Inside Social Work

Talk About the Talking: What Really Matters in the First Three Sessions

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Starting therapy can feel overwhelming,  for both clients and therapists. In this episode of Inside Social Work, I chat with Dr Bronwyn Milkins from the Mental Work podcast about what really matters in the first three sessions and how to set up the work in ways that feel clear, supportive, and sustainable.

Why do the first three sessions feel so important?

Clients often show up with quiet questions. Will this help? Am I doing this right? Is this going to work? The first few sessions carry a lot of unspoken pressure,  for therapists to prove value and for clients to feel like they’re making progress.

What often gets missed is the importance of slowing down. Talking about the process, setting expectations, and being really clear about what therapy might look like can make a huge difference to whether someone stays engaged or leaves feeling uncertain.

What helps people stay in therapy?

When therapists take the time to explain what they’re doing, why they’re doing it, and what the structure might be, it helps people feel safer. Things like consent forms, cancellation policies, funding limits, and how many sessions might be recommended,  these practical steps are actually what builds trust.

Good customer service matters. Clarity matters. And being able to say, this is what we’re working on, here’s how I usually structure sessions, and here’s what you can expect, that’s what helps people stay connected.

How do we balance structure and flexibility?

Having a structure doesn’t mean being rigid. In the conversation, we talk about using scripts, checklists, and clear introductions, while also being able to adapt to what’s happening in the room.

Checking in at the start of a session, asking what’s been sitting with them since last time, or giving space for in-the-moment concerns is just as important as the overall plan.

We talk about how small things like greeting clients warmly, guiding the session pace, or offering a choice about homework or session format can make therapy more accessible and meaningful.

Why the process matters as much as the content

Therapists are often taught to focus on techniques and interventions, but sometimes the most powerful part of the work is how we talk about the process itself.

Talking about the talking means:

  • Making the structure visible
  • Naming boundaries and expectations
  • Checking in on the client’s experience
  • Role-modelling communication, repair, and flexibility

When therapists are transparent about how they work, they give clients permission to ask questions, raise concerns, and understand what’s happening in the room.

How does culture and lived experience shape therapy?

We also explore why culture, gender, and lived experience matter in the therapy room. Social context, internalised beliefs, and how people experience services can shape what feels safe and what feels challenging.

Naming these factors and being open about our own limitations can help create a space where people feel seen and heard.

If you enjoyed this episode, I’d love for you to share it with your colleagues or anyone supporting people in their early therapy sessions. You can also explore more resources and on-demand training via the website. Thanks for listening to Inside Social Work.

Contact Dr Bronwyn Milkins @ mentalworkpodcast@gmail.com

Resources:

👉 Learn more about my on-demand course: Enhance Clinical Outcomes in the First Three Sessions: https://marievakakis.com.au/courses/enhancing-clinical-outcomes-in-the-first-three-sessions/ 

Read The Full Transcript

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Marie Vakakis: [00:00:00] Do you ever feel like you’re meant to have all of the answers in the first few sessions? Maybe you’re wondering if your client is silently asking themselves, is this gonna help? Have you ever sat in the therapy room, maybe as a practitioner or even as a client and thought, are we doing this right? In this episode, we explore the quiet complexity of the first few sessions of therapy, the unspoken expectations, the invisible pressures.

The Sarl Art of building something solid from the very beginning. This conversation first aired on the Mental Works podcast with Dr. Bronwyn Milkins, and I’m so excited. Oh, I’m so grateful to share it here with you on the Inside Social Work podcast. Bron and I dove into the , behind the scenes experiences of therapy.

The pacing, the preparation, the pressure to prove your worth in 50 minutes or less. We talk about what’s actually helpful, what can be helpful to help someone stay, not just physically in the room, but emotionally in the process. We explore the tension between structure and spontaneity and [00:01:00] that internal pull to give more.

Faster. You’ll hear some of the reflections that I draw on from my on-demand training, enhancing clinical outcomes in the first three sessions. I’ll pop a link to that in the show notes if you want to participate in that as we open up about the messy, vulnerable parts of the practice that we do of our practice.

Some of this stuff goes unspoken and we know that it’s hard being a therapist. It’s hard getting in there and working with clients. There’s some admin stuff that is part of therapy that is really important, and there are moments where slowing down can feel counterintuitive, but is essential. We talk about the importance of saying what you’re doing and why, and ting that, and I love how Bronwyn names the questions that so many early career therapists carry.

You know, am I doing enough? Did I get this wrong? Is this even helping? She brings a lot of curiosity and warmth and a beautifully honest lens to the work that we do. Whether you script your intros, like I think we both did when we first started. I know whenever I learn a new technique, I have [00:02:00] some of the questions printed out and, um, under my notes or even pull them out and ask them.

Totally fine. You do that, right? Especially when it’s something new and awkward and clunky, whether you talk about the process or just assume that a client understands that hopefully this episode will invite you to reflect on that, reflect on how you enter the work, how you hold space, how you talk about the talking.

We don’t offer a formula. We do share some insights and some lived experience, and a few gentle reminders for anyone trying to build something meaningful from that very first. Hello, welcome to my office. Let’s begin right in the middle of the mess. Here is my conversation with Bronwyn Milkins, originally on the Mental Works podcast.

Brownyn: Hey, mental workers. You’re listening to The Mental Web Podcast, your companion to Early Career psychology. I’m your host, Dr. Bronwyn Milkins, and today we are talking about how to structure therapy, particularly the first three sessions. The reason why I [00:03:00] wanted to do an episode about this is because I think it’s something that early career psychologists often struggle with.

What we know from research studies is that dropout rates range from 20 to 47% within the first three sessions of therapy. That’s a lot of folks who. Drop out of therapy who really wanted help. So I think it’s really important to make sure A, that early career psychs are confident and they feel good about doing the first three sessions, and B, that clients can get the help that they really need.

So here to help us unpack it all is our wonderful guest, Marie Vakakis. Hi Marie. Hello. Marie is an accredited mental health social worker and a family and couples therapist at the therapy hub. And Marie, could you please tell listeners something that your colleagues would be surprised to know? 

Marie Vakakis: Oh, I think when um, people hear how much study I’ve done, they assume that I just went straight from like school to uni and just kept going.

But I actually took a gap year. Between [00:04:00] high school and uni and I went and got a job teaching English in Ecuador, so I knew no Spanish. I was left when I was 18, turned 19 on, on route, , and got a job teaching English and did that for a good half a year and then came back and studied. 

Brownyn: Wow, that’s so cool.

Did you pick up any Spanish? 

Marie Vakakis: Yeah, a little bit. That was, , I lived with a family who spoke no English, so they, , were really cute and put post-it notes everywhere of what all the different things were called and um kind of would structure the conversation in a way that would be like, can you please pass the salt?

Like they would be really slow and try and like get me to learn the language and yeah, it was really lovely. 

