Signs That You or Your Client has Picked the Wrong Counselor or Psychiatrist, or 5 Customer Service Errors to Avoid

In the make believe world of movies and TV shows that depicts all types of ethical and professional violations by professionals, I thought that it might be a good idea to educate the community about some real-world examples of professionals acting questionably.  Or another way to phrase it would be “How To Tell When It Might Be Time To Move Onto Another Professional.”

First of all, finding a qualified counselor or psychiatrist that truly cares about their clients & not just their pocketbooks, offers great customer service, is genuine, and ethical can be difficult.  Many clients will speak about bad experiences that either they or a friend or family member had with a professional.  All you can really say to that is that there are bad apples in every single professional field; the news regularly shows us coaches, teachers, doctors, lawyers, politicians, etc. who do unethical or immoral things.  However, I do believe that the good practitioners outweigh the ‘bad’ ones.  With that being said, let’s review some of the pitfalls of poor customer service that I have professionally experienced or had clients report to me.

Customer Service Error #1 to Show You Do Not Care About Your Client

*You answer the phone in the middle of a session.  

If you were the client, how do you think that might come across?  Would you feel that it was disrespectful of the time that you had paid for the undivided attention by the professional?  Would you feel like you were less important than whomever was on the phone?

I will say that I did make an exception once and answered the phone in the session with a client but the circumstance was that the lights had gone out in the office, the sky was green, the winds were picking up, and I knew that we were possibly under a tornado warning.  The call was from my parents who told me to take shelter.  I will not bore you with the other details as to how I had ignored the previous 3 calls from them, so by the 4th, I knew something serious was up.

Customer Service Error #2–You Do Not Communicate with the Other Treating Professionals

I recently had a doctor refuse to speak with me about a case because I had questions & concerns about the very expensive, out-of-pocket treatment that she was recommending to my client.  Instead of communicating with me directly about the concerns and course of action, she had a third party speak to me.  I must say that this has probably been one of the most unprofessional situations that I have ever experienced in my 16 years of practicing.  Even when I have had questions with other doctors, they have given me the professional courtesy to discuss their opinion as to why they were recommended a certain approach and we came to an understanding, after all, that is what professionals do; professionals are supposed to role model healthy communication skills.

Most insurance companies strongly recommend that a counselor and a doctor who is administering the medications communicate, but even if it is not a requirement, it is best practice.  Clients want to know that their professionals are communicating with one another and want to be updated about it.  This communication about potential issues can also cover your tail if any lawsuits come up.

Customer Service Error #3–You Do Not Respond to a Request for Records

Sadly, on numerous occasions I have faxed over a HIPAA compliant release for records to another counselor regarding a mutual client and not received any communication back from them.  I had the fax confirmation with the correct fax number for the professional, so I know that it went through, but they never responded in any form or fashion.  Per the Texas LPC Board Rules, if you receive a request for information you are to respond to it in some form or fashion within 15 days of receipt.  I have had to go back to report to my clients that their former counselor had not responded to their request to release information directly to me.  While I could go repeatedly ask the counselor for the information, there is a part of me that wonders what kind of records that they would even be and if their lack of customer service to another professional is a reflection into their treatment of the client and their note taking abilities.

For doctors, I send over the release to the office and never receive a call from the doctor or any paperwork.  If you are a doctor, wouldn’t you want to know how your client is doing in therapy?  After all, the counselor is spending significantly more time with your patient than you are.  I make it a practice to try to send at least one treatment update (2 page document) to the client’s doctor within the first 5 sessions, sooner if there are risk factors that need to be immediately addressed.  While I cannot control what the doctor may do about my recommendations, I can at least know that I have done what I am able to regarding expressing any concerns about my client’s safety or progress to the doctor who is in charge of their medications.

Customer Service Error #4–You Do Not Return or Acknowledge Client Calls, E-Mails, or Texts

Forms of acceptable communication should be clearly spelled out in the Counseling or Psychiatric Agreement so that clients know in advance the ‘rules’ of how to communicate and when.  On my website and in my contract, it states when I will return calls or most emails, unless there is an emergency or some type of crisis, then other specific instructions are given.  I have had several clients stop seeing their doctor because they felt that they could never get in touch with them and that they were just leaving one message after another on their voice mail or with their assistant.  Granted, can some clients be a bit overwhelming and/or demanding?  Yes, of course, especially if they are emotional.  However, if you have addressed these situations in advance, then you can remind them of the policies.

Not returning calls, especially from other professionals, is just poor customer service and decreases the likelihood that I would refer to you.  I understand that people cannot return some calls during the same day because I can’t do that most days.  However, to not make any attempt to return the call after a week is getting to be a bit questionable.  I also understand that sometimes people forget that someone called, but if it seems to be something that is regularly occurring with that office, then it may be time to look for a new office.

Customer Service Error #5–You Forget That They Are Your Client

This could take the form of just going through the motions with them at each visit to outright breaking a Board Rule about a dual relationship.  First, let’s remember that clients are clients, they are not friends, confidants, people to help us feel better about ourselves, venting sources, or business partners.  CLIENTS ARE CLIENTS–period.  Never shall you mix the professional life with the personal life.  Now that is out of the way, let’s also remember that we are being paid to do a job and that job is to be awake, alert, and mentally present for our client during that session.  When counselors or doctors find that they are just ‘going through the motions’ , then we need to step back and assess if there is anything else that we could be doing to help the sessions along, if the client is still benefiting from the treatment, should they be referred, or discharged.  If we feel that the sessions have stalled because of lack of compliance on the client’s end, then we need to confront it.  A non-compliant client can be a liability, so we need to document what we have done to try to deal with the lack of follow through and what the new course of action will be, including possible termination if non-compliance continues.  Along the same lines, we are not to over treat a client, either, or recommend treatments that seem to be more than what is necessary for the client to do well (i.e. using an semi-automatic gun to shoot a mouse).

