For Therapists: How Do I Start Therapy?

Dear Dr. Jacob Ham,

Where should I start, there is so much I would like to write to you and ask you...

First of all, perhaps a little about my context: I live in Germany near the woods and the fields, very beautiful. I have been an ACT therapist with all my heart. In my small private practice I receive my clients, who are very close to my heart. I love my work and I very often doubt my abilities.

So a few weeks ago I read Stephanie Foo's book "What my bones know" and what can I say, from the moment it was about her therapy with you, I was so incredibly touched and at the same time so full of longing to do the kind of work you do with your being and work.

I have a wonderful supervisor. This week for the first time I had the courage to really show myself with the painful thoughts and doubts about our relationship (between me and my supervisor, if I am worth him supervising me etc.), tears are running down my face as I write this because it feels so important and painful at the same time. ...You gave me the necessary courage to really be vulnerable and show my insecurities, and the necessary motivation for change.

And one more thing: In a podcast episode (I think it was the "Being well" podcast), the person opposite you asked something along the lines of how you prepare for the session and you answered something like "I'm working from scratch", from moment to moment, with what shows up in the here and now, process changes, breaks, ruptures, shifts etc. This little phrase "I'm working from scratch" rings in my ears and I tried it both last week and today with my clients. Today's session was so intense, beautiful, connecting and fulfilling, and I have you to thank for that, among other things and to a decisive degree! I have also often paused with my clients to formulate a mutual intention for the session - what a powerful, centering and bonding moment, which I have also learned from you :)! Even though I am just starting out with this type of therapeutic guidance, I have now gotten a real sense of what it can feel like and I want more of it! A thousand thanks to you, Dr. Ham!

Finally, I have a small question:

What do you say to your clients in the first session about how you work? Something like informed consent, so that the client knows what they are getting into? Or do you say nothing at all concerning the way you would work with them?

Hi Julia,

Thank you so much for sharing your journey of growth as a therapist. The work can be so amazing and beautiful and yet so solitary! So few of us get to share the wonder of it with anyone else. I’m glad to be a witness to yours.

As for what I say to my clients, I try to tell them in words tailored for each person, and definitely show them through action, that the way I work is relational, meaning that I think a lot of the work happens through the here and now of our own relationship. Everything we need to know and understand shows up right here in front of us.

So, I invite them to tell me whenever they have an emotion rise up during our interaction, even the uncomfortable ones. Every emotion is a signal of something important. Sometimes, the emotions tell us that there is something bad happening in our relationship that I definitely want to make better. At other times, it tells us we are on the right track and we are moving into more emotional poignancy. Still other times, it tells us that something from the past has awakened to be witnessed, understood and released. Many times, all of these things could be happening all at once, and we have to look at any and every layer of the experience as they ascend.

In return, I will be more honest and transparent about my emotions and experiences in the relationship because they too can often signal something meaningful happening in our relationship and in the work. I won’t just say everything. I focus on sharing the things that serve the work of helping the client (and not serving my own needs).

I end by asking their permission and invitation to work this way. And, when it actually happens, I ask them how it was for them to do it. This is an act of on-going attunement and informed consent.

Sometimes, I don’t say any of this, but just ask if we can start working, and we dive in, and we do this whole process through our bodies, our expressions, and our gestures.

Hope this is helpful to you on your journey!

Jacob