 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast, with Bob Cook and Jackie Jones. Good morning, good evening, or good afternoon, depending on where in the world you're listening. Welcome to the next episode of The Therapy Show, behind closed doors with the wonderful Bob Cook and me, Jackie Jones. And in this episode, we're going to be talking about the first session. It's a big session. Yeah, it's a biggie. It's a biggie. It's a biggie for a lot of people. It's a biggie for most people who are so apprehensive and rightly so because they are bringing their vulnerable cells to the therapy encounter and they don't know what to expect. And though they need to come for various reasons, they feel so apprehensive. So it's a very big step when people come to therapy, especially the first session, the first therapeutic hour, which actually for most therapists is 15 minutes and not an hour. I know that took me a while. It takes some of my clients a while to get around when I talk about an hour and they're like, well, it's not actually an hour, is it? I said, ah, it's like a baker's dozen. It's a therapeutic hour. That's right. So yeah, so let's get on talking about the first session. So here we go. How I see the first session is contact, contact, contact. In other words, the first thing I think about when somebody comes in through the door is contact, contact, contact. And how we can really meet each other, the contactful way. Now that is not so easy. And why is the premise for me in the first session is because without contact, then that 15 minutes may well go quite slowly. Yes. Yeah. So what's, so do you see it that way? Yeah, yeah. And I think the longer I, you know, see clients, it's interesting when you say that that hour goes more slowly. I can kind of gauge where the client is on week to week by how the session goes. If, if the defences are up, if there's something they want to say it, but they're not quite ready to say it yet, those sessions go a lot slower than when there is a true connection, when there's trust, when there's, yeah, all that stuff going on. It's interesting that 15 minutes can feel so different from session to session. Yeah. Well, see, when somebody first comes, you've got to remember two things. It's the first session for the client, and actually it's the first session for the therapist with that client. Yeah. They might, they might be very experienced. Now I'm very experienced. I don't work clinically anymore, but it would have been the first session for me with that client. Nice. Now, even if I've done a lot of clinical work, I still have a sense of curiosity, excitement and apprehension, as well as a lot more other feelings. And clients, as I say, will have many feelings, but usually the feeling which is most prominent would be apprehension. Yeah. Yeah. I think, again, I filter things through my own eyes. So one of the first things that I often do with a client when they come in is ask them if they want to take off and put the kettle on. That's the first thing usually. Do you take sugar and milk and those? Let them know that there's a toilet if they need one. Can I ask you a question? Yes. Can I ask you a question? You can. So for you, does the beginning of the first session start when you open the door and make the tea and coffee and everything else that you're just talking about? Or do you see the beginning of the first session for when those nice assistees have actually happened? Before that's part of it. So you see that as part of it. Yeah. That's what I was interested in, because psychoanalysts, I know we both of you and I come from the humanistic psychotherapy world, if you like, have a psychoanalyst which come from a long tradition of the opposite of what you've just said. In other words, making tea and many of the things you've just talked about there would be heresy to a psychoanalyst. So what would happen in their first session is the client would turn up and knock on the door or buzz the buzz or whatever it is. The analyst would let them in, into the room, sit down and say, let's talk. Now, a perfect example of that was Joey Essex. Have you heard of him? Yeah. That celebrity person. I really quite like, by the way, for lots of reasons, but he had only if you watched it. I did. Yeah, he talked about the same things when he was talking about the death of his mother and his life. And I thought it was extraordinarily brave of him to do that and to do it on television. But he went to see a psychoanalyst, right? And he knocked on the door and the psychoanalysts came in. And the next thing you saw was him sitting down and then the analyst sat next to him and they started. Yeah. So I think the psychotherapists from psychotherapy worlds are often, and I do the same as you, by the way, often brought up in a tradition, which is different for psychoanalytical tradition, which often would say we like a cup of tea when I go to a tour. How are you? Or have those sort of sort of gentle past timing processes to help the person perhaps feel a little bit more at home before they start, which is why I asked you the question. Yeah. Yeah. For me, it's I think it's quite important that the room is set out in, you know, a neutral way that it's kind of like a neutral ground. There's not too much of me in that room because I don't know what could trigger another person. I don't know what certain things mean to certain people. So I try to keep my room as general as possible. I've had clients that even a ticking clock is enough to take them to a certain place in their past. Yes. And if we're talking about the first session, which is I think you're talking for the first session onwards, there is another way of thinking about that. So how are we moving away from the first session? Pups will not, but let me just tell you the story. So when I first opened the Institute up, we used to have, and you know this, Friday night seminars. Yes. For two hours, we used to get somebody in to talk about various psychotherapeutic topics. Now, I always remember I invited two drama therapists in to talk about two hours to talk