Read your clients’ information sources

Be aware of clients’ information sources in addition to your own. Newspapers, magazines and online forums vary widely in quality, but may contain information of use to you and your other clients.

A client who I had advised on the control of panic attacks returned a year later to discuss another matter. At the end of the session, he told me that he had found a self-help book on panic attacks and “you know all that stuff you said? Well, it turns out you were right!”

Therapists may be perplexed or dismayed when clients prefer their own information sources to those of the therapist, especially when the other source is one which the therapist may consider disreputable. Therapists may be unaware of the range of resources available to and used by their clients, whilst clients may think their therapist is merely offering their own opinions.

Therapists usually derive their information from peer-reviewed research articles, professional journals, scholarly textbooks and teaching & training by eminent colleagues. This information is then implicitly or explicitly conveyed to clients in therapy sessions and associated handouts & leaflets.

Clients may have great difficulty accessing therapists’ information sources other than via their therapist. Even if aware that they exist, they may be barred from accessing professional journals or unable to afford necessary memberships or subscriptions. Textbooks are usually much more expensive than comparable self-help books, have opaque titles and tend to be jargon-heavy.

Clients usually derive their information from a wider array of sources, many of which may not be accorded much credibility by the therapists. Newspaper articles, magazine features, self-help books and groups & online discussion forums abound. Therapists who are unaware of these sources may be advised by helpful clients, although this assistance may not be welcomed by the therapists.

Secure in the knowledge that their information sources are of superior quality (which may well be a false assumption), therapists may be dismissive of clients’ newspaper-derived knowledge and online tales of others with similar difficulties. Clients may pick up on such condescension and react similarly to their therapist’s sources.

The science fiction writer Theodore Sturgeon, when told that 90% of science fiction had no literary merit, famously replied “90% of everything is crud”. There are many more newspapers than journals, more self help books than textbooks and more online forums than conferences: you can’t read them all, but if you don’t include some in your reading, your clients may keep the 10% that isn’t crud to themselves.

Check your client can read and write

Checking that your client can read & write assists both you and them. Attempting to use questionnaires, journals or bibliotherapy with someone hiding their illiteracy could end your intervention before it has begun.

Literacy isn’t essential in therapy: psychological therapies aren’t called “talking cures” for nothing and physical therapies usually require little in the way of reading or writing. Clients who cannot write can keep pictorial records or use voice recorders (now built into many mobile phones) to keep notes of thoughts or actions. Much of the literature therapists would wish to hand out to clients could, with a little effort, be offered as graphics or video & audio recordings.

The difficulty for most therapists will be in identifying clients whose illiteracy may be one of their most closely guarded and shameful secrets. Ticking the boxes on your questionnaire need not mean that the questions have been read. Phrases like “your writing is too small” or “I’ve left my glasses at home” may mean exactly what they say, or may be well-practiced cover-up routines. Allocating an illiterate person to bibliotherapy can be a waste of their time and yours.

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BBC Health

A source of good advice and good links to other reputable sites. BBC Health can be recommended by therapists who wish to encourage or support internet research by their clients.

Searching the internet for health related topics is a risky business. A site with a professional appearance need not have content of similar standard. BBC Health is a subsection of bbc.co.uk, the British Broadcasting Corporation’s website. The BBC has an international reputation for good journalism

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Helpful patients are not hateful patients

Therapists should encourage and support, not dread, “helpful patients”. Internet or other research by the client can indicate active involvement in treatment.

In 1978 JE Groves described four categories of “hateful” patient, ie: the patients most physicians dread:

  • dependent clingers
  • entitled demanders
  • manipulative help-rejecters
  • self destructive deniers

To this list a fifth category appears to have been added: “helpful” patients, who search the internet for details of their condition and treatment and provide these to their therapist. Comments from colleagues (in person and via blogs), as well as cartoons and the popular press, suggest that these folks inspire almost as much dread (or, at least, derision) as the other four stereotypes.

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Be ready for clients’ companions

Be prepared to deal with the companions clients may bring to therapy. Dealing gracefully and helpfully with them can’t hurt your relationship with the client.

With the obvious exception of Marital Therapy and Child & Family Therapy, models of therapy tend to assume a 1:1 interaction between a therapist and a client.

In practice, most clients are accompanied, at least to their initial interview, by a parent, partner or friend (sometimes all three). Service information leaflets often neglect to advise clients whether their companion can join them in the consulting room, creating the potential for an awkward first interaction with the therapist: “can my Mum / husband / friend come in with us?”

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Tell clients confidentiality has limits

Therapists often assure clients that the information they provide is confidential. Confidential is defined as “intended to be kept secret”. Whether the information will be kept as secret as the client (or therapist) imagines depends upon the therapist and the service.

Confidentiality in the strictest sense implies that only the therapist will be privy to the information provided by the client. In practice this level of confidentiality is impossible to offer, as therapists have professional and legal obligations to uphold.

Most professions and services require that clients give informed consent to all assessments and treatments, which includes basic information gathering. Clients must therefore understand the limits upon the confidentiality you can offer before beginning to discuss their case. Clients who provide information which necessitates breaking confidentiality may feel betrayed by their therapist if not first advised of their therapist’s obligations.

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