There are so many things that I would change about therapy and how they should run. From someone on the outside looking in, it is easier to find things that just does not make much sense. The one main thing that comes to my mind about what needs fixing is first sessions. First sessions can be confusing for both the therapist and the client coming in for help. There are cases for both sides as to whether clients should pay for the initial session or if they should not pay.
According to psychotherapy.net, between 20-57% of therapy clients do not return after the initial session while 37-45% of therapy clients attend therapy for a total of two times. These are big numbers when you consider the amount of people dealing with mental health issues. The reason for these huge statistics has to do with an increasing amount of variables that can influence the therapeutic experience. I am going to split up the variables between therapist and client even though many of them are similar to one another because they have unique differences.
Variable Among Therapists
There are many variables among therapists to account for a large number of client reduction, but I will start off with some common ones. One common variable would be scheduling with the client. What I refer to as scheduling is if a therapist is late to a session which can be seen as unprofessional, forgetting to send an email or returning phone calls regarding client concerns, and the inability to make an appointment with a client.
Now I get it, life happens, and people are prone to make mistakes at work. However, that does not mean that you should not take responsibility for your own actions because greater than not, you were not prepared for the worst-case scenario. The importance of scheduling is that it allows both the client and the therapist to be certain of time for things, so they do not make any plans in that same timeframe. I know there was a time in your life where you made an appointment or arrangements the same time you already planned something else. Proper scheduling shows that you are professional, organized, and ready to get to work.
Another common variable would be the level of expertise or experience level of the therapist, which is fairly common. This refers to when the issues that the client presents are too difficult for the therapist or that the issue is out of what they normally specialized in. Usually when this happens, the therapist will refer the client to someone else that has more experience with the problem they have. This is a good way for clients to get the best help that they need because there are some therapists out there who are simply “not good.” These therapists do not have enough knowledge, lack core therapy skills (communication, empathy, active listening, etc.), show more sympathy than empathy, and solely cares about getting a paycheck. That’s enough about that as I will save that for another article.
The number one variable (main focus of this article) is the connection or relationship between the therapist and the client. If the therapist does not build enough rapport in the beginning of the session, then the relationship is not strong. If the therapist does not come off as supportive, empathetic, and encouraging, then there is not a strong relationship. Trust and connection are the two most important things a client can get from you. That was a lot of information about therapists, so not let’s focus on the client.
Variables Among Clients
It’s sad to say this, but scheduling is a big part for you as well. You are responsible for showing up on time and coming prepared for the first session. If you come 20 minutes late, you should not expect your therapist to extend the session for you. Be prepared to come on time and show that you really want to find a solution for the issue/s that you are going through. If you really cannot make it because something came up at the last minute, then talk to your therapist to see if you can reschedule the session at a later date.
The next biggest variable would be the kind of expectations that clients have when they first come into therapy. Clients expect the therapist to have all of the answers that they were looking for right when they step foot into their office, which is not reasonable for them to believe. The therapist is there to guide you into creating a treatment plan that works best for you, which means that there is no 100% guarantee that it will work.
You have to generally be motivated to come into therapy and believe in yourself that you can get better and that the problem will go away. This also means that you cannot get angry or frustrated when things are not going as fast as you would like it to be. If you are not motivated, then you are essentially wasting the therapist’s time and also your time. If loved ones or close friends suggested you to go to therapy because they are concerned about your safety, then you should give it a try and see if it can really work for you.
The “First Session” Issue
Another variable would also be the connection or relationship between the therapist and client. If the client does not actively participate in the beginning of the session, then it would be difficult for the therapist to help you. The same thing goes for if you do not give them enough information initially, or if you expect a “quick fix” of some sort for your problems. It is all about seeing if the therapist is a good fit for you, so you can work as a team to tackle your problems. If the therapist is not a good fit for you, then it would be best for them to refer you to another therapist that would be more beneficial. This way would save both you and the therapist time, so you can get the help that you need and for the therapist to schedule another client. This reason here is exactly why I believe that clients should not have to pay for the first session.T
The first session of therapy consists of an assessment, building rapport, treatment goals, and gaining an understanding of what the client is going through. This, however, is mostly beneficial for the therapist, so they can give you a diagnosis of what you may be going through and learn what’s been troubling you for quite some time. For the client, they already know that something is wrong with them and that they need help with finding a solution to it. Why should they have to pay for providing information that they already know themselves? It does not really make much sense to me because it does not make sense.
Let’s go back to the example that I had previously about having a connection or relationship between the two. The therapist discusses payment plans for the client and things are going well for them. They go through a session or two to find out that things are not working out between them. The client is not feeling that connection that they once thought they would have and now the therapy is going south. The therapist decides to refer the client to another therapist that has more experience than them, which means that the client starts back from square one.
The client now has to explain everything back to the new therapist and answer the same questions that they have answered already. Rapport has to be built again and the connection has to form. Essentially, it would take a session or two to get back where you had once been with their previous therapist and that means that they would have to pay for more sessions than they intended to have. Now, I believe that there are a few alternatives that can be beneficial for both the therapist and client regarding this issue.
Solutions
One solution would be simple: to have the initial session cost less than any other session you have after it. For example, let’s say you charge $70 per session for a total of 8-12 sessions depending on how long it takes for therapy to end. The first session should be at a reduced price of $30-$40, so that the client has more satisfaction and benefit with the pay and that the therapist still gets paid even though it was not a good fit for the both of you.
Another solution would be to have a phone consultation before things begin with the client. When you hear the words “phone consultation”, you probably picture selling yourself to a potential client over the phone and that is far from what I am referring to. I am talking about after you have a client and you have scheduled a time for the first session.
With this consultation, you can go over a mini assessment that can provide the therapist with information regarding the client’s concerns and start a treatment plan with them. The assessment would be useful especially for those who work at a government agency and need a diagnosis from the client to work with them. The consultation could be anywhere from 5-20 minutes, so that it is not too long for the both of you.
I believe that both of these solutions could be useful if therapists decide to implement them and use them in their private practice or wherever they work (if they can!). It would also allow more flexibility for clients that do not have enough money to see a therapist and continue for the entire process.
