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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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Blog FAQ

How Long does Counselling Last?

A question that a number of people want answering before they commit to counselling is: “how long will counselling take?”

As a counsellor who practices with psychodynamic, cognitive-behavioural and a systemic approaches, I would suggest that there may be at least two things motivating this question:-

  1. You’re asking for the amount of time until what you’ve brought to counselling feels better.
  2. You’ve have underling concerns that this question might be trying to cover.

What does the Question Mean?

How long Counselling Takes to complete.

To be fair, with this question, I don’t know how long our counselling work is going to take.  The reasons is: I’ve never worked with you on this subject before, and as counselling is not simply a factor of what the counsellor does to the client, then you will be an important a factor in the equation.

Counselling is a collaboration – a joint effort worked at both by counsellor and client together. As a client, if you’re expecting a kind of GP Appointment experience where you describe your problems and the counsellor prescribes a course of treatment, then you’re in for a pleasant surprise when you discover that you can become an equal participant in your recovery.

However, if the amount of time (and money) you might spend meeting with a counsellor is, literally, a concern for you, then you and I can discuss what we think we can (and cannot) achieve in a set number of sessions.  

It’s worth having this conversation because this has to be a mutually agreeable arrangement.

If I am unsure about entering into a time-limited counselling contract with you (perhaps what you want to achieve is vast and you only want to spend a couple of sessions on the matter) then can will discuss my reservations and what might be an acceptable compromise.

Meanings Behind the Question.

Often, it can be useful to look into meanings behind questions.  We do this so that we can understand more about what potential anxiety is being expressed.

So, when you ask: “how long will counselling take”, we might wonder about what could be behind / fueling your question. For example:-

  • “How much money am I going to have to spend?”
  • “Is there something seriously wrong with me?”
  • “Do  you think you solve my problems?”
  • “Have you worked with this problem before?”
  • “Can you cure me?”
  • “I wasn’t happy with my previous counsellor, but I don’t know exactly how to ask you how you will be any better.”
  • “Can you work with me – and for how long do I have to wait until we can begin?”

In my private counselling work, my approach is to discuss and agree with you what will be the focus of our counselling work. 

Once we have understood the focus, counselling can be effectively employed.

A focus can change during counselling work.  It doesn’t have to, but if there appears an opportunity to talk about how our original focus appears to be changing, this might be helpful.

We can begin to end our counselling arrangements when the focus has been address sufficiently for either you to no longer need to meet with a counsellor, or when I (as the counsellor) begin discussing with you about how the focus appears to me to have been addressed, but perhaps not to you.

Group Counselling and Time.

The type of group you join may influence how long you stay a member of the group.

For example, a fixed-term group may state the number of sessions that the group will exist for.

An open ended group might already be meeting when you join as a new member, and may continue to meet when you have left.

The Ethics of Time Spent in Counselling.

As a member of the British Association for Counselling and Psychotherapy, I work with and uphold their (and my) Ethical Framework.

Sometimes, new clients are worried that I will keep them in counselling for a long time. The reality (and I have this written down for you) is that you can leave counselling at any time you wish.  I cannot (and will not) force you to stay in counselling.

Sometimes, clients hold the idea that I will tell them when they are ‘cured’ and only then may they leave counselling. 

These are natural worries and can be talked about when we begin meeting.

  • I do not – in fact cannot –  force people to stay in counselling beyond the point where a person wishes to leave.
  • When a person wishes to leave counselling, it is helpful to spend some sessions bringing the counselling to a close (eg talking about the start of counselling, what we worked through, what things have changed and what unfinished business there is).
  • If a person does not like counselling (or me, as the counsellor) and wishes to leave, we can talk about the dislikes… because sometimes the counselling relationship brings things out in a very real way (sometimes re-enacting difficulties from the past).  If talking these matters through do not help, I will not stop a person from leaving counselling.
  • If a person wishes to leave counselling – and I disagree with the decision – it would be authentic for me to share my thoughts, and my reasons for doing so, but this will not stop the person from leaving counselling. It can add an extra dimension by discussing why s/he and I disagree about ending our counselling work.
  • If a person continues attending counselling past the point where I believe there may be no further therapeutic gains (a thought I will have first discussed within my clinical supervision), I will bring this up in conversation with the client for discussion.  Sometimes ending counselling might be difficult for the client, and avoiding the ending might be a real difficulty for them.  It would be my ethical position to helpfully notice this and bring it up to talk about with the client.

So, ending counselling can sometimes be a little bit complicated – but this is perfectly OK and healthy to be aware of this. 

Types of Counselling.

Brief/Focal Counselling.

