The Beginning of a Therapeutic Relationship

It is very hard to ask for help. First, we need to be self-aware and recognise that we need it. Then, we need to find someone from whom we are actually able to ask for help. If we are lucky enough to find someone, it takes time to arrange a meeting. I need to appreciate what my client went through before they came to me – what made them acknowledge that they were in need of help, how they were looking for it, how they found me, how they decided to get in touch, and what they went though before actually meeting me.

When we finally meet, the first impressions are crucial. We all have our expectations, preconceptions, prejudices even, shaped by our previous experiences. I have to put all of mine aside to remain open to the client. Any prior information can make this difficult. Anything I know about the client before we meet in person, can potentially cloud my first impressions. I have to be able to clearly separate facts from opinions. Naturally, the client comes with all their expectations. It is vital that we explore these at the very beginning of the helping relationship, and that I am clear about what the client wants from me and what I am actually able to offer them. I have to be open, attentive, receptive to what the client is communicating to me, both verbally and non-verbally. I have to set aside my own assumptions. As soon as I understand what the client expects from me, I need to very clearly communicate whether any of it is possible at all, and what the things are that I can actually provide for them. We have to understand each other’s expectations. We have to come to an agreement on whether and how we can work together. We definitely have to agree on our goal.

When a new client comes to my home, it is a very unequal encounter. I am in familiar territory, while they are not. I try to be welcoming but not invasive. I offer them a seat and some tea. While I go into the kitchen to make the tea, the client has the opportunity to get more familiar with their surroundings. They can look around and absorb the place: the paintings on the wall, the props on the shelves, the plants, the art and craft materials around, the view from the window. Naturally, they form an impression of me based on my environment, compared with their own previous experiences and expectations. As I re-enter the room, the client tries to project into me their impression of the environment. They try to match me with my room. It is highly likely that I remind them of someone else, and they automatically attribute their experiences and feelings towards that person to me. I would naturally do the same. I must be aware of what contributes to forming my first impressions of the client. I must very clearly separate the actual present experience of them from my previous experiences with other people. This is not easy. Have you ever been in a situation when a complete stranger reminded you of someone you knew so much that you were unable to detach yourself from the feeling? I sometimes see people in the street who strongly remind me of someone. Even if I am perfectly clear that they are not the same person, I am simply unable to shake the feeling; to separate my past experiences with the other person from the present experience with the stranger. When I am in the helper role, I cannot afford to let this happen. Any previous experiences re-lived can get in the way of truly getting to know the client.

In our first encounter, we mustn’t hurry. We need to make acquaintance at a pace that is comfortable for the client. I cannot suddenly start to interrogate them or launch into some long stories about myself. On the other hand, the client can and must tell me as much or as little about themselves as they wish. In the first session, the only structure we have is the agreed length of time, usually an hour. The client can use this time as they wish. I have to follow their pace. The client needs to be in a state of readiness for the helping relationship. They need to take responsibility, not expect to give it to me instead. They need to be willing to explore and recognise their feelings. They need to put their trust in me. I need to constantly check what the client is experiencing.

The first sentences of the client are truly revealing. Sometimes they need a prompt like ‘What brings you here?’, but most of the time they don’t. They have waited long enough before they even found me; they might have rehearsed what they want to say a million times before. Sometimes the client starts with their expectation: ‘I want you to understand that…’; ‘I want your opinion of…’; I want you to give me some advice…’, etc. This last statement is quite tricky. I have to state straight away that I am not there to give them advice. I have to make it perfectly clear that I am not an expert of the client’s life, therefore I cannot give them advice. I am there to reflect back what they are communicating to me; to help and support them to come up with their own solutions by facilitating their self-awareness. If the client starts with ‘I would like you to give me some advice…’, I need to be very careful. I don’t want to put them off immediately by saying I cannot give them advice. More like I have to acknowledge their need for guidance: ‘You feel you need some advice.’ Later, if it becomes apparent that the client actually expects me to give them advice, I need to gently unravel this expectation.

I need to make sure the client feels that I am fully present at our encounter. I actively listen to them, showing them that they are worthy of my absolute attention and merit every effort I can make to understand them. The client needs to feel that I perceive them as a fellow human being. I need to assure them of my acceptance and honesty.

Often it’s hard to make the client understand that we are equal. We are both fallible human beings with our own sets of strengths and weaknesses. I have to dispel their illusion that I would assume the role of the expert in their life and that I will be the one who will actually solve any of their problems. It is only the client themselves who can do that. I will cooperate, I will go alongside them, I will give them acceptance, honest feedback and support, but definitely not advice. My role is to facilitate the client’s self-understanding by supporting them to express their own feelings, to face their own emotions, in order to see their life more clearly and to get to their own solutions by themselves. I will try my best to understand what is going on in my client’s mind.

The beginning of a therapeutic relationship is about building trust. It can take a long or short time, depending on the first impressions and the previous expectations and experiences of the client. This process can never be hurried. It is important to stress that this trust that has to be established at the beginning of a therapeutic relationship is an adult-adult nature of trust that is needed for the client in order to be able to explore previously feared edges of awareness. I need to demonstrate my commitment to constantly offering them unconditional acceptance, congruence and honesty. The establishment and the maintenance of trust will ultimately determine the quality of our work together.

I don’t do small talk in the first session. The client is in crisis, that is why they came to see me. They need me to receive and understand their feelings. Some clients start with a torrent of monologue about their pain, difficulties, and impossible life situations. They waited long enough to share this with someone before they came to me. There is the danger that the client might feel afterwards that they have exposed too much of themselves the first time. They might withdraw; they might never want to come again. I have to let them know that it is OK. They can share with me as much or as little as they want; I shall always be receptive to them; I will always accept them as they are.

There are clients who have already had plenty of bad experiences when trying to share their feelings with other people. They might be reluctant, they might even present themselves as cynical or aggressive as a precaution, in case I will cause them disappointment as others did before me. I have to demonstrate that I accept them as they are; I understand and appreciate their feelings. Perhaps the hardest type of client is the one who feels that they are not worthy of others’ attention, in this case mine. They are so deeply self-rejecting that they are almost in the brink of self-destruction. I need to communicate my unconditional positive regard for them.

The inner world of a human being is a sanctuary. Therefore, many people only grant admission to theirs after much deliberation. Even then, they might do it in an ambiguous fashion, giving double messages, disguising their feelings, maybe under the cloak of humour. It is truly amazing how sophisticated we are in our self-protection. The choice of words of the client is often a disguise. They might make their problem sound a lot less serious or important than it actually is for them. We have all developed our vast repertoire of preferred disguises. I need time to learn and understand this particular client’s ones; I need to appreciate their personal language – verbal and non-verbal.

In the first session, we need to agree on the duration and frequency of our meetings, but we need to keep in mind that at some point these might not be appropriate anymore. There should always be the possibility to make changes if necessary.

I always take notes after the session. I write down the facts I learned about the client’s life, and also I reflect on my own experience with the client. I self-monitor and record my judgement of the quality and intensity of the therapeutic session. These notes help me immensely to keep track of the development of the helping relationship, the possible differences in our understanding, and to discover any assumptions.

(Read about the middle and the end of the therapeutic relationship.)