So, as a professional if you have a client reporting these situations to you, then you may want to speak with them about their other options for care.  And if you are a professional who is guilty of such errors, then do some consulting with another professional or group and fix them.  All of these errors are fixable and can help professionals keep clients if they are addressed.

Do you have the tools to work with NSSI (self-injury)?

With the prevalence of Non-Suicidal Self-injury ever increasing, my new book shows the incredible increase in the number of cases whose onset was age 12 or younger, it is my opinion that it is inevitable that at some point a counselor, nurse, teacher, youth minister, parent, or doctor will come in contact with someone who has intentionally harmed themselves. While this is a now a ‘hot topic’ with many seminars covering the basics of what it is, debunking some myths, signs of it, and where to look for it, very few get into the actual core issues that contribute to this behavior or how to properly assess for it. First, I would like to go over some basics.

One can’t simply ask a simple ‘yes’ or ‘no’ question of the person who may be harming. Human nature is such that we automatically go to a ‘no’ response, especially if we fear we might get into trouble, hurt someone’s feelings, disappoint a loved one, or have some other negative repercussion from a positive response. Discussing self-injury should be conducted in as a calm of a manner as possible for caregivers as possible, and for the professional they need to address it with the same care as they would with a suicide or abuse assessment. Disappointment or judgement must be absent.

So, how should one properly assess for self-injury? First, you need to be comfortable asking the question and receiving whatever answer is given. Working this population is not for the faint of heart, it is not for everybody—and that’s alright, we all have our strength areas. I do not think that I could work with a pedophile, but thankfully, there are people who are able to work with sexual perpetrators. When asking the question, one should be calm and ask the information in a matter-of-fact manner, no emotions attached. For example, in order to differentiate between self-injury and a suicide attempt, I might say, “People handle stressors in a variety of ways. Some people might yell or scream, some drink alcohol, some purge, and others might hit themselves, an object, or cut. How do you handle stress?” If they answer that they have harmed themselves, then my follow up is “When was the last time that you self-harmed?” and “Have you tried any other methods to harm?” There are several other questions that I ask after that those to get more clarification and to get a better feel as to the level of self-harm that I am working with, and those are covered in my seminar and books.

For tools, the practitioner needs to be educated about what NSSI is and isn’t, they must know how to define it (Favazza and SAFE give good definitions), the locations in which it can occur, the many types of self-harm, and understand how it is different than a suicide attempt. In both of my books, I go over the 35 reasons, that I have collected over the last 15 years of working with this behavior and almost 400 clients, as to why someone may self-injure. In A Practitioner’s Guide to Self-injury: tips, techniques, activities, and debates, I expand upon what I wrote in A Caregiver’s Guide to Self-injury by discussing the possible core issues that are involved with the reasons and tips as to how the clinician can address it. I would say the top tools are being non-judgmental & understanding and knowledge of the behavior. Experience has been that if a practitioner does not have a basic foundation and comfort level in working with this population that they will “tune you out,” i.e. they will not respect your opinions or suggestions.

One of the major mistakes that I have had many clients report to me that professionals have made is to tell the client to “just stop it” or “just don’t do it,” these phrases are instant turn offs for the client and they will shut the practitioner out. It shows a lack of understanding of this behavior. Another significant mistake that has been made is to accuse them of harming to get attention. While there are admittedly some who do it for attention, the majority keep this behavior a secret. For those who are very open about it, they still need help to deal with why they feel that they need to go to that level of behavior to get attention. I go a little bit more into this in the books, but for now, it is important to understand to avoid that accusation. A final mistake that I will list is assuming that the self-harm is a suicide attempt. A phrase that I often use with clients when it comes to communication, but is also very applicable to treatment providers of all types & parents, is to ASK DON”T ASSUME. Assumptions have been an issue with E.R. visits where the staff has assumed the patient had attempted suicide because they had cuts on their wrists, but they did not ask why the cuts were on their wrists.

Treating NSSI is a specialty in and of itself, just like treating eating disorders, severe trauma, Autism, or substance abuse are their own specialty areas. The seminars that I give on this topic can be a very short 45 minute highlight reel up to a 7 hour training that covers the basics to the advanced level. On March 28th, I will be giving a 4 hour CEU training that coincides with the release of my second book. In this training, we will be skipping the basics of self-injury that so many seminars have covered and jump into the assessment process, the addiction debate, the role of eating disorders, core issues, types of therapies, and actual techniques that I use with clients in individual and the support groups that I offer. At this event, I will also make available for purchase The Self-injury Prevention Activity Workbook that contains 30+ activities that I developed over the almost 6 years of running the only exclusively self-injury support group for teen girls in all of North Texas. There are still some tickets left for this event

Memorial Hermann’s Prevention and Recovery Center-Dallas IOP is providing the lunch, handouts, location, and CEUs for the event.

If you’d like for me to speak to your group, I am available to travel. I am especially interested in any groups who would want me to speak at the end of May in So. California, as I will be there as a presenter for the West Coast Addiction Symposium. I have a speaker reel on my website www.LoriVannCounseling.comand on my YouTube Channel, Lori Vann LPC-S.For updates on upcoming seminars, you can sign up for my email list or follow me on Twitter @LoriVannLPCS or Google+. The books are available on my website and Amazon.