about psychotrauma. Yeah. It was at one level. They arrived 20 minutes early and said, well, more than that, half an hour. Luckily, I was there and said, we need to strip the room. So now my training was quite a big training move. With a lot of coaches. Lots of pictures. Would we strip the room, take all the pictures off the walls so that exactly from your perspective, so that people have nothing to project their fantasies into. And we have a neutral room as much as possible, which I said was almost impossible in my room. I said, well, we would like to do that. So I said, go ahead. In their therapy rooms, they would have nothing at all except for a couple of chairs and exactly like you perhaps minimalization so that people aren't able to project their fantasies onto it and get triggered like you've just said. Now, that was very interesting. I enjoyed the discussions about that with them. And we now 40 years late, no, 25 years later, and I'm much more clinical experienced and understand where they're coming from. And you're right. And, you know, quite often, if you want people to get into their unconscious quicker, it's useful to maybe have many of these things on the wall that you're talking about, because they'll actually get to their unconscious, maybe through triggers that you wouldn't even know about. And that's fine for me as long as I then follow it up. Yeah. Yeah, 100%. And sometimes it is enough for them to comment on it or to mention it or to do something that then is another opportunity to explore. But yeah, I think I'm more talking about, I don't know, family pictures of myself and putting too much of me in that room. You're talking about that idea of too much of yourself, which is never an interesting one. And largely I agree with you. Now on the first session, somebody comes in, let's get back to the first session again. I did watch that, Joey. I'm glad you watched Joey Essex Things, which I wanted to mention in this podcast, because he went for his first session, very scared, very apprehensive. It picked, interesting enough, it picked a psychoanalyst, I think, from probably either a psychoanalytical directory or it'd been directed this way, I suspect it'd been directed, actually. But in the first session, he, he, it's really interesting because you talk about contact, contact, contact. He'd be interested, I was interested in how they actually contacted each other. And I thought the psychoanalyst did that in a very gentle way by actually, what I would call inquiry, very different from how I see many other psychoanalysts, by the way, general inquiry questions. He didn't overwhelm Joey Essex too much in the first session. And that is one of the things I wanted to say is that one of the things not to do in the first session is to overwhelm them so they become either more scared or you never see them again. Yeah. Yeah. 100%. Because I think, you know, they're going to have their own story about how it's going to pan out. They will have, I would imagine, fantasized and come up with lots of different scenarios on how it's going to be, what's going to happen in that room, all those sorts of things. And I think if I remember rightly, Joey Essex kind of the first statement that he came out with was how nervous he'd felt and that he hadn't slept well the night before. So he kind of says, go easy on me. And the analyst did. Yeah. Yeah. I thought that was a really, really good programme. I think for someone like Joey Essex, so well modelled for so many people to allow himself to be that vulnerable in therapy and talk about such deep issues was fantastic and the fact that he continued on in therapy. Yeah. After the programme, he was still got, yeah. Yeah. So I was very pleased. So it's really important not to overwhelm. We need to somehow get contact with the person in front of us. And the second maxim, I think, is how we help people to tell their story about why they're there. Interesting. Say a bit more about that. How to get into contact and how we enable them to talk about their story, what brought them in the first place, probably my two starting points. I don't know what your two starting points are. I'm curious about what do you mean, how you enable them? Yeah. I kind of say a little bit. Once they've got the drink of coffee and we're sitting and everything, then the first question I usually ask them is how are you feeling just so that they have that opportunity to say either I'm absolutely petrified or I'm fine or whatever it is. And something about this room is a safe space. There's no judgement. There's no, nothing that you can't talk about in this room to kind of give them permission. I don't know what people think they can and can't talk about in a therapy room and that maybe they think there are certain rules. The only rules I do say in the first session is that you can't come under the influence of alcohol or drugs. That's one thing and there's no violence. You did some separate, many really excellent things. Two of my mentors, if you like, Eric Byrne and Richard Erskine. Eric Byrne talks about the importance of structure hunger and Richard Erskine talks about the relational needs of safety and security needed by everybody. So what you talk, what you're doing I think is setting the safe, the scene and the structure so the person can feel safe and to be in a relationship with you. Good, because that's kind of what I think. Yeah, if they've never been before then they kind of don't know. Well, going back, it's the first session that we've had together. They might have been somewhere else and it might have been done completely different. But for me, I think it's important that I just set the scene, if that makes sense. And there's something about holding them in that safe space as well. That's really, really good. I mean, to set the structure to tell them a bit about what therapies or diseases and what the ground rules are, which will only enable them to feel safe with you. I was a bit struck about the question about how they're feeling. But perhaps you can say a little bit more about that. So what you're