Brownyn: Oh, that’s really sweet. That is so cool. It sounds like a really enriching experience. 

Marie Vakakis: Yeah, it was really fun. 

Brownyn: Cool. Thank you for sharing that. Okay, Marie, let’s set the stage for this. So I thought we could do is kind of compare and contrast between us.

So I’m interested to know [00:05:00] how you go about setting up the first session, what you think really helps retain clients in that first session. 

Marie Vakakis: I think, , I don’t do it all the time very perfectly, but what I’d really try and do is. Talk about. Talking. So really spending some time asking someone what their expectations were.

Why therapy, why now we talk about the consent form. I ask questions, talk about the cancellation policy, , every, every part of that. So really sort of trying to explain how. I work and how I might work with them, how long it might take to see change. Like it’s really structuring all of that. So like in the couples therapy, um, episode we did, I know a lot of people work in different ways with couples, and that can be part of what creates confusion.

If someone’s like, oh, I don’t know what we’re [00:06:00] doing and it didn’t work. But if I sit down and say the first four sessions is just an assessment. It can adjust their expectations. So they’re not walking out thinking, she just listened to us argue for an hour, when actually, that’s one of the techniques is we let them argue and we take notice of the pattern of conflict and then we look at that later on.

So it’s, it’s being clear in how I work, how I might work with that presenting issue, and then finding a way to communicate that. And kind of prescribe a, like a dosage of treatment essentially. So for this is what the frequency in which I would need to see you. Um, so really setting it up from the start around all of that.

Mm. 

Brownyn: And can I clarify, so do you have like a spiel at the start where you lay out these expectations or does this. Information arise kind of naturally throughout the conversation. 

Marie Vakakis: It’s a bit of both. So I have, uh, a checklist. I started [00:07:00] off with a checklist and um, now I have a bit of a script, and then sometimes it just sits in my head.

But I really do have a bit of a spiel of, I introduce myself first, like my, remind them of my name, tell them my qualification, give a little bit of info about how I like to work. I’ll ask for permission to, you know, like, and I just wanna go through, make sure I’ve got all, you know, if I had paperwork, like check all of those things and then explain.

I’m gonna spend a little bit of this session just trying to understand what’s brought you here. So even in that, I would explain that that’s what we are doing. And then, uh, I usually stretch it over maybe two or three sessions. So depending on the person, if they’ve, you know, been into a lot of therapy, like there might be adjustments, but I’ll make sure I come back to some of those things and say, and I just wanna, you know, we didn’t touch on it last session.

I wanna go through a cancellation policy and make sure these things are clear for you. So I do stretch it out over probably two or three, but I do have kind of a set number of things I [00:08:00] want to. To kind of cover. 

Brownyn: And is there anything else that you think might be helpful for early career therapists to know about structuring the first session, 

Marie Vakakis: we might be very clear about what we do, what modalities we use, but for most clients it’s completely foreign.

And even for me, when I’ve gone to see therapists as a client with different, who practice different modalities, I’ve been really at times disappointed, um, frustrated. Annoyed or even angry at the way they did things ’cause they don’t explain it. So it’s really thinking about it’s good customer service and it’s those common factors like the relationship between you is going to be the biggest predictor of a good therapeutic outcome.

Brownyn: Yeah, I think it’s, um, it’s really interesting that you share that because I do do a spiel at the start and it kind of sounds like we have similar approaches. I do tell clients what the purpose is of today, what they might get out of it by the end. [00:09:00] So I’m usually like, by the end we should know a little bit more about what’s bringing you here and how we might be able to work together.

And so I set that up. That expectation and then I let them know that I’ll be asking lots of questions. You have the option to pass if you don’t feel like going there like we just met. People usually find that it’s a helpful process and I sometimes I give them a little bit more information depending on their presentation.

So if they look really nervous, I might notice that, and they’re like, it’s very normal to feel nervous. Um, that’s all right. We’ll, we’ll take good care of you, like that kind of thing. But it’s striking that I’ve never had this with another therapist and I, and I was like, am I doing this? Like, am I doing the wrong thing here?

Like, why doesn’t anybody else do this? 

Marie Vakakis: But I, I don’t, I think it’s wrong not to because. You dunno what you’re going in for. So if someone approaches not to talk about that stuff, I think they still should overt that. They should say, I just launched straight in. So let’s, let’s launch straight in and let’s see what comes up.

And if you have questions, ask, like, if they give you no [00:10:00] boundaries and no parameters and no idea of what to expect, what you can expect of them, like it’s, it’s not a recipe for success. 

Brownyn: Yeah, I agree. And I think the research really backs that up, that it’s really important to give clients that socialisation to therapy.

I mean, that’s the, you know, the jargon word, but it is giving them the safety and structure and like, this is my role and this is what I’m hoping that we can have from you. And when you think about it, like a lot of our clients come to us and that might be experiencing depression or anxiety, they might not be feeling great about themselves, might be quite anxious about therapy.

I, I think this helps. Them by giving them a bit of, um, expectation and structure. What do you think? I think that, 

Marie Vakakis: and it also role models a skill that most people don’t have. So you get to talk about. Clarity and not be avoidant. Like I have some people who are like, I didn’t even wanna take their credit card details down.

I’m like, well then you’ve got some shit. You’ve gotta sort out about money [00:11:00] because you know you really need to role model some of that. A level of humility and accountability, being authentic and what you do and how you do it, it doesn’t matter as much as telling them, this is what I do and how I do it.

Brownyn: Yeah. And maybe adding to that as well, I don’t know whether this is people’s stuff, but you know how therapy works in reality compared to Hollywood. I wonder if people like comparing it to stuff they see in movies or something where it’s like the therapist has this inside every 10 seconds and then the client is healed after a session or something.

I don’t know. Mine 

Marie Vakakis: are, I don’t know what you’re talking 

Brownyn: about. 

Marie Vakakis: Okay, sure. And that, and that’s part of, that’s, that’s the stuff we need to myth, bust and normalise. Yeah. And saying. This is what you might’ve seen. Uh, I, this is how I work and I think about any service that I’ve had where I haven’t felt it’s been a good service.

It’s always been around expectations not being met. And that’s really important. You know, if you take your car to a mechanic and [00:12:00] you think you’re just getting it serviced and then they fix all these other things and you get a few thousand dollars bill, overwhelming. But the same could go as if you took the, took your car there and they noticed something was broken.

But didn’t mention it, and they just did the service and just expected that you were gonna take it to somewhere else to notice that then maybe something drastic could happen and you’re like, hang on, why didn’t anybody tell me this thing needed to get fixed? So it’s really around someone saying, this is what we can do.

