Aim for reliability before availability

Reliability is more important than availability in the long run. Clients who know when you are not available can make informed choices regarding alternative sources of support.

I once worked with a client who rang her GPs so frequently and insistently that they established a rota for taking her calls. She bombarded every new therapist with telephone calls. I told her she could call me between 1030 and 1130 on Monday or Thursday and that if I was on another call, I’d call her as soon as I finished. She rang me twice the first week and two more times in the next six months. She also called her GPs and CPN less frequently.

Many therapists feel a duty to respond to client’s crises. Who better to address a difficult situation: the therapist who has listened carefully to the client’s life-story or the harassed junior medic who has never met them before? Shouldn’t you always be available for your client?

There are few UK therapists who provide an emergency service. General Practitioners (family doctors) and out-of-hours co-operatives provide rapid response for clients in crisis. There is a plethora of helplines, staffed by volunteers and formally trained counsellors. Most other therapy services are not intended to have a crisis intervention role.

So how available to your clients should you be? That’s a matter for discussion in your service and with your colleagues: your availability sets clients’ expectations for others in your service, while the purpose or funding of your service may dictate or restrict your availability. Far more important than availability is reliability.

If your client believes that, by calling every 15 minutes, they may just catch you between sessions, they will call and call when they could have more immediate and more appropriate support from their GP or other emergency services. From a behavioural perspective, the client is on an “intermittent reinforcement schedule”, where the occasional success maintains a behaviour despite repeated failures.

Being clear as to when you will be available gives the client the freedom to explore other options in the meantime. Most people manage most of the time without therapists. The easy availability of a therapist may discourage confiding in family or friends, potentially creating a new problem or at least exacerbating existing difficulties.

If your client knows that they can’t speak to you until Tuesday, they may work out their own way of coping until then, which may preclude the need to speak with you or may at least give you both a foundation for further work. Being reliably available gives the client faith that waiting to speak with you will always pay off, a much more potent reinforcer than the intermittent reinforcement schedule.

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