How To Face My First Patient In Psychological Therapy?
After much effort and dedication we have achieved it. We have managed to finish our clinical psychology studies and, now, the time has come to put them into practice in the working world. It’s time to give psychotherapy.
We have the theory, and we also have some practice, but it usually happens that, like everything in this life, taking the first step is something that intimidates us a lot, and even more so considering that our profession involves a lot of responsibility.
Every psychologist wonders “how to face my first patient in therapy”, flooding them with a lot of doubts and fears. before having to see that first client. Fortunately, here we bring some recommendations to get success from our first sessions with patients and also incorporate them into our professional life forever.
Keys to knowing how to face your first patient in therapy
No matter how much we know, no matter how much we have internalized all the theory of the psychology degree and the corresponding postgraduate clinical training, the first patient is a person who intimidates us. Naturally it should not, but the truth is that the absence of previous experience, beyond the practice that training gives us, makes us, therapists, go to the first interview with our first patient with uncertainty, a little insecurity and even fear.
All this is normal. Really, as the people we are, we cannot help but have emotions when taking our first steps in the world of work, and much more so considering that clinical psychology implies a responsibility as great as trying to improve the lives of other people. However, we must always keep in mind that if we have managed to get there it is for a reason, and that something is that we are worthy of practicing psychology, we have the necessary studies for it. With calm, an open mind and a positive outlook, we will know how to face our first patient in therapy.
Likewise, There are hundreds of manuals, protocols and guidelines that teach us how to work with patients, something that should always give us some security. by having a guide on how we should behave and handle these first sessions. With this same objective, below we are going to talk about several aspects that all new psychologists, and also those who already have some experience, must take into consideration and resolve before giving the first psychotherapy sessions.
Aspects to take into account as therapists
There are many aspects when treating the patient that should not be ignored or ignored. Before even giving the first clinical psychology session, we must take into account a series of basic aspects that every therapist must apply when having a case. Among them is treating patients as we would like our family, friends and other loved ones to be treated. We should have the same code of ethics that we would like someone to have with anyone we care about..
Another point that we must always respect is not to follow the saying “In the blacksmith’s house, a wooden knife.” As professionals we are going to give a series of guidelines to the patient so that they can increase their well-being. It is inconsistent that we recommend that the patient have good lifestyle habits while we do not follow them. We must take care of ourselves, sleeping well, eating at good times and having good habits that will not only have a positive impact on our lives but will also allow us to correctly carry out our profession.
Respect for the patient is applied in any conversation that refers to them, that is, Any conversation that deals with the patient is a conversation with the patient and, even if they are not in front of them, the language must be careful., do not use stigmatizing or pejorative labels (e.g., the schizophrenic, the fat woman…). If you talk to another colleague about the patient, it should be done to try to improve the case, not as a way of gossiping or venting.
As psychologists we have a lot of responsibility, manifested in the form of power over the patient. It is not that we dominate the patient, but due to the hierarchical and unequal structure in the therapist-patient relationship, we have a certain influence over his behavior as we are the expert party in solving psychological problems. This must be practiced with good will and respect.
We are human beings and as such we will make mistakes. This is normal, from which we should learn and seek advice. For this reason, it is essential that we look for a professional team, a group of colleagues who, with different points of view, training and experience, can help us avoid such errors or solve them if they occur. The supervision and support of other professionals will help us reduce the number of errors we can make.improving our clinical practice and ensuring that we offer the best therapy we can give.
Finally, we must understand that we do not have all the knowledge or capacity to be able to treat all the problems that a patient may bring. That is why it is very important, especially with the first patients, to restrict the cases, choosing only those that we are sure we can handle. Naturally, throughout our professional career we will expand our acting capacity by doing specific training, but for now let’s play it safe.
1. Defining our identity
A question that is essential that we have answered before carrying out the first clinical session is the following:
Who am I as a psychotherapist?
