Why Is the Initial Consultation so Important Essay Example for Free

Why Is the Initial Consultation so Important Essay During this essay I will be discussing ethics and what ethical issues the therapist faces in relation to initial consultation with the client. What an initial consultation is and why it is so important that one is completed without exception. I will also explore what the process is, what happens at the initial consultation, and how the therapist will gather the required information. I also aim to explore what benefits and contra indications there are for having an initial consultation. According to a thesaurus the word â€Å"Ethics† means: a moral- code, values, principles and beliefs. This definition leads to the question, what is meant by the phrase, â€Å"Ethical therapist†? An ethical therapist within the UK works within the Code of Ethics which was developed from the British Association for Counselling and Psychotherapy Code of Ethics April 2002. This constitutes of a moral code of principles and values which should always be adhered to whenever the therapist is practising. The Code of Ethics covers for example: 1. Providing a good standard of care, safeguarding both the therapist and client. 2. Only treating clients within your own qualifications   3.  The therapist must attend regular supervision 4. Ensure your client understands the boundaries and limits. 5. Manage the clients’ expectations 6. Conflicts of interest 7. Gaining and keeping trust 8. Ensure that the therapy is â€Å"Client centred† The above points are a brief precis of what the Code of Ethics covers, and are an integral part of the therapists working practice. The therapist must remain professional at all times both in appearance and manner. It is also important to consider the layout of the consulting room to ensure safety for both the client and the therapist. The initial consultation will be the first time the client and therapist meet and first impressions are important to the client and will count. The therapist will have assumptions made about them within the first minutes of meeting. These assumptions will come from the way the client is greeted, the therapist’s pattern and manner of speech and their body language; these assumptions are pivotal to building rapport. A major objective of the initial consultation is for the therapist to assess if this type of therapy is suitable for the client, and whether or ot both client and therapist feel comfortable working with each other while beginning to build a working professional rapport. It is important for the therapist to gather detailed information about the client before embarking on therapy of any kind. As well as taking and recording obvious personal details, name address etc, it is important to probe to discover details about the client’s life, ie hobbies, work, family situation, the client’s GP details and medical history. This is a major factor in the assessment from an ethical point of view, as this alone can determine whether hypnotherapy is suitable for the client. If the client demonstrates reluctance to divulge medical information and/or GP details then it is advisable to ask them to get a letter from their GP stating that hypnotherapy will be suitable. Hypnotherapists treat neurosis not psychosis so it would not be ethical to treat the client with a psychosis. Neurosis is a term used to describe various psychological disorders such as: †¢ Anxiety Disorders – This is an overreaction to normal tolerated stresses †¢ Panic Disorders – Regular panic attacks where the client has no causing heart conditions. †¢ Phobias – A fear that affects the clients’ life Obsessive Compulsive Disorder (OCD) – The client has unwelcoming or intrusive thoughts or behaviours that they have to carry out †¢ Separation Anxiety – An irrational feeling of separation from parents by the child †¢ Post Traumatic Stress Disorder – Symptoms following a disaster †¢ Psychosomatic Disorders – Symptoms of emotions or subconscious cognitions being released, sometimes with increased stress levels †¢ Reactive Depression – Depression that arises from an external event such as bereavement The client will be aware that they have this type of condition and completely aware of reality. Normally these disorders are associated with stress and anxiety but the client is likely to still be able to function within society. Psychoses are identified when the client is unaware that they have a problem. They may have a tendency to blame others or the world as long as it’s not them. There are two types of psychoses: †¢ Functional – This covers schizophrenia, split personalities, bipolar-disorder and delusional or confused states. †¢ Organic – This covers toxins in the body, Alzheimer’s Disease, Parkinson’s Disease, excessive post natal depression and severe PMT. It is unethical for a herapist to treat clients with psychosis if they are not medically trained to do so. It should never be assumed by the therapist what type of psychosis the client is suffering from and an accurate diagnosis should always be obtained. There are many uncertain areas around these neuroses, it must also be understood that they can and may worsen subsequently developing into psychosis. If any of the above neuroses prevail then the doctor’s written consent must be obtained before being able to treat. This consent must also state that the client is not suffering from any form of psychosis. It is important to be aware that some conditions cannot be treated alone and may require specific expertise and specialist work. Extreme caution should be taken by the therapist when assessing if treatment can be given and they should always be prepared to refer the client on to the relevant professionals. Hypnotherapy should not be carried out on clients with certain medical histories or conditions; eg epilepsy. The therapist needs to know all medications the client may be taking; have an understanding as to what these medicines do and any side effects they may have. This should also include any historic medications that have been prescribed. Information can be obtained from the medical history should indicate if the client has any mental health problems. It is a good idea for the therapist to register with the British National Formulary (BNF) to use the drug database to check on medications if there is uncertainty. If the client has any special needs then consent from a