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About Counselling

Why I charge the full fee for DNA’d sessions.

Different therapists will each have a different rationale for their counselling session fees, and what they do when a client does not appear for an arranged session,

With respect to a client not appearing for a session with me (giving no warning): I charge the full fee for that session (and charge a half-fee for sessions cancelled with notice).  This arrangement is put in writing at the beginning of the clinical work so that the client is informed.

Now, you may think that the absent client aught not to pay for a session that they do not/could not attend.   After all, the client was not actually there for that session.

But… I was still there for the session… the whole of it… and I stayed there with the absent client

Read on for a more full rationale that informs my approach for missed/DNA sessions…

Paying the full fee for sessions not attended.

In a client’s absence, I will still be working during the session:-

  • I will sit in the room with the client’s empty chair.

     Sometimes a cigar is just a cigar.

…apparently Sigmund Freud said this… but other sources say he didn’t 😉

What this phrase means that sometimes therapists who work with the unconscious may interpret evidence… when actually the interpretation is a bit of a miss and a literal understanding may be more appropriate.

Freud’s attributed quotation, above, is referring to how the cigar may be interpreted to represent (say) a penis. Sometimes this interpretation may be accurate (the man who always takes out a very large cigar from the box may be compensating for the small penis… or whatever the “penis” represents for him: lack power, potency, etc.) and sometimes the interpretation may not be accurate (the man simply likes large cigars).

So, baring this in mind…

 

  • I will contemplate my responses to the client’s absence (otherwise called “counter-transference”).

As human beings, we often effect other human beings.

Something we might say something like “he made me so angry” – and what we mean by putting it this way is that one person effected anger in the other.

It works a little bit like a dance (an actual one… two… three… physical dance): if you pull me towards you then I’ll feel that pull; your action resulted in my reaction.

It’s similar with emotions.

If I sit there and contemplate my emotions around the client’s absence (my “reaction”), this might help me understand what might be the client’s part in the dance (the client’s “action”).

Do I feel angry at this absence? Abandoned?

Am I feeling relieved? Was this following a difficult session?

Am I puzzled? Was I expecting this?

This pondering about my emotions can help me begin to appreciate maybe what the client’s “pull” on me may be asking of me… begging me… to understand. Something that, maybe, the client’s conscious mind cannot tell me.

 

  • I will ponder about what the absence might be (called unconscious communication).

Sometimes a DNA (“Did Not Attend”) might be about communicating something that could not be said in words.

Thinking this over can assist me in understanding a little about what might be happening for the client unconsciously (e.g. something that the client cannot put to me verbally, or if the client might be acting something out that wishes to be understood by someone).

Maybe the client became angry with something I said in the last session, but the client can’t tell me.

Maybe the client and I are going at a pace that’s too much for the client, but the client hasn’t been able to say “I want to slow down”.

 

  • I will look over my case notes.

It can be useful to read my notes from the day we started up to today’s session. Maybe there’s something I’ve not seen or have not been looking at since it appeared on the first day.

Perhaps the day of the absence is significant: could be an anniversary that’s important to the client, for example.

Maybe there’s a pattern forming with the client’s absence that the client and I have not paid attention to before.

  • From time to time, I’ll check my email & telephone messages…

… to see if the client has left a message for me about their absence or late arrival. Sometimes a cigar…

 

What I won’t do during a client’s session time…

  • I won’t telephone the client / chase them up.

Unlike some other therapists, I won’t telephone the client asking them where they are.

Behind my rationale for this is

(1) It’s likely that both of us already know that they’re not here.

(2) It’s true that the client might have forgotten about the session – but telephoning them during the session time isn’t going to change that.

(3) I believe telephoning during a session time can risk being quite persecutory or shaming.  It also breaks a boundary (that during this time we work in the room together). Telephoning goes contrary to my approach to unconscious communication (if a part of the client is needed to tell me something important by an absence, my approach is to understand/respond to the communication, not react to it).

