I have often found that a lot can be shared by a client during a counseling session. Sometimes it is even difficult for me to summarize what WAS discussed! However, I have found it very important to implement a few strategies both during and after the session so that I can keep therapy flowing in a positive, thoughtful manner from session to session. Following are two suggestions that I hope other counselors may find useful in their work with their clients:
- Summarize at the end of the session with the client. Within the last 5 to 10 minutes of the session, make a summary statement to the client and check in to see if the client agrees with what you have observed, heard and thought during the session. Example: “Eileen, I could tell you were very upset today when you first came in given the conversation you had with your mother a few days ago. It sounds to me like you are willing to work on establishing some better boundaries with your mother, especially since we have identified that one of the main reasons her comments upset you so much are based on your feelings of inadequacy in her eyes. Is there anything else you would like to add to what I just shared?”
- Once the summary is confirmed with the client, propose what the focus of the next session will be or consider assigning homework for the client to do before the next session. For example: “Eileen, it sounds like we need to talk further about how to set some healthy boundaries with your mother. Possibly next time we can discuss this further and even role play what you can say the next time your mother calls you. Before our next session, would you be willing to write down at least three things you would like to say to your mother the next time she calls and starts asking you questions that you feel are intrusive?” Check in to see if the client is amenable to your suggestions.
- Once the client leaves, jot down on a notepad (or type into your computer/progress notes) some key words regarding the summary and the suggested therapeutic activity for the
There may be times when it is not clear what the client wanted to focus on during the session. If you have difficulty thinking of a way to summarize the session, ask the client in the last few minutes of the session, “If you were to summarize what happened in our session today, what would you say?” Listen to the client carefully to see how they respond, and then make connections between their summary and what you either heard the client say or observed the client doing during the session.
The goal is to keep the therapeutic process flowing in a semi-structured, productive manner so that each session continues to move towards improvement in the client’s functioning and the realization of the client’s goals. Ending each session with a summary helps the counselor write a better progress note and helps with the formulation of counseling interventions. It also confirms with the client that you both are “on the same page” in regards to the work the client is doing and the goals the client is accomplishing.
For those of you using the STEPs method for your progress notes (www.stepnotesinc.com), jotting down the summary statement and the proposed activity for next session will help you write a more complete progress note. Elements of the summary statement can be applied to the subject (S), the theory and the therapeutic interventions used (T), and also inform your evaluation (E) of the client. The proposed activity or the in-between session homework is information to note in the plan (P) portion of your progress note.
As counselors, we want to see our clients improve. Summarizing the session and strategizing for the next appointment helps counselors and clients build connections between session. These connections, in turn, will keep the therapy process flowing, and our clients will experience rewards from the therapeutic work they do and the insights they gain.
If you would like to learn more about the STEPs for taking progress notes, visit www.stepnotesinc.com and watch the educational presentation at http://www.stepnotesinc.com/The-Presentation.