If you read last weeks blog (and I KNOW you did) you learned about the struggles some of my clients have with moral issues. Turn about is fair play, so here’s a dilemma I deal with.
I’ve been seeing a client for several months and she’s made terrific progress. She’s handling her emotions well, she’s resolved her conflicts, she’s back at work. She really doesn’t need my help any more, but gosh darn it, she always shows up and is always eager to make another appointment. And I’ve got bills to pay! Do I keep her on, or let her know that we’re done for now?
Here’s another. I’ve been seeing another client for several months and he’s made no progress whatsoever. But he does show up and I’ve STILL got bills to pay. Do I keep seeing him or refer him to another counselor?
Well, the answer to both questions is that I’d have to let the client go despite what it does to my bottom line. It’s what a responsible therapist does. If months have gone by and you’re making no progress with a client, you have to ask the question, what is he getting for his money? Or rather, what is his insurance company getting for its money? That’s the kind of thing you might have to explain later on to a licensing board, so you’d better have a darned good answer.
Likewise, when it gets to the point that my client and I are just talking about politics and trading recipes, its time to cut things off. It is not ethical to be a “paid friend” even if someone is more than happy to pay the bill. I’m not in the escort business, even though it pays better. (Or so I’m TOLD.)
Of course, this begs the question, how do you determine if someone is “getting something out of” our sessions? That can be tricky. For a very depressed or anxious client, just getting out of the house to see me once a week can be therapeutic even if all we do IS talk about the weather. And just knowing that you HAVE an appointment with a therapist makes most people feel better.
Besides nobody is in crisis ALL the time (thank God!). So maybe we have a couple of sessions where nothing really happens, but then all heck breaks loose for my client. It can be a real source of strength for him to know that he’s scheduled to see me in a few days and he can deal with everything then.
So the dilemma continues. And (drat this moral compass!) I’m going to keep doing the right thing no matter what it costs me.