 

  • I won’t email you/write a letter to the client.

 … for similar reasons to the item above.  I may draft some thoughts for inclusion in an email or a letter as part of trying to understand an absence, but I will leave the writing/sending to after the session.

So, in short, whilst you might not be present for your session, your session is still happening in your absence, and I’m still working for you.

Boundaries help us identify conversations to be had.

Setting boundaries help us – the client and I – to identify when a boundary has been stepped over.  Without boundaries being there, we cannot know when a boundary has been transgressed.

Transgressions are an invitation to conversation.

Whilst I may say that “if you miss a session without giving notice, I will charge for that session”, I’m also saying that this is open to a conversation too.

There will be exceptions to boundaries – and we can talk about those as they happen.

Boundaries aren’t meant to punish (although some of our childhood experiences will tell a different story); in counselling they’re there for safety, for containment and to help the counselling work.

Clearly, I may never receive the session fee for a client who has abandoned the work. If the client has left our counselling relationship they will have their own views and perspective about their absence, and we can’t talk about it of course (the client won’t be coming to see me any longer). So even through the client got a full session in their absence, I will be at a financial deficit and may well have to absorb that loss (rather than repeated chase up for it). It’s my position that containing this “loss” is an appropriate approach.

Reading Bion and Winnicott are helpful authors for a more detailed resource for my approach who are interested in learning more.

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News Uncategorized

“In Treatment” returns for Season 3 – Sky Atlantic

Saturday 12th November 2011 – Sky Atlantic – “In Treatment” returns for its third and final season (see http://skyatlantic.sky.com/in-treatment/gabriel-byrne-returns-for-the-final-season-of-in-treatment).

“In Treatment” is based on BeTipul – a drama portraying real-life psychotherapeutic sessions between psychologist and his patients.  Each episode is focussed upon one session between client and therapist and over time one sessions how the therapeutic alliance progresses as the therapy develops.  We are fortunate in that we get to understand what’s going on in the therapist’s mind by being able to attend his own supervision (and sometimes his own therapy) so that we sometimes can learn how the therapist uses his experiences and struggles of clients (eg his ‘counter-transference’) in order to help the clients themselves.

Gripping drama – accurately portrayed.

Because I do not video nor record any of my therapy work for reasons of confidentiality, “In Treatment” is an excellent demonstration to show people, who are interested in my work as a psychodynamic counsellor, how our clinical work could progress between us as client-and-therapist.

“In Treatment” episodes are on Saturdays at 10pm and 10:30pm, followed by Sunday at the same time.

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FAQ Individuals

What Happens in Individual Counselling?

What Happens in the First Counselling Session.

The first session is called the assessment. Before you and I begin therapy, we must be sure:

  • Is therapy is right for you?
  • Is working with me and my style of therapy the right thing for you?
  • Do we both think that our working relationship could be good enough to work in therapy together?
  • Are there any mental issues that might make counselling difficult (or impossible) with me.

What Happens in Subsequent Counselling Sessions.

How it can help you.

You (and your partner if couples counselling) and I sit opposite each other, chairs at slightly an angle, and we have conversations. What we talk about is up to you, and what we discover during our conversations can be revealing, helpful, and life-transforming. Sometimes matters that are difficult to talk about with others can become easier to talk about with me. I don’t talk about our conversations with anyone else – so our therapeutic relationship becomes trustworthy.

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FAQ

Brief Counselling or Open-ended Counselling?

It used to be the case that I offered either brief counselling or open-ended counselling to individuals coming into counselling for the first time.

Experience has taught me that open-ended work can work through some matters in a brief way, and brief work can sometimes need an open-ended approach.  

In other words, it’s the focus of counselling that is the most important, not the length of time spent.

Having written that, I will still  go through an assessment for counselling with new clients.  An assessment is where we discuss what you need from counselling and if I’m the therapist to work with.  We’ll pay attention to the problems that you are bringing to therapy, see how you respond to what I say and ask.

