A professor I had in graduate school, Dr. Ron Welch, would say that the first five sessions of seeing a client are all assessment. He was adamant about it. He would say: “I am still consulting. They are not even my client yet.” I remember thinking, “What are you talking about?” But the older I get, the more I see the truth in his perspective.
A common clinical instinct is to start treating the client quickly, and that’s understandable. The client is in front of you, they are struggling, asking for support, and you know enough to start doing something. But in complex cases (and most cases involving compulsive sexual behavior are complex), moving to treatment before the picture is clear is a liability. The assessment is the work.
Here is a concrete example of why this matters.
A candidate in supervision recently brought a case that illustrates this well. A young adult client comes in reporting both a pattern of substance use and sexual acting out behavior that runs against his own stated values. Over the years, the substances have shifted, and the sexual behavior has taken different forms during different periods. The two seem to trade off: when one increases, the other tends to quiet down, and then they swap. Two sessions in, the candidate asked the natural next question. Which one do I address first?
The honest answer is: you do not know yet! You are not supposed to yet. Consider what is actually unknown at this point. Is the substance use fueling the sexual behavior, meaning arousal only shows up once he is using? Is the sexual behavior the thing he is really avoiding, with the substance use as a secondary escape from that shame? Or are they two separate coping mechanisms that happen to be rotating rather than one driving the other? These are not hypothetical distinctions. They lead to different starting points and different treatment sequencing.
The instinct many candidates have here, understandably, is to reach for the CSAT lens because that is the specialty they are building. But that instinct can become a liability of its own. If you only have a hammer, everything looks like a nail. The question is not what you would like to work on. The question is what is his presenting problem and his stated goal, not yours.
That question does more work than it looks like it does. In early sessions, motivation is the most valuable currency you have. If a client has real energy around one issue and none around another, you follow the energy, even if the deeper root cause sits somewhere else for now. Sometimes the better marker is which behavior is causing the most active disturbance right now. Sometimes it is simply which one the client has the least denial about, since that is where honest work can actually start. None of these are wrong turns. They are all legitimate entry points, and the first several sessions are how you find out which one this particular client needs.
Rushing to pick a lane before that information surfaces means you may be organizing treatment around your specialty instead of his actual need. The first five sessions are often clinical assessment. They are not stalling. They are the most important clinical work you will do with that client. A correct diagnosis leads to a correct prognosis. Are you giving yourself adequate time?