Opening and Maintaining a Private Counseling Practice
The word “psychology”, is derived from the Greek word “psyche” for soul, and “ology” for study. This field, shaped into a type of science by Sigmund Freud, has its own hierarchy. At its apex are psychoanalysts, those who study for years in order to become certified to excavate the depths of the human soul.
While psychiatrists are medical doctors who have chosen to specialize in this work, psychologists generally hold doctoral degrees in the area. They differ from psychiatrists in that they are not allowed to prescribe medications. Still, especially within a hospital setting, a psychologist has access to a psychiatrist who can assist by prescribing pharmaceuticals which might aid in the therapeutic process.
The role of a counselor
A significant number of people feel they cannot afford, and in fact do not need this in-depth level of guided self-exploration. In truth, an increasing number of clients believe several sessions with a trained counselor can help them through a difficult stretch of time.
Clearly, anyone suffering from a mental health issue such as schizophrenia or dementia must be treated by clinicians who have studied this area. Still, someone struggling through the after-effects of a divorce, loss of a long-term job, or bereavement can often benefit by being able to voice their grief to an objective but trained and compassionate ear.
Darkness and Apathy
Emotional pain as a common denominator
During one of my introductory courses, the professor/therapist asked us each to state our belief as to the reasons anyone might be willing or even eager to open innermost hurts to an absolute stranger. He listened while each of us offered our views. Then, after pausing a moment, he replied that, although all our answers were cogent and well thought out, none of them had reached the ultimate root: emotional pain.
Though this pain might stem from an infinite number of sources, it is the one global link which connects all clients, impelling each of them to reach out, like lost ships on an ocean at night, seeking a lighthouse.
Practicalities of a practice
Having begun my training in the U.S., I completed it in the UK, where I moved around 15 years ago to marry my husband. He became and continues to be the administrator of my practice. Over a period of weeks, he was able to feature my practice on over 140 websites.
Unlike America, the British National Health Service (NHS), for the most part, subsidizes counseling.
Thus, it was several weeks before I got my first call from someone requesting an appointment. After she and I had agreed to a time, I began to feel frightened. Could I honestly earn the fee, though not exorbitant, I had set for each session?
When I voiced this fear to my husband, he said,
- “You’ve been well-trained and certified, haven't you?”
- “And you did well in all your courses?”
- “Yes, I guess; but I've never been paid. What if my help isn’t worth it?”
- “Everyone has to have a first client, so why be so worried?”
- “You're right,” I said, without much conviction.
A babies hand shares success
Sharing a tender moment
In fact, the first session proved so successful that this client booked several more for herself, and then began bringing her partner.
During our final meeting, they brought their one-year-old baby.
When, as they were about to leave, I extended my hand to shake both of theirs, the partner, holding the baby, placed the babies hand in mine. In a subtle way, this allowed me to feel a sense of inclusion in the rebalancing of the couple’s relationship and their beginning to set forth in their new life as a family.
An unexpected rival
After being in practice for over a year, I got my first call by way of referral. A university student had felt the need to withdraw from his courses due to a series of panic attacks. After several months, he felt prepared to return to his studies. Apparently, he attributed this renewed sense of strength and confidence, in part, to the therapeutic work we had done together.
Apparently, he suggested a friend struggling with the same types of issues contact me. As she was quite shy, her mother phoned and scheduled an appointment. Right away, there seemed to be a rapport between myself, the daughter and her mother. After two sessions, she mentioned having seen a National Health Service counseling psychologist who wished to contact me by phone regarding her continued therapy. I agreed, somewhat puzzled.
Dr. Pompous lacked communication skills
A few days later I received a call from a man I will dub “Dr. Pompous”.
He said he was willing to treat this young lady, but only if I withdrew from the case. It was clear from his first “hello” he felt certain that I, a mere counselor, would be intimidated by his credentials: a chartered counseling psychologist and member of the British Psychological Society. Aware his service was free under the NHS; I felt no doubt that she would choose his treatment. Still, I refused to grovel, saying instead that I would respect the young lady’s decision-but it would need to be hers. At that, Dr. Pompous put down the phone, a bit less than gently.
I mused, so-much for professional grace or even basic good manners. Still, given his background and his work being free, when the girl’s mother phoned the next day, I “knew” it would be to say a polite “good-bye” on behalf of herself and her daughter. Hence, I felt amazed when she said her daughter was definite in her wish to continue to see me. In fact, she turned out to be one of my most long-term client.
