The First Kiss

1. Undo the Intake Model; Prioritize Client Engagement

The way we were trained to conduct a clinical intake assessment does not engage clients.

Engagement over intake. Many clients disengage after the first psychotherapy session because the traditional "Intake Model" prioritizes gathering comprehensive information over establishing a deep connection. This approach, while seemingly logical for assessment, often leaves clients feeling unhelped and unheard, leading to high dropout rates. The author advocates for an "Engagement Model" that focuses on creating emotional safety and a holding environment from the outset.

Client-centric approach. The Engagement Model shifts the focus from what the therapist needs to know to what the client needs to receive. It acknowledges that while some background information is necessary, it's not essential to know everything immediately. The primary goal is to lay the groundwork for deep engagement, ensuring the client feels understood and valued, rather than just assessed.

Beyond information gathering. The core of the Engagement Model is to answer the client's unspoken questions: "Can you relate? Can you appreciate the depths of my suffering? Do you understand me at a deep level?" By prioritizing connection, therapists can ignite hope and facilitate growth, making the client feel a pull to continue the therapeutic journey.

2. Focus on the Client's Single Highest Priority

What is one thing that my client needs help from me right now and is willing to work on in the first session?

One priority, not four. The traditional Intake Model often focuses on the "4 P's" (Predisposing, Precipitating, Perpetuating, and Protective factors), leading to a diffused focus. The Engagement Model, however, advocates for narrowing down to "1 P" – the single most important thing the client needs help with right now and is willing to address in the first session.

Intentional constraint. Having multiple priorities dilutes focus. Like blinders on a racehorse, an intentional constraint helps therapists concentrate on the client's immediate, highest priority. This doesn't mean ignoring other issues, but rather ordering and ranking them, understanding that trust is earned, not given, and clients may not return if their most pressing concern isn't acknowledged.

Law of sacrifice. To achieve something of greater value (client engagement), therapists must be willing to sacrifice something of lesser value (a comprehensive, multi-faceted assessment). This means accepting that a complete psycho-social history or detailed attachment history might not be fully explored in the first session if the client's current anxiety or pain point is paramount.

3. Avoid "True But Useless" Information; Seek Consensus

In the first session, don’t go digging around for “true but useless” (TBU) information.

Beyond archaeology. Therapists are not archaeologists; the first session is not for digging up every past detail, especially if it's "true but useless" (TBU) to the client's immediate engagement. An overemphasis on gathering facts can inadvertently re-traumatize clients or disembody their experience, particularly if there's no consensus on delving into sensitive areas.

Earn the license to pry. Starting a session like a truth-seeker risks alienating clients. Instead of pushing for background information that might not be immediately relevant, therapists should prioritize developing an emotional bond and gaining consensus on what to discuss. Trust that relevant issues will emerge naturally when the client feels safe.

Effective focus. The Intake Model often fails to commit to an effective focus, getting lost in TBU information. An Engagement Model, conversely, develops a sharp, emotionally charged purpose for therapy. Just as a magnifying glass focuses sunlight to create smoke, an effective focus concentrates therapeutic energy on the client's most pressing, agreed-upon concern.

4. Use Questions to Listen, Connect, and Heal

When used appropriately, questions are more than an assessment tool. Questions have an emotional impact.

Questions as connection. The Intake Model views questions primarily as assessment tools, leading to "questioning sessions" where clients feel interrogated. The Engagement Model, however, uses questions as a means to listen deeply and connect. Smart listening requires smart questioning, moving beyond lineal (who, what, when, where, why, how) questions to more exploratory and influential types.

Types of impactful questions:

• Circular Questions: Explore interconnections and bi-directional influences (e.g., "Who in the family thinks this is a problem?").
• Strategic Questions: Aim to influence, empower, and mobilize stuck situations (e.g., "What happens if we transform your judging mindset into a learning mindset?").
• Reflexive Questions: Generate possibilities and open up new perspectives (e.g., "What does he/she bring out in you that you like about yourself?").

Healing through inquiry. Thoughtful questions can have a profound healing effect, fostering self-reflexivity and personal agency. Instead of seeking confirmation, therapists can intentionally seek disconfirmation, opening their ears to new perspectives. Giving clients time to process questions and allowing their responses to sink in demonstrates reverence and deepens the therapeutic relationship.

5. Give a "Gift" in the First Session

Instead of just “taking” information, we need to give our clients something to hold on to in the first session as well.

Receiver-focused gifting. Unlike gifts that focus on the giver (e.g., a wedding souvenir with the couple's names), a therapeutic "gift" should focus on the receiver. This means providing something meaningful for the client to take away from the first session, influencing their prospective memory and future recall of the encounter.

