Where and when does therapy begin?
The therapeutic process commences with the very first contact with whoever makes the referral. For this reason it is advisable that practitioners make contact by phone themselves with the people they will be seeing, before an appointment time is offered. This means for example, in some practices that the therapist does not accept referrals made via a receptionist as a first cab off the rank approach, as this has the potential to undermine the therapeutic endeavour. The same applies to accepting a referral from a referral team where no consultation has been made with the therapist. Both situations will leave the clinician having to do ‘triage’ work in the first session, when it may become clear that the client or their problem is not suitable for therapeutic treatment, or their problem does not match the skills of the service. Issues of safety and risk for everyone concerned also need to be taken into account.
The first telephone call with the prospective patient, usually a parent, produces a wealth of information that is not to be underestimated, and the time given to this initial phone call should never be begrudged or rushed. The tone of voice and the way the problem and request for help is presented provides important data. We would always ask the parent to tell us a little about the problem and what they particularly want help with. This need only take a few minutes, but already gives us a picture of what may be happening in the family and enables us to begin to formulate a tentative initial hypothesis.
The initial contact via the telephone call also enables the practitioner to explain how the therapy will be conducted and in this sense asserts the therapeutic frame from the outset. Explaining that both parents (where available) will be required to attend the consultation, as well as ongoing treatment, can result in a response that takes the therapist straight into the heart of the dilemma. For example, a mother who was referring her child broke down and wept on the phone, saying that her husband always made himself unavailable for family commitments. The therapist, by being sympathetic but firm about the father’s need to be present was already acting as an ally to the mother, helping her in turn to be firm with her husband, which resulted in his attendance.