How can I help my client get more treatment?
Dasenbrook and Alie agree that having the client advocate with their managed care company for more treatment can be effective. And if all else fails, Alie says the therapist can file an appeal to the managed care company, which is often successful in obtaining approval for more treatment.
What happens if a therapist is denied treatment?
And if all else fails, Alie says the therapist can file an appeal to the managed care company, which is often successful in obtaining approval for more treatment. “If it is denied, then they need to help the client find the services that he or she needs the best way they can.
What do you do when you feel rejected by a client?
Explain to the client that your job is to ensure they get excellent care and that you do not feel you can meet their needs. Give the client space to process their feelings. Some clients will feel rejected, particularly if they felt therapy was going well. Offer a referral to a therapist who might be a better fit.
What happens if a client does not show up to therapy?
When a client repeatedly no-shows, a therapist loses time they could spend with other clients. A therapist may also need to terminate therapy with a client who makes unreasonable demands, whose insurance will not pay for therapy, or who otherwise presents practical or logistical concerns.
What are some ways of engaging clients who may be resistant to services?
Engaging Resistant ClientsMake them as comfortable as possible. You can try to put them at ease by introducing yourself, being personable, reassuring them of confidentiality, and explaining, in an appealing way, how your role works. ... Acknowledge their perspective. ... Find out what they want. ... Use what they find motivating.
What will you do if you are referred a client you are not competent to treat?
If you end up deciding you're not competent to treat a client, be sure to arrange for him or her to transition to appropriate care, says Courtois.
How do you deal with a client in crisis?
How to Handle a Client CrisisRespond rapidly. If a client is unhappy, deal with it immediately. ... Listen without being defensive. ... Say you're sorry. ... Collaborate on the solution. ... Offer amends. ... Avoid excuses. ... Rebuild trust through small, frequent, confidence-building measures. ... Get things out into the open.
How can a therapist overcome resistance?
Resistance is a normal part of the therapeutic process and therapists should be prepared to deal with it. By establishing a positive relationship, using paradoxical interventions, and working toward mutually created goals, you can tear down the walls of resistance and help your client make the progress they desire.
What would you do if you are unable to provide the level of counseling a client needs?
What would you do if you are unable to provide the level of counseling a client needs?An approach that puts the client's needs first.An inclination to work with specialists.A willingness to make the failure about the counselor's skill set, not the client.
When might it be necessary for you to refer a client to other Organisations or services providing patient care?
Some circumstances may necessitate the consideration of referring a client to other clinicians or services. This may be to obtain additional services, or because the clinician feels that the client requires responses that are beyond their own level of skills and expertise [276].
How do you deal with situations in which patients are resistant to current treatment programs?
Quick tips“Stay out of the 'expert' position,” Mitchell says. ... “Don't collude with clients' excuses,” Wubbolding says. ... “When you encounter resistance, slow the pace,” Mitchell says. ... “Don't argue,” Wubbolding says. ... “Focus on details. ... Leave blame out of it, Wubbolding says.More items...•
How might a helper most challenge a client to participate in the helping process?
How might a helper most challenge a client to participate in the helping process? Invite clients to own their problems and unused opportunities. Invite clients to state their problems as solvable.
How would you deal with a client who is in extreme distress?
Take them seriously, and be warm and non-judgemental. Give them your full attention and don't interrupt when they are speaking. Summarise what they have said to show you are listening and to work out what type of help they need. For example, “it sounds like you are feeling XYZ and that you want/plan to XYZ.
What do you do if therapy isn't working?
If therapy isn't working, the first person you should talk to is your therapist. She may opt to change her approach to treatment, pursue more “homework” options for you, or even refer you to another therapist. Be sure to ask the following questions: How long should it take for me to see results?
How would you engage clients who may be resistant to monitoring and evaluating their progress?
Allow the client to find and develop their skills and means to address problems. Use open-ended questions to help the client explore their personal experience without influence. Let the client sit and silently experience their emotions, even uncomfortable ones.
How do you build rapport with resistant clients?
