“Why is the initial consultation so important? What factors will an ethical therapist cover at this time?”

Year One – Module Three
(Word Count – 2226)

This essay endeavours to document the importance of the initial consultation within a successful therapeutic treatment plan. It will comprehensively describe ethicality, before applying this fundamental component of treatment to a beneficial, healing and professional environment. It will present, describe and discuss a multitude of, sometimes complex, ethical issues that may face a therapist upon meeting a client for the first time. Lastly, it will conclude with a summary of such matters, and ways in which the therapist should aim to address and manage these ethical factors in an effective and professional manner.
The initial consultation is paramount in the potential success of any proposed treatment for each individual client. It is the optimum time for a reputable therapist to assess a myriad of informative aspects and circumstances concerning their client. Foremost, upon the client and therapist meeting, face to face, for the first time, approximately 55% of all communication is projected in a non-verbal manner, via body language (Chrysalis Module Two notes), and this is an integral, and natural basis in the formation of first impressions; both of the client to the therapist, and the therapist to the client. Whilst, the remaining 45% of communication is through the words we choose, and the tone and volume in which we deliver them (Chrysalis Module Two notes), this significant proportion of the communicative spectrum would be lost if the therapist were to provide an initial consultation solely via a telephone call. Stated by Hadley and Staudacher in 1996, “The hypnotic induction begins at the door”.
During the initial consultation, the therapist should aim to collect as much information as possible regarding their client, in order to build a “full picture” of the client themselves, and most importantly, the problem(s) that they present with.
A useful tool in collating all relevant details is by use of an initial consultation notation form. This usually includes, although is not limited to, the following items; The therapist should know their full name, and if there is an alternate name by which they prefer to be called, their current address and telephone numbers, of which it is important to establish their preferred contact means and, due to client confidentiality, if they give you permission to leave a message should the need arise. It is useful to know the client’s occupation, any previous occupations, and their typical working commitments (Chrysalis Module Three notes).
Furthermore, it is extremely beneficial to document a brief, yet informative, medical summary of the client, including their registered General Practitioner (G.P.), any current, or past, health problems and corresponding medication(s) (Chrysalis Module Three notes). Some medications, for example Amitriptyline, can cause side effects such as sedation and confusion in the first few days, or weeks, of treatment (Rang, et al., 2002) and could interfere with therapy. It is also advantageous to record any significant family history of health issues, in particular, mental health problems, as ongoing studies continue to provide evidence of an underlying genetic component in such disorders. In fact, some of the more severe mental health illnesses, such as bipolar disorder and schizophrenia, are reported to have a heritability of 70 – 80% (Uher, R., 2014) and it is questionable whether such severe mental health issues should in fact be treated using hypnotherapy.
Additionally, gaining information on their current marital status, together with an overview of their childhood, family members and any past or present problems within the family, will aid in providing strong foundations for both the initial consultation, and any subsequent treatment sessions. The therapist may wish to know any other problems that the client may be experiencing, other than the main issue that they have presented with, whether they are of an occupational, financial, or any other nature. Being made aware of any prior treatment(s) that the client may have undergone, and knowing what has brought them to seek therapy at this point, can also be constructive to the therapist’s understanding and realistic treatment objectives (Chrysalis Module Three notes).
As described previously, an initial consultation provides the opportunity for every means of communication to be assessed, through body language, words spoken, and tone of voice. It is the responsibility of the therapist to record all relevant information, by using the initial consultation notation form, and incorporate their professional expertise in their assessment by noting other factors such as modality. This can help to determine which type of screed may be most suitable for each client they are presented with, and to personalise it accordingly.
It provides the therapist with a chance to establish a rapport with their client, and indeed to see if one can be established at all. Such a rapport may be apparent very quickly, for example, if the therapist and the client both exhibit the same modality, i.e. “visual”. However, a difference in modalities does not indicate that a rapport cannot be generated, if the therapist is aware of the client’s preference, and subsequently “mirrors” certain characteristics of their client (Alder, H, 1994).
