Editors note: This is a guest post from Jeff Morgan. We occasionally have other practitioners share their story and experience of building a private practice. Jeff shares some insights he has gained from building a private practice in Nashville. We’d love to hear your story. If you have ideas you’d like to share with our readers, click here to contact us for more information.
There are many theoretical frameworks utilized by the therapist. Most have their strengths. The healing process benefits from a range of approaches. Yet, in outcome studies, the therapeutic relationship stands out as the main, positive factor. I believe the relationship benefits when the therapist has a clear plan to conduct each session. This starts with understanding session management and the flow of treatment. The following are some of my session processes and tips that might improve your workflow in session.
Before the session, take a few minutes to review the chart. Get up to speed on previous sessions and progress to date. I keep a summary sheet in my psychotherapy notes. This summary includes client beliefs, significant quotes, and a genogram. Reference the client’s goals and note their progress. Identify areas of resistance. If you pray, do so for the client’s well-being. And pray for yourself.
I begin each session with a simple greeting. I follow this by directing an emotional and physical “check-in”. A great tool is to have a laminated sheet with core attachment feelings listed.
The attachment feelings are our deepest and earliest language. A simple feelings-check around various realms of life (physical, relational, financial, sexual, etc.) gives me more information than asking, “How are you doing?”. After the check-in, I have a better picture of the client’s current struggles and successes.
Next, query if anything significant has transpired since the last session. Even if you have treatment processes in mind, the client may need to discuss current struggles. This is the time to ask open-ended questions. Look for ways to re-direct their struggles back to their goals. Most often, their patterns will repeat.
The heart of the session is the treatment. This is where one’s theoretical frameworks come to play. Whatever approach you use, be ready to manage intense emotions. If you conduct couples therapy, you will soon enough have emotions to process. Work to focus emotional content into productive problem solving. The hardest part of being a therapist is managing our own anxiety in session. We do get better.
Finally, keep a gentle eye on the clock. I have four clocks in my office. Two are strategically placed out of my client’s view beside my therapy couch. One is behind me, easily seen by my client. Another is on my desk. I can swivel my chair to follow my client’s lead and still have a clock in view. It is the therapist’s responsibility to end sessions on time. Give the client a five-minute “heads up”. When time is up, say “I know we are out of time. Let’s bookmark this spot for the next session.” If the client is willing, I like to close with a simple prayer. Then I head straight to the desk to write a receipt, collect payment, and reschedule. Then I say goodbye.
Session management is a skill. Clients appreciate preparedness and learn from modeling boundaries. Time management is not a perfect process and there are exceptions that allow a session to run longer. Being a “gentle stickler” to the session boundaries shows our professionalism and our ability to care for our clients. It also keeps the therapist sane for transition to the next session, which can then begin on time.