In brief counselling, the client and I agree a set number of sessions (sometimes anything between, say. four and twelve) and we agree a specific focus for the work (i.e. one specific element in the client’s life). The focus must be reasonable to work with within the time constraints.  We then meet weekly focussing in on the agreed topic until the number of sessions is complete.

It is not usual for the number of sessions to be changed once we have begun counselling. Sometimes the pressure of knowing the date of the ending can help with the focus of counselling.  There are always exceptions to changing the time limit, which we can talk about during the counselling.

One benefit of short-term counselling is that the number of sessions and the focus is agreed upon at the very beginning.  Even though it can be tough work focussing upon a problem and even six sessions can fly by very quickly.

One disadvantage of short-term counselling is that it doesn’t afford any time to work upon matters that are related (or very close to) the focus in any depth.

Short-term counselling is not suitable for every situation and, ethically, if I think that such work is not suitable for a client I will discuss it with the client before offering such a counselling contract.

Open Ended Counselling.

In open ended counselling, the client and I meet weekly for enough sessions to address the focus sufficiently –  allowing the therapy to develop in its own time.  Both client and I keep an eye on what we discussed in the first session (the assessment) as this will be the main focus of the beginning portions of the therapy… although longer-term therapy allows other matters and other matters of focus to find a voice.  At some point (sometimes several points) during the therapy either the client, or I, or both of us will begin to talk about if our counselling work has been completed sufficiently to warrant discussing and/or setting an end date (or a set number of sessions in which to complete and say goodbye).

As an ethical therapist, I would not let open ended counselling continue in an unlimited, forever, manner.  And having an unspecified number of sessions can be a valuable container for the client as he/she addresses his/her concerns and makes changes to his/her life before we both agree that the focus of the counselling work has been addressed and worked through – and now the work should come to an end.

Taking this approach allows a person to work through matters in their own time, in the safe container of the weekly counselling session.

Combined Brief/Focal/Open ended Counselling.

In reality, open ended counselling (at the beginning of counselling) has been the preferred choice for most of my private counselling clients.

It has allowed them the time and space to work through some important matters.

And as those matters become diminished in the person’s life, deciding on when to end counselling can invite a brief/focal experience.

Instead of, say, a client coming into a session saying “I’ve had enough now, bye bye!”, we discuss the ending of counselling.  This can include setting an ending date, or setting a number of sessions to continue, after which we will finish.

This last part – becoming a form of ‘brief’ counselling – can bring up many important aspects to the surface (as time is now running out!) and provided that the relationship between counsellor and client is a well-formed alliance by now, those matters can be looked at swiftly and with focus. 

 

Categories
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.

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FAQ Individuals

Is Counselling Right for Me?

Are you looking for assistance with transforming problems in your life, or are you looking for someone to tell you what to do?

If the former, then counselling may be a helpful option for you. 

If the latter, then maybe counselling is not the solution for you.

Counselling is a form of therapeutic partnership, where you and a counsellor discuss matters that are effecting you.  Thinking of it as a form of consultation, both you and the counsellor conversationally attempt to understand the problems you face – a little like having a different perspective shared with you.  Sometimes the counsellor might help you look into your past for examples on where the current problems first started.  Sometimes the counsellor might help you look to the future to help you ponder about solutions that might help you.  Sometimes the counsellor may sit and metaphorically join you in the current problems just so that you don’t need to feel alone in them.

An aim is to bring understanding to you so that you can feel less burdened by the problems, and to support you in you making your own choices about what might help change things for you for the better.

Is counselling right for you?

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Couples FAQ

Is Couple Counselling Right for Us?

Are you looking for assistance in helping you and your partner decide how to improve your relationship?  Or are you looking for someone to tell you what to do?

If the former, then couple counselling might be something that is right for you.

If the latter, then couple counselling may not be suitable for you.

A couple counsellor has no instructions or recipes that if you follow to the letter you will find that your relationship improves.  However, a couples counsellor is skilled in helping couples learn what they’re not paying attention to (or have stopped paying attention to).  Some couple counsellors will be curious about the past history of the relationship – when was there a time when things were better.  Some couple counsellors will be curious about the present day – how does the relationship nurture unhappy behaviour.  Some counsellors will sit quietly and listen (actively) to an argument go on for a while – learning about what the partners cannot see for themselves.

Couples counselling can help perturb unhappy behaviours – but both partners have to wish for the relationship to change.  Unhappy behaviours may have become necessary for one (or both) partners (eg avoiding sex) – and dislodging these behaviours might release even more unhappiness if this is not first understood – this is just one of the aims in couples therapy.

Do you think couple counselling might be right for you both?