Nonprofit News covers issues that are of interest to counselor clinicians working in a nonprofit setting. This month’s column focuses on several common mistakes that can have a deep impact on your program.

No matter how talented the clinician or staff, mistakes will indeed occur from time to time. The key is to address those mistakes and make needed changes before it takes a toll on your program.

 

Focus on the money first and foremost.

All counseling programs, whether they are for-profit or nonprofit, need to make sure their bills get paid. Some programs have their finances taken care of via large grants, endowments and other sources, but most of us need to find the proper balance between providing free services and collecting enough revenue to survive and prosper. There is no shame in having a healthy bottom line. There is shame, however, in making clients feel like they are little more than a meal ticket.

Recently, I found myself feeling ill. I went to a local urgent care program that is part of a large nonprofit. I have been there many times, and the turnover at this location appears to be very high. I have rarely, if ever, seen the same folks working there twice.

When I got there, they gave me my paperwork to fill out, collected my insurance information again and made sure that I paid my copay before allowing me to sit and wait for nearly an hour to be called. No one ever asked me why I was there, what was wrong or if I was OK to wait. I have no idea how they did their triage, if they did it at all.

Finally, I got in to see a doctor. He did ask me why I was there, although any eye contact was lacking, and he seemed more focused on filling out paperwork. I’ve been told that a very large local clinical program behaves in much the same way.

A simple tweak of this system would involve having the staff start out by asking patients why they are there before having them complete insurance-related paperwork and make their payment. A simple smile, some type of eye contact and acknowledgment of patients could go far here. Some sign of compassion wouldn’t be too much to ask for either.

Ignore the client.

While I was in with the doctor, he seemed to ignore me and my symptoms but was ever so quick to break out his prescription pad. He proceeded to write out four scripts, two of which my primary doctor had advised me never to take because of other health issues (which were included in my chart). When I reminded the doctor of the possibility of these prescriptions leading to a stroke or heart attack if I took them, he responded by saying, “Let’s see what happens.” He then proceeded to ignore my objections and rationale and walked out of the room. When the pharmacist contacted him about this issue, he refused to make any changes and advised the pharmacist that I should simply monitor my symptoms. The pharmacist and I agreed that these scripts would go unfilled.

As a consultant and researcher, I have interviewed countless clients who shared similar stories. Some reported having been misdiagnosed and incorrectly medicated, possibly for years. (They developed this belief after eventually going to another professional who made massive changes to both their diagnosis and treatment. The actual extent or likelihood of misdiagnosis is unknown).

Whether you are a medical profession or a clinical professional, Rule No. 1 should be LISTEN TO YOUR CLIENT. They may not always be correct, but failing to listen to them could result in great harm or, at the very least, malpractice.

The fix is easy: See your clients as equals, see them as humans and act in kind. We all have bad days, but remember that you have two ears. Use them.

Treat clients poorly.

As a former client advocate, one of the most common complaints I heard was that clients felt they had been treated poorly. Common examples included being ignored, being talked down to, being sworn at, being ridiculed, and being judged or otherwise condemned. There are times when clients simply misunderstand a comment, but often their concerns are more than valid.

Sam (names and identifying information for individuals mentioned in this article have been changed, although permission to use their stories has been granted) recalled his last experience with therapy. “My last therapist barely said a word to me and spent most of our work together asking me about my childhood,” Sam recalled. “I told him that I was here to talk about issues at work, but we never got there the whole time we worked together. When I finally confronted him on this, he replied, ‘Who’s the licensed social worker? You or me?’ before going right back to the stuff that I was tired of talking about. Hey, my childhood was great. I mean, there were issues like anyone else, but I’m fine. I was looking for suggestions on how to communicate better with my new boss. I have no idea why he needed to know how long I was breast-fed and if I ever wet the bed or hated my parents. … I left shortly after.”

Sue recalled an experience with a therapist who used some art-based therapy techniques in her general therapy. “She had me bring in artwork based on homework she gave me the session before,” Sue said. “She would look at it like I was on trial or something. Several times she told me my work was too dark or evil and proof that I was terribly disturbed. Sometimes our sessions included me following her orders to destroy my artwork in front of her as a way to ‘release the demons’ in me. I worked so hard on some of those. I was crying, not from the release she promised, but from feeling that I must really be evil and that I had no artistic talent.”

Clinicians need to remember that they are not only supposed to work within the scope of their training but also to set treatment goals with their clients and to demystify the experience as much as possible. It can be very helpful to look into childhood issues that may be impacting the present, and the use of art-based therapy is very beneficial to many, but treatment needs to reflect the needs of the client and not the preferences of the clinician. I have no idea how shaming or damning a client could be considered beneficial.

Fail to return calls or make clients wait excessive amounts of time at appointments.

Brian called for treatment for issues related to grief and loss. He left a voice mail after hours and was called back the following morning by a staff member. He sounded surprised that a clinical staff member was the one calling him. He discussed some of his issues, told us his preferred day and times to meet, and was given a session with one of our clinicians. He asked how long he should be prepared to wait for his session to start. We advised him that his appointment should start on time or within a few minutes. He seemed skeptical.

He was called in for his first session on time, give or take a minute or two. This seemed to shock him. “My last counselor took days or weeks to return calls, if they did at all,” Brian said. “It was not uncommon to wait an hour or more after I was scheduled to see her. I stopped going after awhile because it took me all afternoon.”

It is important to remember that your client’s time is an important as yours. At the offices I direct (www.docwarren.org and www.pillwillop.org), we strive to return every call within 24 hours and to meet with our clients when they are scheduled. Should we fail, which we do on occasion, we tell our clients that we know that their time is as valuable as ours is and, because of that, we will be waiving the entire fee for their session (this doesn’t include sessions that start 5-10 minutes late but anything substantial).

There are other easy ways to lose clients and reputations, but those noted here appear to be among the most common. Thankfully, the solutions to these problems are easy as well. A little attention to detail can be the difference between a successful program and one that may fail. Remember the golden rule: Treat your clients as you would want to be treated. If you do that, you should go far.

 

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“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org.