This is maybe what the time allows. This is my skill set, allows, if I notice these other things, I’ll let you know, and then you can choose to either take it. To somewhere else, or I can give you a quote and we can book it in from like, whatever the process is, is being really clear about that. ’cause nobody likes to feel stupid and I don’t know about you, but no one, like, I don’t even like going to the dentist thinking I’m just getting it clean and I come back with a, you know, hundreds and hundreds of dollars and I’m like, oh no, why couldn’t you say you need this?

This can wait. [00:13:00] Like if you feel pressured and under the spot and someone’s got their fingers in your mouth, it’s really hard to talk about that stuff. 

Brownyn: It is. No, I agree that it’s, it’s part of doing a good service if you think of it that way. It’s really handy and reflecting on how we feel when we don’t get good service in other areas, like helps us empathise with how clients might be feeling.

I find that educating clients around the process of therapy really helps. As well, because sometimes they can have unrealistic expectations about how fast therapy is going to go. So I have had people come to me and an expectation was that this will only take two sessions, and the thing that I’m hearing from them certainly in my opinion, is not a two session thing.

So orienting them to therapy, this kind of thing takes time. I hear that you want some immediate relief. We can certainly talk about some strategies next session or ways of dealing with this in the immediate, but this might be a long-term thing. How does that. It for you. I find it’s really good to have that, that open discussion.

Marie Vakakis: Yeah. But it’s also informed choice. Like [00:14:00] how can somebody have informed decision making if you’re not informing them of what that is? Yeah, 

Brownyn: yeah. ’cause then they’ll do the thing that, I mean, you just mentioned, and they’ll walk out and they’ll be like, she didn’t fix me after two sessions. And it’s like. I didn’t tell her that.

So of course she’s gonna be upset and angry grade. Yeah. 

Marie Vakakis: Or how long, why do I have to keep coming back weekly? And then the therapist might be like, well, I keep booking weekly appointments, so I guess I’ll keep serving them. And it’s, no one’s really clear about where the work’s going. 

Brownyn: Mm, absolutely. I. So maybe we can expand on that with what do you do at a session two?

I’m interested with how you start off a session. Two, actually, 

Marie Vakakis: it, this is funny ’cause I was talking to, I had a peer supervision group, uh, this week and we all had very different ways of doing this. And what someone was like, oh, I do this. I’m like, as a client, I hate that. Oh, what was that? She just.

Welcomes them in and just sits there and looks at them. 

Brownyn: Oh, I hate that. Yeah. That 

Marie Vakakis: was my response. But some, but some people love that, and I told her what I do. She’s like, oh, I hate that. That’s too much [00:15:00] work for me. Oh, 

Brownyn: that’s interesting. 

Marie Vakakis: Yeah, so I usually check in like, how was your day, week, commute, getting here, school, whatever.

If I knew something particular had been happening, I’d be like, oh, how was. I dunno. ’cause you sometimes at the end of the session to ground someone, I might ask them about, you know, what are you doing on the weekend? Or, you know, anything planned for the long weekend or what’s on. Like, so if they’ve given me something to kind of go with, I’ll, I’ll be like, well how did that go?

I might ask them if anything, was there anything I said last session that really you mulled over or landed for you? Or I might sort of, if they’re more quiet and they need a bit more help, I might recap saying, these are the things we covered and these are some of the things that I thought we could keep talking about.

And I just wanna pause that there for a minute and see has there been anything else that I, I missed or didn’t get to talk about? Or if I’ve got any admin that I didn’t cover, I’ll say, look, I wanna. I definitely wanna get into some of that. I just wanna make sure I quickly cover this stuff first. So again, I [00:16:00] really just talk about what that looks like.

And depending on the modality, I might do a bit of a, a me meditation or a grounding, reflective kind of exercise, but I would’ve told them that that’s part of how we work. But again, if someone’s coming in a real flurry because they’ve missed the bus or something’s happened, I might help ground them first before I go into any of the other stuff.

Brownyn: Yeah, you wanna attune to them? Yeah. I do something similar and I say, um, I really wanna know about the in-between what, what happened between now and last session. Sometimes people don’t think about the first session together, but sometimes they’re like, oh, I forgot to tell her this. Or like, oh, I shouldn’t have put it like that.

That kind of thing. And I wondered if you had any thoughts like that. I find that’s really helpful because sometimes they’ll be like, oh yeah, I really wanted to tell you this. Or like, oh my gosh, I was ruminating so hard after our session. I just felt like a really vulnerability, like, you know, hangover.

And so that’s a really good, um, starting point. I mean, sometimes they’ll be like, I was [00:17:00] overwhelmed for like a week after our session. And that’s a really good insight for me because that says to me, make sure you check in with this person about how overwhelming the information is and how overwhelming the session might be for them.

Marie Vakakis: Yeah, no, I, yeah, something similar. 

Brownyn: Then I check in with them. But then I also, um, I give them a bit of like how I do therapy. So I usually say to them something like, the way I like to do sessions is that I bring an idea or two to come with sessions with, and like I look at what you wanna get out of therapy and I’ll come with an idea to help us with that.

And if you wanna bring something to talk about at sessions, then we can absolutely go with that as well. So it’s very much shared space. And if you don’t like my ideas, then we can, you know, on the fly, come up with other ideas. Very flexible. Um. 

Marie Vakakis: Well, how do, how do you go about doing that? Yeah, something similar.

I think it might take a few sessions to really understand the, the goals, like why, why now, uh, what’s happened, and then sort of being able to distill that into how would we know this is [00:18:00] working, what would be different? And then I come to that with either some ideas, but again, whatever I, I tell them to.

But however we go into work, we talk about that. So I might say, you know, if it’s more relational, we might say something like, you, you’re coming to me. ’cause I know that you feel really uncomfortable in social settings. And sometimes there might be a, a whole session that we just understand what that’s like.

But if something is happen in between, then we can work from that event as it’s kind of fresh in your mind and trace that back to some of the things that. You struggle with when it comes to social settings, so explaining that. Sometimes it might be digging into the past to find something we can shift there and sometimes it’s something that’s really recent that might feel insignificant, but it, it activates that same issue for that person that we can explore.

And couples therapy is very much like that too, where what they come in with is, okay, now I can hear that [00:19:00] you struggle with. Feeling appreciated. I now have a tool for that that we can do. Mm-hmm. So you’ve got a bit of a, an idea as you conceptualise the case, and then you see, so if you work really relationally, then even the question of what resonated with you, that might even just be a whole session of, okay, and what made it hard to ask me that?

Then how does it feel me asking you about that Now even that becomes part of the work. So. It’s really again, in, once you are clear in your style, how do you explain that to someone? 

Brownyn: Yeah, that’s a really lovely way of putting it, and I really like how you put it with why. It could be important for couples even to bring up stuff that’s happening in the present because it may relate back to the goals that they have brought to therapy because sometimes clients don’t understand the significance, um, of say like they fought over who’s [00:20:00] taking the trash out and they might not understand.

