Section 22about 11 min · no rush
22

The first sessions: what to say, what to ask

The counselling process gives the map of the counselling process. This chapter is the first two stages in words: the four things you say before a client has told you anything, and the ten things you ask once they begin. The scripts are starting points; make them sound like you.

Before the first word: who is in the room

CTEVT PSC curriculum

Curriculum task 2 is the basic map before the journey: who this person is (name, age, where they live, how to reach them, work or study, who referred them: self, family, school, health post) and why they have come, in their own words.

Ask "What brings you here today?" and then stay quiet. Note when it started, whether it is getting worse, and what it is costing them day to day.

The precaution is the same for every task on this page: do not assume, do not rush, and remember that people describe distress in their own idiom ("man dukhchha", a burning chest, a heavy head), not in yours. Records at this point: an intake form and a few lines of what the client said, filed under a code number, never a name.

The first ten minutes, in words

CTEVT PSC curriculum

Tasks 3 to 6 happen in one flow, before the client has shared anything painful. Each has a script below and one precaution. Read them aloud until they stop sounding like a form.

1 · Introducing yourself (task 3)

"Namaste, please sit. I am [your name], a psychosocial counselor here. My work is to listen, to understand your situation with you, and to look together for what might help. I am not a doctor and I will not give medicines. Before we begin, how was the journey here? And how are you feeling right now?"

Precaution: short, plain, no titles you have not earned. A moment of small talk lowers the pulse; a paragraph about your qualifications raises it.

2 · Confidentiality and its limits (task 4)

"What you tell me here stays between us. I will not tell your family, your school, or anyone else without your permission. There are a few situations where I would have to involve someone, and I want you to know them now: if I believe you are in serious danger of harming yourself, if someone else is in serious danger, if a child or a person who cannot protect themselves is being abused, or if a court orders it. Even then, wherever it is safe and lawful, I would tell you first, and share only what is needed to keep people safe. Is that all right with you?"

Precaution: say this before the client discloses anything, and never promise a secrecy you cannot legally keep. In Nepal anyone who learns of violence or sexual abuse against a child must inform the nearest police office, and the law protects the informant (Act Relating to Children, 2018, Section 68). Which other disclosures are mandatory depends on the setting, so follow your agency's protocol and ask your supervisor when unsure. Write down that the limits were explained and agreed. Ethics & self-care covers consent for minors and low-literacy clients.

3 · Asking what they hope for (task 5)

"What are you hoping will be different after we have met a few times? How would you know it is helping? If there are several things weighing on you, which one would you want to start with?"

Precaution: many clients arrive expecting advice, a quick fix, or a certificate. Do not promise a result; do gently say what counselling can and cannot do, and how soon change usually comes. Note the goals in their words, and any expectation you had to correct.

4 · Explaining what counselling is (task 6)

"Counselling is a conversation where we try to understand what is troubling you and find ways through it together. I will listen and ask questions; sometimes I will teach a skill, like a way to calm the body, and ask you to try it at home. Your part is to say what is true for you, even when it is hard. We will meet for about fifty minutes, once a week for now. Does that sound all right? Can you tell me in your own words what you understood?"

Precaution: the last question is the whole task. If the client cannot say it back, you explained it in your language, not theirs. Keep the consent form for what it is: a record of a conversation that already happened, not a substitute for it.

Assessment, task by task: ask, watch, record

CTEVT PSC curriculum

Tasks 7 to 16 rarely happen in one sitting or in this order; the story decides the order, you make sure nothing is missed. Each row gives one opening question, one thing to watch while the person answers, and what belongs in the file. Function beats symptom lists: what can this person no longer do? The suicide row is not optional for anyone.