Building rapport requires:Managing eye contact appropriately.Helping clients feel a sense of relatedness to you. ... Keeping negative topics neutral—avoid framing statements using negative connotations.Using the client's name.Setting the tone.Letting clients get to know you—that is, being a real person.More items...•
How to help clients access positive states of mind?
To help your client access positive states of mind, you have to find a way to lift and lead them emotionally. To make this transition, I recommend a language pattern that I call “Align, Lift, and Lead.”
Why do you visualize your client's response?
Because the emotional brain learns better through metaphor and imagery than it does through words, another strategy you can use is to have your client visualize her desired response. I suggested Natalie visualize herself successfully navigating a social situation and imagine feeling curious, secure, and calm. Then, I asked her to imagine something in nature that could represent her mind working this way. Natalie smiled and said, “Muir Woods with the redwood trees.” Visualizing the peacefulness of the tall trees in this forest helped her feel calmer and gave her a sense of belonging.
Why did Natalie skip lunch?
Natalie gasped as she realized she was doing the same thing at her job—skipping lunch with peers to avoid fears of being ridiculed and getting praised by her boss for being so dedicated.
How to dissipate anxiety?
Using play and humor are also great ways to dissipate anxiety and trigger new perspectives on events. Natalie and I acted out a role-play in which I let her play a woman with a snobby attitude teasing her while I played Natalie. She began the role-play by wrinkling her nose and saying,
How to reverse traumatic events?
Another way you can reverse the meaning of a traumatic event is to have your client finish her story with a new ending. For instance, she can finish it with a later moment in her life when she was out of danger, in a better situation, or felt competent or empowered.
How to align with client?
You align with the client by reflecting your understanding of the problem, and then you lift the client by affirming her strengths, and lead her by suggesting her desired response to the situation. Here is how I used this language pattern with Natalie:
Can we change recurring emotional patterns?
Closing Thoughts. Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain.
When treatment over a patient's objection would be appropriate?
KP: A simple example of when treatment over a patient’s objection would be appropriate is if a psychotic patient who had a life-threatening, easily treatable infection was refusing antibiotics for irrational reasons. Treatment would save the patient’s life without posing significant risk to the patient.
What are the first few questions in a treatment plan?
The first few questions consider the imminence and severity of the harm expected to occur by doing nothing as well as the risks, benefits, and likelihood of a successful outcome with the proposed intervention. Other questions consider the psychosocial aspects of this decision—how will the patient feel about being coerced into treatment? What is the patient’s reason for refusing treatment? The last question concerns the logistics of treating over objection: Will the patient be able to comply with treatment, such as taking multiple medications on a daily basis or undergoing frequent kidney dialysis?
Is there anything out there to help health care professionals approach the problem of delivering medical treatment against the wishes of patients?
And there are fairly clear policies and laws concerning the ethics and legality of delivering psychiatric care to patients who refuse it. But there is nothing out there to help health care professionals approach the problem of delivering medical treatment against the wishes of patients who lack decisional capacity.
Can you force dialysis on a patient who resists?
As Dr. Rubin stated, one cannot force three times weekly dialysis sessions on a resistant patient even if it means that the patient will die without the treatment.
What to do after setting a treatment plan?
After you’ve set a treatment plan, have an honest conversation with your client about why it’s important to stay the course. Discuss what may happen if they leave prematurely. Explain your role and the client’s role. Be open to questions.
What happens when a client leaves a practice abruptly?
When a client leaves abruptly, it’s not only unsettling, it’s one of the most difficult situations you’ll face as a private practitioner. You’ll wring your hands and wonder what you did wrong. You’ll retrace your steps and analyze your last session to look for clues you may have missed.
What are the risk factors for client attrition?
Let’s look at the 11 most common risk factors that indicate probable client attrition and what you can do about it. 1. Client Has a Specific Disorder. The type of disorder that you’re treating can also affect the client’s willingness to stay around for the duration of treatment.
Why do clients hesitate when they face the truth?
Some clients simply don’t like getting in touch with their emotions. They may start off with the idea that they’re ready to face the truth, but when it’s time, they start to hesitate.
