Access and Communication -

                                              Key to all therpeutic Encounters

Why Access and Communication are key to therapeutic encounters.

Warning!

The below is an article that is now in a publishing process as part of a compilation entitled "strategies"... - it has copyrights and intellectual property rights and it is a criminal act to distribute, copy or refer to it in any format  - it has a short life here before it is fully distributed under copyrights and publicised.

I have just finished a brief phone call from a client. It is the weekend. Saturday morning. Phone caller apologises for calling at weekend and I do understand: all mental health crises (felt) require urgent access - a call for help – and it is not prescribed at only service hours. That initial call matters and upon a fast assessment, all clinicians will be able to determine the urgency of the matter, the type of enquiry a client is seeking and an overall assessment of a best way forward. An evaluation of such nature - on part of the clinician - is usually flawless. A clinician has various determinations to make - and much analysis happens during that call: voice, intonation, pace, questions asked by client and answers provided to key questions asked by the clinician. A determination on urgency and nature of the call can take place in a matter of seconds.

The above example is one of (too) many and as such requires my professional attention. A contract with a client is signed upon moment of call, but if client is not awaiting agreement to be communicated by clinician (counsellor, psychotherapist etc.) client is entering an agreement that is not fully developed. There are instances when client continues that communication with a clinician and insists that “I want to tell you something” – yes, that is well intentioned but yet again, client is not communicating within a framework/agreement. Clinician can stop such communication only when she/he/they are assured and assessment of enquiry is fully determined and assessed. However, all throughout such process the client is outside the framework whereas the therapist is inside the framework. The client may think that a quick unloading is efficient as it stands, but what  client must understand is that confidentiality* principle - one of the most important aspects of any therapeutic contract - had not been communicated by clinician and all such unloading is outside the framework (professionally) and it requires no consent from client if a clinician decides that the urgency of the matter is not safeguarding. The clinician can “treat” prospective client as a prospective client indefinitely and apply knowledge gained and acquired in absolute all formats. If clinician is paid and all contractual forms are acknowledged and verbally agreed, than the clinician is bound by confidentiality and all client material needs consent - which is given by signed contracts or verbally.

The reason I am communicating this to clients/patients is because under current circumstances on remote working and provision of services without a face-to-face encounter or at all times when agreement is not in place, clients need to ensure that their communication is clearly communicated within a formal agreement - it is imperative to understand that if it is not a face-to-face session/interaction - there is no time that can be interpreted by your clinician as “outside the framework”. There is no such aspect unless clearly stated by client and agreed that a follow up meeting (paid in advance) is taking place. The client can be outside the framework, but the interaction is not*, hence time of contact. If client had not contacted the clinician and consented to interaction, the clinician is unlawful to make any references to such encounter, but that it is absolutely very unlikely. 

Have you seen any professional clinicians randomly calling up members of the public saying: "I do offer mental health provision of services, please come in for a session"? Absolutely unlikely from a real professional, and if that is not your experience you have a duty to report such experiences - as discriminatory acts. If such calls are part of the NHS provision of service, it is stilldiscriminatory and under the Equality Act 2010, any member of the public can bring such a case to court. 

So as a client think very carefully and act on that with confidence. A client becomes a client only by consent and voluntary action - watch with much cautiousness over such dynamics because otherwise one can become vulnerable to their own actions.

Do not agree to initial free sessions either (in private care) even if they are offered with much support in mind, because in all that stands as a therapeutic framework - there is no such aspect of free therapeutic work. Your clinician may consider it because she, he, they are aware of particular crises at specific points in time, but from an ethical and good practice framework, no communication is “safe” unless it enters a contractual agreement and that only happens when a client acknowledges services and pays. A client can refute such facts, but client’s material it is no client’s material, but clinician’s material unless the agreement is consensual and stated.

Access and Communication means that a clinician can never be accessed at personal level because access from a clinician’s point of view stands with its advertising of its services. Access also means that a client gives free access to a clinician and if communication it’s not immediately agreed and followed with a contract - a caller becomes a client that has no rights to confidentiality framework, not to mention insurance or liabilities.

There are instances when clients are referred through different portals - could be insurance companies, private practice referrals, the NHS etc. If the clinician is contacting you in his, her, their quality of clinician/psychotherapist etc., that communication is a therapeutic encounter. If the clinician is not contacting you in their quality of clinician, their communication will have absolutely nothing relevant to you other than what the clinician determines as nature of relationship.

There are absolutely no instances when a clinician’s determination can be re/interpreted or replaced by a different framework. Never. If a clinician’s is contacting another clinician and there is a stated agreement as to the nature of call and collaboration – only when such a collaboration is mutually agreed as a process - it may be that such an encounter can be reassessed as a mutual collaboration with sign/ posted periods of time of development and understanding - but if clinical language is in disagreement at all times - individual clinicians may in fact completely disagree on the nature of exchange and form individual interpretations on their encounter. The most important aspect of the above illustration is a question on whether or not at the beginning of relationship there was an equal clinical stance. For instance, psychotherapist with psychotherapist. If that is the balance, than that is mutually agreed stance and all participants have access to communication and interpretation. If relationship starts as clinician and client - the client has no access to clinician’s material formed on client if the client entered that relationship without an agreement. If a client is not a client and states that, the client needs to demonstrate and evidence why they have made contact with clinician and whether or not both parties where on a mutual agreement. 

A clinician has no personal life except family and friends, that is situated outside the framework and all other communications are professional. And even in personal life, the clinician has access to its training and all encounters are going to be assessed accordingly and a personal matter is going to become a professional matter if it involves risk assessment and risk of harm.  

 A clinician is always a clinician except if a clinician is deciding themselves that on specific instances are nominally and predominantly a sense of self more than a clinically trained something else. Knowledge and self-access to that knowledge, practice experience are absolutely always available. That is a fact. 

This article is to help clients before they make that call and want to say something fast…: Your communication ( client) needs to start with asking about an agreement.

Hope it helps!