Outlining the first session
Some clients can be very anxious at the thought of attending for the first time and I do my
best to put them at their ease before they arrive. I explain that it is an opportunity to meet
and see if they feel comfortable working with me as this is so important for the counselling
I tell them that I will ask them some questions about themselves, their health and lifestyle
and also about the issues that they are facing. I also say that they may ask any questions
that they have about the therapy or me at this session.
From there, I encourage clients to go away and think about whether they feel counselling is
right for them. Then if they would like to make a further appointment, they can do so via
email or telephone. This way, there is no pressure brought to bear to make a further
appointment on the spot before they have had the chance to think things through.
The client arrived on time for her session and after sitting down and running through all of
the boundary issues and confidentiality, I took some details from her before asking what
issues were troubling her at that time.
She began to speak about her drinking habits and how it was affecting her current
She said that whenever she consumed alcohol when out with her partner, she would
become argumentative and out of control before waking the following day with no
recollection of her behaviour.
I asked her a lot of questions to clarify some points that I was concerned about. She spoke
about not reacting to alcohol in this way before she had met her partner. She said there had
been many occasions when she had consumed far larger quantities when socialising with
other friends and she had experienced no adverse reactions other than a mild hangover.
She went on to say that this issue had arisen since she had met her partner and only
happened when she was with him and his friends and that no adverse reaction happened if
her friends were present. The client seemed genuinely confused as to why she was reacting
in this way when she was with her partner.
I asked her about how she felt the following day or when she regained consciousness and
she started to cry saying that she always felt terrified when she woke and that physically,
her hangover seemed very severe compared to the amount of alcohol she had consumed
(usually one or two glasses of wine).
She explained that when she was out with her partner, she would be feeling fine, having a
drink and without remembering feeling drunk or starting to get tipsy, she would black out
and remember nothing.
I asked her about her relationship with her partner and she spoke about him being quite
controlling and that he was always angry when she woke up the following day. Each time
this had happened, she woke in his apartment which he shared with his two flatmates.
Identifying possible causes
Although I was forming my own opinions of why this was happening to her, as a
counsellor, I am not in a position to offer solutions but rather enable the client to explore
their issues and find their own way forwards. I do, however, have a duty of care to my
clients and although it was a difficult issue to bring into the conversation, I asked her about
the possibility of whether her drinks had been tampered with or 'spiked'.
The client considered this but was adamant that her partner would not do such a thing.
She made it clear that this was not an option for further discussion and I asked her if she
had seen her GP to rule out any physical causes for her black outs. She said that she had
been to her GP to enquire about contraceptives as she was concerned about unwanted
pregnancies at this stage in her life although her partner was keen to have children sooner
rather than later and had often mentioned this to her.
Her GP had given her some information to take home and read and had advised to
continue to use condoms until she had made a decision about which method suited her
best. The client said she hadn't mentioned to her GP anything about the black outs and
after discussing this, the client agreed that it would be a good idea to rule out any physical
causes before exploring psychological ones.
The client left after making an appointment for next week for another counselling session
and said that she would visit her GP tomorrow.
This was quite a difficult session as I had to keep at the forefront of my mind the client's
safety and well-being whilst enabling her to explore the possible reasons for her black outs.
From what she had said, she had never consumed enough alcohol in a time frame to
suggest that she would react in this way. Even relatively small amounts of alcohol can
cause blackouts if consumed quickly enough as the body fails to metabolise the substance
and 'shuts down' while it copes with doing so, but in this case, the moderate consumption
had occurred over a period of two or more hours and the levels consumed were in the
normal range for this individual.
It will be interesting to see how she gets on with her GP and what she brings to the session