How does client demographics affect client retention?
Your client demographics can impact client retention. For example, a client’s socioeconomic status can influence their decision to drop out of treatment. Poorer patients are less likely to continue treatment. Also, age makes a difference. Those in their 20s are less likely to continue therapy than older clients.
Why do clients miss appointments?
Sometimes, clients miss or cancel appointments because of administrative problems on your end. From not seeing clients on time to providing unsatisfactory customer service, poor administration can negatively affect your reputation.
Why do people drop out of private practice?
Some clients simply drop out because they don’t trust your level of experience. Perhaps you’re just starting out or you’re new to private practice. You can expect drop out rates of up to 75%. Ouch. But the good news is that you’re not alone. Most new clinicians have to face this dismal retention rate.
What percentage of mental health counselors would change treatment plans based on managed care limitations?
A 2001 survey of mental health counselors confirmed that managed care has had a major impact on their practice (Danzinger & Welfel, 2001). A majority (60%) of mental health counselors said they would change treatment plans based on managed care limitations.
What is the secret of working with managed care companies?
The secret of working with managed care companies is not to get adversarial, according to Dasenbrook. “We find that a nice, polite approach is the way to do it. You just go in and advocate for your client. The managed care companies tend to respond to this approach by asking us what we think the client needs and more than likely they approve it,” he explains.
Is psychotherapy a palliative care?
They have come to realize that long-term psychotherapy is a must for some people to be healthy and is not just palliative care for the neurotic.
Is LICSW a 90% managed care?
Paul Alie, LICSW, who has a private practice in Massachusetts that is 90% managed care, agrees: “A therapist needs to think about planning the treatment so that the clients get what they need … in the time that is covered. In my opinion, it is unethical if a therapist doesn’t pay attention to that and just flies through twice-weekly treatment and then at the end of benefits says, ‘Where do we go from here?’ It needs to be part of the planning from the beginning.”
Do managed care providers have to face challenges?
Therapists who work with managed care companies can face challenges when allotted sessions expire. Seasoned clinicians share professional advice.
Can a therapist appeal a managed care company?
And if all else fails, Alie says the therapist can file an appeal to the managed care company, which is often successful in obtaining approval for more treatment. “If it is denied, then they need to help the client find the services that he or she needs the best way they can. Having done all that, I think they have fulfilled their responsibility to the client,” he adds.
What does a therapist do after therapy?
As therapists, we want nothing more than to help people who are suffering—help them feel better as soon as possible and help them, after therapy, live more emotionally satisfying lives. But that usually requires helping them change —change their dysfunctional patterns of thinking, self-destructive behaviors, and self-defeating ways ...
Why do people cling to depression?
Outcome resistance for depression nearly always involves nonacceptance, meaning clients cling to depression because they don’t want to accept some internal flaw or external circumstance. For example, a depressed, perfectionistic college student who’s not doing well in school may not want to give up her depression until she’s getting all A’s. Simply put, she subconsciously feels her depression is a manifestation of her high personal standards, which she’s determined not to give up, lest it lead to mediocrity.
What is the DML in CBT?
Before our session began, I’d asked Christine to record her negative thoughts and feelings on a form called the Daily Mood Log (DML), a CBT tool that helps clients pinpoint their negative thoughts and feelings at one specific moment when they were upset. I reference the DML during therapy sessions, and encourage clients to work with it between sessions as part of their psychotherapy homework.
Why do people have process resistance?
With process resistance for depression, clients may want to recover, but they don’t want to engage in what’s required to do so, such as psychotherapy homework between sessions, perhaps because it forces them to focus on difficult aspects of their lives on a daily basis. Anxiety.
What are Christine's negative feelings?
