Session One - Client Centered Counseling (Carl Rogers)

Before the booked appointment time, reception has called Joan to let her know her 11 am client has arrived for her first session which will employ Client Centered Counseling.

You may wish to review Client Centered Counseling Theory. I encourage you to print "Session One - Client Centered Counseling" for easier reading.

If Joan had been still meeting with an earlier client, she would have ignored the phone but checked the time. It is crucial for a counselor to stick to one’s time, out of respect for the next client.

Joan’s 10 am client has left and Joan is just finishing the notes. Joan still has five minutes so makes sure she is fed and watered and comfortable so she can fully focus on this person.

At 10:02 Joan goes out to the waiting area. There are a few people there. Joan smiles and says, “Hi there! I’m Joan.” Her client knows who she is and in this way Joan does not have to announce the client’s name. But if there is no response, she could say, “I’m looking for Mary.”

Mary looks up and smiles, Joan and Mary shake hands and Mary accompanies Joan to her office. Joan makes small talk along the way to help keep Mary calm – while this is an everyday thing for Joan, this is a first time for Mary.


Introduction - The First Ten Minutes

Joan shows Mary into her office for her first session. First impressions are lasting impressions. Joan, as far as her colleagues are concerned, dresses a little too casually. This does not convey a professional look. And her office is eclectic – fish tanks with peculiar objects in them, bamboo shoots in a variety of types of jar, artwork from China as well as the Ladies Auxiliary, cat mug and cat calendar, etc. She is taking a risk. Some clients could find this very off-putting – they want a professional therapist not a nursery school teacher.

At the same time, Joan and her office are neat and clean. The environment she is trying to achieve is “favorite Aunt” or genuineness since she is not a distanced specialist. She is a counselor, a listener, an advocate, a helper.

Joan offers Mary a glass of distilled water or a vitaminized milk drink and makes the offer of an apple or granola bar. This is because she likes to offer hospitality and because sometimes her clients don’t eat well. Low blood sugar clouds thinking. Mary goes for a water and a bar to eat later.

Joan explains how this session will look.

1. There is a very Initial Assessment Form to fill out.

2. There is an Assurance of Confidentiality to sign and witness.

3. Mary, as a voluntary client, has the right not to answer any of these questions.

4. This form-filling-out won’t take very long.

The form provided by her agency requires very little information. Joan skips the part about “reason for the visit” and will fill it in later. This is because she does not want to interrupt her client once she starts talking about her situation. While Joan does counseling from a face to face perspective – she fills out the form sitting almost side by side with Mary so that Mary can see what it being written down. This builds trust. Joan assures Mary that “what’s said between the walls, stays between the walls” except in four situations:

1. Children are being neglected or abused.

2. The Court subpoenas Mary’s chart. (Unlikely, but client needs to be told this.)

3. Client is leaving with the intent to commit serious physical violence against another person.

4. Client is leaving with the intent to commit suicide or serious violence against herself.

Joan explains that in situations three and four she would try to have Mary voluntarily go to Crisis Intervention at the hospital and would try to have her accompanied. If Mary refused, Joan would immediately consult her supervisor regarding the next step.

Office protocols differ from place to place, but it’s safe to say that in situation one the Children’s Aid Society may need to be contacted (depending on severity reported. Habitually forgetting to pack kids’ lunches is very different from beating them with an implement.)

In situations three and four it is likely the counselor and supervisor would have to call security or the police.

It is important to point out that situation one is normally handled by the CAS. Situation two is a rare occurrence but a good reminder to take careful notes, and three and four are not the norm either. Of course, the setting you work in affects this – but as a student, volunteer or “newbie”, you will be normally be shepherded and protected by your mentor in any event.

OK, the form filling is over. Thank heavens! Boring but necessary and if you are really listening you may already be forming some insights into your client.



Information Gathering - The Next 20 Minutes

Joan makes sure her body language is open, her tone is friendly and calm. She wants to convey empathy and acceptance so that Mary will feel free to open up. Joan reaches for a pen and a small note pad which can rest discreetly on her lap, and she asks the open ended question, “So what brings you in here today.”

Mary bursts into tears. When Joan first started counseling this bothered her. Now she sees it as a good sign and offers Mary some tissues which she has on hand. Joan knows that if Mary cannot stop crying, offering her a glass of water will help. For reasons unknown to Joan, drinking water slows the weeping down enough for that the client can talk.

Mary doesn’t know where to start so Joan says, “Start anywhere…” After about fifteen minutes or so Mary has listed a number of concerns.

