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New blog added 15th January 2017

 

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#Ethical practice. How many sessions and which enquiries should a therapist work with? 

 

 

My blog today is for the benefit of potential clients and for other therapists. I suppose you could say that I am on a mission really and perhaps expressing a few thoughts, thoughts about how we all as therapists need to represent our industry with the utmost integrity and how clearly some practices alienate client trust and need to be rethought.

 

On Friday, I received a call from a person out of the county, in fact two counties away and as it goes that is not unusual as I work by Skype. 
What was very unusual was that the enquirer told me that they were assessing my services with a view to seeing how I could help a family member. So far, nothing at all wrong with this, but what followed next clearly was.

The enquirer went on to explain that something very complex and rather sad had happened in the family a while ago and that they were calling on behalf of a person who the family thought needed help and they thought therapy is the route to go, I can't say what the issue is for client confidentiality reasons, but it is very clear that there is an issue which has consequences and impacts upon the family as a result of the person in question' behavioural pattern.
My reaction to the enquirer was to ask why the person who needs help was not on the phone rather than a family member who may not have sought permission. Out of common courtesy I listened to what they had to say. 

The enquirer went on to say that because of what the family thought of the seriousness of the issue that the family had pushed the family member into therapy with what sounds like a fair measure of pressure. Of the situation I can see that the person needing help is in a state of denial and there are some straightforward textbook answers for their behaviour and I beleive that if the 'person' comes for help of their own free will, then therapy will no doubt be able to help.
I went on to tell the enquirer that as an ethical practitioner I would be unwilling to take the family member on for two reasons,one of them being the fact that another therapy practice was already working with the family member. I also declined to be involved unless they first contacted me of their own free will. I explained my reasons why which you can read below, 

The single big issue here is that forcing someone to undertake therapy (and this is very different from mental health issues where sectioning and cpn need to become involved if the person is at risk to themselves and others) the issue is that unless the 'person' realises that they have a problem,then therapy is very unlikely to help. What will most likely happen is that the person will have a few sessions and seeing that nothing changes, they will bail out. The first thing which needs to happen is getting that person to understand why they need help and what that the continued consequences of their actions would bring to the family. That is the first step. Once the person can see the 'WHY' and understand it then they will make progress in therapy if that is the road they chose to take.

In therapy, we see this all the time with quit smokers in the therapist chair who are there because they are pressured into hypnotherapy or therapy by a family member and see nothing wrong with what they are doing even though every smoker knows the risk. The therapy is never going to work. It will be a big fail!

Getting back to the enquirer, they went on to tell me that they had found a well respected therapist in Cornwall who the family member had been to see and that after one session of therapy that family member had said that they were not happy.There are several reasons here. One is that there was some difficulty fitting around the clients working life which the therapy practice was apparently unable to accommodate, Saturdays were a problem for the practice I understand.

There may well be other issues such as rapport but that is not mentioned, however, the big single fact that sticks out and shouts is that the family member doesn't want to be there and is in denial over their behaviour and beliefs and it is a big obstacle that the therapy practice will have to surmount, so getting to yes is the most important part to making progress.

If you are a new therapist ,asking the right questions and realising the importance of ethical boundaries are vital because our first duty is to protect our clients both existing and potential and we also dont need to set ourselves or or industry up for disappointment and failure. I said to the enquirer that I would not treat his family member unless they contacted me personally and that we had a good chat before hand. Although the enquirer was somewhat taken aback they understood. A person's behaviour and free will is there own business unless they are putting the lives of others and their own at risk.

Now I know that in my usual style that this is rather a long post and I hope you are still all with me.

The last thing that really annoyed me and I think this is a really important issue for me representing my industry, was the next big problem for the client which I clearly understand why they would feel uncomfortable with. After one session costing over £75.00 he was advised that he would need TWENTY sessions and I took it to be from the enquirer that the person needed to pay twenty sessions worth either in large installments or all at once.

Speaking as a therapist with over a decade's experience, there are some treatment programmes where you know that a certain number of treatments are perhaps most likely and so when I talk to my clients I give them a broad overview, an average of how many sessions they might expect with flexibility as to how many sessions they might need because that is indeed sensible and ethical to my mind.Weight management and quit smoking programmes come to mind here.

What I never do with my clients is to claim that a client's issue will be resolved in a certain number of sessions with certainty. Everyone is different and a person's issue may well be resolved in just a few issues and when that happens that is really great and that is what our profession is all about, helping people change or find resolution in the most efficient and effective way. 
To tell a client they need to have twenty sessions is just plain wrong in my view because no therapist can know that for sure.

Certainly in some case there may well be complex emotional issues that take time to resolve but the journey has to be planned and taken in steps and evaluated at every session to see the progress a client is making. 
Our work as therapists should be solution focussed and for this reason I beleive therapy assessment tools are very helpful which is why I use them.

Clients will be looking at us to help them and not just to relieve them of large amounts of cash and telling a client they need to spend huge amounts of money to be fixed amounts to just that. Clients are not cash cows! They are people with issues and challenges who need our help.

I believe we must work hard as therapists to work in an ethical way that is supportive of our industry and of ourselves. We need to keep in mind why we came into this industry .... to help people. 
We are merely facilitators to help people unleash the power of their own minds and inner resources. 
If a therapist is in this industry just to make huge amounts of money, well it might work for a while but you are in the wrong industry. My professional reputation is very very important to me because it is intrinsically linked to my core values and if any of my clients thought I was just after making money I would be deeply hurt. I just would not ask someone to pay all of that money up front or tell them that is how many sessions their problem leads.There are just so many questions of trust here that are wide open.

My mission as I would hope all therapists mission is, is to help people in the most efficient way. From what I heard from the enquirer it would seem that some therapists are not only doing their practice harm they are harming the industry and should reappraise why they are in the profession and how they work with people

If the person in question at the start of this post,calls me and asks for my help, which I hope they do, I will be very happy to help them but I won't be telling them that they need twenty sessions because I just dont know. 
They may get to where they need to be in a few sessions , they may well take over twenty but the point is the client should not be set up in such a way that they are told they need twenty sessions at the first session. Step by step progress assessment is the way forward. I hope the practice will learn from this because it is clear the client will not be going back as a result of being told with such definite certainty they need to pay for twenty sessions.


 

 
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