Word count: 1892 Why is the initial consultation so important? What factors will an ethical therapist cover at this time? In this essay I will be looking at the purpose of the initial consultation, what happens during this meeting and why it is such an important time in the client/therapist relationship. I will endeavour to cover as many of these issues as possible in order to illustrate the importance of this initial consultation and the factors that an ethically minded therapist should cover. The initial consultation…free or not?
The initial consultation may well be the most crucial aspect of hypnotherapy, if not all therapies. Everything from the knowing the client, interpersonal dynamic to the eventual success of the therapy has a basis in this first meeting between the client and the therapist. Indeed, the client’s decision to remain engaged with the therapeutic process may be determined by factors from this early meeting. There is much controversy and debate around whether the client should be charged for the initial consultation. One thought is that charging would be unjust if the therapist cannot provide the sought therapy for one reason or another.
A counter argument to this is: if there is no charge clients may take advantage of this “free” session without any intention to return. It could also be said that a “free” session acts as a lure for the client, implying they may feel obligated to enter into a contract with the hypnotherapist. In my opinion, the initial consultation is fundamental for the evaluation of the client, in order to have a clear idea of the client’s issues and needs. It would be unethical practice on the part of the therapist if this evaluation was not carried out. As long as this is explained to the client in the very first contact then it is right to charge.
However I myself would prefer to offer this as a “free” consultation because I see the first session as an evaluation for both parties. It is an opportunity for the therapist to fulfil their duty of care and understand the client’s needs before undertaking any work with them. It is also an opportunity for the client to explore the possibility of undertaking a course of therapy without feeling any pressure to continue if they feel uncomfortable. I would however make this consultation session shorter than a usual session, to distinguish the difference.
I would also have very clear boundaries around how a free consultation was administered. Some of the benefits of providing a free initial consultation are: • Enables you to get a ‘feel’ for the client, as you will be face to face – is this someone you could work with? • You can check that you do not know the client in any way or that you are not connected to them in a way that is inappropriate (Dual Relationship) • You can check whether they are on any medication, particularly anti-psychotics or anti-depressants • You can gain an understanding of their family history that may indicate possible areas of concern. You can assess their goal with them and determine whether it is obtainable • You can arrange a contract for your therapy including costs and number of sessions before reviewing • You can find out about previous therapy/counselling in the past- was it successful, are there any therapies they didn’t like? Why? You can gain an understanding of their family dynamic and living environment • You can enquire as to any problems that may effect their motivation and self esteem • You can assess whether you will need to run any questions by your supervisor before proceeding further • Conveys professionalism in your field – which can only assist with public relations and instilling respect and trust in this therapy. • May help to encourage ‘undecided’ potential clients attend as ‘what have they got to lose? • Assists with building trust and rapport, you are building a working relationship before the therapy starts in earnest. • You can assess whether you have the skills to go ahead with therapy • You can explain your confidentiality policy • You can assess the personality of the person by using the assessment questionnaire – therefore deciding what style of screed you could use with them • You can also assess modality and obtain other information that ou may need to create a personalised induction • You can makes sure there is no sexual attraction between yourself and client – this would undoubtedly interfere with the therapy and would be unethical practice • You can begin the process of ‘seeding’ the client for ready acceptance of future work • Enables you time to seek GP approval if that is what is needed. It could be argued that the only ‘con’ that comes from offering a free initial consultation is the cost to yourself as you will have given away half an hour or so of your time for free, time that maybe could have been spent with a paying client.
It is important to note that you have to be very careful as to how you advertise and conduct free initial consultations. This is due to complex legal issues relating to using free products as a sales pitch. Knowing and Informing The consultation process should be concerned with two primary aims; knowing the person and informing the person. The latter is somewhat less involved and aims to ensure that the client has a clear understanding of the therapist, the nature of hypnosis, and the guidelines within which both are framed.
Clients need to know that they are dealing with a trained individual, and how that person will work with them. This means that they should know the therapist’s qualifications (and perhaps even a method of checking them, such as a telephone number or web address) and their particular philosophy or approach to therapy. Some clients may have experience of preferred or disliked therapies. The client also needs to be clear about the nature of hypnosis, what it is and what it is not, issues regarding loss of control, revealing secrets, not coming out of a trance etc.
