Word count: 2021 Why is the initial consultation so important? What factors will an ethical therapist cover at this time? In this essay I am going to look at why the initial consultation is so important for both the client and the therapist and how much you can get from just the first meeting. I will also look at all the factors that will contribute to being an ethical therapist from confidentiality, to knowing whether it is a case that you can look at or need to refer on. The initial consultation will probably be one of the most important sessions of all.
This session will form the basis of the whole therapy and help it to be a success for the client. There are certain steps the therapist needs to take to make sure that the client is going to benefit from the whole therapy and this can be looked at in the initial consultation. The initial consultation should not last any more than an hour and in this time you can do all the fact finding you need to do about the client and then towards the end of the session do a PMR with them just so they get a feel of what will happen in future sessions.
Some therapists choose to do a free consultation lasting around half an hour where they can get them to fill in the consultation form, get information about what they have come to see you for etc. The only issue with this is it is taking up your time, which you could be using for another patient who is paying and people may only come because they see the word ‘free’ and not come back again.
If you are going to work with the client, whether you do a free consultation or not, you are going to have to build up a rapport with them quite quickly so they feel safe and uncomfortable to talk about issues, which they may have never spoken about before. There must be a mutual respect. When they first arrive they are likely to be feeling anxious and have many mixed emotions, so as a therapist you need to make them feel at ease. The client may have fears, misconceptions and questions about hypnotherapy so the is a perfect time to speak to them about this and explain what hypnosis is and how it will work for them.
A lot of people see what happens on the television and think this is what will happen to them. You can talk to them about these misconceptions and fears to help them feel at ease and feel safe with you. The client may also think that they are not in control when under hypnosis, again this is something that can be explained to them and you can make them fully aware they are in total control. As I have said above one of the biggest things that you will need to do in the initial consultation is build up a rapport with the client.
Once you have built a rapport with the client they will find it easier to open up to you. If you don’t build this rapport up with them they may not feel comfortable to talk to you or trust you and they will not return again. There are many ways in which you can build up a rapport with the client. I will discuss these now. First impressions are everything so you need to make sure the environment that you will work in is safe and comfortable for them. A person will make assumptions about you using their deductive logic based on your appearance, your speech and you body language before they even try to get to know you, so it is both of your interests to act in a way that will get a good response’. (Chrysalis handout – Module 3) To help to build rapport you must make sure you are actively listening to the client and maintain eye contact with them. You don’t want to be looking around the room when the client is talking to you. Make sure that there is no desk between you and the client and you are sat next to the person or side on.
A desk between you can be like a barrier and not put the client at ease. Do not cross your arms and legs as that can come across as defensive which is not what you want to come across as. Try to sit up straight with an open posture. Don’t slouch as this can come across as looking too casual. How you dress as a therapist is also important. You don’t really want to be sat there wearing a suit. One, it looks a bit too formal and two, you will be sitting for a while so you need to be comfortable. Smart casual is usually the best way to present yourself.
You will need to make notes as the client is talking but keep them short and explain to them why you are making notes and do not doodle or fidget with the pen and paper etc. If you make short notes in the session you can then make full notes once the client has gone. Make sure you use supportive reactions such as smiling when appropriate and nodding but don’t reflect what you are thinking with your facial expressions. You will also need to keep an eye on the time so get a clock but place it above the client so they cant see it and you can keep an eye on the time without having to look around.
One thing the client will want to be sure of is that everything that is said and kept is all confidential. Client confidentiality is a fundamental requirement of keeping trust. You must make the client aware of your confidentiality policy and that all records/files of them are stored confidentially and only the therapist can access these and that you as a therapist comply with the Data Protection Act 1998. You will have to get a lot of personal information from the client which either you can fill in or you can get the client to fill in.
This personal information are things such as name, date of birth, address, contact details, any medication the client is on and also the clients history (is there anything in their history which has triggered the problem they have now). ‘Quite commonly patients are referred for hypnotherapy for apparently simple and limited problems such as tinnitus, back pain or smoking, when one nevertheless finds very quickly that this is only the tip of the iceberg and that help is really bring sought for quite other and usually much more complex and distressing problems. (Hellmut W A Karle & Jennifer H Boys – 1987) As you collect all this information you can build up a picture of the client and the help that they need. You can assess them properly as they are face to face and you can see whether their issue is something you are comfortable working with or if it is something that you can deal with or if it need to be referred on to someone else. Therapists should ‘remain aware of their own limitations and wherever possible, be prepared to refer a client to another practitioner’. (GHR – Code of Ethics)
As a therapist you can only deal with neurosis and not psychosis. ‘Under no circumstances must you agree to treat people who have or have had a psychosis’. (chrysalis Handout – module 2) ‘Neurosis is a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behaviour, hypochondria) but not a radical loss of touch with reality‘. (Oxford dictionary Online) They are consciously aware they have a condition and are able to function within society. Psychosis is a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality’ (Oxford Dictionary Online) They lose perception of reality, they are unaware they have a problem and are already in an altered state so hypnosis would not help this client and will need to be referred onto another professional. You should be able to see from medication the client is or has been on as an indicator for psychosis. You can look but medications in the BNF (British National Formulary) which gives you a list of all medicines and what they are prescribed for.
In this consultation you will need to gain an understanding of the clients back ground. You will be able to get an understanding of their family history and whether any of this is the cause of the issue they are here for. You will be able to ask them about their living environment, do they live on their own, with a partner, do they have children. You can ask them about the occupation. If they are here for stress it could be something to do with their job or the home life.
You will need to ask them whether they have been to see any other therapists before coming to you or if they have been hypnotised before. If they have then find out why they have been before and if it worked for them, if it didn’t work do they know why it didn’t. You can also make sure you don’t have any connection at all with the client as this could cause problems and would be inappropriate. This is known as dual relationship. You can also see if either of you are sexually attracted to one another as this is another situation where you would not be able to work with each other.
It could interfere with the therapy so again you can refer them onto someone else. In the initial consultation you can start to assess the personality of the client. You can start to decide what sort of style of screed to use, whether authoritarian or permissive etc. You can also assess the modality of the person using the questionnaire which was given by Chrysalis. You can see if they are visual people, kinaesthetic or auditory etc. This will give you the foundations for the screed and hopefully you can personalise it to get the maximum affect required.
There will be a contract that you will have which you can discuss with the client. You need to ‘explain fully to clients in advance of any treatment: fee levels, precise terms of payment and any charges which might be imposed for non-attendance or cancelled appointments, and wherever relevant, confidentiality issues. ‘ (GHR – Code of Ethics) You will also cover things such as what hypnosis is and what happens during the sessions, lateness, behaviour (aggressive behaviour will not be tolerated, no guarantee the treatment will work etc.
This contract can be given to the client with the notation form that they fill in. Once you have found out exactly what the client is coming to the sessions for you can then set realistic goals with them. You want to make sure they are manageable. For example if they have come to lose weight don’t set them an unrealistic target of losing 2 stone in a month. Make it so it is achievable as this will give the client more confidence in you and the therapy. As you can see the initial consultation is extremely important as a lot of information is got from this first meeting.
You build a rapport with the client so they feel comfortable to come back to you. You find out there background and all personal details and the goals they want to achieve. Without this initial consultation you would not be able to build up this picture of the client and know if there is any reason why you shouldn’t be treating them, whether it is to do with medication they are taking or its not an issue you are comfortable with dealing with. With doing all of this you have more likelihood the client will come back to see you and success for the client.