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When the next new parents emailed or called to ask about his services, Jonathan was ready. He could now explain to them that in the first stage—Training and Testing—he’d use neurological feedback to help the child stay calmer when learning. In the next two-month stage—Creative Problem Solving—he’d give the child a variety of tools to use at school and home to resolve frustrations. The final phase—Consolidation—would help the child refine the skills needed to keep learning on track. In the end, he could clearly tell them, “That’s six months for a full program of testing, training, problem solving, and strengthening.” If children needed more sessions or time, Jonathan would recontract with the parents for a longer period of one of the three stages. With this contract in place, Jonathan found it much easier to engage new parents, set expectations, and help them connect to him and to his process of therapy for their child. Instead of fearing the inevitable questions these EC parents posed, he was relieved that he now had more effective ways to answer them.

Making Value Visible

Sue, a clinical social worker, was weary of educating new clients during the first phone call. “It’s discouraging that I have to sell the idea of therapy or counseling and explain why it even works,” she said. “From session to session, they don’t see the big picture of how therapy can change their lives in major ways.”

As I coached Sue to help her clients see the value of her services, she decided to try leaving 10 minutes at the end of each session for a review. During the review, she first asked a client to share what he or she thought was of value in the session. Then she offered her own observations, such as “When you talked about your mother, you started to tear up. I know you said you don’t express affection easily, but you showed some in here. That’s progress, and it moves us one step closer to your goal of better communicating your feelings to others.”

This technique allowed Sue to track and validate their progress, which in turn gave clients a firmer sense of the value of sessions and a way to justify the effort and expense of therapy. Although it was a successful method, Sue hadn’t been trained to summarize each session with clients in this way. She needed coaching and role-playing to learn to observe and comment out loud—in essence, to say what she’d normally write in her notes. Together, we shared examples of people who did this publicly with good results. During this process, we came upon one of my favorite behavioral experts, Cesar Milan, the TV “dog whisperer.” He watches for micro movements toward better behavior in the dogs he trains. He then offers immediate reinforcement to the dog and comments on his actions in real time to the owner holding the leash (and the audience at home).

In an episode of the show that fascinated me, the owners, both avid runners, wanted their dog to go jogging with them on a leash in the park. Most dogs love this activity, but not the owner’s Labrador retriever, who hated leaving the house. Milan said that, rather than fixating on the larger outcome of getting the dog to go jogging, the first goal needed to be small—just getting the dog out the door. Although it was tedious work, each time the dog made a small movement toward the door, conscious or not, Milan praised it, explaining each step of what he was doing to the owners. There were backslides and much whimpering on the part of the dog, but within 30 minutes, the dog walked proudly out the door on his leash. Getting to the park and running could take much longer, Milan said, but getting out the door was the critical start.

When Sue heard this story, she told me about a new EC, a young woman in an unhappy marriage, whose stated goal was to separate from her husband. After two months, in which no action had occurred, the client questioned whether therapy was working, and Sue, frustrated about the client’s lack of progress, silently wondered the same thing. Reflecting on the dog-whisperer story, however, Sue realized she needed to start with a smaller goal, one that both she and the client could succeed at and debrief on, marking increments of progress in every session.

Sue reported back that in future sessions, the client was making gains with small goals that could prepare her for separation—getting her finances in order, beginning to reach out to old friends, taking an evening yoga class to connect with a sense of peace. With each step forward, Sue was able to remark on her progress, validate the effort it required, and set small next steps to keep her
client moving forward. Both Sue and the client felt that therapy was now progressing well with this slower, more deliberate approach to defining progress.

Retaining the EC

As we learned above, Harriet, the family therapist from Chicago, was perplexed and discouraged by her inability to retain the younger clients who were shopping for her services via her website. She was glad that they were finding her and booking sessions, but was distressed at their presumptions about the therapeutic process. “They’re impatient and not emotionally aware,” she said. “They don’t understand that sometimes issues get messy before they get better. Just yesterday, after I worked with two parents and a defiant teenager in a pretty intense session that I thought went well, the father said, ‘I’m out of here. If I wanted to argue with my daughter and wife, I’d have stayed home.’ I tried to explain that this was part of the process, that not every session will end with happy faces, but he wasn’t convinced.”

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  • Comment Link Wednesday, 11 September 2013 13:17 posted by Jennifer Knight

    Excellent, helpful article. Thanks for articulating the obstacles to building a private practice and practical tools for how to address them and to turn each obstacle into an opportunity for providing better service.