Reliability is more important than availability in the long run. Clients who know when you are not available can make informed choices regarding alternative sources of support.
I once worked with a client who rang her GPs so frequently and insistently that they established a rota for taking her calls. She bombarded every new therapist with telephone calls. I told her she could call me between 1030 and 1130 on Monday or Thursday and that if I was on another call, I’d call her as soon as I finished. She rang me twice the first week and two more times in the next six months. She also called her GPs and CPN less frequently.
Many therapists feel a duty to respond to client’s crises. Who better to address a difficult situation: the therapist who has listened carefully to the client’s life-story or the harassed junior medic who has never met them before? Shouldn’t you always be available for your client?
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Asking when you don’t understand benefits you and your clients. Pretending to understand can discourage disclosure and support poor decision making.
When I began working with people with learning disabilities, I was told “don’t pretend that you’ve understood what someone says to you”. This seemed fairly obvious advice until I was in the embarrassing situation of having to say “I’m sorry: I didn’t catch that” for the third time in five minutes.
Whether faced with a speech impediment or bombarded with abbreviations & unknown references, it is tempting to nod in agreement and try to move on. In either case, the principle is the same: by attempting to avoid embarrassment now, you’re preparing the ground for future, potentially much more serious, problems.
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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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Therapists can either work on, or work around, the chaos in client’s lives. Identifying clients, rather than their circumstances, as chaotic risks disempowering the client.
“Chaotic†seems to be one of the mildest “unofficial diagnoses†a therapist can apply to a client: it seems more descriptive than derogatory. “Chaotic†is defined as being “in a state of complete confusion or disorderâ€. This would be an accurate description of the circumstances of a large number of mental health clients, especially those who come to the attention of psychiatric services.
The stereotypical “chaotic†client would be someone who misses appointments, over- or under-uses prescription medication, has disrupted and disorganised home and work routines and struggles to achieve any consistency or reliability in their interactions. This state of affairs would usually have been at least part of their reason for seeking therapy.
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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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A newsletter-cum-blog from the British Psychological Society. Summarising a dozen psychology journal articles each month in accessible prose, the Digest is a good light read and a useful pointer to the full articles.
Unlike the American Psychological Association, the British Psychology Society does not make the members’ monthly journal available online, but does offer the BPS Research Digest: a round up of interesting and thought-provoking recent research.
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