Forms of impactful gifts:

• A Story: Relevant fables or parables that resonate metaphorically with the client's struggles and potential resolutions.
• An Aphorism/Equation: A concise, witty statement of truth or a simple equation written on an index card, capturing the essence of a key takeaway (e.g., "Failing is not the same as Failure").
• A Symbol: An image or drawing that speaks to the client on an emotional level, representing a vital takeaway point (e.g., a heart symbol for "Heart out" to encourage reaching out).

Meaningful imprint. These gifts illuminate, create a memorable imprint, and provide a tangible association with the therapeutic work. They are not meant to be rigid or universally applicable; if a gift doesn't resonate, the therapist should be willing to abandon it. The goal is to create a meaningful and sustaining impact, giving clients something to hold onto until the next session.

6. Orient, Reveal, and Regulate Anxiety to Start Strong

In the next hour, I want you to treat this space as yours. I want you to feel emotionally comfortable and safe being here with me.

Setting the stage. The first few minutes of a session are crucial for organizing both the therapist and the client. This involves three key actions: orienting the client, revealing aspects of oneself, and regulating in-the-moment anxiety. Skipping these steps can lead to client "resistance" or disengagement.

Orienting for safety. Orienting means clearly defining the space and process. This includes:

• Stating the room is the client's safe space.
• Explaining the session structure (e.g., asking questions, providing feedback, assigning tasks).
• Mentioning administrative details like confidentiality and the use of outcome measures.
• Asking how they found the service and their prior therapy experience.

Vulnerability builds trust. Therapists should volunteer personal information they are comfortable with, humanizing themselves to establish an immediate, deep connection. Social psychology shows that self-disclosure from one party encourages the other to open up, fostering mutual trust and helping clients see the therapist as authentic.

Addressing present anxiety. Directly asking, "What is it like for you to be here right now?" helps clients acknowledge and regulate in-the-moment anxiety. This question permits them to feel their feelings, often leading to an emotional discharge. If a client freezes or tries to rush, slowing them down and helping them connect with physical sensations of anxiety can be profoundly regulating.

7. Follow Both the Client's Pain and Their Spark

Find a place inside where there’s joy, and the joy will burn out the pain.

Dual compass. Effective therapy requires a dual compass: following both the client's pain and their spark. While "following the pain" involves making room for and deepening the experience of complex emotions without soothing too quickly, "following the spark" means identifying what genuinely interests and energizes the client.

Deepening pain for healing. Unlike friends or family who might divert from painful topics, therapists must create a healing presence that allows clients to explore their suffering. This can be done through empathic reflections, slowing the pace, and communicating attentiveness, facilitating healing rather than premature closure.

Activating resources. "Following the spark" involves asking about interests, hobbies, and what brings joy. This isn't just small talk; it's about "resource activation." Research suggests that eliciting problems alone doesn't predict good outcomes; activating client resources is crucial. Weaving interventions around these sparks can help clients use their passions to address their problems.

Movement requires both. Just as walking requires both a left and a right foot, therapeutic movement needs both pain and spark. It's not enough to cheerlead or solely build on strengths; integrating both aspects creates a holistic and dynamic approach to change.

8. Clarify Roles and Raise Expectations for Therapy

If we can influence a person’s expectation of therapy, we stand a chance of increasing engagement and the likelihood of a good outcome.

Expectation shapes reality. Therapists should never assume clients know what to expect from therapy. Explicitly managing and optimizing expectations creates predictability, which in turn fosters a sense of control for the client. This involves clarifying the roles of both the therapist and the client, and raising expectations for the therapeutic process itself.

Defining roles. Ask clients directly, "What role do you see me playing in our work together?" and "How do you see your role in our sessions together?" Be prepared to propose a cogent metaphor for your role (e.g., an "auxiliary mind," a coach) and outline typical in-session and between-session activities (e.g., exercises, tasks, reflections). This invites clients to become active agents in their change process.

Optimizing belief in change. If a client expresses low initial treatment expectations, address their beliefs about therapy, past experiences, and any blocking myths. Provide a clear rationale for the process, including:

• Explicating roles.
• Suggesting meeting frequency (weekly initially for optimal gains).
• Preparing them for struggles as they step out of their comfort zone.
  Influencing expectations significantly increases engagement and the likelihood of positive outcomes.

9. End with Impact and a Call to Action

And to make an end is to make a beginning. The end is where we start from.

