Establishing a Working Alliance, Assessment & Contracting

When we meet a client for the first time regardless of the approach used, we need to establish a working alliance, assess the client and form a contract. The first session provides a great opportunity to do so. First of all, after the initial contact when we meet the client for the first time either face-to face or online there are a number of steps that we should follow to ensure that we work ethically and to a high professional standard.

Initially, we can check with the client how they wish to be called. After that we can start negotiating a contract, which includes telling the client about our qualification, that we work is bound to the BACP ethical framework and explaining what this means.

It is also important to inform the client about supervision, which enables our personal and professional development. Sometimes client’s issues are discussed during supervision sessions and we have to inform clients about the possibility of this, making sure they understand that their identity will not be revealed. Telling the clients about confidentiality is also important, including limits of confidentiality in case of harm to self or others, or in case of criminal activity such as money laundering, terrorism or drug trafficking. The possibility of referral can also be mentioned at this stage in case talking therapy is not the appropriate intervention for the client’s presenting problem. In some cases clients might benefit from a more active intervention or it can be a crisis situation when referral may be needed. Exploring who referred them to us is also important. We might need permission to seek more information about the client from their GP or other professionals. Explaining the client about the approach we use is also a good practice but we should use simple terms. During our placement informing the clients that I am a trainee counsellor is also part of being congruent. Informing the client and negotiating about the following are also crucial: number, timing, length and frequency of sessions, payment method (in private practice). We also need to consider how we can keep records about clients that comply with GDPR.

The next stage can be an exploration of the client’s presenting problem and relating concerns. Exploring why he has started counselling now is an important factor. Also, exploring how the client sees and describes the problem is important, including its duration, persistence, triggers and effects on self. At this stage we can also ask if the client has had any previous counselling and how they experienced it and what the outcome was.

Looking at the client’s context is crucial at this point, regarding his work, identity and relationships while also considering his resources and potential constraints. It is also important for the counsellor to assess if he can build a working relationship with that specific client and the presenting issues of the client are not too overwhelming. For example, if the counsellor is going through divorce it might not be a good idea to work with clients who have the same issues.

Compatibility should also be checked, it can happen for numerous reasons that the relationship is simply not working with a client. It also has to be established if the counsellor is able to make psychological contact with the person, it is called assessing the level of functioning. It might not be possible with clients with severe mental health issues such as psychosis.

Exploring how we can relate to the client can be a good indication how other people relate to the client. The therapist needs to listen to what the client is saying the problem is, but also we need to pick up on issues that the client is avoiding or overlooking. This way we can explore the client’s hidden agenda. Incongruences can also be picked on. Clients might be vague about their issues or they might present multiple issues, the counsellor should help the client explore and prioritise what the main concerns are. Alternatively, clients might not be aware that they are instrumental in creating their problems and they might feel all these problems as external, they may feel a lack of involvement.

During the first session the counsellor should demonstrate the core conditions to make the client feel heard and understood and to facilitate exploration. Acknowledging the client’s experience and validating his feelings can be a powerful tool to establish trust. Attentive listening is crucial at this point, remarks should be brief though, responding skills should be used. Asking the client about what their expectations are about counselling can be a good basis of a working alliance and then the counsellor can clarify what he can offer and what he cannot. The client can also be invited to establish some kind of shared responsibility of working together. It should be agreed what the client wants to achieve without imposing our agenda on the client. There can be a shift in focus during the therapy so the initial contract needs to be reviewed and renegotiated later. If the client has any questions, the counsellor should answer as honestly and directly as possible.

All in all, the first session is an information gathering session and at the end we can summarise and provide autonomy to the client by asking if he wishes to work together. We can affirm our commitment to provide a safe confidential place for him next time. Receiving this type of validation and acknowledgement can be a new experience for the client who might be in distress. This experience can lead to trust in the relationship, where even negative feelings and emotions can be explored and expressed. Finally, we can ask how they experienced working together. Checking their experience can also be a powerful tool, they will feel involved.

Bibliography:

Integrative Counselling Skills in Action by Susan Culley, Tim Bond, SAGE Publications Ltd; Third Edition, 2011