Every Session
As the timer starts in each session, I ask my client what’s on your mind today? As I listen, I work to understand where we might be headed for this session. Often, I don’t have to wait long to either figure it out or have my client tell me directly. If it is at all unclear, I may ask what they think or feel they need from me in the session and if they don’t know offer them the list to choose from. In general, there are 4 start points that could frame the session and help me to connect and respond to my client—in clinical terms—meet the client where they are; these include crisis management, support, skill building, or insight development. It is often not so tidy, and a session may involve one or two of these so keep in mind this is the starting point.
Crisis management is an immediate intervention designed to stabilize a client who is experiencing acute psychological distress or life-threatening situations. This concept is critical in therapy as it ensures safety and provides emotional containment. Crisis management may involve de-escalating extreme emotional states such as panic, severe anxiety, or suicidal ideation. Some of the activities I will use can include grounding exercises, active listening, problem-solving strategies and at times to just be present to help clients. The importance of crisis management lies in its ability to prevent further distress, calm the sympathetic nervous system and pave the way for therapeutic work once stability is achieved.
Support encompasses so much— fundamentally the emotional, psychological, and practical assistance offered to clients to foster connection, stress reduction and providing a place & space where the client feels understood and heard. Support is foundational when establishing trust and rapport between therapist and client and continues as the cornerstone throughout the therapeutic relationship. Support often manifests through empathetic listening, validation of thoughts and emotions, and reinforcing the client's ability to cope with challenges. Some of my clients have referred to support sessions as venting, dumping or verbal diarrhea sessions, a place where they just need to ‘say all the things.’ The importance of support lies in its role in creating a secure environment where clients feel seen and valued. Support serves as a stabilizing force, encouraging clients to confront their struggles while knowing they are not alone.
Skill building equips clients with practical tools and techniques to navigate life's challenges effectively. It is an active, goal oriented, and solution-focused approach often employing cognitive-behavioral therapy, dialectical behavior therapy, and other evidence-based modalities. Skill building empowers clients to become more self-sufficient, resilient, and adaptive. Applications of skill building include teaching techniques for stress management, communication, emotional regulation, and problem-solving when clients are in a non-crisis or non-stressful state. For instance, clients dealing with anxiety might learn breathing exercises and cognitive re-framing skills to manage intrusive thoughts and physical symptoms. I tailor skill-building interventions to the client's unique goals, ensuring they align with their therapeutic goals and way of being in the world. Skills are often take away items—between session work—that clients will practice and experiment with in their world and then bring to our following session.
Insight Development is aimed at fostering self-awareness and understanding about one's thoughts, emotions, behaviors, relationships and underlying patterns of being. This concept is integral to psychodynamic therapy, humanistic therapy, and other modalities that prioritize self-reflection. The importance of insight development lies in its ability to uncover the root causes of psychological distress and facilitate meaningful change. By exploring unconscious motivations, past experiences, and relational dynamics, clients gain clarity about their inner world. This in turn helps clients to identify triggers of unwanted behaviors, understand the impact of early life experiences on their current relationships, and recognize recurring patterns that hinder personal growth. Insight development often serves as a catalyst for deeper healing and personal transformation.
This four part session framework of crisis management, support, skill building, and insight development helps me to organize and more deeply understand my clients’ needs both in the session and overtime as we work together. Each concept plays a unique yet interconnected role in promoting client well-being while at the same time can highlight movement between states in therapy and life.
I am a full-time practicing Registered Psychotherapist who has been working with clients for over 25 years. I would love to know if this blog is useful to you and any comments you have on this or other therapy related topics. Thank you.