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Private Practice Strategies - By Anthony Centore
Prepare your clients for these nine issues — or else!
Expectations are everything, and getting buy-in for how things work at your practice is
an important part of facilitating happy, satisfied clients. However, too often client education and informed consent resemble the oft-ignored “terms of use” contract for iTunes. Clients are handed a sheet with 2,000 words of 10-point text and asked to sign (or click “I agree”) to move forward. This month, let’s review nine areas where client education is imperative.
1) The wait to get an appointment:
Walt Disney World has long lines, but no one revolts because guests are prepared in advance for the inconvenience. In fact, despite the crowds and wait times (and high prices), Disney World has extremely high guest satisfaction ratings.
Emulate Disney and be up front with clients about how long it can take to
get scheduled at your practice. At my centers, we get new clients in the door quickly (within 24 hours) for their first appointment. However, we’ve learned that we also need to educate clients that 1) the wait times for some specific counselors can be weeks (or longer) and 2) if one fails to schedule regularly with his or her counselor, that counselor could become fully booked with other clients.
2) The responsibility for all fees if insurance doesn’t pay: Some counseling practices gloss over this detail and then have a conflict with clients when a billing issue occurs. If you accept insurance, spend time with clients before their first session and talk through the insurance billing process. It’s OK to disclose what you expect insurance to pay. However, clients need to know that if insurance falls short, the conflict over the difference isn’t between your practice and the client; it’s between the client and his or her insurance company.
In a recent trip to my primary care provider (PCP), insurance didn’t cover as much as we all expected. Because we had discussed the possibility, I paid the difference (with some disdain for my insurance provider but not for my PCP).
3) The no-show/late cancellation fee:
In any given week, a 20 percent cancellation rate isn’t unprecedented for a mental health counseling practice. Still, late cancellation fees become “fine print” when counselors don’t want to talk about them. By avoiding the issue early on, one sets the stage for many awkward conversations down the road. (Spoiler alert: The issue is going to come up — a lot!) Instead, inform your clients about your late cancellation and no- show policy, or suffer the consequences of clients who believe that missing a session “every once in a while” shouldn’t come at a cost. Also disclose the fee prominently via a sign in your waiting room.
4) A realistic duration of treatment:
People want quick fixes, and sometimes counselors are worried about scaring off new clients if they communicate that meaningful change can take time. This reluctance doesn’t help anyone. When treatment duration isn’t understood, individuals and couples might drop out after three to five sessions, saying, “Well,
I gave counseling a try. It didn’t work.” Instead, inform clients that brief therapy starts at around 10 sessions, and some clients will need additional sessions to reach their treatment goals.
5) Sessions can be difficult: Do you know of any counselors who waste sessions “shooting the breeze” with their clients and mollify their clients on every issue instead of bothering with the hard work of therapy? We’ve all had clients who have said, “My last counselor never challenged me” or “My last counselor just sat and listened to me.” Make sure this isn’t the expectation of new clients. In your office, clients make progress — and that takes hard work.
6) Limits to confidentiality: The limits might be old hat to you, but they’re not to your clients. Taking time to go through the limits of confidentiality is both an ethical obligation and a way to show your clients that you respect them enough to inform them of the laws.
7) Treatment record ownership: For most adult clients, this is pretty well
understood. However, when it comes to children or couples/family sessions, it’s more imperative to explain the ground rules to clients. For couples, I’ve found that Principle 2.2 of the American Association for Marriage and Family Therapy Code
of Ethics does a nice job of determining
to whom the record belongs. Either both clients execute a release, or nobody gets the record.
8) Getting stuck is OK: Getting “stuck” is a common phenomenon in the counseling process. Inform your clients of this. Also tell them that not having much to say in session isn’t a sign that they’re “done with counseling.” Rather, it’s a signal to keep working because something is blocking their progress.
9) Things will get better: Hope is a powerful thing. Prepare your clients that the silver lining will get longer, the light at the end of the tunnel will get brighter and pain will pass in time. A client experiencing an issue such as bereavement or major depression might have little hope and think, “I’ll never fully recover.” You know this isn’t true, so make sure you tell the client.
When a potential client reaches out
for counseling, it’s normal for you as the counselor to want to get started without delay. However, taking the time to prepare the inquirer for what it is like to be a client at your practice is an important part of that person’s (and your) ultimate success. What other items would you add to this list? Let me know on Twitter: @anthonycentore. u
Anthony Centore is the author of How to Thrive in Counseling Private Practice and founder
of Thriveworks, a counseling franchise with locations in four states. Contact him at anthony@ thriveworks.com.
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12 | ct.counseling.org | February 2015