saying is that one of your sort of important considerations in a first session is to check up what they're feeling. More if they are feeling overwhelmed or stressed or anxious in that moment sat in front of me. How would you know that? Well, that is a valid question. That is something that I will probably go on to say. You know, if they say, oh, I'm absolutely fine, I will probably say something like, how would I know if you were anxious? What would I be seeing? Or how would I, you know, yeah. Yeah. See, for many people come in the room, you will know, probably you can make an assumption about their level of distress or not. So they'll be agitated. For example, they might be sweating. For example, they might even say like, Jerry Essex did, I feel very nervous and many things. So I can imagine you saying that or a therapist saying that or what you're feeling at the moment to get what I would call a contact transaction. Now, I think that that's what I meant by contact. I don't, I don't probably set the scene as much as you do. It's an interesting one that people have different stars, but I am interested in how they make contact and perhaps even more how they don't make contact. Because how they don't make contact properly is as important as how they do make contact. Yeah. That will mean that's one of the ways they aren't able to make contacts in life and relationships outside the therapeutic sessions. So in the first sense, it doesn't mean I will, you know, necessarily share what's in my head by the way, but you know, I may choose to do that, but I am interested in how they may stop themselves being in a relationship with me, as well as how they are in a relationship with me. So many of my inquiries are aimed at, I'd say, making contact, helping them tell their story and what I believe people most come to therapy for. And that is to find somebody who will help them understand themselves. And to be able to talk about what often is un-understandable, that's the word, it's a Bob Cook word, un-understandable. In other words, love it. They don't understand it themselves. Yeah. Yeah. I like that word. I'm writing that one down. Un-understandable. It's not a Scrabble world, but it's because it's way past seven words, un-understandable. Yeah. So the other thing that I was starting to write down though, when you were talking about the un-understandable business, would you say that you kind of normalise their experience? Could you give an example of that? I think I know what you mean, but I'd like to know what you know what you mean. Well, it's kind of like sometimes clients come and you know, they'll say, I don't think you've ever seen anybody that says bad as me. There's nothing that can, I've tried everything and nothing, and it's, it's, yeah, I wanted, the word that was coming to me then was there's a challenge there put out from the get go. Yeah, because it's on the same lines, which I think you're so good at, by the way, which is actually creating safety and security for them to be in relationship with you. So, of course, by normalising someone or however you do it, by the way, by saying, you know, it's pretty natural in these sort of circumstances for you to perhaps have a level of feelings or feeling or feel X, you know, or whatever you said to normalise the experience someone, is also in the realm of helping them feel safe to open up with you. So, yes, I may normalise, it's not top of my list, by the way. I see it as something I probably do that sort of automatically. So, if somebody said something like that, I probably automatically would normalise an experience. So, but my roadmap for the first session is much more around, if I was thinking about this, and the viewers, sorry, the listeners, it will be contact, contact, contact, helping somebody tell their story, helping them, at least helping them understand that it's okay for them to tell the story, and perhaps help them talk about what is ununderstandable, and then go from there, and then going from there probably is, and I'm not sure if I'll do it in the first session, but I would if it was an assessment session, so perhaps, you know, is there much difference, I would help them perhaps look very gently or tentatively about how the past affects the present and how that might be partly why they're not getting what they want in the world today. Now, if I get to that in the first session, which I usually do, by the way, but it's towards the end, yeah, you see, I think most people come to see you have thought about how come I'm like this, how come I'm over angry, how come I can't stay in relationships, how come I feel so nervous, how come I'm extraordinarily anxious, how come I overthink, how come I XXX, I think most people start thinking about that, right, and if I can help them, and I think they thought this, by the way, help them understand that you don't suddenly become like that overnight, you don't have a baby that's overthinking, you don't have a baby that's over aggressive, you don't have a baby XXX, they become that way, that's part of their personality, and if you can help them understand that the past affects the present and the cure is in the past actually, even though you feel it's in the present, yeah, you're halfway there, whether you get to that in the first session, I usually do get there, but I don't know in how much of a big way, but it's a quite a pivotal, pivotal thing for them to start thinking about. Yeah, it is, and yeah, I'm just thinking, I was at my sister and my mum's earlier on, and my mum's a very certain generation, you know, we have some really good conversations about psychotherapy, where, you know, if it's in the past, just leave it there, why do you need to keep going back? Why do you keep me to harping on about it? And, you know, that's kind of how she sees life, it's happened, it's not happening now, get over it. And that's that's that's that generation, and also for many people, because deny, you know, the automatic psychological survival mechanisms of denial often kicks in, so keep everything in the past, and why talk about it, and let's