Friday, December 14, 2012

Non attendance of sessions

This comes from a manual on the treatment of suicidal people. One can understand why they say what they say but one needs to be careful with it. 

Client drop out.

They also say

lack of follow through
One needs to be careful not to harass or pressure a client. If that happens the client will either move into CC and approach therapy from a conforming stand point which means the therapeutic process is probably significantly compromised. Or they will shift into RC and you never see them again.

This pressuring can happen with the treatment of the suicidal where the therapist becomes a bit scared of a possible suicide attempt. This results in a change in the therapist’s behaviour such as how they deal with a client who drops out of therapy. The unusual behaviour of the therapist can result in outcomes one does not want. The therapist panics and ends up doing ‘poor’ quality therapy. When working with the suicidal one needs to often ask the question:

“If this client was not suicidal would I be doing what I am doing?”

Cigarette lighters

How one deals with non attendance varies significantly depending on the client and the circumstances.

Some people, indeed I would suggest a significant number stop attending because they are not ready to deal with what they are dealing with. Whenever I take a history with a new client I always ask if they have been been to counselling before and if they have, what happened and why did they stop. Not uncommonly they will say  things like:

“I just was not in the right frame of mind.” 
“I just wasn’t ready to do what was required at the time.” 
“I had had enough by that time and needed a break.”
“I felt I was just not getting what I wanted.”

I would say that rarely would a client report it was because they were afraid interpersonal risk, because of stigma or because of the potential for humiliation. The examples I provide above I would say are much more common reasons.

donut salesman

Over the years I have had clients cancel appointments or just not turn up. Some I never see again and others come back later on. Indeed when a client ‘drops out’ that can be a used for therapeutic gain later on when they ‘re-engage’ as they say in the therapy business. One can use No run contracts, No engagement contracts, Phratry contracts and the like to create a variety of therapeutic scenarios for the gain of the client.

However the most important point of all is that the client does not end therapy in such a way as to further their life script. They do not end the therapeutic relationship in a script bound way. It is most wise for the counsellor to raise this issue if they suspect it may be heading that way. Indeed some counsellors raise the issue with every client early on in the therapy.


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