That relates back to a key presenting thing that they’ve come to therapy with. So giving them a bit of rationale around why that might be important to notice and bring up. Sounds important. 

Marie Vakakis: Yeah. And with some clients, especially when I’m looking at maybe more of my A DHD clients, they can, some of ’em can spend a whole session talking about something and then leave and think, that’s not what I wanted to talk about.

Yeah. So keeping that in mind, I’ll allow maybe 10 minutes or so for that, and then I’ll gently with permission interrupt and say. Is this the stuff you really wanted to talk about today? Do you need one of those venting sessions or do we wanna pick up with X, Y, Z? So I would still bring them back into that because that’s, I see that as part of my job.

Otherwise, they might feel completely dissatisfied that they’ve been going to therapy for six months and they’re not getting anywhere. But part of the reason they don’t get anywhere is ’cause they get excited and they overshare. But then that’s what they need some help with is how do I stay [00:21:00] back on track?

And how do I, you know, I need someone to help guide me. ’cause if they knew how to do it, they probably would do it already. So it, it’s finding this balance of making the space useful and also using your knowledge and skills of can we just check in that, is that an avoidant technique? Is it that your brain’s just really excited and maybe that’s not what we need to use this for, or, you know, whatever.

So actually trying to understand that can be really helpful. 

Brownyn: Yeah, absolutely. This has triggered a memory in me because really some of my earliest feedback from clients when I was a provisional psych was like they would say to me, if I keep on talking, interrupt me, please tell me to stop. Um, and so they, and I had a few clients say that to me.

I think precisely because of what you’re describing. They would be excited or start talking about something, but it wasn’t really what they wanted to talk about. And then they would be like at the 45 minute mark, being like, okay, I can talk about the thing now, but everyone got five minutes. [00:22:00] Um, and then they would leave feeling quite dissatisfied.

So one of the key skills that I do, which is similar to yours, is that I might allow it. To go for like 10 minutes and I’ll be like, I noticed we’re talking about this subject and I’m very happy to continue talking about it, but I just wanted to pick up that last time we’re talking about that and I wondered if you wanted to talk about that a bit more, or even something else.

And you know how frequently clients would be like, oh yeah, this wasn’t even the real thing. I wanted to talk about this. That happens so often. 

Marie Vakakis: Yeah, absolutely. Yeah, 

Brownyn: so it’s, it’s a good skill. I like that one. I reckon this might be a difference between us and I think it’s due too with our training, but.

One of my first jobs as a provisional psych was in a six session service, so I’d get these clients, and they’re usually quite complex, but it was a free service, so they would come to our service and we only had six sessions, and so. It was quite time pressured and I was trying to do the assessment in one session.

You give the formulation and treatment plan in the second session, and then you progress session three, four, and five with the work, and then [00:23:00] you do a close the session at session six, and I think it’s like I’ve eased up a bit that I’m like, okay, you don’t have to get everything done in the first session.

You don’t have to give them the formulation complete in the second session. But I think I’m still a bit hurried in that. And I just wanted to see if you are a bit different about. Like, do you share the formulation with them in the second session or the third session or even later? 

Marie Vakakis: Not in that same structured way, because I don’t work from that sort of medical model in that.

In that way, I would still talk about the limitations of how they’ve found me. So if they’ve come through. VCAT that might look different to TAC to NDIS. So it’s still really understanding the referral pathway and then the frequency of sessions or the financial constraints and then actually being able to say, so, you know, we, you’ve had your Medicare, you know, your mental healthcare plan that gives you 10 sessions.

Just from what I’ve seen, I think you might need up to [00:24:00] 40 to manage this. So. Is that possible? And if not, then maybe we can’t go there. And this is the piece that we focus on instead. So I don’t do a lot of diagnostic tools. I, I, I’ll do like a das and a K 10 and a couple other things more for reporting for the gp, but to have some baseline data.

Because I find that things are constantly evolving, and as I’m doing work, maybe I’m doing EMDR, then I might think, oh, I really wanna kind of know a bit more about these schemas. So I might switch to using some of that. And as we’re doing those schemas and as like, oh, that, that parts works really good to bring back into EMDR.

So I don’t have it as structured. I might just bring it up in a more. Informal we’re saying, this is what you’ve said you wanna work on. And I would talk about any, like, there’s no point sending all this intake paperwork, asking for these questions, and then ignoring all of that, how rude to ask someone in an intake session about all these [00:25:00] questions and then ask them the same thing, like have Yeah, agree.

I would be like, what? Didn’t you frigging read it? It took me all day to complete. Yeah. So I would say, based on everything I’ve collected, it’s indicating that these things might be a bit of a concern for you. This is what I’m noticing, or this is, you know, I wanna learn a bit more. So I always talk about what I’m doing and why.

Brownyn: No, that’s really important. It’s like, I feel like for you, you’re, you’re so much more chill, which is lovely and I think I need to take a bit of a chill pill with the session two, and I’ll tell you what shows up for me, which I reckon will show up for some other early career psychs. I worry if I don’t give them enough value in the first few sessions.

Then they will leave. It sounds like I have a big abandonment schema, but I actually don’t, but I, I Maybe it’s because I wonder if they’ll wonder whether I’m competent. That’s, that’s, that’s more like me. That’s the unrelenting standards. Mm-hmm. Yeah. What do you think of that? 

Marie Vakakis: I think that’s really common, and I can totally understand that, and I think that’s magnified in private practice where we see the money exchange.

Mm. What I’ve [00:26:00] learned to, to do and take a step back is. That. If that’s overwhelming and we flood the person, they’re gonna learn nothing. So if we’re over over educating, we’re actually not allowing then for that experience to tap into the emotions, to process things. So we need to take into account what we know about how the brain works, how information is absorbed.

If they’re wanting to hurry a lot, then that’s still information of, okay, what’s this about for you? I know if I was learning something new, like imagine if you were trying to learn Japanese and in that first tutoring session, the tutor gave you the three different alphabets and like a song to learn and then gave you a movie to watch with subtitles and they wanted to jam pack your Japanese experience with all of these things.

You’re gonna leave thinking, I don’t know where to start and I already feel stupid. 

Brownyn: It’s too much. I’ve literally done online courses that have been like, amazing. I’ve [00:27:00] loved the presenter. Um, so they’re self-paced online courses, but then they had like 20 resources for each module. And I was like, I cannot, I cannot read all of these.

I just feel this is overwhelming. It’s kind of, uh, yeah, make me feel stupid, but also it’s like, uh, reducing my capacity to learn in a way because I’m like, oh God, I can’t do all of this. 

Marie Vakakis: Yeah. And so when for someone, I’ve done a bit of work in trying to understand adult learning and course creation.

Having developed a couple myself and really distilling it and simplifying it, and what I want people to do is to complete it and action it. If they feel so overwhelmed that they don’t look at it, my goal’s not to just sell it. I actually believe in the product, so I want them to get the benefit from it.

