How do I 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 world of work. It is time to give psychotherapy.

We have the theory, and we also have some practice, but it usually happens that, like everything in this life, give the first step is something that intimidates us a lot, and more considering that our profession involves a lot responsibility.

Every psychologist asks "how to face my first patient in therapy", flooding him with a lot of doubts and fears before you have to see that first customer. Fortunately, here are some tips to help us get through our first sessions with patients and also incorporate them into our professional lives forever.

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Keys to know how to face your first patient in therapy

As much as we know, as much as we have internalized the whole theory of the degree of psychology and the corresponding clinical postgraduate training, the first patient is a person who intimidates. Naturally it should not, but the truth is that the absence of previous experience, beyond the practice that we gives the training, makes us, the therapists, go to the first interview with our first patient with

uncertainty, a bit of insecurity and even fear.

This is all normal. Really, as the people that we are, we cannot avoid having emotions when taking our first steps in the world of work, and much more taking into account that clinical psychology implies a responsibility as great as trying to improve the lives of others persons. However, we must always be very internalized that if we have managed to get there it is by something, and that something is that we are worth to practice psychology, we have the necessary studies to it. With calm, an open mind and a positive vision, we will know how to face our first patient in therapy.

Equally, there are hundreds of manuals, protocols and guidelines that teach us 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 novice psychologists, and also who already have some experience, should be considered and solved before giving the first sessions of psychotherapy.

Aspects to consider as therapists

There are many aspects when treating the patient that should not be overlooked 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 must have the same ethical code 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 of "At the blacksmith's house, 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 the patient to have good lifestyle habits while we do not follow them. We must take care of ourselves, sleeping well, eating at good hours and having good habits that not only will have a positive impact on our life but will also allow us to correctly exercise our profession.

Respect for the patient is applied in any conversation that refers to him, that is, Any conversation that deals with the patient is a conversation with the patient and, even if it is not in front, the language must be taken care of, do not use stigmatizing or derogatory labels (p. eg, the schizophrenic, the fat woman ...). Talking to another colleague about the patient should be done in an attempt to improve the case, not as gossip or relief.

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 some influence on his behavior as we are the expert part in solving problems psychological. This must be practiced with goodwill and respect.

We are human beings and as such we will make mistakes. This is normal, from which we must 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 view, training and experience can help us to avoid such errors or to solve them in case they are den. Supervision and support from other professionals will help us reduce the amount of mistakes we can make., improving our clinical practice and making sure that we offer the best therapy we can give.

Finally, we must understand that we do not have all the knowledge or capacity 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 capacity to act 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 issueAlthough 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 in time, but not for that reason we cannot stop making the effort to be able to delimit it and, if we find a problem that stands in the way of our clinical practice, reflect on how we can do it overcome.

Among the questions that we can ask ourselves to obtain an answer to the previous question we have:

• What are the most common problems we would like to address?
• Is there an orientation with which we feel more comfortable?
• What type of specific training do we have?
• What is the biggest stereotype we face as psychologists?
• What can we contribute to our patients as psychologists?
• What are our weaknesses? How to turn them into strengths?

All these questions must be answered before starting psychotherapy.. As you can see, some are easier than others, such as psychological problems that we prefer to treat (p. g., depression, anxiety, family dynamics), the psychological orientation with which we feel most comfortable (p. g., cognitive-behavioral, systemic, psychoanalytic ...) and specific training for the type of therapy that we are going to perform.

However, the rest are more difficult 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, can have very internalized. We will detect these stereotypes throughout our professional practice., and we will acquire tools to handle them.

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2. Take care of 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 properly in front of the patient. Although our intention is not to impress the patient, his is to be well prepared, dress appropriately with comfortable but work clothes and show 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 enter into the SOLER technique of Beitman (2004):

• S (Squarely): Face the patient, preferably at a 90 degree angle.
• O (Open): Control posture, avoid crossing legs and arms.
• L (Leaning): Lean forward showing interest and involvement
• E (Eye): Eye contact should be direct but not intimidating
• R (Relaxed): We must be relaxed, without expressions of distraction or concern.

