First Sessions in Therapy. Frontiers Friday #173 ⭕️ (Part I)
Focus on doing the right thing vs. doing things right.
Thanks for reading Frontiers of Psychotherapist Development (FPD) and our weekly newsletter, Frontiers Friday (FF). If you are new here, learn about me, the About Page and our “Grand Plan” overview post.
These posts are meant to be what Lewis Hyde describes as a “Gift.” What this “Gift” concept means is that
Nothing is expected out of you.
I hope you receive it.
I hope this animates and transforms you.
I hope you spread the love to others.
Undoing the Intake Model
Someone asked me after reading my book on first sessions, “When are you going to write another book on second sessions?”
I’m note quite sure how to answer that.
My intention for the book was to rethink our fundamental assumption that we need to obtain a thorough clinical assessment before the “real” treatment can begin. I wanted to see if I could provide therapist not so much as a formula for first sessions, but a form that they can rely on, so that you can touch, move and inspire individuals in the therapy room.
This book tries to fess up to some of the ugly facts in our field, and how we can subvert them:
While the average number of sessions tends to be within 4-6 sessions, the modal number of sessions—or said in another way, the most common number of sessions attended—is one.
Around 20-30 percent of people do not return after the first visit.
From an intake model, we are taught to formulate cases using a comprehensive framework of the 4Ps: Predisposing, Precipitating, Perpetuating, and Protective factors. I argue that from an Engagement Model, we have to engage in a law of sacrifice (i.e., give up something of lesser value in order to attain something of greater value) and focus on 1P: Priority. Client’s priority, that is.
A psychotherapist is not an archaeologist. In the first session, don’t go digging around for “true but useless” (TBU) information. From an intake model, we fail to recognise that our questions have an effect on our clients, for better or for worse. From an engagement model, we can appreciate and harness the healing effects of good questions. The right questions can put us on a quest.
Since the release of the book in 2018, I’ve had some new ideas around this topic, and I hope to share with you in the upcoming Frontiers Friday series.
Thanks for joining the ride, dear reader of The Frontiers. Here are the first five recommendations on this topic of First Sessions.
🎧 Listen: Undoing the Intake Model.
In this podcast interview with Elizabeth Irias, I tell a personal story I did not include in the book, but was dedicated to this special person that has profoundly changed the trajectory of my life.
Key Grafs:Focus on doing the right thing vs. doing things right.
Focusing less on our in-take, and more on what we are giving.
20-30% stop therapy after the first visit.
Clients are 2-3X more likely to discontinue treatment if the intake personnel was different from the treating therapist.
Information is not transformation (e.g., horse-racing study).
The distinction between an assessment tool vs. a conversational tool in using measurements.
Don’t let your furniture subdue you!
Fred Rogers: The most important person is the one in front of me.
Follow the pain AND follow the spark.
3 Layers of Empathy: Will Say, Won’t Say, Can’t Say (with a clinical example).
Timely vs Timeless casenotes, and tapping into client factors, which accounts for 80-87% of outcome.
🎧 Listen: Very Bad Therapy Podcast: 11. The Intake Process (with Daryl Chow)
What hosts Ben Fineman and Carrie Witta did with this podcast was very special. They basically got people with bad therapy experiences to come to the show!
What a great way to learn.
We learn best from screwups. But we don't have a lifetime to learn all of them from personal experience, so we might as well learn it from others.
Listening to this podcast helps you to learn fast, so that you make new mistakes.
In this episode, Bryan talks about his first therapy experience and his rather discomforting experience, with multiple red-flags, right from the get-go.📕 Read: The Backstory That Led to Writing The First Kiss
Taken from the introduction of the book.⭕️ From the Archive: What Therapy Is (Or Isn’t)
The psychodynamic camp says, “Your past is the problem.”
The third wave mindfulness therapist says “Mindlessness is the problem.”
The emotion-focused therapist says, “Your unresolved feelings are the problem.”
The Mental Research Institute (MRI) at Palo Alto says “the attempted solution is the problem.”
The solution-oriented practitioner says “There are exceptions to the problem.”
Meanwhile, the problem-solving camp says “There are solutions to the problems,” and the narrative therapist says, “The person is not the problem, the problem is the problem.”
Here’s our problem: The way we define what therapy is or isn’t could be the source why some clients who do not engage with us.
⏸️ Words Worth Contemplating:
“Our highest priority is to protect our ability to prioritise.”~ Greg Mckeown, Essentialism p. 101
Reflection
When was the last time you opened up to someone for the first time?
Notice Board:
The First Kiss Italian translation is out now!
Deep bow to Guido Rocca for not only taking the time and effort to translate this, but also for his unending patience with me to finally release this.
As a token of my appreciation, the first 10 will get this book in Italian for FREE! Thank Guido for this.A Fire-Side Chat with Scott Miller and Daryl Chow:
Scott and I are doing a free, “no expectations, no agenda zoom” monthly meeting. Just an opportunity to explore deliberate practice, feedback-informed treatment, and professional development together with other like-minded professionals.
Cost: Free
When: 8am Central Time on the last Tuesday of every month. First meeting to be held on February 27th, 2024.
Space is limited.
Registration is required.
To support the work that I do in Frontiers of Psychotherapist Development (FPD), consider getting one of our books, including The First Kiss: Undoing the Intake Model… (available in Amazon etc.).
Direct purchase sure does help (ebook, audiobook, or bundle).
For bulk order discounted rated, please email admin@darylchow.com
Daryl Chow Ph.D. is the author of The First Kiss, co-author of Better Results, The Write to Recovery, Creating Impact, and the latest book The Field Guide to Better Results.