Tips for Establishing an Alliance

imgresI’m starting my first practicum placement next week, and I’m both excited and nervous about having my first session. How should I prepare for my first client to make sure the session goes well?

This is an exciting time, and it is understandable that you have some mixed emotions. You have been preparing for this moment for a year or more while taking academic courses, and you may have had this career in mind for many years. As you move forward in your career, you’ll look back on this time as one of tremendous growth. You may find it helpful to look at my blog posting on general suggestions for orienting yourself to a new training site. I’ll focus here more specifically on preparing for your first client session. Research has shown that the quality of the therapeutic alliance is the most powerful predictor of successful psychotherapy outcome, and following the tips below will help you establish a positive alliance.

I recommend that you start by paying attention to the thoughts and emotions that are present for you as you learn about your new client assignments and begin to schedule appointments. It is often easier to think about the logistical steps or to focus only on the client’s issues than it is to notice our own experience. However, it is valuable to begin now to cultivate an attitude of self-awareness in your client work. Feelings of anticipation, excitement, nervousness, and fear are common at this stage. Talking about these feelings with your supervisor will give you support for managing your emotions in this early phase of your work.

Another strategy that helps with preparing for a first session with a client is to approach every contact with your client as part of the treatment. This means being aware of your role as a clinician in all aspects of the work, including an initial phone call to schedule an appointment and reviewing the intake information you receive before that appointment. Notice how the client talks with you in the phone call and how you are affected by your interaction. Imagine what the client may be expecting or fearing from the session based on what you know about her/his current situation and history. You can begin to develop a clinical understanding or formulation of your client even before you have seen her/him in person. Talk about these phone calls and intake assignments with your supervisor even before you have had an appointment so you can benefit from your supervisor’s experience and guidance in developing a formulation.

Last, use your preliminary understanding of the client to guide how you interact with her/him. You are probably familiar with the general principles of empathy and reflective listening that help with building an alliance. In addition to these general principles, think about what will be particularly helpful with this client. Some clients benefit from expressions of warmth and others prefer more reserve; some clients begin talking right away about their lives and others have a slower pace and need subtle encouragement. Your supervisor’s guidance will help you adapt your style to each client.

I hope you find these suggestions helpful in preparing to see your first client. Please email me with comments, questions, or suggestions for future blog topics.