Leveraging Client Accessibility
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Is it ethical to leverage the accessibility of mental health services?
That’s a loaded question. Of course, if a client ever needs or requests aid, a therapist or counselor must attempt to remove any obstacles in the way of those services. But what about if a clients goal is aimed at building resiliency? Or when a client is beginning to work toward the end of their counseling process?
My children and I recently began watching the new ‘Lost in Space’ series on Netflix. We love space and good storytelling. Most of the shows we watch together have positive narratives where things always work out. Their reaction to the first episode (and episodes thereafter) was very intriguing! The family (younger kids included) find themselves in various dilemmas! Ones that seem impossible to escape! My kids turned their heads away and buried their faces in the couch stating that these kids will not survive! It was as if they believed children and young adults can not have the resiliency to overcome obstacles unless solutions were outlined easily!
Let’s say a new client is needing to talk every other day. This might be justified by the fact of their high risk and need for fairly immediate treatment. Boundaries would need to be put into place. Now, what if this client has been in counseling for a year, and is only meeting once per month, and heading toward their termination session? Does a counselor have the ability to leverage the type and frequency of communication-based on the clients' desire for resiliency and overall well-being?
It feels strange to say that communication can be leveraged for the betterment of others. However, it’s no different than saying that silence is golden.
I have heard of many scenarios play out in the therapeutic alliance. Ones where therapists talk too much, others where clients don’t talk enough. For whatever reason, our communication styles are always fluid and they present opportunities to be mindful and cautious. They set the stage of how relationship dynamics will play out, no matter if it’s professional or casual.
Looking at it more closely, our communication is always being leveraged because it’s a natural response. Our tone, our responses, they are usually based in formulas, upbringings, and conditions.
In my practice I give the following prompt:
“Please know that you can reach out at any point, at any time, for any reason at all. But also know that I may not answer. Use that opportunity to vocalize your need. Just the simple practice of putting thoughts into words and knowing someone will hear them provides a great outlet.”
I have found this prompt grants empowerment, engagement, and leverage. Meaning for those who are practicing resiliency, they can have space and encouragement to both voice their needs and work toward a resolution with the tools they have built thus far in their sessions!
If a client ever exhibits symptoms of regression, then this is not the appropriate response! Completing risk screenings (included in the MSE’s) and setting safety plans in place provides a great deal of benefit! This is why it is so crucial to stay in touch with clients. Thinking that clients are just scheduled bodies that show up for their appointments is not the way to go. It brings lots of money, but not the right thing to do. At least in my eyes.
Here are a few statements I make with clients as needed:
“It sounds like this coming week is going to be difficult. What do you think about checking in midway over the phone?”
“So you’re saying you’re lonely, depressed, and going on a business trip before we see each other in 2 weeks? Would you be able to text or call when you arrive at your destination and track your daily symptoms with me?”
“Let’s connect once (Counseling homework) is complete and see if any change has occurred.”
“If you feel like an anger outburst is coming, consider putting your thoughts into words in a text. I may or may not respond. But it will give us a good map for our next session!”
Alfred Adler, an Austrian psychotherapist, and medical doctor emphasized the training of parents, teachers, social workers in democratic approaches that allow a person to exercise their power through reasoned decision making all the while co-operating with others. He was pragmatic and believed that we can make practical use of the insights of psychology.
By having clients use a tool to convey thought and emotion (using their phone to leave a voicemail or text), they are practicing a naturally Adlerian practice. Adlerians place an emphasis on excavating the past of a client in order to hopefully alter their future. This also increases integration into community in the 'here-and-now'. Being present in an active way!
Most of the time we think of accessibility as needing to be a smooth road. The path of least resistance to treatment. However, most of the time this process seems to be more effective for large organizations turning clients for profit. Getting the quickest treatment to the most amount of people means money, and money keeps the organization running.
In my experience, providing a meaningful process to accessibility rather than the quickest provides a catalyst for deeper buy-in and long term ownership/ goal attainment. For example, insurances ask for diagnosis and a tx plan by the 1st or 2nd session! Meanwhile, just about every therapist has been trained and educated to use various assessments, and have a thorough narrative of the client before giving a diagnosis or Tx plan. Thus we are placed in a paradox! Another example is the prompt to have goals that are client-centered, yet some insurances decline coverage if they don’t meet certain criteria.
When therapy plays by any other rules than the ones ethically and historically laid out and approved, that’s when we begin to see the degradation of services and less than desirable treatment. But when we stick to what we know to be truth and effective praxis, we can confidently interact with our clients and their therapeutic process. When their goals and needs become our basis for treatment, leveraging what treatment method is used and at what frequency no longer sounds like a strange venture.
Looking for treatment planning resources? Check out my article “Top 10 Tx Planning Resources”
https://link.medium.com/0i42KzUVSZ
Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally.
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