So if I’m overwhelming someone in therapy. To the point where they feel like a failure or they, uh, haven’t done their homework, so they don’t wanna come back. I’m doing them a disservice. So they’re not actually getting the treatment. I 

Brownyn: think you’re right. And I’m on board with this. I [00:28:00] am like, okay, yep. I need to slow down.

I’m overwhelming them too much in that session too. But here’s another worry. I’m worried about the, I’m worried about the family and partners. ’cause I think, I do think behind every person who comes to therapy is someone else who is hoping that this will work for them and that this will be a good experience.

Um, who. Who do have people who love them. And so I think about, okay, well this client’s gonna potentially, if they’ve told their partner they’re going to therapy, they’ll be like, how did therapy go? Whatcha doing? And I don’t want the client to be like, oh, you know, we just talked like, well, I didn’t really feel like I got much out of it.

Yeah, I worry about that. But, you know, hearing myself talk about this, I’m like, don’t worry about it. I shouldn’t be worrying about that. 

Marie Vakakis: No, they’re really valid worries because someone brought up in the supervision group, uh, this week, which I love the analogy, like, do you stay awake? And if someone’s listening and you do stay awake thinking about this, I apologise, like it’s gonna, it’s gonna be a flawed analogy, but do you stay awake at [00:29:00] night thinking about who is winning the Tour de France?

No, I don’t. Why? 

Brownyn: I, one, I’m not a big like Tour de France fan, but two, like, you know, they’re doing them like. I’ll find out later. 

Marie Vakakis: Yeah. Or you, you don’t care ’cause you don’t particularly like it. Yeah. Yeah. I 

Brownyn: don’t, I don’t really care. 

Marie Vakakis: Yeah. So the fact that you are worried about some of this stuff with your clients, it’s because you care.

You care about their life, you care about what they’re doing, you care about their relationship. So it’s something to to tune into and be like, I’m worried about it because I care. I’m not worried about who’s winning the Tour de France because I don’t care about cycling. So it’s already, it’s signaling to you a bit of a value.

Yeah, and I think that’s okay. If you looked at some of the sort of feedback informed treatment, whether you look at Scott Miller’s work or session rating scales, then bringing that into your session can actually help you figure out where this is. So it might be saying to the client, last session, I feel like I bombarded you with stuff I wanted to check in.

Did that feel like [00:30:00] a lot? And if they said yes, like let’s try and slow it down. And if you had a really slow session, you might say, I really. This was a different pace to what we’ve had in the past. What was that like for you? And so maybe you end things five to 10 minutes earlier to do that recap and then if they’re like, well, yeah, I don’t know what we covered today, then you might be able to bring in that education.

Well, what I was hoping we would do, and we’ve just done it through osmosis, is I wanted to slow it down, give you a space to really tolerate some of those difficult emotions to feel them in your body. And I know that that’s new for you. So you might get to tell them what it is that you have shown them to do by slowing things down.

And then you can rehearse if your partner parent, you know, you hop in the car and your parent asks you, what did you do in therapy today? What do you normally say? So you can actually script some of that and role play it and help them kind of figure it out. 

Brownyn: There’s a few things in that [00:31:00] that I wanted to point out.

One of them is that with, um. Scott Miller’s work on feedback informed treatment. One of the things that I’ve read in that is that if you wanna get feedback from clients, be specific. So don’t be like, how was today’s session for you? They’ll be like, I no good. But I really like how you said like this has been a session where you’ve sat with emotions more than usual.

How was that for you? Or like, this has been a slower pace. What was that like? So that’s a really effective way to get feedback from clients, and I just wanted to point that out. 

Marie Vakakis: Yeah, and I think it’s because like we chatted off air, I’ve been doing this for a lot longer that I, I have forgotten how to pin that down of, I’m used to doing it now, but I did start off with.

The sheet with the Likert scale and I would give it to people and I think that we can evolve over time. And now I know I use a bit more intuition, which isn’t just winging it, it’s intuition built from, you know, over a a decade of doing this [00:32:00] and lots of professional development where I can pinpoint. Did you feel heard or understood or, you know, if I know they have particular schemas or particular presenting concerns, I might say, what was that like when I was a little more assertive in our session?

Or, I noticed that you sent me an email in between sessions, which you haven’t done before. I. What was that about? So it’s really being curious and reflective. The only way to know for sure is to ask them and, and keep in mind that some want to be a good client. They want to please you. It won’t be a perfect measure, but it’s a really great place to start.

It’s better than assuming. 

Brownyn: Yeah, I really appreciate when clients tell me that they wanna be a good student, be a good client. And I’m like, thank you so much for sharing with me. ’cause I do think it takes a lot of courage and vulnerability. It’s like, I wanna be good for you. And I’m like, no. Um, but thank you.

Thank you for sharing that. What would it be if you didn’t, if you didn’t try and be a good student for me and you were more yourself, how would that be for you? Oh, that feels really scary. It’s a great topic of conversation. 

Marie Vakakis: Yeah. And that’s [00:33:00] maybe where the work is, right? 

Brownyn: Yeah, absolutely. So Marie, I just wanted to hear about how you get into a session three, and then I’ll ask you about any other top tips for structuring sessions one to three.

Marie Vakakis: Yeah, so I would, um, I go through my checklist and I have this all on, on demand training. It’s very general, but I do have a bit of a checklist and I make sure I kind of go through it all. I’ll, I’ll use that third session to just check any of it. And then do a bit of a recap of the, maybe the session frequency.

So I try to book the first three a week apart, and I kind of consider that in my head a bit of an informal assessment phase. And then I might sort of share that with the client and say, this is sort of what I’ve noticed. Here’s sort of my version of a case conceptualisation. Now moving forward, how do we kind of progress and, and avert some of those bits and pieces?

Any communications that I need to make with, [00:34:00] you know, doctor, like really just making sure they understand those reporting requirements and still continuing to get to know them. So I might talk about. Do you feel like you want some things to try at home? Do you wanna experiment with like, do you want me to give you homework?

Do you like to journal? So I also wanna try and ask them about their learning style and what they wanna do, because that’s how I work. And even though I know some people who do more psychodynamic work, don’t ask that as a client that’s really frustrated me because if I don’t know that that’s how they work and they never tell me that that’s how they work, I’m gonna feel like I’m always coming short.

Or not maximising a session. So it feels like I’m just a boat floating in a big ocean, and I’m like, well, I don’t like this. So I’d still really clarify that. Talk about any, I always ask about if they’ve had therapy before, what worked and what didn’t. And the what didn’t I really focus on and check in, like what happens if I run the risk of doing that?

[00:35:00] So if I say something that’s uncomfortable, when is it something we can talk about? And when is it so like that, that’s just a no go zone. How do we know that? How do we do that different with us? How will I know that if you are, if you’ve canceled an appointment, is that you avoiding me? How so? I really talk about the process of therapy after we’ve had a few sessions.