3. Take care of the space

Ergonomics is a discipline that many ignore and even despise, but it really is very important take it into account in every workplace and the consultations of psychologists 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 treating patients, this is an aspect that should not be overlooked. Ideally, light tones predominate, with white, gray, blue or even vanilla, colors that give a feeling of rest, tranquility. Neutral and cool 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 warm, a sensation that can overwhelm and make you leave the office when there is a time when a complicated topic in your story is addressed vital. In any case, and if the patient requests it, 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 the smells, preferably they should be relaxing and it should always be used to generate a feeling of familiarity over time. You should also control the light, use the same color of the bulb and, if possible, use lamps with different intensities. to change it when doing a relaxation exercise in the office.

Finally, the arrangement of objects must also be careful. Order is essential in every consultation, since it must give the patient the feeling that he is going to a place where he is going to structure his life a bit, which in itself can be tremendously chaotic. In addition, we must locate distracting objects out of the patient's sight, 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 attracts too much attention.

4. What should we observe in the first contact?

Both with our first patient and with the rest that we are going to treat, it is essential to pay attention to how it is and how it 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 data collection, not an interpretation. The observation must be made free of interpretations and value judgments.

Some of the things we can look at are if the patient is dressed well or badly, is he nervous, agitated, sweats, how he smells, at what rate he speaks, if he overbreathes, if the verbal and non-verbal communication are coherent, if he has wanted to come on his own or they have forced him, if he comes 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 conflict with our values. This does not mean that we should justify his comments or actions, but rather understand why he has done it.

It is not necessary that they tell us everything in the first session and, in fact, that is very unlikely to happen, almost that it is not even recommended that it happens. 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. Make this situation more invasive than it already is by subjecting it to extensive questioning the only thing that will achieve is that we obtain a lot of information, but this will be kept in a folder forever because the patient does not go to come back.

It is for this reason that in the first contact we must ask the right questions, those that the patient want to answer us and that we perceive that it will not be unpleasant to answer them in this first session. We may have a clinical interview at hand, with all kinds of questions to know all the problems of the patient in its extension, but for now the best we can do is give a few strokes on the motif of query. The idea is that this first session generates trust and security, that 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 that we can tell you, since to begin with we still do not know it too much and we are in the first session, in addition to our role is not to "believe" or "think" giving our values, but our criteria clinical. We can answer that we find it interesting that you show interest in what we can think, but we must emphasize that our values ​​are not important but 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, his belief system and the acquisition of relaxation and confrontation strategies in the face of life problems daily. 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 his therapist is there to support him, always from a professional perspective, is a patient who is very likely to improve.

Basic principles of the patient

Although this is addressed throughout the career, every psychologist must be very clear about the following points of the patients:

1. Patients do the best they can

It may not seem like it at first, but all patients, if they get into it, try to do the best they can. They may show it at a different pace, and they may not do all of the things we've 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

Although they have not been 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 those who make their life change are themselves. Us We cannot force them, what we can do is advise them and give them those tools to promote change..

3. The life of patients with suicidal ideas is unbearable

You should never underestimate someone's suicide attempt or his or her suicidal ideas. There is a widespread assumption, even among professionals, that many people who say they are going to commit suicide actually do so to get attention.

Even if this were the case, we must understand that no one threatens with such a thing just because, but that his life is being something really complicated, he is almost at the limit and he needs help. The life of a suicidal patient, even if he does not threaten to do so, is truly unbearable.

4. Patients don't fail, psychotherapy fails

If a patient does not improve with the psychotherapy that has been applied or has simply given up in the middle of the process, We must be responsible and understand that the one who has failed is not him, 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 quitting, and more tailored to his needs to motivate him to to get better.

If the patient shows no signs of improvement but is interested in continuing to see a psychologist, what can be done is change the course of therapy or refer you to another psychologist who we believe is better qualified to treat your case in particular.