Upon the initial consultation, it is likely that the client will feel uneasy, perhaps sceptical, and somewhat vulnerable about the therapeutic treatment that they are hoping to receive. It is the responsibility of the therapist to discuss and effectively alleviate any such fears, which will also aid in building rapport, installing confidence and positive expectations in the client, that the therapist is going to able to help with their concern(s) and for the client to feel that all sessions are of a confidential nature.
Taking all of the factors discussed so far, it is imperative for the therapist to conclude whether they feel their client is suitable for therapy, and if so, whether they themselves feel they have the appropriate skills and experience to progress with further treatment. Should the therapist feel any sexual attraction towards their client during the initial consultation, they should refrain from working with them, as this would interfere with future sessions, hence the overall outcome of their therapy (Chrysalis Module Three notes).
Many therapists offer this initial consultation for free, although doing so can carry certain disadvantages. For example, the therapist giving their time up for free, clients abusing this offer of “free therapy”, and should the session not be what the client anticipated, it may cause them to not wish to return for further sessions, and be detrimental to their ongoing physical or psychological concern(s). Costs of subsequent sessions (and any cancellation notifications and/or fees) should be discussed so the client is fully aware of the financial expectation of their therapy.
This essay has not yet provided a full definition of ethicality as, primarily, it is imperative to detail all of the information that a reputable therapist should acquire from their client, before examining how their work ethics can potentially affect future treatment.
The word ‘ethical’ is defined as “being in accordance with the accepted principles of right and wrong that govern the conduct of a profession”. (http://www.thefreedictionary.com, accessed 15th October 2014). Whilst this is similar to ‘moral’ in that both are related to the principles of right and wrong, ethical differs in that an external body, such as a profession, governs particular guidelines for an individual, as opposed to the internal and personal beliefs (morals) that that person may hold.
It is an essential requirement of many associations, such as The British Association for Counselling and Psychotherapy (BACP), for their members (therapists) to be ethically minded and also willing to be accountable for the ethical basis of practice. However, such associations also emphasise the desire for their members to possess good moral qualities, such as empathy, wisdom and courage, and that such attributes have been developed out of personal commitment rather than the external requirement of the authority itself (http://www.bacp.co.uk, accessed 15th October 2014).
Associations such as BACP and The National Hypnotherapy Society document a range of principles that guide attention to fundamental ethical responsibilities (http://www.nationalhypnotherapysociety.org, accessed 16th October 2014).
These principles include “being trustworthy”, in that the therapist honours the trust placed within them. The therapist must ensure a high level of confidentiality regarding their client, and not disclose any information for any other purpose than for which it was intended. Moreover, the therapist must endeavour to satisfy the client’s goals and expectations of successful and effective therapy. This principal also encompasses that of “beneficence”, which is the commitment to the client’s well being. Therefore, if a client presents with a concern that the therapist may not be skilled in treating, an appropriate ethical decision would be to definitively not treat that client, but to refer them to a different therapist with more experience in that area. Should this not be done, this would be unethical, and could be viewed as exploitative, using the client’s vulnerability and trust, for the therapist’s potential financial gain (http://www.bacp.co.uk, accessed 15th October 2014).
Ensuring that the client knows of their ability to help self direct their own therapy is a principle known as “autonomy”. The therapist has a responsibility to ensure the client is aware of all therapeutic options available to them, such as age regression, and to emphasise the importance of the client’s voluntary participation in these services (http://www.bacp.co.uk, accessed 15th October 2014). Failure to do so could also be construed as exploitative, in that the client has not been sufficiently informed of the quickest and most effective, and hence cheapest, treatment available to them.
Honouring the client’s rights, subjectivity, beliefs, dignity, ideas, and ultimate goals of therapy is of crucial ethical importance in the therapeutic field. This may also be viewed as “justice” in that all clients will be treated fairly and impartially, regardless of religion, sexual orientation, marital status age, political values, financial or social standing, or disability (http://www.nationalhypnotherapysociety.org accessed 16th October 2014).