With, um, with the data you shared, I, I probably focus on that a little bit more with, with male clients in particular because about 50% don’t come back for their second session and we know, oh, I 

Brownyn: didn’t know that. That’s interesting. We know, we 

Marie Vakakis: know already that it’s harder to get men into therapy. Yeah.

It’s, and that disproportionately the workforce is female. Yes. So I would overt some of that and, and be really clear at the start that. You are not, you’re in the norm. If you think after the first session, I don’t understand the point of this. Bear with me. We, we need to find a bit of a groove. ’cause it does take some time.

So [00:36:00] Wow. Using That’s 

Brownyn: awesome. Using, 

Marie Vakakis: yeah, using demographic information is helpful if it can. You can overt that stuff, right? So if you’re working with someone in the queer community, we know there’s higher risk of suicide attempts and self-harm. 

Brownyn: Yep. 

Marie Vakakis: We know that there’s an overlap with body dysmorphia, eating disorders and maybe autism.

So this information is only as useful as it helps inform treatment not to discriminate. It’s to inform how we work or what we are maybe more attuned to and what we’re going to look for. And it should be the same for medical services, but I can’t talk to that. But it, I would overt some of those things a little bit more saying session three, you’ve done more than 50% of men who attend therapy.

What’s that been like? What’s work? How can we tweak it? What do we need to adjust time, duration? Do we do it walking? Do we do it telehealth? Do we make it um, less frequent, longer set like. And then we start to kind of adapt because all of those things are options. Half hour sessions are an option. Walking sessions are an option.

90 minute sessions are an option. Yeah, [00:37:00] like there’s so many different ways of working. We don’t have to be so rigid. 

Brownyn: Yeah. I love how you talk about that so overtly, like I, it sounds like a real strength of yours and it feels like. I’m like kind of coming into some of that stuff, like when you were talking about how you ask clients, how they went with previous therapists and how would we know if they’re approaching that.

I think that’s awesome because sometimes we will ask clients like, how is previous therapy? And then in our minds we’re like, okay, I won’t do that. But it’s so helpful to ask the client like, what would be the signs that this is happening? 

Marie Vakakis: Because that’s a pattern for them. And it could be if it’s happened multiple times, it could be a pattern that is an underlying concern or a symptom of what they’ve brought to you, or just either related or slightly tangential that we can bring in if needed.

It’s, it’s part of the information I. 

Brownyn: Yeah. No, absolutely. Okay. Marie, I just wanted to ask you, is there anything, any other hints and tips and tricks that you have for [00:38:00] early career psychs that we haven’t mentioned? And then I will say I, I’ve got two. 

Marie Vakakis: Yeah. So I would get you to think about. Write a checklist so you can, you can attend my training and, and you get a checklist with that.

But really thinking about what are all the bits that I need to know and cover? And maybe start off with printing it out as a checklist and just having it on your, um, iPad or on your note, you know, your pad, whatever you use, and. Get used to going through it. And that can be, you know, if it’s an NDIS referral, that might be different to Medicare to if you’re working in an organisation.

So being clear of session frequency, funding restrictions, um, gap pay, like be. Understand the admin side because it can be a really big rupture for a client if they feel like they’ve been ripped off or things ended after three sessions and they didn’t realise, like just got into trauma work. Like being really clear about the parameters and having a [00:39:00] way to understand and explain that.

Brownyn: Mm-hmm. Can I just add to that? ’cause it’s actually a huge gripe for me when, um. There’s not clear admin processes for clients. I don’t think it’s understanding of the presentations that we see. So like clients often come to us in distress. They might have limited like cognitive capacity and they’ve got, you know, a lot of distress in their lives.

And I feel like as a service provider, the least that I can do is make this an easy process with them and understand their funding and what’s happening for them so that I can make sure that this service goes smoothly for them. And so, yes, I would really recommend that, that people do that. It. It really provides a sense of relief for my clients to know that I’ve got this under control.

Marie Vakakis: Yeah. And I’m, I’m, I’m less, I’m less forgiving of people in private practice who don’t do that because I think you are now a business and that’s your job. Just like you go to a restaurant, you don’t care if it’s a big one or a little one. You expect certain standards. So if you’re going to be going out into private practice, I [00:40:00] know you love therapy, but you are a small business and a service provider who.

Also could do damage to an entire field. So you need to get your systems and processes up to scratch. You need to have a way to have a consent form. Be clear on the funding requirements. Don’t be flap, you know, flappable and distressed in sessions. You need to be. Clear contained. There’s no one else to blame but you.

So you have to put in the supervision. You’ve gotta charge for longer sessions. If you need more admin time, you need to book in more breaks like that. It it stops with you unfortunately. 

Brownyn: Yeah, it’s a huge responsibility, but it’s so important to fulfill those like responsibilities. 

Marie Vakakis: Like I’ve been a client of so many people, and I’ve had some who have no consent form, have ones that they’ve clearly copied from another practice that had their information on it.

I had one at the online form. Someone must have used it. They, they sent the link wrong, and so when I filled it out, it had someone else’s [00:41:00] Medicare card details as part of the question, oh, I’ve, I’ve just had all sorts of terrible things, and I’m like, I’m sorry, but that’s just not good enough. If you, if you don’t like that stuff and you can’t do it, go work for someone else.

I, I really don’t think it’s okay. 

Brownyn: No it’s not. And yeah, it makes me feel upset actually. And it’s like, you know, getting mental health help for my family members. Um, and my family members are DVA, um, because my dad’s a been in the Navy and so my family members can access counseling for free. And the amount of times that I’ve helped to set them up with psychologists who.

Won’t inform them of that, and we’ll make them use a mental health care plan for like 10 sessions. And I’m like, this is supposed to be free. Like they need to make sure that they contact DVA. You don’t even have to sign up to DV to to cover this. 

Marie Vakakis: Yeah, absolutely. So that’s, that’s one of the first things that I get people to think about is good rapport and enhancing clinical outcomes starts from before the client’s in the room.

It starts from grounding [00:42:00] yourself, understanding the systems or processes, and with time, like now, if I get a Medicare referral, I don’t need to go back and I know the spiel, I know the restrictions. I know the item goes off my heart like, that’s fine. 

Brownyn: Yeah. 

Marie Vakakis: But it didn’t start like that. And with my regular clients, the less new clients I have, I might be able to back to back a couple.

’cause I kind of know their story already and their, yeah, their story’s so fresh in my mind. Whereas new clients might require more time. So it’s really taking the time to do that. Properly. And if you can’t, then even maybe overt in it saying, look, this is, I know this is an EAP service. We’ve only got three sessions together.