The peak-end rule. Memory is biased towards remembering the peak and the end of an experience. Therefore, how a therapist closes the first session can leave a lasting imprint on how the client remembers the entire encounter. The goal is to create an emotional impact, not just to handle administrative matters.

Creating a memorable close:

• Sum up: Connect the dots of the session's key themes.
• Preview: Give a hint of what's to come in future sessions.
• Share feedback: Offer your reflections and impressions.
• Client reflection: Ask, "What's the one thing from this session that struck you the most?"
• Tangible takeaway: Write down a key pointer on a post-it or index card for the client.

Call to action. Concluding with a "call to action" conveys confidence that therapy is about creating real-life change, not just talk. This can involve:

• An Experiment: A behavioral task for the client to try (e.g., observing thoughts in social situations).
• Attentional Focus: A key sentence or word to remember and hold onto.
• A Reflection: Journaling or discussing the session with a trusted friend.
• Self-Prescription: Encouraging clients to identify what they feel compelled to do.
  These activities extend therapeutic engagement beyond the session, seeding change in the client's daily life.

10. Embrace Routine Outcome Monitoring and Formal Feedback

What gets measured, gets managed.

Measure what matters. Routine Outcome Monitoring (ROM) is crucial for both evaluating service effectiveness and improving quality in real-time. Using measures like the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) at every session allows therapists to track client well-being and engagement, making the data visible and integrated into the therapeutic conversation.

Beyond pre-post. Relying solely on pre- and post-treatment measures is insufficient; it's like driving blind. Session-by-session ROM provides continuous feedback, allowing therapists to:

• Identify significant improvements or dips in client progress.
• Enquire about factors contributing to gains or setbacks.
• Adjust interventions to better meet client needs.
• Establish a baseline for the client's "hero's journey."

Data informs intuition. While intuition is valuable, it's prone to overconfidence bias. ROM provides objective data to complement clinical judgment, helping therapists spot deterioration and refine their practice. By using ROM as a conversation tool, therapists can deepen engagement and ensure their work is truly client-centered.

11. Record and Score Your Sessions for Deliberate Practice

In order to get better, we need to counteract flow states, and seek to judge the way we perform, especially in our first sessions.

Objective self-assessment. Just as musicians and athletes review their performances, therapists need to record their sessions to objectively assess their work. This "deprivatizes" psychotherapy, moving beyond biased recall to a fact-based review of interactions. Recording sessions, especially the first ones, is invaluable for identifying specific areas for improvement.

The Impact of Session Grid (ISG). To make recordings actionable, therapists can use tools like the Impact of Session Grid (ISG). This involves segmenting recordings into 5-minute blocks and rating the "vitality" or impact of each segment. This structured approach helps therapists and coaches identify:

• Moments of strong engagement or disengagement.
• Areas where the session felt "lifeless" or "dynamic."
• Specific interactions that led to positive or negative shifts.

Learning from the "dead" and "dynamic." A "dead" session might show a flat line on the ISG, indicating a lack of movement or direction, while a "dynamic" session would show peaks of engagement and emergent themes. By analyzing these patterns, therapists can pinpoint specific behaviors or interventions to refine, moving from a non-dynamic "Intake Model" to an impactful "Engagement Model" that guides clients through a "Hero's Journey" of setup, confrontation, and resolution.

12. Understand Your Own Circle of Development for Growth

Revere your Panic Zone and direct all your energy toward your Learning Zone, and watch it slowly evolve into your comfort zone.

Therapist's growth edge. Just as clients have a "Circle of Development" (Comfort Zone, Learning Zone, Panic Zone), therapists must identify their own to guide professional growth. This self-awareness clarifies what to work on, magnifies focus, and informs how to approach each first session.

Defining your zones:

• Comfort Zone (CZ): What you do well and are used to. While good, staying here too long can lead to stagnation. (e.g., "Providing clear and playful strategies to clients.")
• Learning Zone (LZ): The optimal threshold just beyond your current ability, where growth happens. This should be based on aggregated outcome data and coach feedback. (e.g., "Learning to help clients face feelings they avoid.")
• Panic Zone (PZ): The tipping point where you become overwhelmed, leading to fight, flight, freeze, or sleep. This defines what not to focus on for now. (e.g., "Trying to improve in more than one area at a time.")

Iterative refinement. Your Circle of Development is dynamic and evolves. Regularly revisiting and revising your learning objectives, ideally with a coach, ensures continuous, focused improvement. Protecting time for this deep learning is crucial, as it inoculates against burnout and replenishes energy. By intentionally stretching into the Learning Zone, therapists can expand their Comfort Zone and enhance their effectiveness.

Last updated: December 1, 2025