Listening to intuition
Cons and competitors
Given the availability of counseling via the National Health Service, the pool of those prepared or able to pay for private psychotherapy is sparse. Perhaps this scarcity fuelled some of the ruthless tactics I began to observe. As my client base grew, and my advertising more extensive, odd coincidences began to occur. Several people booked appointments, then failed to appear. My efforts to contact them by phone proved futile. Interspersed with these no-shows were a series of calls ostensibly seeking information regarding my qualifications to practice.
A by-product of learning to listen to others is the enhanced ability to be attuned to one’s own intuitions. Thus, if a call made me feel uneasy, I did not dismiss this feeling as undue sensitivity. I logged each one, with its date and phone number, with a few comments about my concern, in a folder which I labelled “peculiar”. Several such callers inquired, in different ways, whether I would advise opening a practice in the city where I then lived. Was there enough work to make it worthwhile? Where and how was I trained? Etc.
I kept my responses vague, and then referred these questioners to my website. In fact, there are several avenues by which one can become equipped to open a practice. My suspicions became concrete when I received an email stating a thorough search of the Internet had yielded no information to a despairing student as to how to train to become a counsellor-could I please help her?
Even before the advent of the Internet with its near infinitude of information, a phone call to any university would have provided such knowledge. Clearly, some individual or group hoped I would write something by which my credibility could be damaged.
The final flimflam
In time, I made hypnotherapy a part of my practice. While often fruitful in treating phobias as well as general anxiety, the use of hypnotherapy is prohibited when dealing with any aspect of medication.
One evening, an otherwise articulate man phoned to ask if I still provided “Hypno … hypno …”
Obviously, for whatever his reason, he wanted me to finish a word he was perfectly capable of pronouncing. Rather than doing so, I replied that the use of any type of therapy depended on the facts and circumstances involved. Sounding vexed, he said he needed assistance in adjusting to the side effects of one medication and withdrawal from another.
Then, after rambling for a few sentences, he said, “So I wondered if you could use hypno …, hypno.” Still not completing the word, I replied this type of approach would not be applicable to his situation. Then, with a perfunctory “Thanks.”, he ended the conversation. For whatever reason, I can only conclude this interchange was being recorded with a plan for some type of sabotage.
In order to put an end to what I felt to be bogus appointments my husband and I instituted an on-line prepayment plan through one of the well-established companies.
Inevitably, this change was not welcomed by every caller. Some voiced legitimate qualms regarding payment via the Internet A few elected to find someone else when I refused to be flexible in terms of accepting payment by cash or check. Though disappointing, I knew it was better to lose a client than risk further pranks by fraudsters.
An intriguing trick
Before concluding this section, I believe it is worth noting that, even a seemingly foolproof method can be used to bamboozle. This payment plan does, however, channel the deceit towards a third party.
At one point, I received a prepayment made by a client who had come for only one session around ten months before. Reaching his voice-mail, I left a message saying I would be happy to book an appointment as soon as he contacted me. After a few days of silence, I felt compelled, both legally and ethically, to return his payment. Without further knowledge, I can only conclude he pretended to have returned for a further session in order to appease someone who had become distressed by his recent behavior.
Hypnotherapy: Accessing the Subconscious Mind
When I began my practice, I planned to utilize various aspects of what has been called “the talking cure”. As its name suggests, this method encompasses elements of various types of theories and approaches, ranging from the earliest avenues to the growing focus on Cognitive Behavioral Therapy, (CBT).
At any rate, as its name indicates, “the talking cure” involves an interchange between client and counsellor, during which the client is urged to explore sources of unhappiness from the past, and then seek a pathway towards freedom in the present and future. As time passed, I began to read and hear an increasing number of reports on the benefits to be harvested via hypnotherapy.
At first, I admit I was skeptical, based on the circus-like ways in which “hypnotism” has been treated. Now, having learned a good deal more, I am saddened by the results of the belittling of what is, in many cases, a tool of understanding and progress. To summarize, when skillfully done, hypnotherapy can hasten the recovery process by placing, in the unconscious mind, ideas which the client wishes it to absorb. While hypnotherapy can be an adjunct to regular counselling, it can also be deployed on its own, after a complete explanation of its workings has been provided.
