English for Psychotherapy and Counselling: Handbook for Practitioners. Английский для психотерапии и консультирования: практическое руководство

• If the client is at risk of harming themselves

• If the client is at risk of harming someone else

• If there is suspected abuse or neglect of a child, elderly person, or dependent adult

• If records are subpoenaed by a court

• If the client provides written permission to share information

Most therapists say something like: “What we discuss here is confidential, which means I won’t share this information with anyone without your permission. However, there are a few exceptions where I’m legally required to break confidentiality, particularly if there’s a risk of harm to you or someone else. Does that make sense? Do you have any questions about confidentiality?”

Risks and benefits: while therapy is generally beneficial, it can sometimes be uncomfortable as clients explore difficult emotions or memories. The therapist discusses both potential benefits and any risks.

Practical matters: this includes session frequency, length, fees, cancellation policies, and what to do in case of emergency.

Client rights: clients have the right to ask questions, refuse any intervention, seek a second opinion, and end therapy at any time.

While many therapists provide written consent forms, the verbal discussion is equally important. The therapist should invite questions and check for understanding throughout this explanation.

Establishing Therapeutic Boundaries

Boundaries are the professional limits that define the therapeutic relationship. Clear boundaries create safety and help clients know what to expect. Boundaries are established from the very first contact and are maintained throughout treatment.

Therapeutic boundaries include:

• Session structure (length, frequency, location)

• Contact between sessions (whether clients can call or email, and under what circumstances)

• Social media policies (most therapists maintain strict boundaries around social media connections with clients)

• Physical boundaries (professional, appropriate physical space)

• Role clarity (the therapist is not a friend, but a trained professional providing treatment)

Boundaries are not meant to be cold or distant. Rather, they create a consistent, safe framework within which the therapeutic relationship can develop. Good boundaries actually build trust because clients learn that the therapist is reliable, consistent, and professionally committed to their wellbeing.

Building Rapport

Once the administrative matters are addressed, the therapist invites the client to share their story. This is typically done with an open-ended question such as, “What brings you to therapy at this time?” or “Tell me a bit about what’s been going on for you”.

Building rapport – a sense of connection and trust – is the primary goal of the first session. The therapist does this through:

• Active listening: giving full attention, avoiding interruptions, and showing through body language that they’re engaged

• Empathy: trying to understand the client’s experience from their perspective

• Unconditional positive regard: accepting the client without judgment

• Validation: acknowledging the client’s feelings and experiences as real and understandable

• Appropriate self-disclosure: occasionally sharing relevant professional experiences (but keeping the focus on the client)

Research consistently shows that the quality of the therapeutic relationship is one of the strongest predictors of positive therapy outcomes. A strong therapeutic alliance means the therapist and client are working together collaboratively toward agreed-upon goals.

Collaborative Goal-Setting

Toward the end of the first session, the therapist and client begin discussing goals. What does the client hope to achieve through therapy? What would improvement look like for them? This collaborative goal-setting ensures that therapy is focused and meaningful.

The therapist might ask, “If our work together is successful, what will be different in your life?” or “What would you like to focus on first?”. These goals provide direction and help both therapist and client track progress over time.

Closing the First Session

As the session draws to a close, the therapist typically summarizes what has been discussed. This might include acknowledging the main concerns the client has shared, highlighting any strengths noticed, and outlining the next steps.

The therapist provides encouragement, recognizing the courage it takes to seek help. They discuss the frequency of future sessions and schedule the next appointment. Many therapists also check in about how the client is feeling: “How are you feeling about our meeting today? Do you have any questions or concerns?”.

The goal is for the client to leave the first session feeling heard, hopeful, and clear about what to expect moving forward. While one session cannot solve all problems, a strong first meeting creates the foundation for meaningful therapeutic work to come.

Comprehension Questions

1. According to the text, why do many clients feel anxious before their first therapy session?

2. Why is the first impression so important in therapy?

3. What is a “safe space” and why is it important?

4. What are the main elements that therapists explain during informed consent?

5. What are the limits to confidentiality that therapists must explain?

6. How do therapeutic boundaries help clients?

7. What are the ways to help therapists build rapport with new clients?

8. What is the therapeutic alliance and when is it typically established?

9. Why is collaborative goal-setting important in the first session?

10. What should happen at the end of the first session?

VOCABULARY:

