Use your casenotes as a Foley file

Making notes of information incidental to the case enhances interactions. The more personal details you retain, the more intimate the interaction and the greater the sense of personal attention.

Compare & contrast the following:

Last time you said you were going on holiday with your husband and daughter but you were worried about the journey: how well did it go?

Two weeks ago you said you were going to Greece with David & Sally but you were worried about the flight: how well did it go?

Item one says: I was listening. Item two says: I was really paying attention.

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Setting homework has negative implications

Setting “homework” for clients implies that no relevant work would otherwise occur between sessions. When clients fail to do their homework but achieve positive change anyway, the focus may fall on the former rather than the latter.

Physical therapies often entail a certain amount of work on the part of the client inbetween sessions with the therapist: daily exercises may be set, weekly diet sheets may be provided, medications may be prescribed.

Psychological therapies may also require work inbetween sessions. The notion that therapeutic change occurs only within sessions, in the presence of the therapist, is disproved by the evidence: the greatest portion of therapeutic change is attributable to factors entirely outwith therapy.

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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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Transfer control of the session with codes

Unfamiliar co-therapists can use code phrases to transfer control of the session. Both they and the client can then focus on the client’s issues rather than the dynamics between the therapists.

While there should be no confusion in the mind of the client as to who is leading the session, there may be some stress for the therapists. Trainees may wonder if and when their supervisor will take over (or in some cases, may wish their supervisor to rescue them!). Supervisors may wish to ask a question or reinforce a point, but hesitate to undermine the trainee by interrupting.

The client’s focus should be on the issues they bring to therapy. Any awareness of unease on the part of their therapist may distract from this focus. Transfer of control of the session from one therapist to the other should be obvious to the client, but wrangling between the therapists should not.

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Know your client’s strengths

If you don’t know your client’s strengths, how can you capitalise upon them? Client factors account for 40% of the variance in outcomes and a wise therapist will play to their client’s strengths.

Clients are often defined solely in terms of their difficulties. “I’m seeing my obsessional woman this afternoon.” “When that guy with MS turns up, tell him I’m running late.” “Can someone attend to the broken leg in cubicle three?”

Modern medicine has come to be construed as an interaction between a physician and a disease rather than between a physician and an ill person striving to get well. (Scovern, 1999)

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