At the top of her DML, Christine briefly described her upsetting event as “sitting in this workshop thinking about my decades of sexual abuse by my husband.” Next, she circled and rated all her negative feelings—such as sad, anxious, guilty, worthless, lonely, hopeless, angry —on a scale from 0 (not at all) to 100 (extremely severe). Almost all of Christine’s ratings were at either 90 or 100. From a cognitive-therapy perspective, our negative feelings don’t result from what happens to us, but rather from our thoughts about what happened. This idea, originating from the ancient Greek philosopher Epictetus, can be liberating. In Christine case, she can’t change what actually happened—the abuse was real, horrific, and prolonged—but she might be able to change the ways she’s thinking about it, which could help her right now. So I also had Christine record her negative thoughts on the DML and indicate how strongly she believed each one on a scale from 0 (not at all) to 100 (completely). Here are a few examples:
Why is resistance not helpful?
Although these ways of looking at resistance may sometimes contain a grain of truth, they’re not particularly helpful, mainly because they carry a pejorative taint, sounding like put-downs masquerading as therapy-speak. In addition, they implicitly situate the therapist in the role of wise expert trying to fix a broken, dysfunctional client—not a good base for a mutually trusting therapeutic relationship. Also, thinking about resistance this way can allow the therapist to blame the client for treatment failure.But what if we could reframe the client’s resistance as something positive, healthy, and helpful, revealing something honorable about his or her core values? If so, then my first goal as a therapist might be to explore the many good reasons a client might have for not changing. This shift in therapeutic tactics has required a massive internal change in how I think and function as a clinician, but it’s revolutionized my therapeutic experience—and I’m now seeing recovery at rates I’d have thought impossible as recently as 10 years ago.
Can a clinician do a controlled outcome study?
As clinicians in private practice, we can’t do formal controlled outcome studies, but we can do process studies pinpointing variables associated with therapeutic success or failure. This type of research can help us understand how therapy actually works, thus leading to new and more effective treatment strategies. Jackie Persons, my former student, got me started with this in the 1980s. Since we were both collecting data on depression severity for every person we treated at every session, we decided to pool and analyze our data using statistical modeling techniques to see what we could learn.
What happens if a client is unhappy with the therapist?
When a client is unhappy with the therapist’s services, objects to the therapist’s philosophy, or accuses the therapist of wrongdoing, the client may terminate the relationship. If the client does not, the therapist must assess whether the relationship can continue.
When terminating a client because you believe they are a danger to you or someone else?
When terminating because you believe they are a danger to you or someone else, and you are therefore unwilling to meet with them in person. When terminating with a client who has a history of threatening to file licensing board complaints. When terminating with a client who has difficulty processing rejection.
When Should I Send a Therapist Termination Letter to the Client?
And if a client repeatedly no-shows, a termination letter may be the only way to ethically terminate therapy. If a client later claims you abandoned them, the termination letter may offer some protection.
What are the general guidelines for therapy termination?
Therapy Termination Activities: General Guidelines for Therapy Termination. Therapy termination can make both the therapist and client feel insecure. Therapists may wonder if they did enough to serve the client and may feel defensive if the client is unsatisfied. Clients may worry that termination is their fault or may fear leaving therapy means ...
Why is it important to know when to terminate therapy?
For therapists, knowing when to terminate therapy is an important skill that can protect both the client and the therapist. The following strategies can help you manage your therapy termination session no matter why therapy has ended.
Why is it important to discuss termination with a child?
It is important to discuss termination at the beginning of therapy and to prepare the child as far in advance as possible.
When is the end of therapy important?
When a therapist and client have a long and trusting relationship, the end of therapy is a major milestone. But when a therapist is not a good fit for a client or there is an issue in the relationship—such as repeated no-shows or dissatisfaction with therapy—handling termination is even more important. Clients can terminate therapy ...
What happens if you don't encourage your client to meet their needs outside of therapy?
If you don’t actively encourage and help your client to meet these needs outside of their therapy with you, then they’ll feel dependent on you. If you’re someone’s only real source of human contact and attention, then of course they’ll feel as if they can’t stop seeing you. But don’t confuse this with ‘successful therapy’.
What is clean therapy?
Clean therapy happens when the therapist: understands that the role of the therapist is to help the client with specific problems and not to meet their basic needs on an ongoing basis. helps the clients be clear about what these needs are and how to meet them effectively in their own life. 2. Draw their attention back to their original therapy ...