TaskAskWatchRecord
7 · Psychosocial problems"Can you tell me what has been troubling you lately? When is it worst?"Four dimensions: feelings, behaviour, relationships, thinking. How often, how strong, what sets it offSymptoms in the client's words, patterns and triggers, any screening score (a screen is not a diagnosis)
8 · Daily functioning"Walk me through a usual day, from waking up."Self-care, sleep, meals, work or school, chores, time with people, what has dropped away since this beganA short line per area, with the client's own 0 to 10 rating of how they are managing
9 · Family environment"Who do you live with? When something goes wrong, who do you turn to at home?"Tone and body when each person is named; who decides, who provides, who is feared. Family is not automatically supportHousehold, roles, atmosphere, a genogram (family map) if you drew one; strengths as well as conflicts
10 · Work or school"How are things where you work or study? How do you get on with the people there?"Load, fairness of rules, bullying or harassment, someone there who is kindStressors and protective people; attendance or performance changes
11 · Childhood history"What was it like growing up? Who were you closest to?"Attachment and losses, school, friendships, big events (a death, migration, a disaster, abuse). Go gently and stop where the client stopsA brief timeline of significant events; strengths from childhood too
12 · Decision-making"Tell me about a recent decision. How did you go about it?"Impulsive, avoidant, or balanced; who else is involved. In many families big decisions are collective, which is a style, not a deficitStyle, influences, one example in the client's words
13 · Suicidal thoughts"Sometimes when people carry this much pain, thoughts of death or of ending their life come. Has that happened to you?"Stay calm. If yes: plan, means, timing, past attempts, what keeps them here. Vague hints are followed up, never ignored. Never promise to keep this secretExactly what was said, the risk level, and every action taken. The full ladder is on Suicide: assessment
14 · Coping"When something upsetting happens, what do you usually do?"Problem-focused or feeling-focused; alcohol, withdrawal, aggression, self-harm. Some harmful coping began as survivalStressors, strategies, whether each helps or harms
15 · Social support"Who is there for you when things get hard? Anyone you could call at night?"Size and quality of the circle; emotional, practical and informational help; community groups. Draw the me-map togetherThe map, the gaps, and whether each source helps, harms, or does neither
16 · Psychotic features"Have you ever heard or seen things that other people around you could not? Do you know what day it is today, and where we are?"Ask plainly and without alarm. Talking to themselves, answering something unseen, fixed beliefs that their family or faith does not share, held against all evidence, causing distress or harm. Then assess safety, daily function, alcohol or drugs; fever, head injury or confusion about time and place means a medical check the same day (delirium)What was observed, orientation to time, place and person, and the referral made. Urgency sets the speed of referral; see Psychosis

Three paper tools carry half of this stage: the genogram for task 9, a life timeline for task 11, and the me-map for task 15. All three are on Tools & techniques, and all three work with clients who do not read. Precautions across the table: ask about sensitive areas only as far as the client allows today; compare what you hear with what you see; and let the client rate their own functioning before you rate it.

Test yourself

1) Say the confidentiality script aloud in the Nepali you actually speak, then list the four limits without looking. 2) A client answers task 8 with "I manage fine" but has not bathed in days and missed a week of work: which do you record, and how do you ask further without shaming? 3) In task 16 a client says a neighbour has been sending voices through the wall for a month, and also has a high fever: what do you assess next, and how fast do you refer?

Key points
  1. Four things are said before the client shares anything: who you are, what stays private and the limits the law and your agency set on it, what they hope for, and what counselling is; the last check is asking them to say it back.
  2. Assessment asks about ten areas, but function comes first: what can this person no longer do, and who do they have?
  3. Suicidal thoughts are asked about directly, calmly, with every client; a plain question brings relief and never plants the idea.
Quick check

Three friendly questions to settle what you just read. This is reassurance, not a test: a wrong tap is part of learning, and you can try again.

When do you explain confidentiality and its limits?

The best test that a client understood what counselling is:

A client hints vaguely that "it would be easier not to wake up". You:

Learn more

Pick one, not all.

Free bookWhere There Is No Psychiatrist: the interview chapters: how to ask about mood, function, family and risk in a low-resource clinic, question by question.
PracticeThe Nepali informed-consent form in the CTEVT course pack: read each line, then say it to a classmate without the paper; swap and time each other.

Learning about the mind can stir the mind. If something here sat heavily, saying it aloud to someone you trust helps.