An initial consultation for any new client is very important. It is during this time that as a therapist you will be able to gather most of the vital information you will need in order to give the best possible treatment plan. There are exceptions however, for example, if you are carrying out one off sessions for people who want to quit smoking. During the consultation it is essential that you gather information about the clients’ health and current medication as this could present you with an issue that is beyond your limitations of practice. With this in mind I intend to look at the importance of the initial consultation and some of the ethics you will need to consider during this process. Some therapists will offer a free initial consultation; this can work in your favour if you are just starting out. It will give you the chance to outline your therapy style without the potential client feeling as though they are paying for something they are not entirely certain about. You can discuss fees and session lengths and you will both be able to decide whether you will be able to work with each other before committing to any financial outlay.
It will give you the opportunity to start building rapport, with the pressure of cost out of the picture your client may be more at ease and more likely to open up, giving you the chance to obtain the relevant details you will need. One of the down sides of offering free sessions is that you will have given away your time, and although this may be beneficial in the long run if the client is willing to continue there is the possibility that they will not require your services. If you have too many free sessions in order to build a practice you may find that you have worked a whole week for free. You must also consider the legal issues relating to using free products as a sales pitch. It may leave you open to accusations that you were offering free sessions to attract venerable people who need help. The first thing to consider is how you will conduct the consultation. There will be a lot of information to take on board in a fairly short amount of time. “As with everything else in therapy, the ease, comfort, and confidence of the therapist are crucial” (Hypnosis for Change Karle and Boys (2010) If you appear flustered or unprepared the client will start to lose their confidence in you and your ability.
You need to be able to build and maintain a good working relationship with your client. Your initial session will go much smoother if the client is at ease with you, as stated by Sydney Rosen (My Voice Will Go With You (1991) “Most therapists, regardless of their “school”, will agree that this rapport, the “doctor-patient relationship, “ is of central importance. First impressions are crucial. There is always the possibility that your personalities will clash, or that the issue they have come to you about is something you can not help them with. You will need to be able to handle the possibility of referral to a more experienced therapist and will need to consider the impact this may have on your client especially if they are not in a stable frame of mind.
Find out as much information as possible about the issue the client is coming to see you about. You may have a number of questions you would like to ask a client during this session and may have a consultation form for this purpose; this is usually referred to as the “notation”. Gathering this information is vital to assess whether you can ethically work within your limits. As stated in Hypnotherapy: A Practical Handbook “Initially we seek to satisfy ourselves that the problem with which the patient presents is within our professional competence” The notation can be added to with each session ensuring you have an up to date view of the client and their on going progress.
The way in which you construct your notation is a matter of choice, not all of the queries or questions will be relevant to every client, however it is imperative that you find out details on the clients medical history and if they are taking any medication. If the client is reluctant to give you this information then you have to question why. You should already have the client’s name, if they have contacted you, but this may not always be the case if they have been referred. You should ask them by which name they would like you to call them. This will make them feel more comfortable and it will help if you choose to use their name in one of the scripts. Address and contact details need to be noted and whether or not you can contact them or leave messages on any of the telephone numbers given as not all clients will have told their family that they are coming to therapy. You may ask if they are married or have any children and what their names are as they may refer to them during their consultation or other sessions.
It is important to go over some history with the client which could include childhood memories, were they good or bad, family medical history, their medical history, schooling, if they have had any sort of therapy before and what was their experience of this was. You may want to ask them about their current and past employment, how does work affect them, do they enjoy the work they do? Are there any issues arising from working relationships with colleagues? Are they having any problems with friends even? Hobbies and interests are good to know as you may be able to build them into the scripts creating a familiar and comfortable place, this will also help build the relationship as you take an interest in them, and it is also useful to find out what they dislike or fear. They may not be coming to see you about their fear at this point but it would be useful to know so it doesn’t come up or get written into a script, for example if the client has a fear of water you wont want to put them in a boat over a deep lake in the script.