Later in the assessment session, we’ll discuss our approach to the focus for counselling (open-ended / brief) and see what approaches we agree / disagree with.

Brief Counselling.

Brief counselling works on a single (usually) focus and is a set number of sessions (discussed and agreed between you and I).  The therapist and client have to be able to work well together – a kind of instant therapeutic rapport that can be used in the work click to read more.

Open Ended Counselling.

Counselling that is not limited to a set number of sessions.  But we will still work with a clear focus of our work (which might be at working towards an achievement, a change in emotional state, a transformation of life circumstances and so on).

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FAQ

Can I ask my Doctor/GP for Counselling?

Counselling can be made available to you on the NHS via your GP.

There is often “stepped” process involved – including a waiting list to begin treatment depending on your presenting issues.

An illustrative example would be:

  • Initially, your doctor may first ask you to come back again in a few weeks time to see if things are better.
  • If things don’t feel better then next you may next be given access to reading material – a form of self-guided self-help therapy.
  • If this doesn’t help you may be offered access to a computerised [tooltip text='Cognitive Behaviour Therapy (CBT) is a form of talking therapy that is focussed on helping a person change the ways they think, how they feel, and their behaviour, in a stepped process. CBT has a reputation for being a manualised treatment (patient is diagnosed and a matching treatment prescribed) which is how computer-based CBT treatments have been created.
    http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy'] CBT [/tooltip] treatment.  This may help you identify and deal with your problems through suggestions the computer may offer based upon your responses to questions.
  • If these “self-guided” therapies remain ineffective, a referral to a low-level  (trained & qualified) therapist may be the next step – involving a waiting list of several weeks or months.
  • If the low-level impact fails to help you, you may be referred to another therapist for further treatment.

Low-level impact treatments are cost effective to the NHS because of their being no need to train highly skilled therapists.

The initially-mild interventions offered to you should be overseen by a therapist who should have an initial qualification, adequate experience & appropriately supervised (i.e. newer (lower-cost) therapists are more commonly used early low-impact intervention stages of a patient’s NHS counselling).

You may later be offered a fixed number of sessions of face-to-face counselling if the previous therapeutic intervention didn’t work for you. You may be offered to meet with a more experienced psychotherapist or psychiatrist if the previous experiences of therapy are ineffective.

Why CBT/Stepped Process?

This NHS stepped process is partially due to costs and partially due to new procedures introduced called IAPT (read more).

CBT is a treatment that GP’s can understand – it principally works on a diagnoses/prescription modality, where several treatments can be normalised (i.e. the CBT therapist follows someone’s recommendations/instructions for treating a particular ailment).  Of course, one would not take a prescription from an unqualified GP, so one would not be prescribed a form of therapeutic treatment from an unqualified CBT therapist – but there are various levels of experience & qualifications.

IAPT originally only offered CBT (cognitive behavioural therapy).  Mild forms of CBT can be offered by minimally trained therapists using a form of manualised therapy (e.g. you may be diagnosed and a therapist may refer to a set of therapeutic interventions that are recommended for your form of diagnosis).

Whilst CBT can be effective for certain issues it is not a fix-everything therapy and not everyone likes to feel like they are responding to a manual-of-therapy.  If you can be helped by the processes then this will be beneficial – albeit that to get to the higher forms of treatment the previous experiences of treatment may have to have failed first.

Private Counselling – Your Choice of Treatment.

Unlike NHS Stepped-Treatment, private counselling with Dean Richardson begins with the FULL service.

There is no tiered/stepped process with Dean. You start immediately with full 50-minute weekly sessions working with Dean face to face.  No computers giving you questionnaires.  No books to read.

You and Dean will begin with an assessment session (meeting to talk about what you need from counselling, and discussing what counselling may and may not be able to help with).