Rapport, Boundaries, and Therapeutic Relationship Terms

A. Find words or phrases in the text that match these definitions:

• Easily hurt physically or emotionally (paragraph 1): _______

• The person receiving therapy (used throughout): _______

• Agreement and permission based on full information

(paragraph 5): _______

• The quality of being open and honest (paragraph 5): _______

• Listening with full attention and engagement

(paragraph 11): _______

• Understanding and sharing another person’s feelings

(paragraph 11): _______

• Acceptance without criticism (paragraph 11): _______

• Working together toward a common goal

(paragraph 13): _______

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B. Complete the collocations from the text:

1. therapeutic _______

2. _______ spaces

3. informed _______

4. _______ consent

5. build _______

6. establish _______

7. _______ listening

8. open-_______ question

9. _______ regard

10. collaborative _______-setting

C. Word families

Complete the table:

D. Vocabulary in context

Choose the correct word to complete each sentence:

1. The therapist showed great _______ (empathy / sympathy) by truly understanding the client’s perspective.

2. Clear _______ (borders / boundaries) help create a safe therapeutic environment.

3. The client felt _______ (vulnerable / week) sharing such personal information.

4. Therapists must _______ (establish / install) trust from the very first meeting.

5. The _______ (relationship / rapport) between therapist and client developed quickly.

6. _______ (Informed / Knowledgeable) consent ensures clients understand the therapy process.

7. The therapist practised _______ (active / busy) listening throughout the session.

8. Setting _______ (collaborative / collective) goals helps focus the therapy work.

GRAMMAR FOCUS:

Present Simple vs. Present Continuous / Question Formation

A. Present Simple vs. Present Continuous

We use different tenses to describe different types of actions in therapy:

Present Simple:

• For regular routines, permanent situations, and general truths

• For describing what professionals generally do

Form:

• Affirmative: Subject + verb (+ s/es for he/she/it)

• Negative: Subject + don’t/doesn’t + main verb

• Questions: Do/Does + subject + main verb?

Examples from therapy practice:

• Therapists explain confidentiality in the first session.

• I work with clients on Mondays and Wednesdays.

• Clinical psychologists don’t prescribe medication.

• Do you feel comfortable discussing this topic?

Present Continuous:

• For actions happening now, at this moment

• For temporary situations

• For describing what is currently happening in a session

Form:

• Affirmative: Subject + am/is/are + main verb-ing

• Negative: Subject + am/is/are + not + main verb-ing

• Questions: Am/Is/Are + subject + main verb-ing?

Examples from therapy practice:

• I am listening carefully to what you’re saying right now.

• The client is describing their recent experiences.

• We are working together to identify your goals today.

• Are you feeling anxious at this moment?

Key differences in therapeutic context:

Exercise 1: Choose the correct tense

Complete the sentences with the correct form of the verb in brackets:

1. In our first session, we typically _______ (discuss) what brings you to therapy.

2. Right now, I _______ (explain) how confidentiality works.

3. Most therapy sessions _______ (last) between 45 and 60 minutes.

4. At this moment, the client _______ (share) very personal information.

5. Clinical psychologists _______ (assess) clients using various methods.

6. I _______ (listen) carefully to what you _______ (say).

7. We _______ (not make) major decisions in the first session.

8. _______ you _______ (feel) comfortable talking about this now?

9. Therapists _______ (build) rapport from the very first meeting.

10. I _______ (think) about what goals we should focus on.

Exercise 2: Correct the mistakes

Find and correct the mistakes in these sentences:

1. I’m usually working with adolescents and young adults.

2. Right now, I explain the limits of confidentiality to my client.

3. Are you understanding what I’m saying about boundaries?

4. The therapeutic relationship is building over time.

5. What do you feeling about starting therapy?

6. I’m believing that the first session is very important.

7. We are typically discussing informed consent at the beginning.

8. The client is seeming nervous in every first session.

9. Do you currently experiencing any major stressors?

10. I work on establishing rapport with you at this moment.

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B. Question Formation in Therapy

Asking the right questions is essential for building rapport and gathering information. In therapy, we use both closed questions (yes/no answers) and open-ended questions.

Closed Questions (Yes/No):

• Present Simple: Do/Does + subject + main verb?

• Present Continuous: Am/Is/Are + subject + verb-ing?

• Present Perfect: Have/Has + subject + past participle?

Examples:

• Do you feel ready to start therapy?

• Are you experiencing anxiety right now?

• Have you been in therapy before?

Open-ended Questions (encourage detailed responses):

Use question words: What, Where, When, Why, How, Who

Examples:

• What brings you to therapy today?

