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?”

The pros and cons of a third party being present will depend upon the service, the setting, the presenting problem, the client and the therapist, but this is not a decision best made standing in the door of your room. If your service offers no guidance, you should know in advance who is welcome within and who must wait without.

If you are unwilling to see anyone other than the client, you should know where the companion(s) can wait out the session and how long they need wait. In a hospital setting, there may be a cafeteria; in a community clinic, there may be a nearby cafe. Consigning companions to sit in the waiting room for an indeterminate time may make the client uncomfortable and distracted, especially if their presence is a favour to the client: if the companions include children, this is unfair on them, their carer and anyone else in the waiting room (ie: your next clients).

If you are open to client’s companions joining the session, you should be clear as to numbers (no more than two companions in my sessions) and age limits (no children under the age of consent, although I’ll make an exception for sleeping babies in the absence of a creche). Spending the next ten minutes scrabbling around for extra chairs will undermine your welcome, so ensure that you are prepared for the numbers you are willing to accommodate.

If you prefer the client to be unaccompanied for part or all of the session, ensure that the exclusion of the companions is meaningful. I’ve seen a couple of clinics where excluded companions have been sat on a chair immediately outside the (not very soundproof) door of the consulting room, giving a decidedly mixed message to all concerned.

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