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You might wonder why therapists need tips about self-care. After all, we’re supposed to know all about coping with stress, to have lots of techniques at our fingertips, and (most of all) to have a dream job helping others which is fulfilling and satisfying. All that might be true, but therapists can be tempted to put other people’s needs before their own, and sometimes they need to stop and take stock. After all, as every airline tells you, you put your own oxygen mask on first so you are in a fit state to help others.

Why therapists need self-careJohn Duffy, PhD, a clinical psychologist and author of The Available Parent: Radical Optimism for Raising Teens and Tweens, defined self-care as “attending to your own needs such that you are content, focused, motivated, and ‘on your game.’” That goes for therapists as well as parents.

Therapists can care just too much, (see my other blog on ‘why your empathy can get you down’) and are at risk of ‘burnout’ which basically means you are so overloaded emotionally you simply can’t cope any more.

At the other end of the scale, they can cope by compartmentalising so much that they don’t empathise with clients at all. As in any job dealing with people in distress, a bit of detachment is necessary so you don’t get so caught up in your client’s point of view that you can’t help them look at things differently. But too much is counter-productive.

Self-care helps you avoid both of these extremes, staying empathetic and engaged without becoming overwhelmed. So here are our top tips.

Self-care for therapists 
  1. Accept that your self-care routines are as important as doing your accounts, seeing clients and answering the phone. Schedule time for them in your diary, and ditch any guilt or doubts about prioritising your own needs.
  2. Set specific hours during which you are available to clients, and be strict with yourself. Have a separate phone for work which you switch off every day, and if someone genuinely can’t attend during your usual client hours, consider adding an ‘out of hours’ fee to your usual price.
  3. Set clear boundaries. Let clients know under what circumstances, and how, they should contact you between therapy sessions. Needing to change or cancel an appointment is obviously OK, but daily updates, calls and questions (unless you have agreed to this as part of the therapy) are too much. If frequent between-session contact is part of your therapy, make sure you factor it in to your working hours (and hourly rates).
  4. Get a good supervisor or support group who can be there for you through your victories, moments of doubt and personal crises (we all have these, we’re people as well as therapists). I'm happy to recommend supervisors if you don't already have one. .
  5. Get organised. Use time management protocols like this one so you know what you can realistically take on and what you should either hire someone else to do or turn down.
  6. Talking of which, outsource if you can, especially time-consuming jobs or the ones you don't enjoy. For example, when I went full time, I hired a cleaner. Two extra client hours per month - which I enjoy more than cleaning - pays her wage.
  7. Use relaxation techniques regularly. It’s always good to use the self-care methods you give your clients but, for some, it can overlap too closely with work. For example, I often find myself analysing someone's voice and delivery if I listen to a relaxation audio, although my clients love the ones I give them. If that's you as well, look for alternatives e.g. going for a massage if you’re a hypnotherapist.
  8. Quality of self-care can be more important than quantity. Ten minutes with a book, playing with your kids or dog, chatting to your partner or friends, watching 'mindless' TV, or walking around the block will boost your emotional batteries.
  9. If you worked for someone else you would have around four weeks holiday a year. Take holidays from your therapy too, and don’t answer work calls or emails while you are away. It’s what vacation responses and answer-phones are for.
  10. Since I’m writing in December, make it one of your New Year Resolutions to improve your self-care. If you’re reading this at any other time of year, pick a date and make a resolution anyway!
How to improve your self-care routinesAs you probably tell your clients, it can be hard to make too many changes at once. Then you end up giving up the whole thing in disgust and not making any changes at all.

Pick one of two of the ideas above and put them in place right now. Start with the easiest.

Then, each month, add another or improve the ones you already have (e.g. number 8 - take fifteen minutes a day for yourself instead of ten) until you are confident you are taking care of yourself as well as you take care of your clients.



If you have enjoyed this article, please use the share buttons on the grey bar (below the author details) to share it with others who might enjoy it too. Thank you.



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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook,both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision
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Many therapists are taught to work with SMART goals – in case you aren’t familiar with this, it’s a mnemonic and stands for Specific, Measurable, Achievable, Relevant and Time-limited. As far as therapists go, it’s a really good system which allows you to understand exactly where the therapy is going and to recognise when you get there. But as far as motivating clients goes, it can be a bit dry.

A client’s goals should be something they really, really want (to quote the Spice Girls). After all, they have contacted you to make life better. And something like ‘I will reduce my average daily calorie intake by 10% this week by cutting out cake and beer’ is more like a statement of fact than anything terribly exciting.

Building better therapy goals

So, if SMART goals are good for us but not so much for our clients, how can we build exciting and relevant goals for our clients to work towards? How can we use these to motivate them, and help them understand the ripple effect where making one small change can reach into many areas of their lives? This is definitely true by the way. I once had a client who, six months after getting rid of a phobia had taken up golf, lost weight and re-decorated her home – all things on her ‘to do’ list for a long time. Dealing with one issue gave her the mental and physical energy to tackle the rest.

