Therapeutic Excellence

Suggested Checklist for Therapists

I've seen it too often. They go rushing out of the hall, proudly clutching their 7 day certificate in their excitable hands, eager to go out and change the world. But how do they plan to actually do this?

Well, mostly by setting themselves up as therapists.  No bad thing in itself, but there are a number of considerations that anyone doing this might like to take into account first. 

So, listed below in no particular order are some key pointers about how to gain the relevant experience.

Getting Experience in Mental Health
It is important to know who your local mental health team are, and how they work.  You may need to refer someone to them someday.   Do you know how to do this?  I recommend getting clinical experience by taking a part time position for a while working as an orderly, auxiliary or volunteer in a mental health unit, or similar facility. Your local mental health charities will also be able to advise you as to the best way to go about this.   Many clients will have their own personal experience of the mental health system, and it can be extremely useful to have some grounding in this field in order to be able to relate to many of the external factors influencing such clients.

Insurance and the Law

• Are you insured? You need to be these days, not only for any potential claims for malpractice but also for things like trip, slip or fall.
• Do you have any evidence that you have carried out a risk assessment? Is your toilet up a flight of steps? Is the carpet safe and secure? Are your floors suitable and not slippery? And so forth.
• If you are doing deep trance work, have you made sufficient provision for when your client is going to be driving home?

Record Keeping

• Do you keep case notes in any form on your clients and sessions?  If so, are you familiar with the Data Protection Act?
• If you take referrals from GPs, what do you do with the referral letters? Where do you keep them? Do you have a secure and lockable cabinet?

Confidentiality

• What is your own personal Code of Confidentiality? Does it match the legal standards adhered to by Medical and Nursing Staff that is expected by the law and by the paying public? Do you know what these codes are and how the law applies to them and to you?
• If a client discloses that they are likely to cause harm to themselves or another person, do you know how to handle this information securely and safely?
• When telephoning your clients at home, do you know who else may be in the house that your client doesn’t want to overhear the conversation?
• Have you checked with the client if it is ok to leave messages if required?

Criminal and Civil Law

• Do you know the relevant criminal and civil laws that apply to therapists?
• Do you understand the potential legal implications of doing "change history" patterns, "hypnosis" etc when you have a client who, for example, is going to give evidence or be cross examined in a court room (i.e. an assault survivor, or witness to an assault)?

Other Agencies

• Citizens Advise Bureaus, benefits agencies, probation services, and crisis housing centres are the front line for many people with serious issues in need of urgent attention. Do you know where these centres are? What they do? Their roles? Who staffs them?
• Sometimes the problems presented by a client may exceed the boundaries of the therapist’s role, and an involvement with outside agencies is required.

Physical Health

• Do you understand the physical health issues faced by your clients?
• Do you understand diabetes and how it affects people both physically and mentally? Heart failure? Angina? Arthritis and how steroids work and affect people? Have you studied physiology and health?
• Do you know what to do should a medical emergency arise during a session, such a seizure, an asthma attack or diabetic crisis?

Making Referrals

• If you have a client who you are unable to handle, do you know where to refer them? Your clients come to you because they consider you to be the expert, but if their problem is a serious one that you are unable to assist with, do you know how to smoothly handle the situation and get the client to the help they need?

Pharmacology

Many people with psychological problems and distress are already medicated with psychotropic medication prior to seeing a private therapist. These medications are typically either anti-depressants or anti-psychotics with anxiolytics being common too. There are a great many other common medications that can have cognitive effects and you need to know about these.

• Go and buy, beg or borrow a copy of the Physicians Desk Reference (USA) or British National Formulary (UK) and learn about drug classification, effects, side effects, withdrawal etc. Both these books can often be begged from pharmacies, since they are updated twice a year.
• Other situations can arise through ignorance - got a client who is asthmatic? Did he bring his inhaler? Got a client who gets angina? Where's his GTN? You need to ensure you understand these issues and know what to do should there be a medical problem.

Medical Evaluation

• How do you know that the client's problems are really psychological?
• How do you know that their depression isn't the result of a brain tumour or diabetes?
• How do you know their persistent low mood and fatigue isn't an early sign of heart failure?
• How do you know their anxiety is actually anxiety and not a heart arrhythmia?
• Have your clients seen a physician prior to seeing you?