Interlude #4: my approach to first sessions

[kaberett]

I semi-regularly end up trying to infodump my (theoretical) approach to a first session with a new counsellor; I've been asked about this often enough that I'm going to try to make a summary here. (I say "theoretical" because in practice what actually happens is I forget everything I advise other people to do and mostly panic: I can easier teach twenty what were good to be done than be one of twenty to follow mine own teaching.)

From my perspective, the point of a first session is to establish whether I think I can work with the counsellor in question.

Again, I've had a lot of practice at this: I've got a good sense of what constitutes a dealbreaker for me. For example:

• I need counsellors to be sufficiently not-shit at me about trans stuff that they will gender me correctly. Ideally they will know enough to need no explanations at all; bare minimum is not treating it like a problem that needs to be explored at length.
  
• I need counsellors to not believe the Simon Baron-Cohen model of autism: because while it doesn't define everything about me, it's an important qualifier to how I interact with the world and conceptualise Stuff, and it would take so long to get someone up to speed on being Not Shit about it that I refuse to pay someone to educate them, and furthermore if they're a professional in this area and think SBC is good for anything other than kindling I do not consider them competent.
  
• I'd like counsellors to be aware of poly before working with me, but I don't mind explaining it to them; I just need them to not treat it as pathological.

There's also how they react. In a first session I give the edited highlights of my history of trauma and depression. I'm lucky enough to be able to do this without triggering myself (largely by dint of kiiiiiiiind of dissociating while doing it), and while doing it what I look for is:

• how quickly they get over the idea that I'm a nice white upper-middle-class lady, so there can't really be anything that wrong
  
• how rapidly the look of dawning horror arrives...
  
• ... and how well they tread the line between explicitly acknowledging that it's all pretty horrifying versus making me take care of them (or otherwise worry about how what I'm disclosing is affecting them)
  
• what kind of questions do they ask? How do they prompt me to continue? Do they do so respectfully, in ways that make me feel safe? (Importantly, I don't have to justify the feeling of safety - I'm allowed to just go with it.) What do they focus on? Are they clearly going to get entirely hung up on a particular incident from my childhood instead of being willing to consider broader patterns in a holistic sense?
  

Other things that are really important:

• Modes of communication. How do they feel about communication outside sessions? Are e-mails to make arrangements okay? How about e-mails of I'm-in-crisis? How about providing the background information in written form (either in advance, via e-mail, or bringing a printout to a session) so they can familiarise themself with the situation in advance and actually focus on working on how I relate to it, versus just having me recount?
  
• Communication full stop: am I having to explain everything three times in order to have it make sense? Am I having to ask them to rephrase their questions or explain themself multiple times?
  
• Do I feel physically comfortable in their space? e.g. my current counsellor's workroom is big, high-ceilinged, and has artwork I find really soothing on the wall; and I have a choice of chair or sofa to sit on, and I'm okay to take my shoes off and curl my feet up on the sofa, and there are cushions I can hug and hide behind. As a bare minimum, I need counselling space to not be sensory hell (irregular background noise, radio through the walls, blinking fluorescent lights); ideally it will be somewhere that I actually find soothing and can experience as safe (per the above).

And so in summary, my checklist going into a first session is:

• what's the edited-highlights-of-my-life I want to give this person?
  
• am I comfortable with the ways they respond to them?
  
• do they have minimum required knowledge such that I won't be spending so much time educating them that they should be paying me?
  
• are they pathologising or fixating on things I don't want the focus to be on?
  
• do I think I can be I comfortable in their space?
  
• are we communicating adequately well, bearing in mind that we'll build on it?
  
• is there enough flexibility in communication methods for me to cope?
  
• am I responding well to the ways they choose to guide our discussion? Do they feel useful?

... all of which I expect to need to sit with and work out over the days following the session, but are roughly what I try to bear in mind going in, and are what I focus reflection on after the fact.

Next up: a slightly more formalised version of how I plan for sessions than the demonstration (under access lock, tag "counselling log") a few weeks back.

Comments

[worlds_of_smoke]

thank you for sharing this. It's incredibly helpful.

[kaberett]

Really glad. Thank you for saying. ♥

[quirkytizzy]

I like this. Very regimented - sooo stealing this for my next theraputic new person!!!

[kaberett]

WOO. Glad it looks helpful :-)

[umadoshi]

Thank you for this post--it's really helpful. *bookmarks*

(Or...what forests_of_fire said. *g*)

[kaberett]

Super-glad it looks helpful :-) I am of course keen to hear what other people would add to it...

[jack]

Thank you. I'm sorry you've needed to figure all this out, but it's really useful to read.

[kaberett]

I'm really glad it's helpful! And thank you for the sympathy - tbh at this stage I'm mostly glad I can use the experiences to help other people, at least some of the time, but... yeah.

[cadenzamuse]

This is a really helpful guide.

Communication full stop: am I having to explain everything three times in order to have it make sense? Am I having to ask them to rephrase their questions or explain themself multiple times?

I have seen my new therp three times, and I think that we are missing this. Last session, I mentioned that I was having a hard time not beating myself up for getting a job at a point when I wasn't doing my best all the time to look for jobs. And she said, "You don't need to feel that way." And I said, "I need a new story to tell myself." And she looked at me blankly. And I said, "Or a replacement thought." And she looked at me blankly.

And I sat there thinking, "I know you are not a narrativist, but you are supposed to know something about CBT and be the therapist--I thought you might have a process for helping me find a new thought! Track with me here!"

Sadly CAT therapy apparently has not yet come to the US, but I am seriously thinking about seeing her one more time and explaining what's not working, and asking if she has a different process to try or if she can suggest someone with a narrativist background in addition to CBT and DBT.

[kaberett]

I'm sorry that you are having trouble with your therapist, because... wow, yeah, that's... staggeringly incompetent of them.

[nilchance]

This is really helpful, especially since my first counselling appointment is coming in a week. Thank you for sharing it.

[kaberett]

You're very welcome - do please holler if you have any follow-up questions!

[sfred]

Thanks for writing this (and I guess linking to it recently where I found it and bookmarked it?).
I had a first session yesterday evening and this post was useful in preparing for it.

[kaberett]

Oh, thank you so much for letting me know it helped!