It might be useful to send such information to clients when they make their consultation appointment and then review it during the first face-to-face meeting. As explored above, meeting with the client for the first time is very much concerned with learning about them and their needs and their expectations of the possible therapy. It goes without saying that this is also a crucial time for the therapist to gather as much information to begin a successful therapeutic relationship. Information and data will usually be collected and added to a form that is generally referred to as a ‘Notation’.
This will cover details such as: • Full name (also name they like to be referred to) • Address and contact details (including permission to use these contact numbers etc) • Occupation • G. P. name and surgery • Medical history – current Medication and health problems, addictions • Relationship status • Childhood – brief description eg happy, average, bad childhood • Hobbies/interests • Problems in work life • Problems in close relationships • Any previous experience of Hypnotherapy or other therapies • Dislikes/fears What is the clients goal and is this a long term problem/If so what brings them to therapy now • Any other issues All of the above information is required if the therapist intends to work within an ethical framework. Talking to the client face to face gives the therapist more information by observing body language for example and it is also an opportunity to begin to build trust and develop rapport but probably most importantly it is necessary to find out if the work requested is actually within the therapist’s professional scope.
Medical history and current medication will give a good indication as to whether the client can be helped in this setting. If there is any suggestion of mental illness it could be detrimental to the client to pursue this course of action and unethical for the therapist. If in doubt the therapist has a duty to seek approval from the clients GP, informing him of the intended changes the client would like to make, and the course of therapy intended. This can only take place with the clients consent and without this the therapy cannot egin and should not. The therapist has a duty of care to refuse the client and any other action would be unethical. Some times it might be necessary to refer the client on to a more relevant professional. If the client is assessed as a suitable candidate for hypnotherapy it is now important for the therapist to get to ‘know the client’ and to begin to build a working relationship based on mutual respect. Listening to the client, being truly present, will go a long way towards the client feeling safe and heard.
Paying attention to the client’s personality is also important, and we need to try and ‘mirror’ that to a degree. For example if a client is very shy and reserved he will feel uncomfortable if the therapist acts in a flamboyant and theatrical manner. If in telling his story the client observes facial expressions and body language that seem judgemental the client is unlikely to feel positively towards the therapist. In order to build rapport we must behave in a way that facilitates the required response, alienating the client will only serve to close down the relationship before it has even started.
When actively listening to the client it is important to be empathic rather than sympathetic. This is far more helpful as this helps the client to find a solution to the problem as opposed to a moment of sympathy, which the client could ordinarily get without seeking professional guidance. During this gathering of information, the therapist is able to learn more about the client’s lifestyle, childhood, relationships, personality traits, likes and dislikes style and modality.
With this knowledge the therapist can craft or adapt a screed to suit that persons preferred modality and style. In learning about the client the therapist is able to help in a much more effective way and is able to avoid any words and images that might be detrimental to the treatment. As rapport develops and more is revealed about the client, it might become necessary to change the style of a screed, but it is at least a starting point that will have more relevance, than if the therapist started with a generic script.
The more personalised screed is likely to have a more positive outcome. It is also useful to find out if the client has had any experience of therapies previously and if the experience was a positive one. Find out if the client has any previous knowledge, exposure or expectations of hypnosis. Do they have any fears surrounding pursuing a course of hypnotherapy? Now is the time to discuss these issues and to try to allay any fears they may have. If the client has no previous experience of Hypnotherapy, use this time to educate the client about what hypnosis is and isn’t.
The therapist should end the initial consultation by summarising what was said, they should give a brief outline of the main points, issues and themes that the client has raised. This gives a complete picture of what was discussed and also it allows space to clear up any misunderstandings. Conclusion To summarise, the initial consultation is important because it gives the client and therapist chance to evaluate each other face to face and to decide whether they can realistically (and ethically) work with each other.
There are many important factors that need to be given careful consideration before any therapy commences and the information gathered (and imparted) at this time is key to gaining the knowledge required for a successful outcome, if therapy commences. References and Bibliography Chrysalis Module 3 handout ‘The role of the Subconscious’ Karle and Boys Hypnotherapy, A Practical Handbook (2nd edn), Free Association Books (2010) Heap and Dryden, Hypnotherapy A Handbook,Open University Press (2010)