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?

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Think before you act for your client

Stop and think before you take action on behalf of your client. You may be depriving them of the opportunity to help themselves (with appropriate support).

Therapists are people who want to help. People of equivalent qualifications in other fields are usually paid more and have better conditions: we don’t do it for the money, but because we want to make a difference.

Trainees want to help. Faced with overwhelming distress or disability, you want to make a difference but have only a limited repertoire of knowledge to draw upon. You may (mistakenly) feel that you must compensate for your shortcomings and so attempt to offer more practical help where possible.

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Give clients your full name and title

Introduce yourself with your full name and professional title. Clients can then decide how to address you as rapport builds, especially if you provide a reminder of your name (ie: a readable ID badge).

One client called me “doc” for most of our first meeting, until I felt compelled to advise him that I did not have a doctorate. He replied that he called every therapist “doc” as there were far too many of us for him to remember all our names.

In the first stage of a consultation, clients are bombarded with information, amongst which is the name and / or title of their therapist. People who are anxious or in pain usually have poor concentration and therefore poor memory, so the chances of a client remembering your original introduction are small.

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Using clients’ given names uninvited can backfire

Uninvited use of a client’s given name can impede rapport in a number of ways. Moving from a position of formality to informality and intimacy is easier than backtracking.

A therapist’s first encounter with a client usually requires the use of their name, if only to ensure that you haven’t picked up the wrong person. The usual practice is to use either the client’s full name (as given on their referral letter or case file) or their title and family (last) name. Some therapists attempt to establish an air of informality by using the client’s given (first) name, but this is a risky practice for a number of reasons. In decreasing order of seriousness:

The client’s given name is first and most commonly used by their parents and siblings. Being called (without invitation) by one’s given name can throw the client into a child role with the therapist as parent (especially if the therapist then goes on to introduce themselves by their title and family name). Depending upon the client’s experience of childhood, this might be reassuring or anxiety provoking. It is definitely disempowering and may be seen as patronising.

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