When Your First Counselling Appointment Doesn’t Work Out
I was recently reflecting on my first experience in counselling, not associated with previous (and brief) youth counselling experiences. This was my first time reaching out as a young adult and I was away from home for the first time.
It was my first year of university, living in res; I remember being extremely distraught—crying (and sobbing) almost every day—and deeply lonesome. I knew at that time that I was struggling and I had the thought that counselling would be a good idea.
I am old enough to say that the 1990s was a ‘dark age’ in mental health. Not to stereotype—there were, as there have always been, incredible therapists and therapy being offered. But asking for help was still very taboo, one rarely talked about mental health problems, and mental health conditions were often minimized or sometimes even maximized. If you you were a youth or adult back then, I hope you had a better experience than me.
When I think of that era, I’m slightly amazed that I ever reached out at all. But I did. And it didn’t work out.
You may be concerned that this is going to be a depressing article and yes, it might be, briefly. But that’s not my purpose. I actually want folks to try again if the first time ain’t no good. But I’ll get to that.
I didn’t know much about mental health back then (I had never taken a psychology course, and was studying journalism) so I wasn’t clear about the type of mental health provider that I had been scheduled to meet with at student health. After hearing my complaints, the diagnosis was homesickness. While that was obvious, even to me, he said that there was no need for me to return and that it was something that would pass with time. But it didn’t. And I was very eager to return to my hometown of Vancouver, BC, after toughing out my year.
I remember feeling really disappointed that I couldn’t talk to someone, as if I had failed a counselling test and I wasn’t eligible to be a client. It was pretty discouraging.
Fast-forward one year later, and with mounting personal problems, I decided to try once more. I was terrified to reach out, again worrying that I would not be accepted. Fortunately, I had a very welcoming first session with the counsellor I met, working together for the better part of a year.
This was the first of several excellent counsellors that I saw over the course of my life, including the person that opened my eyes to a career in counselling, something I will always be grateful for.
Why Might First Sessions Go Bad?
It’s interesting when one looks at the counselling research and finds large-scale studies which have found that the most common number of counselling sessions is one. Yep. One. But this is not to say that people don’t try again. And thank goodness they do because counsellors are just as varied as counselling clients, meaning that it’s got to be the right combination.
I have thought a lot about the possible reasons for a stoppage after session one. When I received training in Client Directed Outcome Informed Therapy (CDOI), I was taught that ending after one session is often related to problems in the therapeutic alliance—the quality of the relationship between counsellor and client.
CDOI points to several key components that make up a quality therapeutic relationship:
- Whether the therapist can understand, respect and work with the client’s beliefs about change
- Whether the therapist can share in and support the client’s goals, meaning or purpose for therapy
- Whether the means and methods chosen by the therapist make sense to the client
- Whether the client views the therapeutic relationship as positive and beneficial
Let’s break this down:
Beliefs About Change Conflict
When the client and therapist disagree about how things will change— i.e. what will need to happen to create change in the clients life.
This conflict can come from therapist and client having very different life experiences or backgrounds, or life philosophies.
A common conflict is when a therapist believes that the client needs to take direct action to change their circumstances but the client may believe that the universe with respond with signs of when to proceed. Neither party is right or wrong, but can both work together meaningfully?
Client Goal Conflict
Disagreement about the goals for the counselling sessions.
Most typically, goal conflict surrounds a therapist who believes that a client isn’t “facing” something that the client thinks is unimportant. Another example would be therapists who become frustrated when clients don’t do their ‘homework.’
A client may also feel that there are goals that need to be addressed but the therapist disagrees, perhaps even thinking that doing so could be harmful to the client. Here, there is a need for dialogue.
Most of the time, therapists can support clients’ goals, although there are some times when doing so could contribute to unnecessary client vulnerability (for example, exploring a client’s trauma when their life is already very chaotic).
Also, of note, in some situations, the client feels strongly that they don’t need counselling help while the therapist thinks they do, leaving the very therapy itself in dispute.
Counselling Strategy Conflict
Related to beliefs about change, this happens when the therapeutic methods that the therapist is proposing do not make sense to the client. The client may have a different strategy that they perceive would be more effective, or they many not have any specific ideas, except a strong feeling that what the counsellor is proposing will not work.
Therapists versed in a variety of therapeutic methods will have the opportunity of offering choice to clients. Sometimes, however, a referral to another counsellor is better, if there is no agreement on method.
Therapeutic Rapport Conflict
Often referred to as the ‘vibe’ between counselling client and therapist, if this feels poor, opening up in therapy may prove to be difficult, if not impossible. If a counsellor feels a strain, they too may struggle to be their relaxed and best self in session.
From a client’s perspective, this can be related to: the perception that the therapist is judging them, feeling like the therapist is “too different” to click with, lack of trust in the counsellor or the belief that the therapist lacks the experience to help them adequately.
When a therapist feels like the rapport is poor (for example they are ‘walking on eggshells’, feels misunderstood by the client, or more rarely, feels unsafe) it is typically in the client’s best interests for the counsellor to refer them to another therapist. When done with compassion and for therapeutic reasons, this is never about punishing a client, but rather directing them to therapy that will help them the most.
Other Factors / Circumstances
And yes, sometimes the one-session phenomenon has nothing to do with the session itself or anything that happened in the therapeutic relationship. Possible factors can include:
- The arising of a sudden, consuming life crisis where other things fall to the wayside (including therapy)
- Recognizing after the first session that one is currently too busy to devote regular time to therapy
- A change in work schedule/erratic work schedule
- Unexpected health problems
- A sudden loss in finances (such as from a job loss or losing work benefits that would normally cover counselling)
- A conversation from a loved one who disapproves of counselling which puts the counsellee in an awkward position
- A long-time coping strategy of avoiding things that are difficult. This can apply to therapy too, even if the session was not “bad” per se.
What To Do Instead
It can be tempting to say “just forget it” when it seems too hard to book session two. And in fact, you could be right, circumstances may indicate that it’s not the right time to return.
But if it’s not circumstances holding you back, there are some options to consider:
Talk to your therapist, particularly if it’s about your session experience. Contact them to make a time to talk over the phone, have a secure video call or if possible arrange a time to meet at their office. Concerns are best handled directly as tone and intention are difficult to convey over email or SMS, possibly resulting in further misunderstanding. Also, therapists should not engage in confidential discussions over email as email is not considered to be a secure form of communication.
From this conversation, see how your counsellor reacts: are they defensive? Probably best to go elsewhere. Open and dialoguing? Perhaps your therapeutic relationship even feels stronger now.
Find another therapist, particularly if you feel uneasy or emotionally unsafe with the therapist you saw. Or, if this is the third, fourth or fifth therapist you are trying again with, perhaps there is a fear about therapy that is unknown to both you and the therapists you have been seeing. Even if you don’t know what this is or why it’s a problem, it can be useful to talk to the counsellor about the pattern you see; when you just meet a counsellor once, they may not pick up on any patterns until you bring it up.
I wish you an excellent session two and beyond!
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