First Impressions in Psychotherapy By John Marzillier, PhD on 3/11/12 - 12:52 PM

A woman wrote to me, having heard me on a radio programme. She had picked up my concern that not enough attention was being paid to the quality of the therapeutic relationship (as opposed to techniques) and wondered how her 25 year-old son, who was seeking a psychotherapist, could assess that in advance of therapy when neither of them knew any therapists where they lived. The obvious answer is that he should wait until he and the therapist meet. Therapy is after all a personal relationship and only by knowing the person could there be a real alliance. If on meeting the therapist for the first time, he felt uneasy or badgered or misunderstood or puzzled or demotivated, then perhaps the therapist was not the right person and he should find someone else. But is that right?

First impressions are important. Think of meeting someone for the first time and how even after the end of a brief exchange, you have already formed an opinion of them. I met a neighbour at a party my wife and I gave, someone I was prepared to like having already met his charming wife. To my surprise, I disliked him. What was it about him that provoked this strong reaction? Thinking back, I realised it was that he had shown not the slightest interest in me and my attempts to engage him in conversation had been met with distracted inattention. I even resented the fact that, when I moved past him to get someone a glass of wine, he made no effort move aside! (This says as much about me as him, I realise). A prospective client could do something like this, evaluating the therapist by how he or she responded and how the client felt in the session.

But therapy is not the same as a conversation. Most therapists are good at putting clients at ease, asking questions sensitively, listening attentively and making the client feel safe and understood. For most clients the experience of the initial session is likely to be positive, allaying anxiety, reinforcing the hopeful expectation that at last help is at hand. Unless the therapist is distracted or disturbed, the first session will generally pass well. That does not mean the therapy will always be bathed in this arm glow of positivity and, if it were, we might wonder whether the therapy was really that helpful. As Patrick Casement points out in his autobiographical memoir, Learning from Life, good therapists must learn they should not always be nice to their clients.

In the first session unconscious processes in both therapist and client will be at play. I recall reading about a client who knew from the therapist’s name alone that he would be the right one for her. Once I heard a client’s hesitant and garbled message on my answering machine and that made me reverse my just made policy of not taking on any new clients. And on another occasion, opening the door to a new client I took fervently against her and, to my shame, manoeuvred the session so that I could refuse her help. For all these factors, conscious and unconscious, the first session may not be the best place to judge the therapeutic relationship, although of course a judgment will inevitably be made. The truth is that the success of the relationship can be judged only in the experience of it.

Perhaps I should be a bit more psychological in my response to this woman’s question. Why was she contacting me, not her son? Was she just an over-protective mum, simply anxious that her son should find the ‘right’ therapist? Or was she anxious that he would find such a therapist who would replace her? Was she seeking help for herself? I don’t know and, no longer being in practice, means I will never know. My first impressions therapeutically occur now only in the virtual world and that is altogether different.

File under: The Art of Psychotherapy, A Day in the Life of a Therapist, Musings and Reflections