Just like everything in life, structure is required. The amount of structure that is in place is fluid, but some structure is necessary. I spoke to a clinician this week about ways to work with cancellation fees and she said it is so hard to discuss with clients. I asked her to reframe the idea of charging fees to focus on the clinical facts that she should be working with the client to ensure engagement and attendance. The byproduct of that should be you shouldn't have to be stressing about charging fees. So here are some conversations you should be having with your clients to ensure they have good clinical outcomes and attend their sessions.
1. Explain what is expected. Some clients have never had therapy, or some have and had bad experiences. It's the practitioners role to ensure you educate them about what to do and what is expected. Then demonstrate that appropriate behavior. I know this should go unsaid, but honestly, some clinicians speak to their clients about cancellations and then regularly cancel on their clients.
2. Have a balance. Yes, you want to let the client lead the sessions. However, there is still an aspect that you should also remain the expert. If they aren't attending, follow up. If they cancel, discuss with them their reasons why. Phone calls, letters, SMS its all appropriate when you and the client work together in the engagement process. Remember, sometimes they aren't dropping out; life just happens and they've forgotten to reschedule an appointment with you.
3. Plan for the end. I speak to so many practitioners who don't actually talk about what the end of therapy looks like. Discussing with the client your expectations that they will attend their final session, that there will be a final session, and what breaks in therapy look like. Those are all things that give the client hope and provides the client trust that you aren't just keeping them in therapy for their money. It should also help the client raise with you when they would like to take a break and thus ensure they are comfortable enough to come back to you when they're ready.
4. Educate. The client is going to feel better. They are going to feel worse. Provide the client with information ahead of time so they understand this. I know, you've told them in therapy once when they were upset. Have you provided them a hand out? Is that information on your website? What resources does the client have to actually understand their journey? How can they access that information?
What other things do you do as a clinician to foster good clinical outcomes?