1. She feels weepy “all the time.”

2. She’s failing at school.

3. She thinks her boyfriend doesn’t love her anymore.

4. Her parents are driving her crazy with their phones calls and insistence she be a straight A student.

• Joan has tried to use active listening but has had to work at it. When Mary’s talked about crying jags, Joan wanted to interrupt her and tell her about the virtues of crying – but this is Joan’s turn to talk and talk and talk.

• When Mary mentioned not doing well in school, Joan noticed herself settling back in her chair and crossing her arms – not an inviting posture. Joan might interpret this as a criticism or judgment. She discreetly corrected this.

• When Mary wanted to talk about her boyfriend, Joan wanted to say, “Why do you think that!?” But the “why” question can seem very caustic.

• And when Mary mentioned her parents, Joan immediately started to think about the last time she called her mom. Had it been three weeks? Oops! Get on track!

To keep herself on track and for charting later on, Joan finds it helpful to write down some key words for note taking. This time she wrote:

- lots of crying

- worried about school

- boyfriend? love?

- parents phone, relentless

Some of Joan’s colleagues are able to discreetly chart and counsel at the same time – Joan isn’t able to and that is fine. During a student placement Joan was in a session where the social worker typed her notes on a laptop while the client talked. The “clickety clickety” combined with the attention given to the laptop made Joan wonder if perhaps it was the computer that was there for counseling!

• Joan was happy she knew her basic counseling skills. At one point Mary, when talking about crying, said, “I have another friend, Susan, who cries and cries. And she … blah, blah, blah.” Joan was able to redirect her by saying, “I’m glad you have a friend like Susan. Can you tell me more about the times or things that seem to make you cry?” To practice client centered counseling also means keeping the client on topic.

• Mary sounded like she was failing all her courses. So Joan asked her a closed question – “How many courses are you failing right now?” It was only one!

• At one point Mary seemed very unclear about Joan’s relationship with her boyfriend Andy. Did Andy not want to be with Mary at all or did he just not like it when she cried? Joan was able to use paraphrasing to get a better grasp of the situation, saying, “What I think I hear you saying is that Andy is uncomfortable when you cry and may leave the room when you cry?” Mary says, “Yes, that’s how it is.”

• And when Mary was talking about the parents, at one point Mary just clammed up. She wanted to say something, but couldn’t. So Joan used an active listening technique, “Tell me more about how you respond when your mom calls?”



Discussion - The Next 10 Minutes

Now Joan needs to take the material Mary has given her and paraphrase it so that it is clear, “itemizable” and something that can be worked on. Joan is always discreetly keeping an eye on the clock – she has it on the shelf just behind the clients head. The client doesn’t even know it’s there.

Joan says in a friendly tentative tone, “OK Mary, I need to review with you the things I think are the ones that are bothering you, and then we can decide which one you’d like to work on first.” Joan is about to paraphrase. I have put in numbers for the reader’s help, but Joan doesn’t use them.

1. “It sounds like you are crying a lot and you don’t feel you have control over when it’s going to happen and how often.” Mary nods her head, “That’s right.”

2. “It feels like you are failing all your courses but there is only one course you are failing right now.” Mary says, “Just one course I’m failing – but I am not doing as well as I could in all of them.”

3. “Your boyfriend is a nice guy but he is getting frustrated with the crying. He claims he loves you even if he doesn’t say it unless asked.” Mary says, “Yeah…”

4. “And your parents, well they obviously care a lot. But they call so much you no longer want to pick up the phone. Especially since you got a D on your last essay.” Mary responds, “Yes, I sound like a terrible daughter, don’t I!?” Joan doesn’t want to go down that road right now so she uses a close-ended response, “No, you don’t!”

*****

There is no way that all of these can be worked on today so Joan asks her, “What do you want to address first!?” Mary is emphatic, “I can’t deal with the others until I can deal with the crying.”

There is nothing Joan would love to do more than preach at Mary about steps she needs to take to stop crying and start living and give her a fact sheet. But that would make Mary feel horrible – like she was failing even more. And Joan doesn’t live in Mary’s body 24/7. Mary knows but needs to think about it, be able to describe it for herself, listen to what she has said, and thereby get more perspective on it. Joan's job is to provide a growth promoting climate.

It is now 11:40 and time to starting winding down – at the time they just are getting started. It would be tempting for Joan just to skip her lunch and keep going with Mary. And in an emergency – for example if Mary had to be taken to the hospital by taxi – Joan might have to in order to accompany her (to make sure she goes and stays.)

But Joan knows that:

1. if she burns out by not taking her breaks, she’ll be no good to anybody. She has learned this by experience as have most people in the counseling profession.

