How can we connect with our clients better in the first session?

It is common knowledge, by now, that the quality of the relationship between therapist and client is crucial to the success of therapy. Without a good connection, the client will almost always not make nearly as much progress as with one. But what are the factors that influence a good connection?

Grindheim, Moltu, Iversen, McAleavey, Tømmervik, Govasmark & Brattland (2024) also wondered about this, and decided to find out. They carried out a qualitative study with semi-structured interviews of 12 patients and their 12 therapists. These interviews were completed after the first treatment session, using reflexive thematic analysis. In other words, they rather impressively interviewed clients as well as their therapists in order to get 'both sides of the story.' Their interest was to identify barriers to connection as well as facilitating factors.

Their analysis was especially interesting because they found that therapists and clients shared a number of themes In addition, we found that patients and therapists described certain comparable experiences and actions. These included

(a) feeling uncertain about what to expect

(b) forming first impressions

(c) balancing multiple concurrent concerns

(d) seeking feedback from the other

(e) sensing a way forward.

From their research , the authors concluded that clients and therapists both use the first session to form an impression of the other (which is unsurprising). However, they also feel a high level of concern with the impression they themselves give. During the first session, much of their activity is directed at monitoring the other person's in-session reactions and responses which might give clues about how the other is seeing you.

This is an interesting finding, not only because it emphasises the relational nature of therapy (that even while we are tlking about our issues, we are simultaneously trying to figure out what the other person is thinking about us), and highlights the intersubjective aspect of therapy (that both therapist and client are caught up in trying to impress the other and read into what the other is thinking of them.)

Øyvind Grindheim, Christian Moltu, Valentina Iversen, Andrew McAleavey, Kristin Tømmervik, Hege Govasmark & Heidi Brattland (2024) Points of departure: A qualitative study exploring relational facilitators and barriers in the first treatment session, Psychotherapy Research