Therapists must understand the boundaries between themselves and their clients at all times, and undertake to never allow these to be crossed, nor to harm or exploit the client in a financial, emotional or sexual manner. This principle is known as non-maleficence (http://www.bacp.co.uk, accessed 17th October 2014). Although, stated previously, that therapists should refrain from working with a client to whom they have a sexual attraction, should any other relationship develop, which is anything other than a professional one, the therapist has a duty to terminate any further therapeutic sessions and cease to accept payment for these (http://www.nationalhypnotherapysociety.org, accessed 16th October 2014).
The difference between ethical and moral has previously been described in this essay, however all therapists are likely to encounter certain clients and situations which may challenge their moral beliefs, and thus cause difficulty in accommodating all fundamental ethical principles. Every individual, and hence every therapist, is unique, with each having their own personal (positive and negative) experiences in life, influencing and shaping their own moral values, and potentially forming prejudices of some description.
A therapist who has difficulty in accepting homosexuality may find themselves morally challenged after the initial consultation with a lesbian or gay client, and hence question if they indeed wish to treat them. This could be argued as ‘unethical’, as it does not honour the client’s beliefs, ideas, or goals of therapy. However, knowing their own morals coupled with their limitations and areas of expertise, they are honouring their commitment to that client’s wellbeing in opting not to treat them (nor attempting to change the client’s sexual orientation), and referral to another therapist would make that decision an ethical one. It is crucial that the therapist is completely accountable for all decisions made (http://www.bacp.co.uk, accessed 15th October 2014).
This essay has examined the utmost importance of the initial consultation within the therapeutic community. This consultation, sometimes offered free of charge, provides the chance for the therapist and client to meet face to face for the first time and to establish some kind of rapport. After collating both basic and more personal details about their client, the therapist is able to make an informed decision on whether they wish to, and are suitably skilled to, treat any particular client. If future sessions are agreed by both parties, the therapist will be suitably prepared to personalise screeds, according to that client’s modality, increasing the chance of successful treatment.
Ethicality has also been defined within this essay, with many of the fundamental ethical principles described. Therapists working in the field of hypnotherapy, counselling and psychotherapy are governed by external bodies such as BACP, who list these principles expected from all of their members. Morality has also been defined, and whilst many therapists may possess many of the same personal, moral qualities, such as empathy, they will ultimately differ in areas of expertise, potential prejudices, and personal beliefs.
Consistently working in an ethical manner will ultimately mean therapists will face many situations where certain principles are challenged. The fact that two different therapists may reach opposing conclusions with regard to the same client does not infer that either has worked in an unethical way, but that they were aware of their individual strengths and limitations, and this may have been influenced by a prejudice originating from their own life experience. Having the capability to identify such circumstances is paramount in adhering to ethical practice. Every client seeking help in the form of therapy is likely to be vulnerable in some way. The therapist has a profound role to play in the recovery and healing of their client, and should utilise the initial consultation in a highly ethical and mutually beneficial manner.

References:
RANG H.P., DALE M.M., RITTER J.M. (2002) Pharmacology, 4th Edition, Churchill Livingstone, Edinburgh
HADLEY, J., STAUDACHER, C. (1996), Hypnosis for Change 3rd Ed. New Harbinger Publications
CHRYSALIS COURSE NOTES - Year One Module Two, Hypnosis and Mental Health – Further Techniques – Counselling Skills 1
CHRYSALIS COURSE NOTES - Year One Module Three, Hypnotherapy and Counselling Skills http://www.thefreedictionary.com/ethicality http://www.bacp.co.uk/admin/structure/files/pdf/9479_ethical%20framework%20jan2013.pdf http://www.nationalhypnotherapysociety.org/about/code-of-ethics/ UHER, R, (2014) Gene-environment interactions in severe mental illness. Front Psychiatry. May 15; 5:48
ALDER, H., (1994) NLP: The New Art and Science of Getting What You Want. Piatkus books