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Counseling? How we begin matters.

October 31, 2016

A parent called seeking counseling for their adult son. The young man had plenty of issues. The issues were long-standing.

I explained that given the parent called, I would begin by meeting with both parents first.

I advised that by meeting with the parents first, I could obtain a better developmental history and that at times, there were clues in the developmental history that helped to understand the present day issues.

I also advised that at times parents may have issues or at least different views of the child’s problems that contribute to or intertwine with the child’s issues. I explained by meeting with the parents first, I would be able to assess those areas too.

With a good developmental history and understanding of the parents, I would be in a better position to help their son. I asked the parent to speak with their partner to see if they wanted to proceed. I advised that this first meeting would be a good three hours.

The parent called back to set an appointment. I reminded that the appointment is for both parents together and that our meeting would be a good three hours. The parent agreed and we set an appointment.

On the date and time of the scheduled appointment only the one parent arrived. I advised that the appointment was for both parents and that with only one present, we couldn’t proceed. I reiterated why.

The parent said, but it was a three hour meeting and was prepared to continue.

I advised that for me to be most helpful, I need to meet with both parents together. I advised that if the partner wished to join in, I would be pleased to set another appointment.

The parent couldn’t believe that I would walk away from a three hour meeting and lose the revenue, but then said that my integrity was appreciated. With that, the parent also thought that their partner would take the situation more seriously too.

With regard to my approach to counseling, I take the perspective that the client is always in charge of their life, but I am in charge of my counseling.  I talk with every client by phone before setting an appointment.

There is no sense in someone coming in for a meeting without first determining if I can be helpful or without determining the best way to begin given the circumstances. This doesn’t mean I am helpful to everyone I see, but at least I try to make sure that there is at least a good chance I can be helpful.

To add, very often the people I see have been seen by other counselors previously. Their experience with me has to be different because we know that doing the same thing over and over again that doesn’t work is crazy-making. I believe the people who come to see my have already been through enough, otherwise they wouldn’t even be seeking help, so I try to deliver a more considered approach. It begins with the first phone call and we stick with the plan unless there is something drastic to suggest otherwise.

It is better to take our time and begin the right way, then run headlong fast and furious the wrong way.  Your well being is worth more than money. How we begin matters.

I am Gary Direnfeld and I am a social worker. Check out my services and then call me if you need help with a child behavior or relationship issue or matters concerning divorce or separation. I am available in person and by Skype.

 

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Gary Direnfeld, MSW, RSW

gary@yoursocialworker.com
http://www.yoursocialworker.com

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Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert in social work, marital and family therapy, child development, parent-child relations and custody and access matters. Gary is the host of the TV reality show, Newlywed, Nearly Dead, parenting columnist for the Hamilton Spectator and author of Marriage Rescue: Overcoming the ten deadly sins in failing relationships. Gary maintains a private practice in Dundas and Georgina Ontario, providing a range of services for people in distress. He speaks at conferences and workshops throughout North America.

If your relationship is faltering, then set it as your priority.

Read: Marriage Rescue: Overcoming ten deadly sins in failing relationships

4 Comments
  1. Hi Gary

    I tried posting online but the internet connection is slow today.

    Gary – I like reading your posts. They are always thoughtful. But I cannot help contrasting your practice with how counselling is practised in my country – India. The bulk of counsellors are in the public sector – health settings – where they see at least 10 “clients” a day. I held a top-level government position related to these personnel for 4 years. Your piece set me thinking. You demonstrate (I think) a commitment to change by making 3 hour appointments and also by making yourself walk away from a 3 hour slot when the client does not appear to be equally committed. Such a luxury of time is unavailable in developing countries where the client-worker ratio is very skewed. To spend that much of time on a single individual comes at the cost of being available to other clients. Your piece set me thinking about what other ways could go into ensuring that clients know you are committed to facilitating their change process.

    On 31 October 2016 at 12:53, Gary Direnfeld, MSW, RSW wrote:

    > Gary Direnfeld, MSW, RSW posted: ” A parent called seeking counseling for > their adult son. The young man had plenty of issues. The issues were > long-standing. I explained that given the parent called, I would begin by > meeting with both parents first. I advised that by meeting with the” >

    • Hi Melita. Statistically, most people drop out of counseling after the first visit, so if we are to be helpful, it better be a good first visit. Also, very little is accomplished in the standard 50-minute session. Between sessions, momentum is lost. A third of the next session is taken up with remembering what was said the week prior. This is very inefficient.

      By having a lengthy first meeting, very often that resolves the issues for which people sought counseling. This is far more efficient in the long run, not to mention more humane.

      Just to add, the standard 50-minute session is what the world of counseling is built on. It represents the vestiges of Freudian psychoanalytic therapy and the therapeutic hour. Indeed, I am now hearing from colleagues in the United States that insurance companies are trying to even shorten those sessions in an effort to decrease pay-outs. This is very short-sighted and inefficient for reason’s stated.

      I so enjoy being in a fully private practice because I can provide services in a manner that better suits the people we serve.

  2. I am a Social Worker and can verify that insurance companies in the US, as well as the failure of our mental health system, have indeed lowered the threshold of appropriate client care.

  3. Gary glover permalink

    Interesting perspective. Thank you for your thoughts on this. My experience is also that many of my clients have been to the rodeo many times before and need something different. As much as I agree that a complete systems assessment is very useful, in the cultural context I work in now, I am finding that amounts to the “same old,same old” for my clients, who are primarily marginalized rural and small town, feeling disempowered and angry, and I often know them and/or their families prior to their presenting to the community addictions/mental health agency I work for. If I insist on full assessment, as my agency would like, I often confirm their distrust and damage the alliance. I do have a program option of “Open Access” or walk in counselling which allows short term counselling without the full bio-psycho-social intake and this is quite useful. My experience is Similar to yours in terms of session length and I find that if I take the time at first to explore their context fully and provide a reasonably complete re-frame from my “psychobabble” perspective, it shortens the actual time required and is a much more rewarding and respectful experience for the client. My supervisor asserts that there is good clinical evidence that any session longer than 45 minutes is a waste of time. This is not my experience but I wonder if you have any academic evidence that supports the value of longer sessions?

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