• How are you feeling about being here?

• What would you like to achieve through therapy?

• How do you usually cope when things are difficult?

• What made you decide to seek help at this time?

Exercise 3: Form questions

Create appropriate questions for a first therapy session using the prompts:

1. (you / ever / see / therapist before)

_______________________________?

2. (what / bring / you / here today)

_______________________________?

3. (how / you / feel / right now)

_______________________________?

4. (you / have / any questions / about confidentiality)

_______________________________?

5. (what / you / hope / achieve / through therapy)

_______________________________?

6. (how long / you / experience / these difficulties)

_______________________________?

7. (you / feel / comfortable / talking about this)

_______________________________?

8. (who / know / that you / come / therapy)

_______________________________?

Exercise 4: Open or Closed?

Identify whether these questions are open or closed. Then, rewrite the closed questions as open questions:

1. Do you have a support system? __________

2. What does your support system look like? __________

3. Are you sleeping well? __________

4. Have you thought about your goals for therapy? __________

5. What brings you here today? __________

6. How are you managing stress? __________

7. Is this situation affecting your relationships? __________

8. Do you want to tell me more about that? __________

COMMUNICATION:

Intake session

Setting: Dr. Maria Santos, a clinical psychologist, is meeting her new client, Robert, for the first time. Robert is a 28-year-old man who has been experiencing anxiety.

Part 1: The Greeting and Opening

Dr. Santos: Hello, Robert? I’m Dr. Santos. It’s nice to meet you.

Robert: Hi. Nice to meet you too.

Dr. Santos: Please, follow me. My office is just down this hallway. (They walk to the office) Have a seat wherever you’re most comfortable.

Robert: Thank you. (Sits down, looks a bit nervous)

Dr. Santos: So, I know first sessions can feel a bit awkward or strange – you’re talking to someone you’ve just met about personal things. That’s completely normal. We’ll take things at your pace today.

Robert: Okay, that’s good to hear. I am feeling a bit nervous, actually.

Dr. Santos: That’s very understandable. Before we get into what brings you here today, I need to go over some important information about how therapy works and confidentiality. It might feel a bit formal at first, but it’s important that you know what to expect. Does that sound okay?

Robert: Yes, sure.

Part 2: Explaining Confidentiality

Dr. Santos: Great. So, first of all, everything we discuss in our sessions together is confidential. That means I don’t share what you tell me with anyone else without your written permission. This confidentiality is really important because I want you to feel safe talking openly about whatever is on your mind.

Robert: Okay, that’s clear to me.

Dr. Santos: However, there are a few limits to confidentiality that I’m legally required to tell you about. If I believe you’re at risk of harming yourself or someone else, or if there’s suspected abuse of a child or vulnerable adult, then I would need to take action to ensure safety. Also, if a court orders me to release records, I will have to comply. But in all of these situations, I would discuss it with you first whenever possible. Do you have any questions about confidentiality?

Robert: No, I think I understand. Those exceptions make sense.

Dr. Santos: Good. And just so you know, you can ask questions at any time – either today or in future sessions. This is your time, and I want you to feel comfortable.

Part 3: Discussing the Therapy Process

Dr. Santos: So, let me tell you a bit about how we typically work. Sessions last 50 minutes, and most people find that meeting weekly works well, at least initially. We’ll work together to identify your goals and figure out the best approach to help you. My style is collaborative – that means we’re working as a team. You’re the expert on your own life, and I’m here to provide support, tools, and a different perspective.

Robert: That sounds good. I was worried you might just tell me what to do.

Dr. Santos: (Smiles) No, therapy is really a collaborative process. I’ll offer suggestions and we’ll explore different strategies, but ultimately, you’re making the decisions about your life. My role is to support you, ask questions that might help you see things differently, and provide evidence-based techniques that might be helpful.

Robert: Okay, I like that approach.

Dr. Santos: I’m glad. Now, I do want to mention that therapy can sometimes be uncomfortable. When we talk about difficult experiences or emotions, it can bring up challenging feelings. That’s actually a normal part of the process, and it often means we’re working on something important. But I’ll always check in with you about how you’re doing, and we can adjust our pace as needed.

Part 4: Exploring the Client’s Concerns

Dr. Santos: So, Robert, tell me – what brings you to therapy?

Robert: Well, I’ve been struggling with anxiety for a while now, maybe about six months. It’s been getting worse recently, and it’s starting to affect my work.

Dr. Santos: I appreciate you sharing that. When you say “anxiety”, what does that look like for you? What are you experiencing?