Shepherd David playing the harp before Saul the first King of Israel
The harp as a healer
Most hypnotherapists use music or other relaxing sounds as a background accompaniment. Although I have accumulated a number of CDs of authentic birdsongs, ocean waves, flowing fountains and such, I have found harp music to be the most effective. Given the above-mentioned choices, so many clients have chosen the harp CD that I now save time by placing it in my player before the session begins, though keeping the others at hand for those who prefer sounds drawn from nature.
Indeed, the harp has a history as a provider of serenity. The Christian Bible recounts that King Saul could be guided back from the absolute edge of despair by hearing its music played by David a shepherd brought to his court for this purpose.
As I clarify to each client prior to agreeing to implement hypnotherapy, it does not work for everyone. Any number of factors may influence the level of openness and sensitivity. When asked by one caller if there were any guarantees, in honesty, I could only respond that no form of therapy can provide guarantees, as to do so would be neither realistic nor ethical. Still, later meetings with clients after such sessions have erased any doubts I once held as to its validity.
Listen to Patricia Spero classical harp music
Risking meeting a rogue
Potential therapists, during training, are advised to deploy utmost caution before agreeing to see a client referred by any branch of the judicial system. Such individuals have, in all likelihood, exhibited some type of anti-social behavior. Being ordered to see a counselor may aggravate aggression. Alternatively, such a client may strive to smarm his way into obtaining case reports which could be used to free him from the consequences of his actions.
Thus, I felt apprehensive upon being contacted by a probation officer, asking if I was willing to work with a young man, aged twenty-three, under a suspended sentence due to a series of check (cheque) forgeries. Naturally, I needed to give this some thought. I asked if, as a woman in a home office, if this would be safe. The officer assured me that this was a first offence, and the client had never shown any signs of any violent behavior. Hence, after speaking by phone with the young man himself, I agreed to meet with him.
Some initial rancor
The moment I met this client I saw he was not among those intent upon charm. Instead, he slouched in, wearing torn jeans and a T-shirt with discolored spots on its front. His greeting was brief, curt, in fact edging towards rudeness. He plonked himself down on the chair across from mine before being invited to do so.
Once he was seated, he half-mumbled, “O.K., Go ahead. Say what you need to; I don’t mind. I just have to sit here for an hour.”
I explained, in essence, that I was not a guru or judge, that this hour was his to use as he wished, but he might find it more fruitful to talk than to sit, bored and sulking. Grudgingly, he began, and then continued, gaining more verve as the session went on. By its end, I sensed he and I were both surprised things had grown almost pleasant.
The empty dias
Upswing and improvement
During our following sessions, despite his occasional surge of frustration at what he perceived as injustice, he continued to progress.
Following one deep relaxation, He "saw that scrawny kid I was, who’s lunch money got beaten out of him every day, by older and stronger boys". Soon, he had started stealing items from shops, first searching for food, then for the joy of revenge, and later, when he earned an income, for the lift of adrenalin. As he concluded, “The thing was, I kept punishing the wrong people.”
Nearly always, a tinge of sadness pervades what has been decided, mutually, to be a last session. While the option to re-connect is still there, the pivotal goal has been more-or-less met. A few moments before he left, he and I reviewed the trajectory of our sessions. I said, with a smile, “that at first he had seemed to say, All right, I’m here, dammit.” Now, after a degree of turmoil, we had reached an upbeat ending.
A heartening aftermath
I have found that, with nearly all of my clients, there is no further contact after the final session. Though I have often wondered about the course of their lives, I view it as their choice whether or not to re-open communication. Thus, I was amazed when this young man phoned me several months after our sessions had ended. The reason for his call was to thank me for my assistance in helping him reach a decision which he only wished he had made a few years before.
Near tears, I in turn thanked him for letting me know the effort we had made together had been of significance to him.
Pain and depression
And so my practice continues, sporadic but consistent. I have learned a great deal from this work. The counsel-client relationship is unique. For a given time, I may learn the most private and intimate details about a life-and sometimes share a few of my own. Then the contact ends, and the client and I move on in our separate directions. Still, a small lake of closeness has been created. Even after most of its waters have drained, it remains within each of us.
Note: All names or identifying characteristics of individuals mentioned in this article have been changed in order to protect their privacy.
© 2014 Colleen Swan