I recently spoke at the 2018 UK Hypnosis Convention on this subject and showcased a protocol called Goal Modelling© which was developed by my husband and myself from a method used at Cranfield University to manage change within businesses. Now you might ask, 'Why is managing change within a business relevant to my clients?' Good question and I have an equally good answer (I hope).

Dave and I realised some time ago that we actually do very similar work, although I may have the easier version of it. He helps large organisations implement change. Within that environment, change is often decided upon at the highest levels but implemented by those who are closer to the 'shop floor' - the customer-facing teams and their line managers. If they don’t see value in the changes, especially if they feel that change has been 'imposed' on them without much consultation, they tend not to be motivated to put the new ideas in place or make them work. This is where Dave comes in - he helps management to analyse if the changes are the right ones to make, and staff to understand why they will benefit by making it work.

My clients come to me already motivated in many cases. In fact, many therapists would think twice before working with someone who says the only reason they want to change is that 'someone else decided I need to do this'. But even motivated clients benefit from understanding all the different effects the changes they’re implementing will have.

The Goal Modelling Protocol ©

The Goal Modelling protocol says that change has three results:
  • The features– the practical stuff that happens because you've made the change
  • The outcomes – the things that happen as a result of the features
  • The benefits – what the client actually gets out of the features and outcomes.
To give you an example, let’s say your client wants to stop smoking to improve his health. You ask for an example of improved health and he says ‘I could play football in the park with my kids without gasping for breath’. This could be something you’d use in your sessions, but we can do better. Look at this:

  • A feature of quitting is improved lung capacity, that happens for everyone
  • An outcome of that (for this client) is that he can play with his kids more easily
  • The benefit means taking this even further and saying why is that a good thing? What will playing football with your kids do to make life better? Most likely the answer will be along the lines of ‘Our relationship will improve’ or ‘We’ll have more fun together’. That’s the benefit and that’s also the client’s real goal. Quitting is just the way he’s going to get it.
So the SMART goal is your goal, as a therapist: it’s what you want to achieve within the therapy. Your client’s most compelling goals are the benefits he’ll get after that. 

Goal Modelling can help you identify the client's most desirable outcomes, and will also give you lots of information on which to base very compelling suggestions for your session. So both you and the client benefit.

If you are interested in learning more about this approach, there will be a CPD workshop available from 2019. In the meantime, I am happy to come and talk to peer support or supervision groups, schools etc. You can email me at debbie@cpd.expert to find out more.


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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook,both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision
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Whatever kind of therapy you offer your clients, it would be hard not to be aware of mindfulness which has become a popular intervention in pretty much every well-being approach. So what’s all the fuss about, and should you be using it with your clients?
 

What is mindfulness?Mindfulness is about being ‘present’ – aware and non-judgementally focussed on what is happening in the moment. It arose from Hindu and Buddhist spiritual practices, but over time has become secularised and separated from them so that it is acceptable to those who follow other religions, or none at all. In fact, part of its appeal to some people is that it can be used as a practical stress management tool without carrying any of the emotional or spiritual ‘baggage’ often attributed to meditation and even self-hypnosis.
The value of mindfulness
Mindfulness is now so popular it has become big business – the Global Wellness Institute values the industry at $3.72trillion and the top mindfulness app, Headspace, has been downloaded more than eleven million times, giving it an annual revenue of £50million.
 
Does mindfulness work?
For many people, yes it does. Here are just a few findings about it:
  • Mindfulness increases pre-frontal cortex activity in the brain, essentially ‘turning down’ the stress response
  • An 8-week course of Mindfulness Based Stress Reduction (MBSR) lowered the level of the stress hormone ACTH and inflammatory protein molecules by around 15%
  • In another study, those using MBSR showed an increase in grey matter in the brain in areas associated with learning, memory and emotional processing
MBSR has also been used to improve chronic pain and fatigue, depression, anxiety, life-stress, psoriasis, cancer, executive control (problem-solving skills), weight loss, and smoking cessation results.
 
Mindfulness and therapists
There is evidence to suggest that therapists can benefit from using mindfulness as well as their clients. You can probably guess at most of the benefits, such as avoiding stress and burnout, and increasing concentration, compassion and empathy. But there are also specific benefits, such as being able to listen to clients mindfully or coping with your own reactions if your client is describing something emotional or distressing; some research even shows that therapists who practice mindfulness are rated more highly than those who don’t for warmth or understanding.
 
Mindfulness and therapy: how can mindfulness help my clients?
Mindfulness training talks about the difference between ‘mindless’ and ‘mindful’ behaviours. When you are acting ‘mindlessly’ you are not really paying attention. Think about driving, for example, and how easy it can be to take a wrong turn because it’s the way you usually go. You can experience automatic negative thoughts and feelings like this too.
 
The opposite of this is to act ‘mindfully’, becoming aware of our reactions as they happen, so we can learn to accept or control them, or choose to react differently.
 
