Studies show that over one-third of people who receive counselling do not return after their first visit (Simon et al., 2012). These statistics can be very discouraging, especially for clinical counsellors who are just beginning their careers.
Every counsellor has their personal style and approaches, but the way in which you build your relationships with your clients can make all the difference in attendance and outcomes. There are many reasons out of your control that a client may choose to discontinue counselling. However, establishing a “therapeutic alliance” with your clients from the onset can greatly improve the number of people who stay committed.
Therapeutic alliance is a concept that first dates back to Sigmund Freud in 1913, correlates with Carl Rogers’ person-centered theories, was reformulated by Edward Bordin in 1979, and continues to be studied and practiced today. It refers to the positive relationship built between a client and a counsellor that is vital to successful outcomes and is comprised of 3 components: goals, tasks, and bonds.
By taking a closer look at these three aspects, you can develop strategies to grow this alliance with your clients and keep them engaged from the first session.
Create Bonds with Your Clients as a Clinical Counsellor
During your counsellor therapist career, an essential component of building a therapeutic alliance, especially within your first session, is creating a bond with your client. Creating a trusting and positive relationship with your client is quite possibly the most powerful influence you’ll have on engagement and outcome.
Sexton, et al. (2005) specifically examined the aspects that positively affected therapeutic alliance during the first sessions. They found that clients felt a greater connection when they experienced traits from their counsellor such as being emotionally and verbally warm and friendly, comfortable, displaying focused listening and engagement, and positive actions such as providing interpretation and feedback. They also found that the depth of the connection made during the first session led to an even greater connection during the second.
During your first session be sure to be friendly, personable, compassionate and genuine. You may be their counsellor, but it is important for them to feel that you are human. Use active listening skills and be sure to acknowledge and legitimize your client’s issues or concerns. Offering validation is a key aspect of making clients feel accepted while showing empathy and understanding, making them see you as an ally rather than against them.
Set Collaborative Goals with Your Clients
Setting goals is another component of therapeutic alliance, allowing you to define the distinct purpose of your client-counsellor alliance during the first session. It is important to involve your client in the process and come to a mutual agreement on what the issues are and the goals to work towards. This step not only sets a path for your work together but also helps to build the aforementioned bond. As each client is unique, their goals will differ from one another.
Studies have shown that goal setting has a direct and positive effect on behaviour change (Epton, et al., 2017). Not only setting goals but making sure they are clear, defined, created collaboratively and mutually agreed upon are all important factors that are proven to lead to more positive behavioural outcomes and engagement. (Tyron, et al., 2018).
Asking a client what their own goals are during the first session gives them power within the dynamic to contribute with their own beliefs and values in regard to their issues and solutions. Listening, understanding, and acknowledging those goals builds trust. This, in turn, creates motivation and engagement, and your clients will strive harder to succeed under your guidance.
Mutually Agree on Tasks with Your Clients
In addition to goals, a research review conducted by Hilsenroth and Cromer (2007) found that giving clients the opportunity to collaborate with their counsellor during the first session to develop the tasks needed to reach their goals conveys trust and appreciation and only builds on the partnership between client and counsellor. Using the extensive knowledge and various methods and techniques you learned during your clinical counsellor training, you will come to an agreement about how the process you suggest will lead to the achievement of the goals set. By focusing on the bond aspect of your alliance and truly understanding your client, you will be able to choose the methods that you feel will work best for them.
The Hilsenroth and Cromer review also concluded that conducting a longer, more in-depth initial session in order not to rush through the many aspects involved was beneficial. Not only will you have to go through the tasks related to goals, but quite often during the first session, you’ll also have to discuss the formalities of your sessions. This includes topics covering payment, cancellation, frequency of meetings, and so on. Involving your client in this conversation and coming to mutual agreements is yet another way to increase your alliance and improve engagement. Overall, it is important that your client feel that they are beginning a mutual endeavor with someone they can trust to help them through the difficulties they are facing.
Are you ready to begin a rewarding career as a clinical counsellor?
Contact Rhodes Wellness College to learn more.
Bordin, E. S. (1983). A Working Alliance Based Model of Supervision. The Counseling Psychologist, 11(1), 35–42. https://doi.org/10.1177/0011000083111007
Epton, T., Currie, S., & Armitage, C. J. (2017). Unique effects of setting goals on behavior change: Systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85(12), 1182–1198. https://doi.org/10.1037/ccp0000260
Hilsenroth, M. J., & Cromer, T. D. (2007). Clinician interventions related to alliance during the initial interview and psychological assessment. Psychotherapy: Theory, Research, Practice, Training, 44(2), 205–218. https://doi.org/10.1037/0033-3220.127.116.11
Sexton, H., Littauer, H., Sexton, A., & Tommeras, E. (2005). Building an alliance: Early therapy process and the client-therapist connection. Psychotherapy Research, 15, 103-116.
Simon, G. E., Imel, Z. E., Ludman, E. J., & Steinfeld, B. J. (2012). Is dropout after a first psychotherapy visit always a bad outcome?. Psychiatric services (Washington, D.C.), 63(7), 705–707. https://doi.org/10.1176/appi.ps.201100309
Tryon, G. S., Birch, S. E., & Verkuilen, J. (2018). Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome. Psychotherapy, 55(4), 372-383. https://doi.org/10.1037/pst0000170