First Sessions in Therapy. Frontiers Friday #174 ⭕️ (Part II)

Follow the pain, follow the spark, and the law of geometric progression.

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

1. Nothing is expected out of you.

2. I hope you receive it.

3. I hope this animates and transforms you.

4. I hope you spread the love to others.

First Sessions (Part II)

This is Part II on first sessions in therapy.

---

1. 🐍 Web-Read: The Cobra Effect

   The law of unintended consequences is one to really watch out for—and cobras.
   

2. 👩🏼‍💻Exclusive Read: Follow the Pain, and Follow the Spark
   In the twin pieces from Chapters 24 and 25 of The First Kiss, I talked about the need to juxtapose between following "what hurts," and following what makes someone come alive—plus an incident early in my career when I thought I was going to get punched in the face.
   

3. 🁾 Web Read: The Domino Effect
   The process starts out linear by becomes geometric
   A video on the law of geometric progression… It all begins with the first piece.
   

4. 🧐 Research: Predictors of dropout after the first session for traumatised youths
   This Norway study asks the question, What are the factors that lead to dropout after the first session for youths who experienced trauma (e.g., domestic violence, physical and sexual abuse, or the sudden death or suicide attempt of a caregiver).
   
   Key Grafs:

   • Dropout after the first session rates: 25%

   • Predictors that influenced dropout: a lack of caregiver attendance, lower rates of youth-perceived parental treatment approval.

   • Surprising Findings: Youth-rated alliance or caregiver alliance, did not predict dropout after 1st session. Only weaker therapist-rated youth alliance did.

     • Three reasons speculated by the researchers:
       a. Change in alliance is a much stronger predictor of dropout with large effect sizes, compared with alliance measured at a single time point where effect sizes are smaller
       b. The first session may have been too early for parents and youths to truly know the degree to which they agreed with the therapeutic tasks and too early for them to rate their relational bond with therapists.
       c. therapists are likely to have met a wide variety of youth, making it easier for them to more precisely determine their own abilities to form an alliance with a particular youth.

   • Types of treatment (trauma-focused cognitive behavioral therapy or therapy as usual in a community) did not make a difference in dropout.

   • Caregivers’ actual participation in the first session makes a difference.

   • Youths’ perception of their parents’ approval of treatment seems to influence treatment attendance.
     The researchers explained,
     “Since the youths’ reports of their alliance with the therapist were not a significant predictor of dropout, the results suggest that, at least in the first session, youth are more oriented toward their caregivers’ opinions than toward their own relationship with the therapist.
     Since trauma treatments may be particularly emotionally demanding, youth may need active encouragement and support from their caregivers to endure the process.”

   • Implication: Therapists should "engage caregivers in therapy and address possible discordance in treatment goals and tasks." Don’t just keep parents in the waiting area.
     
     

5. ⏸️ Worths Worth Contemplating:
   “Find a place inside where there’s joy, and the joy will burn out the pain.”
   ~Joseph Campbell, mythologist, writer.

Reflection

In the first sessions, how do you “follow the pain” and “follow the spark”?

Notice Board:

1. Big thanks to the AOD Mid-North Coast Local Health District in New South Wales for spending 2 days together. Hat tip to David Hedger and people working backstage to make this happen, all in service of helping those who help, and raising the bar of care. Thanks to all participants for working your hats off.

2. Thanks to people who pledged to support Frontiers of Psychotherapist Development (FPD). Sorry I hadn’t picked this up earlier. Here’s what some of you said:

   

   About 5-6 hours is spent each week to organise and curate Frontiers Friday, so as you can imagine, this means a lot to me.
   

3. 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 27^th, 2024.
   Space is limited.
   Registration is required.
    

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.