You and Dean will meet weekly (usually the same day, same time, same location – which helps many people manage their commitments elsewhere).

With Dean’s assistance you might decide to discuss choose how many counselling sessions you wish to attend (such as brief/focal counselling) or you may with to work with Dean until the focus of the needs for counselling have been fully addressed.

No waiting lists – no maximum number of sessions.

It’s a very personal counselling service that aims to create a therapy that works for you and your needs.

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FAQ

How Long is a Counselling Session?

Length of a Counselling Session.

Counselling sessions with Dean Richardson – both individual & couple counselling – face-to-face or Skype sessions – last for 50 minutes and occur weekly.

Couple Counselling sessions have the option to be extended to 90 minutes (prearranged) weekly.

Because each appointment time is reserved exclusively for a particular client, if you arrive late for your appointment our time cannot be extended to make up the the time. Similarly, if you arrive early the session will still begin at your appointment time.

Unlike many GPs, you won’t be kept waiting for your appointment to begin.

Length of a Group Session.

Group therapy sessions with Dean Richardson last for 90 minutes and occur weekly.

Because the group start together, if you are late you may or may not be allowed to join (depending on what the group has previously agreed about late starting).  The group always ends at the agreed ending time – is not extended for any reason.

Categories
FAQ

How do I begin Counselling?

Beginning counselling in Portsmouth, Hampshire with Dean Richardson is straightforward.

It might help you to be aware that once you have arranged to meet for a first session with Dean (the ‘assessment’) you’re pretty much assured to begin counselling with him – should you choose to.  The assessment session is to ensure that the problems you present for counselling are matters which Dean and you can work with.  It is not to evaluate you to past a test that would allow you into therapy.

Dean takes on a limited number of simultaneous cases.  This is to ensure that you (or you and your partner, or the support group you may join) gets the best out of Dean as therapist.  Dean makes sure that he is not overworked by having a maximum number of cases at any one time during the week.  So, when you look on the front page for list of times Dean is available, you know that Dean is already available to take you on as a new case.

Individual or Couple Counselling.

  1. Take a look at Dean’s available appointments range.
  2. Contact with Dean – letting him know when you’d like to meet.
  3. Dean will return your contact to confirm – or offer another appointment time that’s near to your choice.
  4. You and Dean will meet for a counselling assessment to discuss your needs from counselling and to see if you and Dean both believe it will be beneficial for you to work together in therapy, or if maybe a referral to a colleague or another service might be a better choice.
  5. If there is nothing contraindicative to proceeding into counselling, you and Dean will arrange a weekly appointment (usually the same day, same time and same location as the assessment appointment).
  6. For individual counselling Dean and you meet together weekly for either a fixed number of sessions (see Brief Counselling), or until the issues you came into counselling for are worked through sufficiently for you and Dean to both recognise that the counselling is done.
  7. For couples counselling, you and your partner will meet with Dean until the issues you and your partner came to address have been sufficiently worked through for you all  to agree that the work is done.

Support Groups.

  1. Take a look at Dean’s available groups.
  2. Contact with Dean – letting him know which group you’re interested in joining.  Choose an appointment time from here to come for a meeting to discuss your needs from group therapy.
  3. Dean will return your contact to confirm your appointment time, or to offer one as near as possible to your choice.
  4. You and Dean will meet for a 50 minute talk to discuss your needs from a support group and to discuss if both you and Dean believe it will be beneficial for you, or if a referral to a colleague or another service might be appropriate.
  5. If you and Dean both agree about you joining a group, you both will arrange for you to be added either onto a waiting list to join a not-yet-meeting, or to be given a starting date to join an existing group. 
  6. Because some groups only accept new members when the membership quota has dropped below the maximum membership number, you may be waiting for your place in the group to become available.  You and Dean will look after your needs in the meantime either by arranging holding sessions with Dean, or by discussing other means to look after you whilst you wait.
  7. When your place in the group becomes available, you will be given your start date.