“I don’t have anything to report,” Joel said to me as we began our session.  This had become our beginning ritual, despite having worked together for almost a year. 

Joel is not the only client who starts a session like this.  In other instances, I’ll be talking with someone for a few minutes and then, after a brief silence, I’ll hear something like: “Well, I think that’s about it.  There wasn’t much else that happened this week.”  In these instances, I feel like the baton has been tossed to me and it’s my turn to run the next leg of our race toward the end of our hour together.

The Weekly Report

Over the years, I’ve spoken with colleagues and supervisees who experience the same dynamic.  More recently, I was meeting with a therapist who sees me monthly for consultation.  He was telling me that he has been fighting falling asleep with several of his clients.  “I may not feel tired when the sessions begin,” he shared, “but as they continue, I find it incredibly hard to keep my eyes open.  I try to focus, but my thoughts start drifting, and before I know it, I’m either thinking of something completely unrelated to the session, or I realize that my eyes have almost closed and I’m starting to sleep!” 

He and I continued to explore this sleepiness phenomenon.  We looked for similar themes in his cases and looked for anything from his own life experiences that were somehow being activated in these sessions.  Try as we might, there was nothing that seemed to weave these cases together until we stumbled upon what I call “The Weekly Report.”  What we realized, was that when his clients used their sessions to walk him through the activities of their week, sometimes chronologically by talking through each day, his mind began to drift.

Framing Therapy

“How have you framed therapy with your client?” is one of my first questions to most of my colleagues who see me for consultation.  Some people ask me to clarify this question, while others talk to me about their theoretical orientation.  For me, when I ask this question, I am looking for something a little different.  I’m more interested in how each of us explains the process of therapy; what we tell our clients they can expect from our work together.

Some of this, of course, is grounded in our training and the theories with which we are most closely aligned.   But I believe that the way we explain the process of therapy in our initial sessions can set the stage for how it evolves over time.  During the first few sessions that we meet, we have an opportunity to frontload information about how therapy works so that later, if or when the time arrives, we can revisit what we’ve shared. 

As I begin my first session with each client, after introductions, I try to reserve a few minutes at the beginning to provide some structure.  “I’d like to take a little time to get some basic information from you,” I’ll begin, “which will include completing some paperwork.  Then I’ll tell you a little about me and give you an opportunity to ask me any questions you might have.  I”ll turn the session over to you so that you can tell me in more detail why you’re here.  Then, after I have a sense of what brings you here, I’d like to reserve about 10 minutes toward the end of the hour to tell you how we might work together.  Does that sound ok?”  Most people, even those in crisis, seem to appreciate the structure for that first session.

Structuring Our First Session

While offering the opportunity to explain why someone has come to therapy is extremely important in that first session, what I share in that last ten minutes; how I explain the way I work and the way we might work together is equally important.  Even if someone is so nervous that it’s hard to listen to me in that last ten minutes, I’m still able to provide some structure for how we’ll proceed.  While not necessarily in this order and depending upon the exact nature of the presenting problem(s), here is some information I’ll typically share how I see the process of therapy:

  • Most people don’t come to therapy to keep everything the same, so the fact that we’re here together means that you want to change something in your life.  The process of change looks different for each person, but there are some general things to keep in mind as we begin our work together.
  • The beginning sessions of therapy are about fostering safety and building a relationship.  We can only make changes when we feel safe and usually safety comes from the rapport and connection between therapist and client.
  • Before we talk about changing anything, it will be important to understand how you came to be who you are.  It’s very hard to change who we are, how we are, or why we are, if we don’t fully understand where our feelings come from.  Getting information about family, growing up, and related history allows us to talk about change from an informed place.
  • Many of the behaviors and feelings we want to change---our survival strategies--- have served an important purpose for us.  In therapy, we’ll want to understand how we developed these survival strategies, how they served us, how they may continue to serve us in some contexts, and how they may no longer be necessary in other contexts.  Then we can begin to develop new survival strategies where we need them.
  • Once we have developed some of these newer survival strategies, we want to be sure that we can access them not only in therapy, but in life outside of therapy.
  • Therapy is not a linear process, so we may be practicing some survival strategies outside of therapy while still learning other new survival strategies in our sessions.
  • While what we talk about in therapy is important, how our relationship evolves during out work together is equally important.  Some of the survival strategies we want to strengthen and others we want to change may become apparent in our relationship.  This is an opportunity to experience them in the moment and make changes in the present.
  • Sometimes the exact content of our discussions may be less important than the feelings that are beneath them.  We may sometimes take a moment to stop and observe what we are feeling if it feels that we are getting stuck in the content.

Most folks appreciate hearing about my “frame” for therapy.  For most of us, especially those of us who have not engaged in therapy before, hearing an explanation that demystifies the process makes it less formidable.  Providing this information at the beginning creates a bookmark.  It allows us to return to this material and/or be reminded of it at various points during our work.

What May be Under The Weekly Report

And this brings us back to “The Weekly Report.”  Joel, who often started his sessions with a report of his weekly activities frequently felt at a loss for what to say.  After many sessions of sharing his week with me, I waited during one particular session for him to pause.  “I always appreciate it when you tell me what has been happening for you during the past week,”  I interjected.  “This lets me know what has been happening ‘outside.’  I’m also interested in what has been going on ‘inside.’  As you’ve moved through your week, what have you been thinking about?  What have you been feeling?”

For a brief moment, I saw Joel’s eyes widen and his cheeks redden.  His breathing shifted slightly and then he looked down.  “I haven’t been sleeping,” he admitted.  “And I keep thinking that things would be easier if I just disappeared.”  Joel’s mother had died almost a year before he came to see me, and he was her primary caregiver, along with hospice staff.  She was his only living relative, and his loss was palpable when he began therapy.  As our work continued, he talked less and less about his grief and more about his job and other commitments. 

“Do you think these feelings might be related to your mom,” I asked.  Joel nodded almost imperceptibly.  “Can we spend some time revisiting your feelings about losing her; how you’re still dealing with this loss?” He nodded more visibly.  I quietly reminded him about our very first sessions together where we acknowledged that what we talk about in therapy might sometimes be less important than the feelings that exist “under” what we’re talking about.  

This generated a discussion that spanned almost two months of sessions.  We talked about how difficult it was to feel like an orphan in the world and how Joel felt he had lost his sense of purpose.  It was easier for him to focus on the activities of his week than to look beneath them. 

Weaving Together Weekly Reports

For some of us, it’s important to share “The Weekly Report.”  We need to let our therapists know what has been happening in our week because it provides a context for what we hope to address in therapy.  I don’t think I would ever ask someone not to share what was happening during the week between appointments.  I do, however, want to make sure that the reason I’m hearing “The Weekly Report” isn’t because that is how someone understands the workings of therapy.

When I talk about the way I approach my work with my clients in that first session, I have a point of reference that I can return to when our goals aren’t clear, when we feel stuck some way, or when we get locked into a rhythm of reporting the activities of the week.  Sometimes, we might even redefine “The Weekly Report.”  Rather than explaining only the activities of each day of the week between sessions, we can explore the thoughts and feelings that arose as well.  

As we consider “The Weekly Report” more broadly, maybe therapy is a collection of weekly reports and the challenge is to listen carefully and to weave them together into one cohesive volume. 

Monday you can fall apart.  Tuesday, Wednesday break my heart.  Thursday doesn’t even start.  It’s  Friday I’m in love.  Click Here.

—Robert Smith, The Cure