Robert: It’s mostly worry. I worry about everything – work performance, what people think of me, whether I’m making mistakes. And physically, I feel tense a lot. My heart races sometimes, especially at meetings.

Dr. Santos: That sounds really challenging. It takes a lot of energy to carry that constant worry around. You mentioned it’s affecting your work. Can you tell me more about that?

Robert: Yeah, I’m having trouble concentrating. I keep second-guessing my decisions. I even avoided a presentation last week because I was so anxious about it.

Dr. Santos: I hear you. It sounds like the anxiety is limiting what you feel able to do. That must be frustrating.

Robert: It really is. I used to be more confident.

Part 5: Beginning Goal-Setting

Dr. Santos: Robert, if our work together is successful, what would be different for you? What change would you like to see?

Robert: I’d like to feel calmer, more in control. And I want to be able to do my job without this constant worry hanging over me.

Dr. Santos: Those are great goals. Feeling calmer, having more control, and being able to engage fully with your work. We can definitely work on those things together. In our future sessions, we’ll explore where this anxiety comes from and develop practical strategies to help you manage it.

Robert: That would be really helpful.

Dr. Santos: (Glancing at clock) We’re coming toward the end of our time today. Before we finish, I want to check in – how are you feeling about our conversation today?

Robert: I feel good, actually. I was nervous coming in, but I feel like you understand what I’m going through.

Dr. Santos: I’m so glad to hear that. It takes courage to take this step and come to therapy, and I want you to know that I’m committed to supporting you through this process. Let’s schedule our next session for the same time next week. Does that work for you?

Robert: Yes, that works.

Dr. Santos: Perfect. And Robert, if anything urgent comes up between now and then, you can call the office. But otherwise, I’ll see you next week. Take care.

Robert: Thank you, Dr. Santos. See you next week.

TASK 1: Comprehension and Analysis

Answer these questions about the dialogue:

1. How does Dr. Santos make Robert feel comfortable at the beginning?

2. What does Dr. Santos explain about confidentiality?

3. What are the limits to confidentiality that she mentions?

4. How does Dr. Santos describe the therapy process?

5. What type of questions does Dr. Santos use to explore Robert’s concerns?

6. What are Robert’s main goals for therapy?

7. How does Dr. Santos show empathy during the conversation?

8. What does Dr. Santos do at the end of the session?

TASK 2: Identifying Communication Techniques

Find examples in the dialogue where Dr. Santos uses these rapport-building techniques:

1. Normalizing the client’s experience: _______

2. Asking open-ended questions: _______

3. Reflecting/validating feelings: _______

4. Explaining the collaborative nature of therapy: _______

5. Checking in on the client’s comfort: _______

6. Summarizing what the client said: _______

7. Acknowledging the client’s courage: _______

TASK 3: Role Play Practice

Work in pairs. Student A is the therapist, Student B is the client.

Scenario 1: A new client’s first session. The client is feeling depressed and withdrawn. Practice:

• Greeting and creating comfort

• Explaining confidentiality

• Using open-ended questions

• Building rapport

Scenario 2: A client who is anxious about confidentiality. Practice:

• Addressing their concerns

• Explaining limits clearly

• Checking for understanding

Scenario 3: A first session with a client who has been in therapy before (but with a different therapist). Practice:

• Asking about previous experience

• Discussing expectations

• Collaborative goal-setting

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TASK 4: Discussion Questions

Discuss with a partner or in small groups:

1. Why do you think the therapeutic alliance is so important?

2. What might happen if a therapist doesn’t explain confidentiality clearly?

3. How can a therapist balance being warm and friendly while maintaining professional boundaries?

4. What cultural differences might affect how rapport is built in the first session?

5. Why is it important to give clients choice and control from the first meeting?

6. How would you feel as a client in your first therapy session?

PROFESSIONAL PRACTICE:

Introducing the Therapeutic Framework and Informed Consent

Understanding how to explain the therapeutic framework and obtain informed consent is a critical professional skill for all mental health practitioners.

Key Components to Cover in a First Session

1. Welcome and Orientation

Create a warm, welcoming environment from the moment of first contact. Your goal is to help the client feel safe and comfortable enough to share personal information.

Sample language:

• “Welcome. I’m glad you’re here. Please, have a seat wherever you feel comfortable”.

• “I know it can feel a bit uncomfortable talking to someone new about personal matters. That’s completely normal, and we’ll take things at your pace”.