Monthly Archives: January 2015

Why I don’t do free consultations

Recently I had a call from a prospective client looking for a therapist. He and I had one or two phone exchanges, discussing my approach, plus logistics like schedule, insurance matters and fee. At the end of the second call, which, like the first, lasted minutes, we agreed upon an appointment time and I indicated my fee for a first session. The caller balked, saying he’d hoped for a free consultation, and adding that he’d seen numerous therapists over the years, all of whom had offered an initial free session: a “screening” he called it; a “feeling out process”, seeing if we’d “connect” he added. I was dubious about his claims.

I replied that, contrary to his personal experience, free consultations are not a norm in psychotherapy, though some, perhaps many, do offer a free session at the outset. I added, pleasantly I hope, that the assumption of a free consultation was inappropriate for various reasons, not least of all because a therapist’s time, which is actually our only reimbursable commodity, is not free. The caller gently deferred on this point, but asked to call me back as to whether he’d make an in-person appointment. I sensed that his shopping had yielded other willing participants in the free service department, and that I’d not hear from him again.

Indeed, we did not meet. So, for those who have received free consultations from therapists, or who might think them appropriate, if not a standard of the profession, I will now explain why they are not.

Firstly, returning to the earlier point, a therapist’s time is his or her only reimbursable service. Meaning, there is no commission placed upon an individual’s mental health. That said, if anything, therapists might reasonably raise fees if a person’s circumstances improve, as they may be an indicator of a person’s growth and the therapist’s good work. To put it another way: why shouldn’t therapists, like everyone else, merit a raise from time to time?

Secondly, if a therapist doesn’t receive a fee, then he or she is simply giving away their time. If a private practitioner, there is no agency, hospital or other institution that will absorb the cost of the therapist’s time; not PTO that will pay for an un-reimbursed hour, and the opportunity cost of the “free” time cannot be written off taxes.

Well, what of the ideas tabled by that caller? You might ask. What’s wrong with the idea of “feeling out a therapist” as he put it; checking to see if a “connection”, a rapport, seems apparent before making a commitment to actually engage in therapy. My answer is as follows: an opening session may be a breezy, shopping encounter for a would-be client or mental health patient, but it is not and cannot be such for any mental health professional. From the outset of an episode, even during an initial telephone exchange, therapists incur responsibilities, legal and ethical–what’s called fiduciary terms–which are rivaled by few other professions. Take confidentiality, for example. That responsibility, to keep client material private, kicks in before therapists even meet their clients, when they are speaking by phone. Why? Because if I receive a later phone call from that caller’s girlfriend, for example, who wants to give background for a prospective therapy, contribute to the intake process, it’s not as though I can exchange information with that person. In a first session, in which a client may be deciding if there is a connection, a therapist must make certain assessments: is the person in danger? Is psychotherapy even appropriate for them? Are they suicidal, a danger to others, and what are the recommendations for other treatments that will best serve them? This is not a feeling out process. It is work; it requires years of education and training, and it’s not free.

Free consultations, a kind of coupon therapy, does occur in our business, and a therapist may ethically choose to work for a significantly low fee with someone of especially low means, or pro bono with someone who cannot pay at the outset of an episode. But, of course, we can’t do this with many people, and with most the practice is inappropriate, especially if done for business reasons: a teaser of free service, designed to entice customers; ideas borrowed from retail culture. Such gestures can contaminate therapy, creating tacit dependencies that likely undermine therapeutic goals, enabling false understandings as  to the nature of therapist-client relationships.

 

Graeme Daniels, MFT

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New Changes to Child Abuse Reporting Law

Graeme Daniels, MFT 

            In August of 2014, the California legislature passed bill AB1775, which stipulates important changes to the Child Abuse Reporting Act, and was apparently sanctioned by CAMFT(and conveyed to CAMFT membership the same month), despite objections by the National Association of Social Workers, which reasonably argues that AB1775 will stymie therapeutic disclosures and hamper child abuse prevention efforts. This law went into effect on January 1st of 2015. Ostensibly, AB1775 calls for all mandated reporters to report instances of child pornography to authorities, social services or police. Legislative author and state assembly woman Melissa Melendez, who authored the bill (it was actually written by lawyers for CAMFT–The California Association of Marriage and Family Therapists in concert with law enforcement and child advocacy groups), pledges to crack down on child pornography, though the impact of the law is likely more far reaching.

To explain: pre-existing law dating back to 1980 (the once Child Abuse and Neglect Reporting Act, or CANRA law) stipulates that mandated reporters alert authorities to sexual exploitation, material that depicts minors engaging in obscene sexual conduct, through the mediums of film, videotape, negative or slide. The language of AB1775 is updated as followed: “sexual exploitation includes downloading, streaming, or accessing through any electronic or digital media, material in which a child is engaged in an act of obscene sexual conduct.” Meanwhile, Penal code 11165, subsection 311.4 defines obscene sexual conduct as, among other things, “exhibition of the genitals for the purpose of sexual stimulation of the viewer”, as well as lewd and lascivious acts, which are further defined in subsection  288.2 as that which depicts touching intimate parts of the body, including “buttocks of a person and the breasts of a female” (subdivision d). The law further removes the need to observe an “identifiable victim”, as is typically required by social service investigators. Thus, the idea is not to protect victims per se, but rather to capture those who view obscene material, and engage therapists as informants. **But if you work with adolescents in particular, note the word minor (meaning under age 18), the reference to “electronic or digital media” (i.e.: cell phones and computers), and the language of the penal codes, and understand why sexting, for example, is now reportable under the law.

Of course, the issue is bigger than that. A person who discloses to you that he or she looks at teen or preteen pornography, who is perhaps seeking help, afraid they might hurt minors more directly, must be reported to Child and Family Services, who will likely defer to law enforcement investigation due to lack of identifiable victims. As an experienced sex addiction/offender therapist, let me describe the likely fallout: arrest, incarceration, loss of job, estrangement from peers, family, possibly lifelong registry on a public sex offender list. Next, because sex offender treatment is under the exclusive authority of The California Sex Offender Management Board (CASOMB), which certifies providers, YOU WILL LOSE CLIENTS that you report if you’re not certified. Finally, for those who recall the CAMFT Bylaws debacle of 2013, observe that once again CAMFT has co-signed an initiative that will bind its vast membership without actively engaging that membership in the process. Don’t be taken for granted! Discover research by Dr. Karl Hanson, whose work distinguishes child pornography users from child predators (versus conflating them), become educated as to the implications of this short-sighted legislation, and learn through the website, www.stopAB1775.org, how we can block it.

Graeme Daniels, MFT

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