Obviously the most significant question is why they have chosen to come to therapy now? Has it been a long term issue? If so why did they feel they couldn’t come sooner? The more information you gather the better you will be able to help, and the more successful you will be. The initial consultation should be a discussion based session. This will help you to personalise the therapy your client will need. You will gain more and more information as each session goes on but you need to have a good foundation to start with. Every client you see will be unique so there are infinite numbers of initial consultations to be conducted. As with treatments there isn’t really going to be a one size fits all when it comes to meeting clients for the first time. It is also an opportunity for your client to express any concerns they may have and to ask you questions about hypnotherapy, as stated in Hypnotherapy: A Practical Handbook (Hellmut and Boys 2010) “since relatively few people have a realistic understanding of the nature of this technique or of the experience which results from it’s use”
If the client has been refereed to you rather than seeking you out they may not have been told that hypnotherapy was an option. At this point it is good to be able to reassure the client of any pre conceived ideas they may have about hypnotherapy or therapy in general. They can ask questions which will build on the connection and trust you would like to achieve, especially if this is the first time they have experienced hypnosis. It is vital that the client makes a positive bond with the therapist. This may also give you an idea as to how many session the client may need depending on the issue they have come to you about. As stated in Hypnosis for Change (Hadley and Staudacher 2001) “The more fully you understand the causes of a problem, the better you will be able to define it and resolve it. At the same time, it is also necessary to educate your client about hypnosis. The more the client understands the more confidence he will have in the hypnotic process. This is also the time to establish rapport and trust. By reassuring your client of his safety, he will be receptive to a good working relationship.”
A look at ethics
From The Hypnotherapy Society Code of Ethics April 2002
There are many ethics to consider when practicing as a therapist. Some of the crucial ones to bear in mind during an initial consultation are:
•Suitability for your expertises. Do you have the skills to go ahead with therapy? “Practitioners should give careful consideration to the limitations of their training and expertise and work within these limits” – When collecting information on current medications you may find that a client is taking anti psychotic or antidepressants medication or they may present you with an issue you have little knowledge of.
•Checking that you do not know the client in any way.
“Practitioners are requires to consider the implications of entering into dual relationships with clients, to avoid entering into relationships that are likely to be detrimental to clients.” – Although this type of relationship could also be beneficial it may be inappropriate if lines of friendship and therapist/client become blurred.
•There may be questions that you would need to ask your supervisor before you went ahead with any further treatment. “All hypnotherapies, trainers and supervisors are required to have regular and on – going formal supervision/consultative support for their work in accordance with professional requirements” – This will ensure you work ethically and that the information you need is current and correct.
•You can make sure you are not sexually attracted to the client as this will undoubtedly interfere with therapy; any form of exploitation of your client is not expectable. “Practitioners must not abuse their client’s trust in order to gain sexual, emotional, financial or other kind of personal advantage. Sexual relations with clients are prohibited”
•You can arrange a contract for your therapy which includes confidentiality, time and place for sessions, number of sessions and costs. “Practitioners are responsible for clarifying the terms on which their services are being offered in advance of the client incurring any financial obligation or other reasonably foreseeable cost or liabilities” “Practitioners are required to be honest, straightforward and accountable in all financial matters concerning their clients and other professional relationships.” – This is for your own safety as well as for your clients.
•Confidentiality is obviously one of the biggest issues that must be upheld, which is pivotal in keeping the clients trust. “The practice of hypnotherapy depends on gaining and honouring the trust of clients. Keeping trust requires: *attentiveness to the quality of listening and respect offered to clients *culturally appropriate ways of communicating that are courteous and clear *respect for privacy and dignity
*clear explanation of the role, type and scope of hypnotherapy to be utilised *careful attention to client consent and confidentiality.
The consultation room and first meetings.
Sometimes it is easy to forget the little things that make any therapeutic session successful. Creating the right environment of calm and professionalism will assist in ensuring the client is relaxed and happy. It is an idea not to have an environment that is cluttered or have décor that’s too bold but at the same time you don’t want it to be too sterile looking, obviously if you are doing home visit you will not have a say in the way in which the room is decorated but this may be more comfortable for the client so as therapists we need to be able to adapt to the surrounding to put the client as ease. The way we dress will make an impression too. Clients will often expect you to look smart but not overbearing so smart casual seems to be an accepted medium. Dressing in a similar way each time you see your clients will give them a sense of familiarity and will help the client to ‘pick up where they left off’
To summaries, gathering all this information and taking into account ethics, environment and appearance will make for a better treatment for each individual client. If they decide to go ahead with further sessions this induction will be key for making sure you have adequate information to be able to provide a personalised script and develop treatment ideas. An accurate record for each client is not only good business practice but vital to the continued relationship you have.