There’s all this stuff I’d love to do, but that doesn’t feel like it’s gonna be useful for you right now. So I’m just gonna cut to the chase. This is how I can help you in this short amount of time. How does that sound? Like? You might have to use a bit bit of humor being like, yeah, this feels like a rotisserie of just lots of different people and you come in.

Yeah, it’s really sterile. That’s okay. [00:43:00] While that’s the restriction, how can I make it helpful for you? So whatever, whatever it is, you can overt that and just make that clear that these are the limitations of this. No, totally. And is there anything else. I’d be being clear about boundaries and don’t expect the client to follow them.

It’s you that has to follow them. So if you’ve said, I won’t reply to emails midweek, because I only work Monday. So if you email me Wednesday, I won’t be back until next Monday and they email you. It’s on you to not reply. 

Brownyn: It’s so true. I’ve, I’ve had supervision around this. I’ll tell you what I’ve had.

’cause I’ve been like, I should, I don’t, I don’t reply to clients. And then, um, I replied to a client and my supervisor was like, why did you reply to them? And I’m like, because they asked me a question and I was, and I was like, I felt compelled to reply to the question. And he’s like, no, you don’t. And I’m like, ah, okay.

Mm-hmm. 

Marie Vakakis: Or have, um, an auto office reply that just says, 

Brownyn: yeah, I need, yeah. 

Marie Vakakis: Thank you for contacting. Marie, [00:44:00] I currently only work one day a week. If it’s regarding a cancellation, you can do it through the Manxy portal. You can contact admin if it’s an emergency contact this. I won’t be checking my email in between my work days.

So figuring out some of those process things, again, this, this is where it’s maybe a pet peeve of mine around the different modalities. It’s got nothing to do with what, whether you’re a psychologist, OT, psychiatrist, like some of this stuff, it doesn’t matter. This is the basic customer service bit, and funny enough, I think this is the most important and it’s what’s never talked about or explicitly.

Or trained, like no one gets trained this way. No, 

Brownyn: they don’t. Absolutely. It’s usually something that we have to find out through mistakes, but you know, it shouldn’t be that I’ve had to learn through mistakes. We, we should have clear guidance around this. 

Marie Vakakis: Yeah. And when I listen to, I don’t know if, I mean you are a fan.

We’ve talked about it for the very bad therapy podcasts, listening to that. Oh yeah. Love very bad therapy. So many of [00:45:00] those ruptures come back to not communicating clearly. 

Brownyn: Mm, a hundred percent 

Marie Vakakis: how you work, how you can work sessions in between boundaries, uh, communication with partners, with parents, with like all, a lot of that comes down to that not being clearly articulated or understood.

  1. But then we also can’t take full responsibility for everything, right? Because we are human. No. And we make mistakes. Yeah. And we overlook something. And sometimes clients need to take some personal responsibility. We had one parent who after two sessions, three sessions was like, I feel really lied to. I called and asked for a psychologist and I had a mental health social worker.

And I was like, it’s on the website, the email, the confirmation email In your introduction. You still had three more sessions. What’s this really about? So at some point we can’t address everything of everybody’s, 

Brownyn: no. Yeah. And 

Marie Vakakis: we just have to accept that we will get it [00:46:00] wrong sometimes and that’s okay. 

Brownyn: Mm, no, that’s fair.

Okay. Is it right if I share my two things? Yeah. The first one is I’m very interested in client’s strengths. This is something I tell my clients explicitly, um, usually about three quarters of the way through the first session. And I’m like, I’ve heard a lot about, um, your concerns and it’s good that we’ve been able to understand them a little bit.

I don’t generally like seeing people as a bag of problems, so I usually also like to hear about the good things about them. And I’m wondering if you could please tell me a bit about your strengths or. Things that you’re passionate about, you know what gives you a bit of joy? And I find that this is really helpful for two ways, two way.

The first way is that it helps me work out, um, how they see themselves. Um, and sometimes they struggle with it straight away and they’re like, I cannot think of a thing. And then I say, what would someone who loves you say are the strength about you that. Usually better able to give them that. But if they can’t think of anything, then that immediately says to me, okay, like we’ve got somebody who, who cannot like think of anything good about [00:47:00] themselves, but they can tell me all their problems.

And then I usually like to say to them like, it’s really important for me to know about your strengths because this isn’t your first rodeo or first difficulties that you’ve had here. You’ve come through difficulties in the past, and I wanna use those strengths to help us in the present. Yeah, I love that.

That’s 

Marie Vakakis: really 

Brownyn: great. Great. Yeah, I’m gonna add that to. Thank you. Yeah, no, um, I think as psychologists, like particularly, like we’re just trying to like, yeah. Pathologise and so I’m like, I, I wonder like if clients have that expectation, they’re like, she’s gonna be here to make me feel bad about myself and how like crazy I am.

And I like to reassure them that they do have good things, positives about them. The second thing they do is I usually tell clients about the change process. This usually, how much I tell them, usually varies, uh, depending on how much expectation I think they might have. Or like, maybe they’re not very, uh, realistic about what change looks like.

So I usually say something along the lines of like. It can be hard to take the first step in in change and getting to where you wanna be if you already knew [00:48:00] how to get there and the path and how difficult you’d already be there and you wouldn’t be here. So there’s gotta be a good reason for you to take the first step, and that usually ties into values.

But then I’m also like, you know, change requires you to usually go outside your comfort zone. So this will be a difficult process, but I’m here to help you along the way and I’ll make sure that we’ve got the tools to help you get across. 

Marie Vakakis: Yeah, well, which the way you phrase it actually, if you look at the, um, taxonomy of deliberate practice, that’s instilling a message of hope.

So if you look at those core bits of deliberate practice, I. That’s, it’s giving a message of hope. 

Brownyn: Yeah. And I try and do that. I try to, because I think a lot of clients when they come to us, like, you know, they’ve been struggling this for some time and sometimes like, you know, going to therapy is like, you know, I’ve tried everything.

This is the last resort. Mm-hmm. And they might feel like there is no hope. So to have somebody say to them, look, there is some light at the end of the tunnel here and I help guide you along the way. I know it seems dark and scary, but I’ll be here with you. I think does provide people with, yeah, a lot of hope and good.

Marie Vakakis: [00:49:00] Yeah. One of the, um, practitioners in my peer supervision group was sharing some resources from a, uh, I guess a conference that they went to, and they said this one particular presenter, her philosophy is everybody is already whole and capable. And so even, you know, if you’ve got philosophies like that, that’s worth sort of sharing and saying, I see you as you’re not broken.

You might have some coping strategies that don’t serve you well, but I see you as worthy, as competent as whole already. So there’s different ways, different spills you can have based on what modalities you use or your own style, or if you’re fusing that in with any spiritual or religious, um, beliefs, like you can bring some of those things in.

Brownyn: A hundred percent. Yeah. And like, I guess like did you build up your kind of philosophy of people over [00:50:00] time? Like do you reckon 10 years in you’re like, you know, I’ve got a pretty solid idea about my beliefs. 

