Overview — Purpose of the First Steps

Starting a counselling session well sets the tone for safety, trust, and therapeutic progress. The initial steps collect essential information, build rapport, clarify expectations, assess risk, and co-create goals and a plan.

Before the Client Arrives — Pre-session Preparation

• Review referral information, intake forms, and prior notes.
• Prepare the room (privacy, seating, tissues, water) or check telehealth setup (camera, sound, secure link).
• Set intentions for the session: key questions, assessment areas, and potential safety checks.
• Minimise interruptions (phone off, sign on the door if in-person).

Step-by-step: How to Start the Session

1. Warm Welcome & Introductions
   • Greet the client by name; introduce yourself and role succinctly (name, qualification, agency).
   • If in-person, offer a seat and a brief moment to settle.
2. Explain Confidentiality & Limits
   • Briefly explain confidentiality, record-keeping, and mandated limits (harm to self/others, child protection, court orders).
   • Answer questions — transparency builds trust.
3. Administrative Items
   • Confirm identity details, preferred name/pronouns, emergency contact, and consent to proceed (in writing or verbally).
   • Discuss session length, fees (if applicable), cancellation policy, and contact procedures between sessions.
4. Initial Rapport Building
   • Use active listening, open body language, and brief empathic statements to create safety.
   • Start with a low-risk question—“What brought you here today?” or “Tell me briefly what led you to seek support.”
5. Focused Presenting Problem & History
   • Clarify the main concerns, duration, severity, triggers, and previous help-seeking.
   • Use a timeline or problem mapping when helpful.
6. Risk & Safety Assessment
   • Assess immediate risk: suicidal ideation, plans, intent; harm to others; severe substance use; active psychosis.
   • If risk is present, follow local protocols: safety planning, emergency contact, crisis services, or higher-level care.
7. Strengths, Supports & Cultural Context
   • Ask about personal strengths, coping strategies, family/social supports, and cultural/religious factors that matter to the client.
8. Set Goals & Collaborative Plan
   • Co-create 1–3 initial goals with the client. Ensure they are specific, achievable, and meaningful.
   • Discuss initial steps, homework (if any), and how progress will be measured.
9. Contracting & Closing the Session
   • Confirm next appointment, contact options, and any between-session supports.
   • End with a brief summary of the session and an empathic closing statement.

Typical First-Session Timeline (45–60 minutes)

Sample Clinician Scripts

• Opening: “Hello Asha — I’m Seetha. Welcome. Before we begin, is this still a good time for you?”
• Confidentiality: “What we discuss stays between us, except in situations where I must act to keep someone safe — for example, if there’s risk of serious harm.”
• Presenting Problem: “Can you tell me, in your own words, what brought you here today?”
• Risk Check: “Sometimes when people feel like this they also have thoughts about hurting themselves — have you had any such thoughts?”
• Goal-setting: “If we work together for a month, what would need to change for you to say this was helpful?”
• Closing: “Thank you for sharing today. I’ll write a short plan and we can meet again on [date]. Is there anything you need before we finish?”

Documentation & Next Steps

• Record a concise session note: presenting issue, risk status, assessment findings, goals, agreed plan, and follow-up date.
• Upload consent forms and emergency contacts to secure records.
• Arrange referrals or additional assessments if needed (psychiatry, social support, medical).

FAQs