Rookie Counseling

Sometimes new counselors feel like they are winging it during session. Clients come in with ten topics to talk about and counselors feel they are frantically throwing interventions at their client as the conversation twists and turns. It is difficult to know for certain if the session is productive. This can be particularly hard to determine when clients are easily distracted or tend to ramble. Clinicians might end the session wondering what happened and if the client gained anything at all.

So, how do therapists bring structure to their sessions?

Here are basic elements of each session that most therapist’s involve in their work.

The Greeting

“What would you like to talk about today?”

This question’s answer provides the skeleton for that day’s session. Depending on your theoretical orientation, you may be able to work from a loose outline for addressing client concerns in a way that honors your theory’s mechanism of change. If your theoretical orientation is more person-centered, you work to monitor your client’s emotions and follow their direction.

The Content

The client is responsible for bringing content to session and is in control of what they talk about. The therapist is in control of how long the client talks about it. The counselor is in the passenger seat, but the client is driving. Sure, the therapist can read a map and give directions if needed, but the counselor ultimately decides where to go. It is important that counselor’s allow their client’s to be in control of their work in session. It is the counselor’s job to use their intuition to know when to slow the client down, back track, or go deeper.

Most people know what is bothering them, sometimes they even know why, but the counselor’s skill set is what makes deeper understanding and processing possible for their clients.

What do you do when your client has “nothing” to talk about?

If a client comes in with “nothing” to talk about, it is the counselor’s job to remind client’s of their therapy goals. It becomes an ethical concern when counselor’s begin allowing clients to pay for therapy that doesn’t dig deep. As much as therapist’s may enjoy their client’s company and vice versa, counselor’s are not paid to be a friend. Therapists have an ethical obligation to provide therapeutic treatment to clients.

What if clients bring too much content?

If your clients bring in wild stories that leave you feeling lost trying to follow them, try slowing them down. When clients slow their speech, it allows them to slow their emotions down as well. The anger and annoyance and joy they flicker between when telling the story of their week can mask deeper emotions that you might miss if you’re lost in the content of their stories.

Grounding clients at the end of session

The final portion of each session should prepare clients to return to their day. The work of therapy is, by nature, emotional, difficult, and sometimes disorienting. Bringing up traumatic events and digging into current stressors can leave clients feeling emotionally volatile. Ethically, counselors need to help client’s regulate and return to baseline before sending them back into their lives. Depending on how heavy a session is, some clients need five to ten minutes to ground themselves at the end of session.

Confirming the next session

As the final goodbye is being said, many counselors confirm the time for the next meeting with their clients. It is a way of marking the end of the meeting and ensuring that clients are available for the next session. This should happen two to three minutes before the end of session to allow for last minute scheduling adjustments.

Your client is driving, you just need to bring the map

If you still feel lost in the midst of session, take some time to conceptualize your client and make sure you know where your client is coming from and where they want to go. If you’re feeling lost in sessions, go back to your theoretical roots. Finding a theoretical framework is like finding a compass. You may not know the exact steps to your destination with your client, but you know which direction to go.

Ultimately, your training and intuition will show you what to focus on.