of sexual assault and sexual abuse, they may have had to speak in court. They may have had to speak to a solicitor, they may have had to speak to a doctor, they may have had to speak to the police. And every time they rediscuss this or re-bring this up, it’s re-traumatising. So my observation would be, read the referral, but I’m definitely with you, Ken, don’t have an expectation that what’s in the referral is what’s going to be discussed in the therapy room.

Ken Kelly: Yeah, yes. And the opening line of, what is it that you would like to bring today? Worked well for me. So you’ve done your contracting, you’ve said who you are, you’ve spoken about your modality. So with that said, we have about 50 minutes left for this session, and I wonder what it is that you’d like to bring today? Is a beautiful invite. Yeah, it just lays a little welcome mat out. And it’s a very clear indicator that it’s your turn as the client. And then it really is just about going where the client goes. Well, for me, when I was in practice, it was person-centred modality, so I would be going with the client wherever they chose to go as opposed to directing that. And it would be different every time, it really would.

I want to just touch on future sessions. So we’ve spoken about this being the first session, but when the client comes back in, you see them for the next week. Let’s say week one, you say, I wonder what it is that you’d like to bring today. And they speak for 35 minutes nonstop, giving you a narrative of what’s been going on for them, and how it’s been, and a whole lot of narrative. Where do you pick up the next session? How do you open that next session when you have all of this information that they brought in the last session?

My thought on it is that I don’t, I just lay out the same welcome mat and I wonder what it is that you’d like to dive into today. And the reason for that is I don’t wanna set the agenda. So I don’t wanna say, last time you said this, and this, and this, so let’s dig deeper.

Because they might have had a terrible morning with somebody on the bus who took their seat, and they’re really angry about that. So it’s what are they coming in with and where do they find themselves in that moment. Somebody might mention something as they’re leaving therapy, they might mention next time I come I might want to speak to you about my relationship with my mother and then in the next session, I might say, as you checked out last week, you mentioned that you’d like to at some stage speak to your mother, but that’s up to you when you choose to bring it, I wonder what it is that you’d like to bring today.

And again, just handing it softly over to them. No expectations from my side, but at least linking together what they may have mentioned in the last session.

What’s your thoughts, Rory?

Rory Lees-Oakes: Yeah, I’m with you, Ken. I think let the clients set the agenda. I used to say in subsequent sessions, it’s good to see you, make sure they settled, and say so where would you like to begin? Or where would you like to start? And that is usually an interesting invitation for clients to then talk about what they wanted.

You might have on the first session someone who brings something incredibly heavy, incredibly powerful, and you think, this has to be what the therapy is about.

They come the next week and they talk about something different. And what you have to do, certainly as a person centred therapist, is put the first session to one side, bracket it and work with what is being presented today.

Because that first session could have been a test to make sure that you are resilient enough to hear the story. The times I’ve had clients say to me, I don’t want to tell you my story because I’m afraid it might upset you.

My story is so bad, it’s devastated me and I don’t want it to do that to anybody else. And on that point, I think I would say, I really appreciate that and I really understand that, but it’s fine, share when you are ready. Give them the impression that you’re robust enough.

It’s always useful to think about if someone’s brought something in the first session and they not talk about it in the second, just be patient, just wait. Because it may be they’re just waiting for the time where they’re feeling comfortable to be able to talk about the real issue that’s going on for them.

It’s a bit of a waiting game sometimes.

Ken Kelly: Yes. You mentioned having to repeat a story many times over, and I’ve worked in services where certainly we would be seeing service users who went through that process of having to tell their stories many times over.

And there can be, in some cases, almost a rehearsed narrative. And it can come across without emotion. It can almost seem like a removed story.

So there’s another first presentation that you might see, and it’s a protection mechanism.

But now, for the first time, this person is in your therapeutic setting where you are receiving that information with kindness, openness, and seeing the whole of that person with a deep level of empathy.

And I wanna speak about counselling skills for a moment. In that first session, I think the two counselling skills that are most often used are active listening and silence. Often, not always, but often. I think that the true mastery of active listening sits in a seasoned counsellor, we mature into active listening, and it is incredibly powerful.

So that’s my thoughts on the skills in that first session, Rory?

Rory Lees-Oakes: Yeah, it’s beautifully put, Ken. And I think I’d add to that by saying that also it’s about the counsellor being present.

You know that they are giving a hundred percent attention to the person sat in front of them. That person can get a sense of that, they can feel it. Just to listen to them and I think there’s no better service one human being can offer another.

Ken Kelly: Yes. I just wanted to circle back to one more thing. Good note-taking. Good note-taking skills become quite important because you’re right, Rory, we wouldn’t go into session two expecting that they’re now gonna recover some of that ground, they may bring something completely different.

But if they do start recovering some of the ground, if we’ve taken good notes, then we’re able to show that we listened actively the first time by being aware of what the person is bringing.