What Are the First Things You Ask a Client as You Begin Psychotherapy?

By Charles Schaeffer, PhD

Starting psychotherapy effectively means building a strong therapeutic alliance where a client trusts they will feel understood and seen by you. The first things you can ask a client to do in order to accomplish this are:

· What are the most important parts of your identity that I really need to know to understand you?

· What are the things about me you think might get in the way of really understanding you?

· What’s it like sharing this with a therapist that is (disclose racial or cultural identity)?

1. Client-Focused

Starting therapy and building a therapeutic relationship requires knowing your client as best as you can. When your client shares the important parts of their identity:

· Actively listen

· Reflect content to make sure you understand them

· Explore how the client learned about their identities

2. Therapist-Focused

Therapists carry their own important identities inside and outside of therapeutic relationships that impact the therapeutic alliance. To see how this may show up in your sessions:

· Disclose your important racial and culturally identities to your client

· Explore the client’s perceptions and reactions to those identities

· Reflect back client content to communicate understanding

3. Therapy Relationship-Focused

Clients and therapists enter therapeutic relationships with different social histories and identities that impact the therapeutic alliance. To create a strong therapeutic relationship, you can:

· Encourage the client to share where they foresee gaps in understanding by the therapist

· Explore where the client has felt judged or harmed by people that hold your racial, gender, and/or cultural identities

· Seek supervision and continuing education around client identities that are unfamiliar and/or you have not lived

No matter what modality you practice, starting and completing effective therapy always depends on how much your clients can trust that all of their identities can be shared and seen by you. Following this guide, you and your client can create the foundation of a strong alliance by inviting all important identities into the session.

Charles Schaeffer, PhD, is a licensed psychologist, and adjunct clinical faculty member at New York University who has been teaching students and patients how to use the latest research to overcome panic, sleep, and anxiety disorders for over a decade. Schaeffer was previously research director and guest host for the Dr. Fritz Show on WWRL-AM radio in New York, NY. His writing and expertise have been featured in Psychology Today, HuffPost, Vice News, and NBC News Health. He lives in Brooklyn, NY.