Our identity as psychotherapists is a very complex and varied issue., which although difficult to describe on paper, it is very necessary to understand what it is before working with people, each of them with their own identity and way of seeing life. It is clear that our identity is something extensive and unstable over time, but that does not mean we cannot stop making the effort to be able to delimit it and, if we find a problem that gets in the way of our clinical practice, reflect on how we can do it. get over.
Among the questions that we can ask ourselves to obtain an answer to the previous question we have:
All these questions must be answered before starting psychotherapy.. As you can see, some are easier than others, such as the psychological problems we prefer to deal with (e.g., depression, anxiety, family dynamics), the psychological orientation we are most comfortable with (e.g. , cognitive-behavioral, systemic, psychoanalytic…) and specific training for the type of therapy that we are going to perform.
However, the rest are more complicated to answer and require a more extensive reflection process. An example of this is the one that deals with stereotypes, stereotypes that not only the patient has about what psychotherapy is, but also that we ourselves, still inexperienced, may have deeply internalized. We will detect these stereotypes throughout our professional practice.and we will acquire tools to manage them.
2. Take care of your appearance and non-verbal language
Although this is addressed throughout all clinical psychology subjects and also in subsequent training, the truth is that on many occasions, especially the most novice psychologists, forget how to behave appropriately in front of the patient. Although our intention is not to impress the patient, our goal is to be well prepared.dressing appropriately in comfortable but work clothes and showing a pleasant attitude but showing what we are, psychologists with the intention of helping another person.
Non-verbal language is very important in psychotherapy, therefore, we must take into account the following aspects that are included in Beitman’s SOLER technique (2004):
3. Take care of the space
Ergonomics is a discipline that many ignore and even despise, but it is actually very important. take it into account in every workplace and psychologist consultations are no exception. The consultation should offer calm, relaxation, peace, security and trust, a place where the patient should feel comfortable opening up to a stranger.
Everything, absolutely everything, must be taken care of and although we are still inexperienced in caring for patients, this is an aspect that should not be ignored. Ideally, light tones predominate, with whites, grays, blues or even vanillas, colors that give a feeling of rest, tranquility.. Neutral and cold colors are preferable to warm ones.
The space must be adequately acclimatized, although preferably tending towards the cold. It is better for the patient to feel a little cold and provide him with a blanket before he feels hot, a feeling that can overwhelm him and make him leave the consultation when there is a moment in which a complicated topic in his life history is addressed. In any case, and if the patient asks us, we can regulate the thermostat or open a window as appropriate.
We must also control aspects that may seem unimportant but that influence the patient’s memory. Among these aspects are smells, preferably they should be relaxing and the same one should always be used to generate a feeling of familiarity over time. You should also control the light, use the same color bulb and, if possible, use lamps with different intensities. to change it when doing a relaxation exercise in the office.
Finally, the arrangement of the objects must also be careful. Order is fundamental in any consultation, since it must give the patient the feeling that they are going to a place where they are going to structure their life a little, which in itself can be tremendously chaotic. Additionally, we must place distracting objects out of the patient’s view, such as books, figures, and mirrors. If possible, When the patient is face to face with us in the consultation, there should be nothing behind us that draws too much attention.
4. What should we observe in the first contact?
Both with our first patient and with the rest we are going to treat, it is essential to pay attention to what he or she is like and how he or she appears during the first contact. We must take into account everything that our senses can capture, as well as the emotions, feelings and thoughts that our patient reports feeling. It is very important to understand that this It is a collection of data, not an interpretation. The observation must be made free of interpretations and value judgments.
Some of the things we can look at are whether the patient is well or poorly dressed, appears nervous, agitated, sweats, how he smells, at what rate he speaks, if he overbreathes, if verbal and non-verbal communication are coherent, if has wanted to come on his own or has been forced, if he is accompanied…
We must do all these things to observe in the most neutral way possible. It doesn’t matter what we believe in this first session. We must put ourselves in the person’s shoes and try to understand them, even if they say things that may clash with our values. This does not mean that we should justify his comments or actions, but it does mean that we should understand why he did it.