guardian should be sought and ideally they should be present during the therapy sessions. It is also essential that the therapist gains a thorough understanding of what the client’s expectations of hypnotherapy are. The client may have previous experience and details should be obtained around the type of therapy received and what this was used for. Any particular styles used and the client’s reactions to these styles. Success of therapy is very important and exploring the client’s previous experiences will reveal barriers and/or successful approaches for this client. If the client has had negative previous experiences then these issues need to be approached carefully. If the client shows signs of not trusting the therapy or believing that it will not work for them the efficacy of the treatment may be compromised. The therapist will need to work on these issues and reassure the client, going onto advise if treatment sessions need to be extended to allow for the situation. It may also be decided that due to negative emotions or pre-conceptions, therapy will not be suitable for the client at this stage. The therapy style and approach should always be explained and discussed with the client. This helps with building trust and rapport and also provides reassurance for the clients with no experience of hypnotherapy. It should always be stressed to the client that they remain in control at all times and that the therapist will always keep the clients moral belief system at the forefront of the therapies conducted. It is important the therapist understands the client’s goal and their reason for seeking therapy. The goal should be discussed during the initial consultation so that it becomes a part of the contract between the client and the therapist. It is imperative that goal must be achievable and tangible. If the initial goal is not realistic, the therapist should explore with the client why it is unachievable and create a realistic goal. Complex goals can be made manageable by breaking the goal down into steps. Whatever the goal is, it must be ensured that it will not have a negative effect on the client’s health The therapist should consider that it is desirable to have a neutral client/therapist relationship; thus avoiding a possible conflict of interest if you know each other either as a friend, neighbour, work colleague or a relative. Working with people you know is best avoided. This is because the client/therapist relationship would rarely be neutral and it would be difficult to foresee whether this would have a beneficial or negative impact on the sessions. Therefore having a duel relationship with the client should be avoided as it may be detrimental to them and would breach the Code of Ethics. It is stated in section 7 of the National Code of Ethics for Hypnotherapists that, â€Å" The practitioner has the right to refuse or terminate any treatment if it is a reasonable belief that it will not be, or continue to be, efficacious. † It is at this point that the therapist should explain fully to clients in advance of any treatment; the fee levels, precise terms of payment and any charges which may incur for non-attendance or cancelled appointments and wherever relevant, confidentiality issues. This means that terms and conditions should be clarified in relation to the specific client’s needs. It should be advised that maybe, for therapeutic reasons, the treatment will need to be modified or extended, this must be discussed and the client must be made aware of the impact of these changes will have on the overall cost of the treatment. All services must be presented to the client in an unambiguous manner, including realistic outcomes of treatment and any limitations, the therapist should not under any circumstances guarantee a cure or successful resolution of the problem . This will ensure that the client has complete control over their decision to buy the services of the therapist and undergo hypnotherapy. At this point in setting the contract, the therapist should ensure all terms and conditions are made accessible to the client as it is ethical for both the client and the therapist’s well being. It must be discussed that everything that happens in the therapy sessions are confidential, however if the client says that they have committed a crime or wants to harm themselves then the therapist should consult their own supervisor for guidance. The therapist should explain that they may discuss their sessions with the therapist’s own supervisor, advising that names will not be mentioned. It is important that the client is fully aware that the therapist also undergoes regular supervision to ensure standards of practice and ethics are being met. There is a question whether to charge for the initial consultation. There are many things to support charging for the first consultation. The fact that the consultation is a vital part in assessing the client and potential therapy indicates that it should carry a charge. However it can seem that charging for this session is unjust if the therapist cannot provide therapy. A possible outcome of not charging is that clients may take advantage of this â€Å"free† time with no intention of seeking further sessions. It is therefore important that the therapist sets out the terms and conditions for the initial consultation, before it starts. I would charge for the first consultation regardless of whether treatment will commences, as this reduces the problems and issues that may occur around free sessions. It also provides some payment for the therapist’s time and ensures neither party is taken advantage of. However I would consider refunding the clients money at my discretion. In conclusion I consider it is imperative for an ethical therapist to gather information around the client’s background and history. There are many significant factors that have to be investigated before hypnotherapy can be carried out on a client and this is why the first consultation is very important regardless of whether it is envisaged that one session will complete the treatment or a series of sessions will be appropriate. A contract between both parties should be made every time a new course of treatment is commenced ensuring the safety of both parties. It must be remembered that the effectiveness of any hypnotherapy treatment heavily relies on the information, insight, rapport and openness of the initial consultation.