Caring and Treatment Happen Before the First Session

A woman reads a paper while she talks on the phone.In my first interpersonal neurobiology (IPNB) article two months ago, I went into detail about the significance of starting therapy with our advertising and our first phone contact, email, or voicemail. Our intentions need to be clear and of the utmost integrity as these greatly influence the client even if they do not attend a session. Our kindness and helpfulness also beneficially impact ourselves.

“Mutual empathy occurs when two people relate to each other in a context of interest in the other, emotional availability and responsiveness, cognitive appreciation of the wholeness of the other, the intent is to understand… Growth occurs because as I stretch to match or understand your experience, something new is acknowledged or grows in me” (p. 89, The Stone Center).

Although this may only be a message or a brief conversation, as therapists, it is important for us  to understand its significance. Many clients seek therapy because they are desperate. Maybe their marriage is falling apart, their child is suicidal, they are too depressed or anxious to function at work or within their family. When some form of emotional pain, loneliness or fear, is present, kindness and intent to understand and help is beneficial.

“Mrs. Jones, I can hear how terrifying this situation is for you and your family. And I can only imagine how painful it must be to see your daughter lying in that hospital bed, not knowing if she will come out of her coma. Some people, myself included, believe the comatose person can sense people around them. All the love the family feels and conveys to her with your presence will help her. I appreciate your call. Please continue to call for support as you need. And no matter what happens with her, I’m available to your family—to help through the grieving, recovery, or prevention of future suicide attempts.”

Here, I address her loneliness, her fear, and the power of her love and presence for her daughter. Also, I give her support and let her know she will not be alone in the future, no matter what happens. We will work to prevent this from happening again—lots of reassurance. Consider how much more beneficial this would be than the client hearing, “Yes, this sounds very difficult. Why don’t you call me when you are ready for an appointment.”

The power of IPNB is amazing in that just me writing this and you reading it changes our brains. We can feel the caring and reassurance in the speaker’s words and sense the relief of the client as she lets in the caring and reassurance. It is especially important to identify the power of the love and caring the family has for the daughter. No matter what transpires here, once the family or the daughter comes into the office for therapy the family’s love needs to be a point of focus.

“As I sit here now I remember how I felt when I talked to Mrs. Jones on the phone during her daughter’s comatose period. I could feel the love, concern, and caring in that hospital room. I feel it now. I feel appreciation for the family and how much you gave to your daughter. This probably helped her pull through and allows her to sit here with us today. Please take a moment to experience what you feel in your body right now, as you hear this from me and reflect on where you’ve been these last weeks.”

The more we can feel these emotions as either giver, receiver, or observer, the more we will be able to benefit others and participate in the experience.

© Copyright 2010 by Christopher Diggins, MA, LMHC, therapist in Seattle, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Camilla


    March 9th, 2010 at 1:54 AM

    it takes a lot of patience to be a therapist as I have inferred by reading this article…it is no easy task to be able to talk to and assure persons who are undergoing a lot of stress and problems.
    It takes a lot of practice as well as understanding of the particular case and the person being interacted with to be able to give a good therapy session. a salute to all you professionals out there!

  • gina s

    gina s

    March 9th, 2010 at 5:50 AM

    knowing that someone cares is enough to start the healing process for some people

  • Christopher Diggins

    Christopher Diggins

    March 9th, 2010 at 8:08 AM

    Camilla and Gina, how correct you both are. It is both an honor and a big responsibility to be a therapist. And it takes lots of practice being a good “human”. Being a human being, learning to face and heal our own emotional pain and to become more compassionate toward ourselves and others is crucial to becoming a good therapist. And it is a process with no ending point. Thank you both for your responses.

    Christopher Diggins



    March 9th, 2010 at 7:20 PM

    It is extremely importnat to talk assuringly to the people if they happen to call you in distress before actually visiting you. If the therapist is not able to handle the situation correctly, then the person may easily fall into further issues because he/she is without guidance.

    What it will also mean is that the person will not turn up for the actual therapy session, thereby not solving the problem and letting it get the better of him/her.

  • chris d

    chris d

    March 12th, 2010 at 7:06 PM

    Arnold, yes, we definitely want to help them feel safe and cared for so that they show up and this sure helps with the first session

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