What we do and say in the first moments of an initial session have a profound impact on the whole treatment.
Research shows that the most important factor
in a successful outcome for therapy
is a positive therapeutic relationship …
as determined by the client.Scott Miller
A journey of a thousand miles
begins with a single step.
Lao-tzu
Think of times when you were a client and the beginning did not go well. The professional may have appeared distracted or focused on the chart. You may have felt attacked or lectured. The professional may have been rushed from the initial moments. How we interact with clients at the very beginning matters.
Here are some of the questions being answered by the client in those first few minutes:
- Does this person care about me or just her paycheck?
- Will it be safe enough here to be honest about what I can’t do?
- Do I have any input and choice in this process?
We know that positive change is most apt to happen in a supportive relationship. Engagement is the formation phase of that powerful bond. It sets the tone for a collaborative, client-centered process. When the bond is not formed or is lost, it is difficult to reengage.
How to engage quickly and effectively?
- If you begin with some small talk, refer to the client’s experiencerather than yours. For example, ask about the traffic he encountered or whether it has stopped raining yet. Respond to the client’s small talk with simple reflections (Tip #6). Even when what is being said is mundane, respond to it.
- Use your body language and eyes to focus on the client. Face the client at the beginning, even if you will need to turn toward your computer later. Keep your eyes on the client rather than your notes.
- Introduce yourself very briefly, maintaining eye contact. Resist adding detail about your credentials or role unless asked.
- If you introduce how you see the first session going, include the client’s point of view and ask permission. For example, “I need to find out about your medical history and eating habits today. There will also be plenty of time for you to tell me your perspective and what you want out of this. How does that sound to you?”
- Begin with open questions as early as possible (Tip #60): For example, “What brought you here?” “What do you hope to get?” “Tell me what your doctor has told you.”
- Hold your closed questions for the first few minutes and circle back to them later.
- Roll with any resistance you hear. When you ignore statements such as “My wife made me come,” you reduce engagement. Instead, simply reflect it. “This wasn’t your idea.”
The engagement stage may be brief, lasting only a minute. Clients who have experienced negative relationships with nutrition or medical professionals will likely need longer. It may take several minutes or even most of an initial session.
How do you know the client is engaged and you can move forward?
- There will be reasonably good eye contact.
- You may notice a shift in body language toward relaxation.
- The client will share some of what matters and may begin asking questions.
Attend to engagement at the beginning of each session even if the client is long term. Most people take a few moments to feel connected again. Wait to jump into the work until you sense the engagement.