Why is it important to be clear with someone from the beginning?
Draw their attention back to their original therapy goals. This is why it’s so important to be clear with someone from the beginning by establishing very clear and measurable goals. If nobody knows when therapy has been successful (because no clear goals were ever defined), then nobody knows when it’s supposed to finish.
Is it right to keep someone in therapy?
It's not right to keep someone in therapy when they no longer need it. And remember - they're paying! Click To Tweet
How to start a treatment plan?
Every good treatment plan starts with a clear goal (or set of goals). Identify what your client would like to work on and write it down. Don't be scared of limiting your work, you can always adjust these as time goes on. However, it's helpful to write down and discuss what your client's purpose is for starting therapy.
What is treatment planning?
Treatment planning isn't something you do at the first or second session and then forget about. It's an integral part of the counseling process. It's a clinical discussion that's simply put on paper to provide a clear outline and clearer understanding of the direction in which you plan to go.
What makes therapy more effective?
A couple things we know for sure- 1) talking with clients about progress makes therapy more effective and meaningful for clients and 2) most ethical guidelines state that a therapist or counselor should have a treatment plan in mind while working with clients.
Why is it important to have a clear goal?
Having a clear goal makes sure everyone is on the same page and keeps you both accountable to focusing on what is necessary. It also helps your client to feel like therapy is something that is more than esoteric, something they could describe to a spouse or family member, if desired. 2. Active participation.
Is therapy hard work?
Therapy is often hard work but can have amazing results. However, success is 100% dependent on the client's motivation and willingness to engage in the process. 3. Support. Another aspect of treatment planning that is so often forgotten in private practice settings is the client's support system.
What is the best way for a patient to indicate the right to refuse treatment?
Advance Directives. The best way for a patient to indicate the right to refuse treatment is to have an advance directive, also known as a living will. Most patients who have had any treatments at a hospital have an advance directive or living will.
How to refuse treatment?
The best way for a patient to indicate the right to refuse treatment is to have an advance directive, also known as a living will. Most patients who have had any treatments at a hospital have an advance directive or living will.
What are the rights of a patient who refuses treatment?
In addition, there are some patients who do not have the legal ability to say no to treatment. Most of these patients cannot refuse medical treatment, even if it is a non-life-threatening illness or injury: 1 Altered mental status: Patients may not have the right to refuse treatment if they have an altered mental status due to alcohol and drugs, brain injury, or psychiatric illness. 6 2 Children: A parent or guardian cannot refuse life-sustaining treatment or deny medical care from a child. This includes those with religious beliefs that discourage certain medical treatments. Parents cannot invoke their right to religious freedom to refuse treatment for a child. 7 3 A threat to the community: A patient's refusal of medical treatment cannot pose a threat to the community. Communicable diseases, for instance, would require treatment or isolation to prevent the spread to the general public. A mentally ill patient who poses a physical threat to himself or others is another example.
What is the end of life refusal?
End-of-Life-Care Refusal. Choosing to refuse treatment at the end of life addresses life-extending or life-saving treatment. The 1991 passage of the federal Patient Self-Determination Act (PSDA) guaranteed that Americans could choose to refuse life-sustaining treatment at the end of life. 9 .
What must a physician do before a course of treatment?
Before a physician can begin any course of treatment, the physician must make the patient aware of what he plans to do . For any course of treatment that is above routine medical procedures, the physician must disclose as much information as possible so you may make an informed decision about your care.
What is a threat to the community?
A threat to the community: A patient's refusal of medical treatment cannot pose a threat to the community. Communicable diseases, for instance, would require treatment or isolation to prevent the spread to the general public. A mentally ill patient who poses a physical threat to himself or others is another example.
When a patient has been sufficiently informed about the treatment options offered by a healthcare provider, the patient has the right?
When a patient has been sufficiently informed about the treatment options offered by a healthcare provider, the patient has the right to accept or refuse treatment, which includes what a healthcare provider will and won't do.
