Check you have the right client

Check you have the right person before you begin your session. There is scope for confusion in busy clinics, but mistakes can occur even in otherwise empty waiting rooms.

There was only one person in the waiting area. I said her name and she followed me into my room. After 10 minutes or so, it became clear she wasn’t my client: she was in a lot of pain and had been awaiting a GP; when I walked into the waiting room, she hadn’t listened to the name I called. She missed her actual appointment and I missed my actual client.

Outside of addiction services, therapy clients rarely have anything to gain by posing as someone else. When dealing with people who are distracted by pain, hallucinations or medication, however, there is potential for confusion.

Most therapists are accessed via reception staff. Depending upon the layout of the facility, receptionists may be able to point out your client in the waiting area (or at least confirm that your client has arrived). In a busy outpatient clinic or GP surgery, this may not be possible.

Calling a client’s name in a busy waiting room may get you someone with a similar name awaiting another therapist. Explaining your role and name dropping the referrer may be enough to alert the client that they are in the wrong session, but clients are frequently referred without adequate consultation or by locums or other staff whose names they don’t know.

First time clients may have psyched themselves up to speak to a stranger about their most intimate concerns Even if not in pain or on medication, they may not be listening for much other than their cue to reel off their story. Details such as the wrong GP or profession may pass them by.

Clients with multiple appointments or a history of referrals may be numb to the whole process. They no longer attend to therapists’ names or professions: they just follow the latest person to call their name and do what they’re told, however unusual it may seem.

Short of requesting photo ID, there’s no foolproof way to prevent identity confusion, but the potential can be minimised by requesting that the client provide a piece of personal information: “can you just tell me your correct address?” or “can you just confirm your date of birth?”. Don’t give the information in the question: “is your date of birth 29.10.64?” can be answered with a nod that proves nothing.

The aim is to request a single piece of fairly specific data, the provision of which both confirms the clients’ identity and passes control of the conversation back to you, so that the client doesn’t launch into their story before you’ve been able to explain consent or confidentiality.

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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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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Overusing clients’ names can mask inattention

Use of a client’s name to foster engagement may mask flagging concentration and inattention. Using a client’s name sparingly permits more accurate judgement of attention to the conversation or task.

“…a person’s name is to that person the sweetest and most important sound in any language.” (Carnegie, 1936).

Whilst using client’s given names uninvited can backfire, a genuine (and successful) attempt to remember and recall someone’s name can pay dividends.

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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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