Speaker 1: What's up everybody, I hope you're doing well. So lately I've kind of been thinking about those aspects of therapy that are so kind of just ingrained, default, innate, that at least in my circles we don't end up really talking about them all that much. And I thought today we might talk a little bit about how to structure the beginning of your therapy session. Now before getting into this video I want to make clear that I'm just kind of sharing my own personal reflections about what I think is important to consider at the beginning of a session, and also your individual licensure jurisdiction may have its own legislation and ethical guidelines for how you're expected to conduct the beginning of your session, so make sure you're also brushing up on those things as well. Okay now let's get into these tips. So my first tip for how to structure the beginning of your therapy sessions is before the session's ever even started, and that's to be prepared. This just takes like one to two minutes of my time per client. I'm looking back at the old note just to see what are the treatment goals we're focusing on right now, how did we focus on them last time, and should we continue that thread for today? What would that look like in today's session? On my particular therapeutic approach I am always happy to deviate from whatever thread we were on last time to pick up on some new direction based on what's come up, but it's also really helpful to make sure we're holding the frame of here's what we've been working on. Should we continue with this thread or are we choosing to intentionally move in a different direction? And my next tip for how to structure the beginning of your sessions is start on time, please. Now there are definitely one-off times where I start session one or two, maybe three minutes late, but if this is happening consistently for you or you're getting much later than that in starting your sessions, that is a problem. It's like before your session's even started your client is already getting this impression of you that you don't really have time for them, you have other priorities, so that's not really a good foot to start off on. The next tip for how to structure the beginning of your sessions is for however you structure things to keep it fairly consistent. Again you can always deviate from your structure, but if you have a consistent structure that you pretty much stick by every single time you meet with your clients, then that sense of routine creates its own type of safety for your clients. The consistency also creates like helpful cues like, oh we're entering the therapy session now because Marie is saying the same thing, she kind of says every single time. So keep that value of consistency in mind as we continue to talk about the rest of the tips here. The next thing to consider for how you structure the beginning of your sessions is what sort of niceties or like kind of polite remarks you might offer at the very beginning of your session, or particularly for in-person sessions, that time between seeing your client in the waiting room and walking into the office. Personally I feel most comfortable offering some kind of polite commentary that is not related to what we're doing in therapy at all, because we're like walking in a semi-public space in the waiting room and hallway, but I might say something like, oh it's so good to see you, or hey did you make it here okay in the rain outside? Of course this is something that's totally up to you, you can tailor it to your own style and therapeutic approach. Whether you decide to offer some sort of, you know, polite niceties or not, it is helpful to kind of have a sense of what's on brand for me in that sense, what aligns with my therapeutic approach, so that however I'm interacting with a client in the waiting room is consistent with what they're experiencing from me once we're actually in the session. And though it plays out a little bit different in virtual therapy because you don't have to walk from point A to point B, it can be worth considering whether you have any sort of niceties that you like to mention at the beginning of your session. The next tip is to consider what avenues of hospitality you might like to lean into at the beginning of your session. I talked about this in a recent video and you can make it your own, but I always like to kind of check in with my clients, like do you need something to drink, is the temperature okay, anything that might align with trying to help your client feel as comfortable as possible so that they feel ready to engage with the session. And the next tip is specific for virtual therapy sessions. It can be really helpful to do a check-in about technology, confidentiality, and also location. I almost always start off the virtual therapy session by saying something like, hey, can you hear me okay? Good, I can hear you also. Just kind of acknowledging that technology seems to be working okay or it's, I'm sorry, there's a little bit of an echo, can I try to adjust, change my volume, kind of situate ourselves within technology. We are also expected to know where our client is located just in case of some sort of emergency where we need to call for help for somebody to show up to them in person. With that said, it may not always be kind of therapeutically advantageous to say tell me your address every single time you see a client. I notice most of my clients tend to sit in the exact same spot every time we meet, and so I can just tell by looking at their background that yes indeed they're again in their home sitting in the exact same place as last time and every other time we've met. But sometimes I might log on to a call with a client, it looks like they're in their parked car or just in a different location, in which case I try to find a casual way to kind of check in and know where they're located. And then of course for virtual therapy sessions the confidentiality piece is just so much more challenging to kind of hold consistent because we can't control the environment that our client is existing in, so if there's any clues that we can see that maybe confidentiality might be compromised, we definitely want to check in on that and try to ensure confidentiality to the best of your ability. The next tip for how to structure the beginning of your sessions is as appropriate, have space for a safety and symptom check-in. Now again I said this is as appropriate because if you across the board asked every single person if they've thought about harming themselves or somebody else or if they've had any symptoms of depression, anxiety, if they've used substances, etc. It just wouldn't be appropriate to ask that for every single person. But depending on the population you work with and particularly specific clients needs, it may make sense to kind of have dedicated time at the beginning of each session to check in on somebody's symptoms. Having this right at the beginning of your session, it ensures that you don't miss anything important that might be going on such as, you know, significant thoughts of self-harm for example or other disruptive symptoms, and also it shows to your client that you care. And then after you've done all of these things, then you can sort of kick off your formal structure for your session. This obviously needs to be tailored to your specific therapeutic approach and to each specific client, whatever structure you're utilizing for your sessions. But whether you use a more structured or less structured approach, I find it helpful to still have some consistency in how you kick things off because this kind of helps clients know what to expect. I generally say kind of the same thing every single session, just in different paraphrasings. It's usually something like, so we can always pick up where we left off last time, or if there's something that's come up that feels relevant, we can start with that. Do you have a preference for where we start from? And this is where those preparations we talked about at the beginning really come in handy because I really love to be able to have a synopsis of like one to two sentences of saying, yeah, last time we focused on this, this, and this, and we kind of earmarked this other thing as something we could come back to or something you would work on. And then they generally go, oh yeah, you're right, okay. And we can kind of pick up from where we left off. And then of course, if something significant popped up since last time, then you know, I created the structure for them to kind of interrupt where we left off to say, oh actually, can we talk about this other thing that happened? And you know, we can just earmark where we left off to come back to later. Now even though it's taken me a while to list all of the tips in this video, in practice, it just takes one or maybe two minutes to run through all of these at the beginning of each session and then let the time be for the client to work through all the stuff that they're working through. So it doesn't have to take up that much space. But by having this set at the beginning of every single session, there's a sense of consistency, which helps foster routine, which helps foster safety. Your clients kind of know what they're stepping into every single session. And they also feel like you're prepared because you remember what we talked about last time, you showed up on time, you considered my needs by, you know, asking if I needed a glass of water, all these little things just add up. So your client could say, okay, let's get to it. And before we close, I'd like to thank TherapyNotes.com for sponsoring this video. Therapy Notes helps with scheduling, notes, billing. You can charge your client's card on file. They have a HIPAA secure telehealth platform and so many other features. If you'd like to check out Therapy Notes, you can get two months to try it for free with no commitment, just by clicking the link in the description of this video. Well, I hope you found this video helpful. And I'm aware as I make this video, that the structure that I'm describing fits for the type of population, the type of work that I do. And I'm imagining that as some of you are watching, you might be thinking, ah, Marie, you forgot this important piece, which might be relevant for somebody working in a different context. So if that's coming up for you, feel free to leave a comment below so other folks can kind of learn from your experience as well. And until next time from one therapist to another, I wish you well.