compartmentalise it, just like Joey Essex said to that analyst in the first session, but then he also said, I need to talk about this because I'm not moving on. Stoke, yeah, yeah. So even though he was terrified of going, he knew that. Yeah, and it is, it is terrifying, you know, and it can be overwhelming to people, and it's scary looking back, you know, and I'm not sure who it was who said it, but if it was hard, you know, going through it, why would you want to go back there again? Absolutely right. Absolutely right. So the first session is ultimately, sorry, is very, very important for two people, therapists and clients, meeting each other first time to attempt to get the, you know, a human discourse going enough, so between the two people in that co-creative relationship can actually, you know, summarise or at least get to a place where where where the clients can see that coming back may help them. Yeah. Wonderful. Yeah, and I don't know if we've got much time, but perhaps next time we can talk about, we have started to talk about the art of that, but you see people are trained for many, many, many, many, many years how to help that happen. In other words, when I say contact, contact, contact, what does the therapist do to enable contact, contact, contact, and what does the therapist do when the person resists contact, contact, contact, which they're bound to do mostly? Yeah. Now Giorgio asks, actually, nearly didn't go back. Yeah. Yeah. So he would have broken contact in a big way. Yeah. But the, the analyst was very good because he allowed him to do it at his own pace, which is another thing that's really important is the therapist in the first session works out the pace between the two of them needed so the person can feel safe to be able to talk in their own rhythm and their own pace. Because if that doesn't happen, again, contacts will break down. Yeah. It's, it's funny, you know, unless you, you've kind of had the opportunity to sit in a room with just one other person where, you know, it's not just chatting. It's a completely different universe behind that closed door, which is kind of like what we wanted to open the door on in these podcasts. Yeah. You're right. And what you've, none of us talked about, which is quite remarkable because we've come to that, this confidentiality. Yeah. Now you did in a way, because you were talking about how safety security, so you sort of did spell it out. But I do want to say that from the listeners that from the beginning, we talk about confidentiality and what that all means, because people, if they don't feel secure, probably won't open up in the first place. So sort of hallmark of our career. And the next podcast, I'm assuming might be what I would call what we, well, we start in the first session, but take six, seven, eight sessions, maybe, or at least the next four or five, and that's the creating of what is talked about when they talk about the working relationship. Because unless the therapist and the client can have a working relationship of trust, safety, security, confidentiality, they won't come back. Yeah. So that's really, I think the next podcast really is, we start that in the first session, and then we continue to build on that, which will become a template for this therapeutic encounter to foster. Is there anything that you say towards the end of the first session to the client as, I don't know, just what might happen the following week when they're not in the therapy room, between session one and two, if that makes sense? Yeah, I usually say something like, I'll probably see you next week when it works out the diaries and everything else, and we'll continue where we've left off until then, have a good week. It's usually something like I say that. Yeah, yeah. Now, of course, you know, I'm not saying I'll always do that, maybe I'll summarise what we've, where we've got to, and then say something like that. But one thing I think you're leading, or perhaps you're not leading to, is that if it's 15 minutes hours, I always think about having that summarisation, or those transactions, probably after, you know, closing down the subjects area, after 45 minutes, so that we can actually summarise, say what I've just said, before the clock hits 50 minutes, and we have to go. Yeah, yeah. I think for me, maybe it's the parented person in me, I don't know, I have been said before, now that I am quite parented, but it's more kind of a, you know, just a bit of self-care stuff between now and the next session, you know, it's... Yeah, I'd say that, I'd say well done, and you know, it's really important you've got here, and sometimes this will stir things up and trigger things, but so make sure that you know what should have a hot bath, or what's the television, don't do anything dramatic tonight, and just be aware that we can percolate this, and I'll see you next week. Yeah, yeah. It's that kind of, you know, it's not like you walk out the door and that's it, there is an internal process going on from here going forward now, so just be mindful that you might have, you know, have certain memories pop up, that's absolutely fine, we can talk about that next week. Yeah, that's a really good way to end, I think. Yeah. Good, yeah, I'd look from a master, I'm still learning, everything you're saying, I'm writing so many notes down, Bob. It's a good, it's a good, I like the way you have an emphasis on the first session on safety, security, relational needs, and the way you end, it shows a high emphasis on containment, safety, and security, so that the working relationship between the two of you will foster, which is what I think the next podcast should be about. Sounds like a good follow. The working relationship and the therapeutic encounter, something like that. Yeah. I think that's, because that's what the first session is really setting the template for. Yeah, brilliant. So we will go on to episode five next time. Yeah, thank you very much. Thank you Bob. Take care. Thank you. You've been listening to The Therapy Show, behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.