Marie Vakakis: Oh yeah. And they, they changed and there was so much originally, um, it was interesting ’cause I was actually just reflecting on it after a recent podcast episode that I had released called, um, growing Yourself Up and.

Initially I was very good at sort of pinpointing what someone else was doing wrong, maybe pathologising that coming up with a diagnosis and saying, well, of course that’s their dismissive attachment style, or they’re going to be irritable because you know, that’s a symptom of depression. And it did change over time to start to recognise the role that I played in that even within therapy.

So. Personally, it’s been, you know, incredibly useful to start reflecting on that. But in therapy, starting to attune more to what I do in the space can, can really impact how well this goes. I can really get someone on site or offside. I can, I. Sometimes I could do the best thing and it might not be what that person needs, [00:51:00] so I don’t have to take full responsibility.

But I do play a role in that and really starting to use that as a tool to guide the therapy in itself can be really, has been a real big change I think for me. 

Brownyn: No. Awesome. Okay. There’s just one other thing I wanted to mention, and I reckon you’ll be better at this because of your social work training than me, and it is a mistake that people can make is ignoring culture or contextual factors.

I had this happen to me like really early on when I was, you know, just starting out and I remember someone came to me with a workplace bullying issue and I think. Just because I was starting out, I was using a very strict CBT approach, so thoughts, feelings, behavior, and I completely missed that Their workplace was full of misogyny and it was a very much a boys club.

So they were experiencing this workplace bullying that was a [00:52:00] direct result of these attitudes that were, I guess, like discriminating against my client. Um, and so the client. Graciously told me that they felt very unheard in that, and it really highlighted to me that we need to consider these factors and it’s like, I, I’m just gonna assume that you do this much better.

Marie Vakakis: I’m getting better at it. And I find that it’s then helped create more of a reputation for working with a certain presentation. Again, I think the more you, um, niche down, you get familiar with the particular populations. Or challenges. So if you worked at somewhere like Foundation House, you’re going to be a lot more attuned to the impact of trauma and the refugee and migrant story of.

People who come from countries that are experiencing a lot of conflict. So that’s going to be something different to working with in the queer community. If you’re working in with a lot of people with disabilities or disabled people, then you need to start to [00:53:00] have a language around internalised ableism discrimination.

So I’m getting better at ting that sometimes it’s more professional than other times. And sometimes I have to sort of say, you know, you know, if I’m working with. A person you know, who’s a big tall man, I might say, I don’t think that you can express anger in the same way because given your stature, it’s probably not safe and it’s safer than if you are a black man.

It’s still not safe. If you get angry, people get scared. So me being able to name that for them can be really helpful. If I’m talking with someone who is from a, a migrant family community that we know experiences discrimination, I might check in with that. Like during Covid I did check in a lot with my Asian Australian clients and saying, has this changed for you?

Some will say yes, no. Maybe, I don’t know. Is it something we need to bring in [00:54:00] and I can then be honest, more honest with, look, there’ll be things that I can’t relate to from a lived experience because I’m not from that background. I just wanted to name that. I can see that that might be a factor in this.

So I think we do have to be aware of that intersectionality and talk about it because. It’s so I, it’s important for the work, but it also can be part of the story that’s led the person to be there, and a great source of strength and resilience and an amazing resource. 

Brownyn: Yeah, it’s like I’m getting really good at talking about neurodivergent sources of trauma just from being a neurodivergent person in neurotypical world, like ableism, medical gaslighting, um, feeling unheard, having to mask that kind of stuff, which can, you know, pause like a lot of damage and harm to a neurodivergent folk.

Um, but yeah, I hear what you’re saying. It’s like recognising this can be really important. Hmm. Okay. Um. I could talk about this forever, I [00:55:00] reckon. Um, but you know, we’ve got things to do. Sure. Listeners got things to do. What’s the biggest takeaway you hope listeners will learn from our conversation today?

Marie Vakakis: Talk about the talking. Mm, wise. I can’t take credit for that. That was my, um, my lovely supervisors at the re center. But it’s, yeah, it’s really just, it’s, talk about the talking and o overt the process. 

Brownyn: Mm, so helpful. And do you have any favorite resources you can plug for early career folks? 

Marie Vakakis: Yeah, so I do have an on-demand training called Enhancing Clinical Outcomes in the initial three sessions.

So that’s on my website. That’s about I think 60 to 90 minutes. I would you Google the taxonomy of deliberate practice? And I think that gives you a really good tool. ’cause it’s not about diagnosis, it’s not about treatment modalities, it’s around the bits that you bring to the room and it gets you, it gives you prompts to actually script.

If you’re looking at introduction, how do you [00:56:00] say it? How do you greet someone? How do you bring them from the waiting room? So if you look at some of Scott Miller’s work, and I think there’s a few YouTube videos that he talks about that, um, that resource. Then picking only one or two to focus on. ’cause again, we’re human, so we can’t focus on improving all of those things.

No. So we need to be deliberate about the bits that we work on and how do we measure the growth of that. So it’s probably really overwhelming to people of like, I’ve just spent all these years and I’ve got these massive hex debt for all these skills, and you’re telling me that the most important thing is the relationship.

And they’ve not taught me that. Oh my goodness. Yeah. Yeah. Unfortunately. That’s, that’s okay. 

Brownyn: Yeah. Unfortunately. Yeah, that’s it. And, and I will say that like, yeah, focusing on that, I think returns has so much return. So like, um, I was saying this to Maria off air, but I reckon like client retention is, is probably a strength for me.

And I literally used to like write out scripts. I used to practice scripts. I used to think about and reflect on what I could do [00:57:00] differently, like what happened in sessions. And I would say like. Over the past few years, I’ve probably had one or two clients not come back after our first session and like I can easily pinpoint why.

So yeah, I’d highly recommend it. Sounds like a great course, Marie. 

Marie Vakakis: Thanks. And even this, hopefully it’s given people something to think about. So this conversation in in itself will be, I guess, an eye opener for some folk. 

Brownyn: Well, thank you so much, Marie, for coming on. It’s been, it’s been eyeopening listening to you and I’ve certainly learned lots myself.

I need to take a chill pill at session two. That’s my main takeaway. 

Marie Vakakis: I’m gonna ask more about strength. I love that question. 

Brownyn: It’s so good. I love hearing about their strengths as well. It’s really good. So, as always, listeners, thank you so much for listening. If you’re loving the show and you don’t wanna miss an episode, do press follow on your podcast listening app.

You can do that in Spotify. You can do that in app, or you can do that in probably every other podcasting app. If you do that, then you get the episode straight away so then you don’t have to keep on, you know, coming back and finding it. It’s really good. That’s a wrap. Thanks for listening. [00:58:00] Take care listeners.

Catch you next time. Bye.

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