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The approaches used in the opening session also will affect what the clientdoes, expects, and feels during the course of therapy. The type of approach usedcan influence the degree of integrity the client maintains; the degree to whichthe client feels responsible for the abuse and for recovery; the degree to whichhe reacts to the therapist as a person rather than as an authority figure; andthe degree to which she accepts the counselor as a person rather than merely asa professional. The type of approach chosen should be flexible enough to meeteach client and to allow the nature of the therapeutic relationship to evolve.
The therapeutic relationship is central to every approach, and the beginning ofthe therapeutic relationship is more critical than in long-term therapy.The point of starting therapy is to establish a collaborative and openrelationship. This is not necessarily an ideal or even a realistic goal, but asthe therapist works with the client to develop a strong alliance, the client willbe a more likely candidate for long-term treatment modalities (p. 5).
The focus of the initial session is to create a collaborative and openworking relationship with the client. The focus is not to initiate the treatment, butto generate an alliance that will help the client undergo treatment. Sometherapeutic interventions can be used to establish an open relationship, butthe most effective approach is to establish rapport and trust through empathicintervention. By being empathic, the counselor can promote a client's sense ofself-worth and responsibility. Typically, the counselor does so by expressingacceptance of the client and acknowledging her feelings, thoughts, and beliefs. Thetherapist can help the client identify the feelings and thoughts that are drivingthe substance abuse as a way of helping the client to understand his addiction.
Typically, in the early stages of therapy, the therapist attempts toestablish an alliance using a nondirective, nondefensive approach. During thisphase, the therapist listens and uses reflective listening, asks questions, andasks the client questions, for example: Why do you want to attend therapy?What are your goals? How are you feeling? How is your environment? Are you sick?
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