Week 110 - How to Approach a Challenging First Session

June 23 – June 30, 2018 . . . . .

WEEK 110

June 25 – June 30, 2018


Monday, June 25, 2018

How to Approach Working with a Client Who Is Hostile

Marsha Linehan, PhD shares how she works with clients who act out during a first session.
Running time: 05:49

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Tuesday, June 26, 2018

Ways to Reassure a Client Who Is Reluctant

Lynn Lyons, LICSW tells the story of how she got one hesitant client to give therapy a chance.
Running time: 7:20

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Wednesday, June 27, 2018

How to Stay Present with a Client Who Is Challenging

Richard Schwartz, PhD and Robert Hedaya, MD discuss ways for practitioners to stay engaged during a difficult first session.
Running time: 09:17

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Thursday, June 28, 2018

How to Get Past Complaints in Couples Therapy

Andrew Christensen, PhD shares two strategies to keep tensions low and engagement high when working with couples.
Running time: 08:31

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Friday, June 29, 2018

Critical Insights

Ron Siegel, PsyD and Kelly McGonigal, PhD highlight the key concepts in this week’s videos.
Running time: 17:45

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Can We Share a Pain We Never Felt?
Neural Correlates of Empathy in Patients with Congenital Insensitivity to Pain


Saturday, June 30, 2018

Focus on Application

Joan Borysenko, PhD, and Rick Hanson, PhD connect exercises and techniques with this week’s discussion so you can begin using these ideas right away with your clients.
Running time: 20:47

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4 Responses

  1. On the question about empathy for the people in the life of the client–especially the ones the client may be complaining about–I would never suggest this anywhere near the first session. This being said, I think there are ways of fully validating a client’s hurts and feelings vis a vis, without engaging in bad mouthing that person. In other words, it is usually important for the therapist to remain open to the idea of changing or improving one’s feelings about a hurtful person in the client’s life. I have had the experience, well into therapy, of a client being threatened or suspicious of me not “taking sides”, as they put it, and this led into a transformative discussion about what it would mean for them for me to “take sides”, or not. And what they need to feel fully understood. I never did, in that case, “take sides”, and they still felt fully validated by me on their path towards changing their own relationship, and boundaries, with the person who had been hurtful.

  2. Again, thanks to all that shared. These sessions energize and renew me. I am aware that I start sessions a bit differently. This difference existed when I worked with a large system and now in a smaller program and also in my private practice. The difference is to talk with them about the nature of therapy and confidentiality. I listen to their preconceptions and then I support their accurate understanding and I usually need to talk about the limits of my confidentiality. I share that many individuals have wished for death and I do not call the psychiatrist and recommend hospitalization because of that. However, if the client and I have reached an understanding that they are planning their death and/or the death of someone else and they have a plan, a date and the means, then I am required by law to break my confidentiality and take steps to preserve their life even against their permission. And I also familiarize them with the laws about abuse of children and of vulnerable adults that require I report to protective services in my state. I want the client to trust me and so I find this conversation establishes respect for their need to know and helps build trust in our relationship. I do this in the first session since I do not want to have someone come in for help and I “trick” them into the care of the hospital or the relationship with the law.

  3. I have been a counsellor working in the youth justice sector for 12 years and during this time, I learned about “Motivational Interviewing (MI).” All my work is highly influenced and drives my work with mandated clients. Related to what Rick was speaking about trying to speak of ‘corrective feedback’ – one aspect of MI that help me always try to work from an MI stance: (1) If the person says it, they believe it (which means: If you can have clients voice what is challenging with their behaviours, you have already set the stage for them to think about how to do it differently). I believe this is another variation to effectively get into ‘corrective feedback’ and exploring new ways of living.

    Another great series by NICABM! Keep up the great work

    1. MI is one of my favorite methods or working with clients. You are lucky in many ways to work with teens who learn more easily to not hold back. Like Lynn said, they respond to her when she spoke her truth. Adults do not always have that skill and we adults/counselors need to realize many folks have had to hold back their truths for many years for a variety of reasons. That takes its toll on the nervous system. I appreciate your approach and also the ideas presented on the forums.

      To this day, as a counselor, we do a lot of holding back which takes its toll on the body. So much gets repressed just in telling their story, to hide shame or guilt or in the form of rescuing the recipient. I hope supervision is promoted more and more in our work with clients. These forums help us get that in an educational fashion.

      Thanks for your guidance forum speakers.