A Focus on Counseling Client Education

Expectations are everything; and getting buy-in for how things work at your practice is an important part of facilitating happy, satisfied, clients. However, too often client education and informed consent resembles the oft-ignored “terms of use” contract in iTunes. Clients are handed a sheet with 2,000 words of 10-point text and asked to sign (or click “I agree”) to move forward.

This month, we’ll review nine areas where client education is imperative. Additionally, you can click here to learn more about opening your own Thriveworks Counseling franchise.

1. The Wait to Get an Appointment

Walt Disney World has long lines, but no one revolts — guests are prepared in advance for the inconvenience. In fact, despite the crowds and wait times (and high prices), Disney has extremely high guest satisfaction ratings.

Emulate Disney and be up front with clients about how long it can take to get scheduled at your practice. At my centers, we get new clients in the door quickly (within 24 hours) for their first appointment. However, we’ve learned that we also need to educate clients that (1) the wait times for some specific counselors can be weeks (or longer), and (2) if one fails to schedule regularly with their counselor, that counselor could become fully booked with other clients.

2. If Insurance Doesn’t Pay, the Client is Responsible for All Fees

Some counseling practices gloss over this detail and then have conflict with clients when a billing issue occurs. If you accept insurance, spend time with clients before their first session and talk through the insurance billing process. It’s okay to disclose what you expect insurance to pay.

However, clients need to know that if insurance falls short the conflict over the difference isn’t between your practice and him/her; it’s between the client and his/her insurance company.”

In a recent trip to my Primary Care Provider (PCP), insurance didn’t cover as much as we all expected. Because we had discussed the possibility, I paid the difference (with some disdain for my insurance provider, but not for my PCP).

3. The No Show / Late Cancelation Fee

In any given week, a 20 percent cancellation rate isn’t unprecedented for a mental health counseling practice. Still, late cancellation fees become “fine print” when counselors don’t want to talk about them. By avoiding the issue early on, one sets the stage for many awkward conversations down the road (spoiler alert, the issue is going to come up—a lot!).
Instead, inform your clients about your late cancellation and no-show policy, or suffer the consequences of clients who believe that missing a session “every once in a while” shouldn’t come at a cost. Also, disclose the fee prominently via a sign in your waiting room.

4. A Realistic Duration of Treatment

People want quick fixes, and sometimes counselors are worried about scaring off new clients if they communicate that meaningful change takes time. This reluctance doesn’t help anyone. When treatment duration isn’t understood, individuals and couples might drop out after three to five sessions saying, “Well, I/we gave counseling a try. It didn’t work.”

Instead, inform clients that brief therapy starts at around 10 sessions, and some clients will need additional sessions to reach their treatment goals.

5. Sessions Can be Difficult

Do you know of any counselors who waste sessions “shooting the breeze” with their clients and, instead of bothering with the hard work of therapy, mollify their clients on every issue?

We’ve all had clients who have said, “my last counselor never challenged me”, or “my last counselor just sat and listened to me.” Make sure that this isn’t the expectation of new clients. In your office, clients make progress — and that takes hard work.

6. Limits to Confidentiality

It might be old hat to you, but it’s not to your clients. Taking time to go through the limits of confidentiality is both an ethical obligation and a way to show your clients that you respect them enough to inform them of the laws.

7. Treatment Record Ownership

For most adult clients this is pretty well understood. However, when it comes to children or couples/family sessions, it’s more imperative to explain to clients the ground rules. For couples, I’ve found that section 2.2 of the AAMFT Code of Ethics does a nice job of determining whom the record belongs to — both clients execute a release, or nobody gets them.

8. Getting Stuck is Okay

Getting “stuck” is a common phenomenon in the counseling process. Inform your clients of this, and also that not having much to say in session isn’t a sign that you’re “done with counseling.” It’s a signal to keep working because something is blocking your progress.

9. Things Will Get Better

Hope is a powerful thing. Prepare your clients that the silver lining will get longer, the light at the end of the tunnel will get brighter, and that pain will pass in time.

A client experiencing an issue like bereavement or major depression might have little hope and think, “I’ll never fully recover.” You know this isn’t true; so make sure you tell the client!

When a potential client reaches out for counseling, it’s normal to want to get started without any delay. However, taking the time to prepare an inquirer for what being a client is like at your practice is an important part of that person’s (and your) ultimate success.

What other items would you add to this list? Let me know on Twitter at @anthonycentore, or by leaving a comment below.

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Dr. Anthony Centore

Anthony Centore

Anthony Centore, PhD, is Founder and Chair at Thriveworks — a counseling practice focused on premium client care, with 340+ locations across the US. Anthony is a Private Practice Consultant for the American Counseling Association, columnist for Counseling Today magazine, and author of "How to Thrive in Counseling Private Practice". He is a multistate Licensed Professional Counselor (LPC) and has been quoted in national media sources including The Boston Globe, the Chicago Tribune, and CBS Sunday Morning.

Check out “Leaving Depression Behind: An Interactive, Choose Your Path Book” written by AJ Centore and Taylor Bennett."