Sarah Ozol Shore

Clinical Question:

A client comes to his first therapy session because his wife asked him to.

He is cooperative, thoughtful, and clear that he does not think he has a problem.

What should the therapist do next?

This essay is about the difference between rejecting someone else’s formulation of the problem and having no therapeutic purpose at all.

https://sarahozolshore.substack.com/p/the-client-who-didnt-have-a-problem

Therapists: What do you do when a client comes in with nothing to talk about?

Do you start looking for something? Go back to last week? Ask about work, family, mood, sleep? Wait and see what happens?

This can feel uncomfortable for some and it can also feel like working pretty hard to keep the conversation going. Most therapists get good at doing this.

Question: What do you tend to rely on to give the session a sense of direction in the first place?

How do you think about these sessions clinically?

https://substack.com//note/p-210082574?r=q0wqo&utm_source=notes-share-action&utm_medium=web

Imagine a client who says, “Do you think I’m a bad person?”

The therapist hears shame and responds with compassion, context, and reassurance. Those responses may be thoughtful and clinically reasonable but avoid the true center of the question.

In this week’s essay, “The Client Who Thought She Was a Bad Person,” I examine what happened when the therapist stopped helping the client decide whether she was good or bad and began paying attention to what the question was doing in the therapy.

The client became more anxious. She presented more evidence. She pressed more directly for a judgment. The therapist could finally see that the question was pulling the clinical work away from the client’s actions, motives, impact, and responsibility and toward a verdict about her character.

The essay explores a central principle of clinical work:

The therapist had to understand what was happening before she could decide how to help.

Two clients can say the same words for very different reasons. A response that helps one client may keep another client’s difficulty going.

Until the therapist understands what is happening, even a compassionate and clinically reasonable response can help keep the problem in place.

Read the full essay here: https://open.substack.com/pub/sarahozolshore/p/the-client-who-thought-she-was-a?r=q0wqo&utm_campaign=post-expanded-share&utm_medium=web

Most therapists have had an experience like this:

A client tells a story. You offer reassurance. Then another story. More reassurance. By the end of the session, you've said many reasonable and supportive things. But you leave wondering whether anything actually you offered helped create a shift or change for the client...

What if the problem isn't that you didn't say enough or said the wrong thing, but rather...

What if you were asking yourself the wrong question?

In this week's essay, I explore the difference between orienting yourself in client sessions around the question of:

*What should I say?*

versus orienting yourself around the question:

*What is this material showing me?*

It's a shift that fundamentally changes how we think about assessment, progress, and intervention.

**The Client Who Wanted Reassurance**
https://sarahozolshore.substack.com/p/the-client-who-wanted-reassurance

**The Client Who Talked the Whole Session**

Most therapists know this session: the client talks continuously, maybe moving from topic to topic, or telling one extremely detailed story, and leaves feeling genuinely heard—while you as the therapist are left with the sense that very little clinical work actually happened.

When this happens, its sometimes because as therapists, we have not organized the clinical hour.

This essay examines clinical leadership, how therapists unintentionally establish a passive session structure, and why listening well is not enough.

https://sarahozolshore.substack.com/p/the-client-who-talked-for-the-entire

Why Good Interventions Fail: Assessing Regulation in Real Time

Online Training Seminar
Friday August 7, 2026
12:00 Eastern Time
Zoom

Many therapists have had the experience of doing work that seems clinically sound: asking thoughtful questions, offering careful reflections, naming patterns, inviting emotion, or helping a client make connections. However, sometimes these clinical maneuvers land flat.

This seminar looks at one reason that happens: the therapist’s stance may be asking more of the client than the client can actually take in during that moment in the session.

This seminar will focus on how to assess regulation in real time, how to recognize when a client is becoming less available rather than more engaged, and how to recalibrate the clinical work when the session begins to outpace the client’s capacity.

This is a training in clinical discernment: how to understand what kind of therapeutic work is actually possible in a given moment with your client

Free online seminar
Monthly offering
Register here: www.sarahozolshore.com/clinicaltrainingwebinar

When clients ask their therapist to be “more directive,” they may be asking you to identify where the client’s thinking repeatedly closes, direct attention toward what has not yet been examined, and lead a clinical process capable of producing something new.

In **The Client Who Asked You to Be More Directive**, we distinguish advice-giving from clinical leadership and consider what therapists are professionally responsible for bringing to the therapeutic encounter.

https://open.substack.com/pub/sarahozolshore/p/the-client-who-asked-you-to-be-more?r=q0wqo&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true

Here's a question that's been on my mind clinically:

Did graduate school teach you how to formulate a case, or did it teach you diagnosis, theory, ethics, and treatment models?

If you didn't get case formulation training in graduate school, what about your practicum or internship?

I think many clinicians pursue modality training because they're trying to fill a gap that was never acknowledged. I'd genuinely love to know whether your own training prepared you to answer the question:

What is happening psychologically with this particular client?

This essay explores the difference. I would love thoughts and feedback from the clinicians in this group.

https://open.substack.com/pub/sarahozolshore/p/you-were-never-taught-to-understand?r=q0wqo&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true

The Clinical Effectiveness Institute is hosting an online seminar for clinicians:

Why Good Interventions Fail: Assessing Regulation in Real Time
Friday, August 7, 2026
12:00 to 1:00 PM Eastern

The seminar looks at one core idea: before therapy can go deeper, a client needs to feel calm and steady enough to take part in it.

It also looks at how different things a therapist might do, like asking a thoughtful question, sharing an idea about what might be going on, or simply sitting quietly with the client, can each ask something different of that client.

Many therapists assume a client is ready for deeper work simply because the client seems calm on the surface or agrees easily with what is being said. The seminar will show why that assumption is often wrong, and how a client can look fine on the outside while struggling to take in what is happening in the room.

Clinicians who attend will leave with a clearer way to notice when a client is ready to go further and when the better move is to slow down and help the client feel steady again first. This skill applies across therapy styles and approaches, not just one particular method.

There is no charge to attend. Register here: https://www.sarahozolshore.com/clinicaltrainingwebinar

The Clinical Effectiveness Institute is hosting an online seminar for clinicians:

Why Good Interventions Fail: Assessing Regulation in Real Time
Friday, August 7, 2026
12:00 to 1:00 PM Eastern

The seminar looks at one core idea: before therapy can go deeper, a client needs to feel calm and steady enough to take part in it. It also looks at how different things a therapist might do, like asking a thoughtful question, sharing an idea about what might be going on, or simply sitting quietly with the client, can each ask something different of that client.

Many therapists assume a client is ready for deeper work simply because the client seems calm on the surface or agrees easily with what is being said. The seminar will show why that assumption is often wrong, and how a client can look fine on the outside while struggling to take in what is happening in the room.

Clinicians who attend will leave with a clearer way to notice when a client is ready to go further and when the better move is to slow down and help the client feel steady again first. This skill applies across therapy styles and approaches, not just one particular method.

There is no charge to attend. https://www.sarahozolshore.com/clinicaltrainingwebinar