Help Clients Discover What’s Bringing Them to Therapy with This Exercise

Everyone who goes into therapy has a story to tell about why they are there—this is called the presenting problem. As therapists, we listen, but we don’t mistake the initial story for the entire story. As we edit this story with our clients, some major characters become minor ones, and some minor characters might go on to receive star billing. The client’s own role might change too—from bit player to protagonist, from victim to hero. The story a client comes into therapy with is rarely the story they leave with.

But every story needs a beginning, and in therapy, it all starts with the presenting problem. It might be a panic attack, a job loss, a death, a birth, a relational difficulty, an inability to make a big life decision, or a bout of depression. Sometimes it’s less specific—a vague feeling of “stuckness” or a nagging notion that something just isn’t quite right.

For instance, when Julie first came to see me, her presenting problem was pretty clear: She’d recently received a cancer diagnosis and wanted help getting through the treatment and being newly married. Since her doctors seemed confident that she’d be fine after surgery and chemo, she wanted to see a therapist who wasn’t part of a “cancer team.” She wanted support with being newly married in this unusual situation. Of course, where we started—learning to live with cancer—was not where we ended up. But those early desires of Julie’s to be raw and honest about her experience, to be “part of the living,” were important narrative threads that ran throughout our work together, even when her diagnosis changed entirely. At first, Julie knew she needed help navigating a new world of oncologists and pink ribbons and overly optimistic yoga instructors, and we adjusted to her needs as things changed and time went on.

Whatever problem a client first comes in with, it generally presents because the person has reached an inflection point in life. Do I turn left or right? Do I try to preserve the status quo or move into uncharted territory?

Use this free worksheet straight from Maybe You Should Talk to Someone: The Workbook to help your client figure out what’s bringing them to the therapy room. As in therapy, the work your client will do in these pages (and the rest of the workbook, if you choose to get it) may take you into uncharted territory even if you choose to preserve the status quo.

But don’t worry about inflection points right now. Just let your client tell their story, beginning with their presenting problem.