It is not necessary for them to tell us everything in the first session and, in fact, that is very difficult to happen., it is almost not even recommended that it happen. The reason for this is that the patient, on his first visit to the psychologist, finds himself in a tense, unusual situation, something that is not comfortable for him. Making this situation more invasive than it already is by subjecting the patient to an extensive interrogation will only result in us obtaining a lot of information, but this will remain stored in a folder forever because the patient will not return.
It is for this reason that in the first contact we must ask the right questions, those that the patient wants to answer and that we perceive that it will not be unpleasant for him to answer them in this first session. We may have a clinical interview on hand, with all kinds of questions to understand the patient’s entire problem, but for now the best we can do is give a few insights into the reason for the consultation. The idea is that this first session generates trust and securitythat the patient sees it as a pleasant place and wants to return.
It can always happen that in this first session the patient wants to know what we think as psychologists. This is not something we can tell you, since to begin with we still do not know it very well and we are in the first session, in addition to the fact that our task is not to “believe” or “think” giving our values, but rather our clinical criteria. . We can reply that we find it interesting that you are interested in what we might think, but We must emphasize that our values are not important, but rather what the patient needs and wants to tell..
The healing part of psychotherapy is not only in the readjustment of the patient’s cognitive processes, their belief system and the acquisition of relaxation and confrontation strategies in the face of the problems of their daily life. This healing part is also found in the development of a basic attitude of understanding, approach and acceptance on our part that the patient or client perceives. A patient who feels that her therapist is there to support him, always from a professional perspective, is a patient who will most likely improve.
5. Knowing how to organize time and information is key
A large part of the work that the psychologist must face each day does not occur during therapy sessions, but between them. To manage all this information and avoid problems, it is advisable to use centralized information management platforms, such as Eholo, one of the most used.
Eholo is a digital platform created especially for psychologists and psychological centers, with which each professional will be able to organize all those logistical elements that are necessary to work: you will be able to schedule sessions both in person and online, automatically transcribe the content of the sessions by video call, create personalized files for each profile in the cloud, set reminders, allow each client to schedule their own visits on their own from the public agenda, send digital informed consents to each client, develop and assign clinical records so that both you and you can consult them other professionals and make secure and encrypted video calls, among other things. You will find more information about Eholo on this page.
The basic principles of the patient
Although this is addressed throughout the career, every psychologist must be very clear about the following points regarding patients:
1. Patients do the best they can
It may not seem like it at first, but all patients try to do the best they can. They may demonstrate it at a different pace, and they may not do all the things we have told them to do, but The simple fact of introducing certain changes in their lives is already a big step for them..
2. Patients are responsible for their change
Even if they were not the cause of your problems, they are responsible for changing them. Naturally, they go to therapy to obtain the necessary tools to overcome their problems, but the ones who make their lives change are themselves. Us We cannot force them, what we can do is advise them and give them the tools to promote change..
3. The life of patients with suicidal thoughts is unbearable
You should never underestimate someone’s suicidal attempt or suicidal ideation. There is a widespread assumption, even among professionals, that many people who say they are going to commit suicide actually do so to attract attention.
Even if this were the case, we must understand that no one threatens such a thing just because, but rather that his life is being something really complicated, he is almost at the limit and needs help. The life of a patient with suicidal thoughts, even if he does not threaten to do so, is truly unbearable.
4. Patients do not fail, psychotherapy fails
If a patient does not improve with the psychotherapy that has been applied or has simply abandoned it halfway through the process, We must be responsible and understand that it is not him who has failed, but our psychotherapy..
This does not mean that we are bad professionals or that we have not used tools that work, but that the specific case required another type of intervention, one less intimidating, to prevent him from giving up, and more adapted to his needs to motivate him to improve.
If the patient does not show signs of improvement but is interested in continuing to see a psychologist, what can be done is to change the course of the therapy or refer him to another psychologist who we consider is more qualified to treat his particular case.
