Fine point about which a client comes to that tipping point: will she or he continue old patterns?
We try to be optimistic in this business, but do you ever tell someone after just one meeting: "I don't think I can help you?"
Also, regarding the critical first meeting, do you ever find that in therapy evaluations, as in real life, first impressions can turn out to be misleading?
It hasn't happened too often that at the end of the first session I say that I don't think I can help them -- I think that has happened only 2 or 3 times in 35 years for me with patients who just made me so uncomfortable that I knew I couldn't work with them. It is slightly more common to reach that point after 3 or 4 sessions. Once I saw a woman for around 4 sessions and then couldn't continue with her because she was just too much like my mother -- it was my problem more than hers but I knew my countertransference would be a huge problem.
And yes, I have found my first impression can be misleading -- these are usually the cases where after a few sessions we find we can't work together and they leave or I suggest I am not the right person.
I think that it is very true that sometimes you can tell right off the bat whether or not the person with whom you are working is going to be willing to do all of the hard work that is going to need to be done in order to go through the therapy program successfully. There are those who want everything to be perfect in one session and it does not always work out that way. Therapy is a process, sometimes a short journey and sometimes a more arduous one. I think that the more people realize this the better the chance is for you to make a connection with someone and to be able to better help them during their time of need.
Thank you Dr Fuller both for this post and also 'The Woman With Stars On Her Dress'. The combination was exactly what I needed to dig back in and keep going with my arduous journey through The Work.
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