Wednesday, October 10, 2018

4 Important Aspects of A Couples Therapist's 1st Session

I am often asked what to expect by couples coming to see me for their 1st couples therapy session.  There are several areas I set out to cover during this meeting also referred to as an “intake session.”  A productive intake balances a couple’s need to speak about what brought them in to see me with a structured and emotionally safe conversation.  By the end of this meeting, a couple should experience some interplay of spontaneity and an organization of the information discussed.

One important aspect to the intake session is a conversation about what led the couple to contact me.  How have they reached this particular point where they decided to address some important, often critical aspects of themselves and their relationship?  From the clinician’s point of view, how this narrative is articulated is as important, perhaps even more so, that what is actually said.  For example, is the presenting problem(s) described in victim-villain terminology?  Is there blaming and shaming or instead some shared understanding of the problem(s)?  And, does each partner conceptualize “how they got here” in a similar, somewhat different, or entirely different way?  Another part of the intake is the couple’s description of what solution-focused couples therapists call their “attempted solutions.”  This includes any past or present individual and/or couples therapies.  This information serves to inform the clinician about what has been helpful, to potentially build upon, as well as what was not, in order to avoid.  It also provides a beginning assessment of the couple’s general attitude toward therapy, each other, and their sense hopefulness at this point in time.   

Another area of the intake conversation is what Dr. William Doherty, terms “the best of times” assessment.  This question asks each partner to describe a memory of connection or joy during his or her relationship.  Dr. Doherty uses this assessment tool as part of his “discernment” counseling protocol.  I believe this also fits with the couple therapy intake process.  The response to this question provides 2 things: it can signal a positive feeling in the room which counter balances the weight of the moment.  The couple is offered the opportunity to “look back” to a nostalgic place and by association perhaps look forward to possibilities.  It also provides a quick assessment of any ambivalence related to the request for services at this time.  If either or both partners are reluctant to answer or remember “a best of times” then there is usually some ambivalence towards couple therapy.  This might lead me to pivot towards assessing for discernment counseling instead of couples therapy as the starting point.  Both partners need to have made a clear decision to pursue their couple’s work in order to ensure some success in their couple’s therapy. 

Other aspects of the intake session include the noting of any substance abuse, addictions, and/or trauma histories.  Additionally, as a trained systemically oriented couples therapist I inquire about the 5-common stressors that influence couple satisfaction/dissatisfaction.  Usually the more of these stressors present the greater the emotional turmoil between the couple.  And this starting point needs to be determined at intake.

The emphasis of an intake session is to get a struggling couple off to a productive and meaningful therapeutic start.  A first couple’s first therapy session is a balance between allowing a couple to speak freely about what brought them in.  And about experiencing a trained therapist who can make sure there is some semblance of order to a difficult beginning conversation.

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