How do you get through all of the things you need to get through in your first session?
You manage the client's expectations. Your mandatory administration. The foundation of therapy. Build Rapport. Give them some skills in their first session to want to come back. Oh, and you're doing this in 50 minutes.
Most practices have not thought about increasing their first session appointments by 30 minutes. This way you have extra time to lay down a great clinical foundation. The client will still get a full 50 minutes to unload. Win/Win.
Another aspect is by providing yourself with some extra breathing room. In the first session cover the bare minimum that you need to cover and then explain to the client that the first three weekly sessions are to assist with building the foundation of therapy as well as allowing time for each of you to suss each other out. This will allow you to plant the seeds of your own practice boundaries. Consider these topics:
Weekly Bookings
Even if this isn't your norm for new clients, try the approach out. Even with three weeks of weekly appointments to establish a solid rapport with your new client. This period of time allows for you to cover all of your bases as well as helps the client understand they are important to you. It provides you with the ability to lay the foundations of the client journey. What are some of the barriers to therapy and solicit a solid commitment for them to attend. Once you understand the barriers you can provide solutions to their barriers.
The Journey
What does the client's journey look like? What should the client do when they realise they are "feeling good" and no longer need to attend? What happens when the client cancels their last appointment or just doesn't attend? A clear conversation about your expectations around the end should be discussed at the start of their journey.
The How
Most clinicians speak to clients about ensuring the client prioritising themselves for therapy. They'll impress upon the client the reasons attendance to therapy is the best way forward, but have you spoken with your client as to HOW they choose themselves? How do they choose themselves over their children? How do they say to their boss they can't attend that important meeting?
Feeding information through to your client is important, but without the how, it may not be as useful as one would think.