2. If this was a 10 am client, she would have to be winding down now to permit note taking, a three minute run to the lady’s room, and still start the next appointment as close to 11 as possible.

3. In fact Mary has already done a huge amount of work today.

i. She had admitted she has problems and she needs some help – the first and biggest step.

ii. She has thought about them, said them out loud and had them repeated back to her, therefore she is more aware of what it is that is bothering her.

iii. By doing step ii she already has some perspective on her problems.

iv. Because her counselor is so affirming and understanding, Mary knows that these challenges can be dealt with.

4. Homework will extend the session and learning into the whole next week!

Joan says, “Mary, I need you to know that what you are describing – while very difficult for you – is very ‘doable’ for you. These are challenges that many people face and by acknowledging you have problems, reflecting on them, and explaining them to another person – in this case, me – you are well on your way to dealing with them.” Joan is careful to reflect content and feelings.

Joan continues, “Mary I want you to chart your crying this week. Here is a seven day or weekly time chart that I use for time management but also works for mood mapping. I am asking you to rate your mood on a scale from one to five – one is very sad – three is neutral – five is very happy. If you like you can draw faces instead. Instead of hourly, I’m asking you for your general mood from when you wake up until noon, noon to three, three to six, six to nine, and nine to when you go to bed. I also want you to chart what you are doing during this time – where you are and with whom. There may be some patterns here. Bring this with you to your next appointment so we can review it and strategize.”

As part of her holistic health approach, Joan requires all of her clients to have a wellness appointment to rule out health concerns. “Mary, I need you to book an appointment with your family doctor or nurse practitioner to have a health check up. You need to book that today. Sometimes the reason we are not feeling well is that we have a physiologic problem – for example, low hemoglobin, low blood sugar, low thyroid, high blood pressure, and that sort of thing. By getting that adjusted, we will start to feel better physically as we feeling better emotionally. The secretary will be happy to let you use her phone.” Joan is not using “we” in a condescending way. She means “all of us” – not just Joan.



Conclusion - The Last 10 Minutes

Joan gives all of her clients her “business card” which is really an information card with emergency numbers on it. The health services number is on it.

Joan Smith MA RSW

 joan.smith@college.com

 123-4567 #8910

 www.college.com/joan-smith

Important Numbers

 emergency number: 911

 24/7 crisis intervention: 234-5678

 warm line: 345-6789 – 8 to 4, Mon to Fri, except holidays

 health services appt: 123-4567 #5678

 counseling appt: 123-4567 #4321

It is crucial for clients to know they are never alone. There is always someone "there to care." Joan encourages her clients – if they are having a particularly difficult day – to leave a message on her answering machine or email her. Within two days, Joan will make a quick follow up call or email – just to assure the person that she or he has been heard and this concern can be addressed at their next appointment.

The Goodie Bag

Joan knows that her clients may never remember what she said, but they will remember how she made them feel. So all of her clients get a goodie bag at their first visit – it’s a gift bag or cloth bag with information and items that are useful and fun. See Handouts for more on this. Journal and Pen

Joan also encourages her clients to accept a simple notebook or journal and a colorful pen to jot things down with over the next few weeks. As they reflect on themselves and their relationships with others, they may have interesting dreams or insights “out of the blue”!

*****

As the client is getting ready to leave, Joan asks her if she has anything to look forward to over the next few days and pushes at Mary until she comes up with them. Mary admits she and Andy are going to a movie, her next step is a coffee with her friend Sally, and her favorite TV show is on tonight.

If Mary could not come up with anything at all, Joan would have to ask Mary if she was thinking of hurting herself, of committing suicide. And if so, Joan would follow the office protocol regarding suspected suicide risk. But to be honest, if the client was suicidal, Joan would have had some indications earlier on and would have gotten help from her mentor or supervisor.

Joan reaches out her hand to shake Mary’s and thanks her for coming in and walks with her toward the desk where Mary can make another appointment. She is encouraging Mary to come in once a week for the next three weeks. This is a matter of routine. If the client doesn’t book there and then, she might not. And even if she calls a week later, the appointment spaces that fit with her classes may be filled already.

At Joan’s workplace, hugging the client is not permitted. Clients are vulnerable and actions can be misinterpreted. If the client hugs Joan, Joan is careful not to embrace but to put her hands warmly on the clients arms and assure her that she is a good person, and she can do this.

*****

Sounds overwhelming? It’s not. Remember that...the most important thing is that the client feels she/he was listened to, was heard. And that, because you are there and you care, there is hope, there is a future.
- / jan

End of Client Centered Counseling Sample Session


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