For clients, mindless behaviours are those which they’re carried out so many times that they’re no longer really aware of doing them – the kind of situation described as being on ‘automatic pilot’. An example might be snacking, where your client comes home from work, checks her phone in front of the TV, and simultaneously finishes a huge bag of sweets without really noticing how many she’s had.  Snacking mindfully, on the other hand, would mean she:
 
  • rates her hunger level, and confirms that the feeling she’s experiencing is hunger and not something else (e.g. boredom, tiredness, a need for comfort)
  • removes distractions from the experience of eating (turns off phone, TV, etc)
  • eats slowly and chews thoroughly, rating her hunger levels again periodically
  • becomes aware of how the food affects all her senses – taste, texture, smell, sight, hearing
  • becomes aware of any changes in the sensory experiences as she eats
 
By immersing themselves entirely in the process of snacking, clients will tend to be more aware of how much they have eaten, and when they are full, leading to a reduction in overall intake.
Similar approaches can be used for cravings of all kinds – the best-known approach is RAIN (Relax into the feeling, Allow it to be there, Investigate bodily sensations, Note what is happening from moment to moment).

Would you like to know more?There is plenty of information online, but if you would like to have it conveniently in one place, we offer an accredited (level 2) home-study course on Mindfulness for Therapists, suitable for talking therapists of all kinds. This includes links to hundreds of interventions you can use with your clients. You can find out more about the course HERE.
 
 

 

 
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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook,both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision
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Have you ever driven past a new housing estate with a big sign that says ‘If you lived here, you’d be home by now’?
Starting therapy is a bit like that. Most clients who come to see me have had their problem for some time. They’ve lived with it, or around it, or just avoided whatever situation made it worse. To re-frame the sign, if they’d had therapy a year ago, they’d have solved it by now. So what stopped them?

Fear of changeIt’s well known, among those that deal with stress, that change can be stressful whether it’s perceived as a positive or a negative event. Moving house is widely accepted as one of the most stressful things you can do, and it often doesn’t matter whether you’re going from a hovel to a palace or the other way around. It’s the process of change itself that people find difficult.

Why is the prospect of change difficult?Therapy is all about change - it’s why our clients come to see us. So what is it about change that could also be inhibiting the results, or even stopping them from contacting you in the first place?


  • The risk of failure. What if the therapy doesn’t work? Say they come to a therapist to quit smoking, and then they don’t quit? What will their family and friends say? What about the time and money they invested? Maybe it’s easier not to try.
  • They don’t feel strong enough. If your client suffers anxiety or depression, in particular, they often also experience mental and physical fatigue. Doing anything new is difficult because the ‘thinking parts’ of the brain which deal with language, planning and memory are adversely affected as well, so the prospect of changing long-term habits feels like too much effort.
  • Fear of what’s involved. People worry about what the therapy will ask of them emotionally and practically, and what they will have to face. Some assume they will have to reveal - or discover – hidden trauma that they might have preferred to remain hidden.
  • Fear of success. If you have a flying phobia, for example, you know if the therapy is successful your family will want you to go on holiday with them. So if the therapy is successful you'll have to do the very thing you've been avoiding all these years, which is a scary prospect.
  • Wondering if it’s worth it. If your client has never been, confident, slim or a non-smoker they may wonder if it’s worth the effort to achieve their goal. They struggle to imagine life the way they'd like it, and the status quo is familiar even if it’s not particularly comfortable. 
  • Fear of other people’s attitudes. If people find out you’re having therapy, will they think you’re ‘weird’, ‘crazy’, ‘weak’ or even ‘laughable’? If you’re overweight and want to trim down, for example, will you have to go to a gym class where everyone else is slim and will mock your lack of fitness? 


How can you help your clients deal with change?Am I blaming the client for their failures here? No, absolutely not. Some of the processes I’ve mentioned could be completely unconscious and the client may not be aware of them. Even where they are aware, your client has legitimate reasons for their fears.

Some of those reasons might stop some people from signing up with you at all. That’s tricky to deal with because you don’t know who they are. But you can assume they exist and make sure that your website and other literature addresses their concerns.

Offer plenty of information about how you work and what’s involved. Offer to answer questions or concerns without a ‘hard sell’. Stress that you offer a confidential service and that your therapy is client-led. Reassure people that life following therapy can be good, but at the same time be honest about whether you are the best person to help, and what the chances of success are.

Once your clients actually become clients, it’s easier.

  • Don’t ignore or dismiss the client’s concerns about change, talk about them openly and look for solutions within the therapy, even if you feel you’ve been ‘side-tracked’ from the original problem for a while.
  • Emphasise that they’re choosing change to make life better, not because there is something intrinsically wrong with them.
  • Set reasonable and realistic goals in terms of achievement and time frame. 
  • Make sure you know why the client wants to change, and how exactly what they think this will do for them. Keep them focussed on those positive outcomes.
  • Don’t expect change to happen at the same speed for each client – work at a rate the client is comfortable with. Chunk down the goals into smaller steps if that’s easier, and build in rewards for each step the client succeeds in taking. 
  • Ensure that you work with the client’s likes and dislikes as much as possible – if your weight loss client dreads going to the gym, for example, find something else to keep them active.
  • Planning is fine, but it needs to be mixed with a certain amount of flexibility - treat every client as an individual.
  • If things aren’t going to plan, discuss this with the client. Why do they think this is? What is getting in the way of progress - and what would help them overcome it?
  • If a client has multiple issues, it's often best to tackle one at a time. All at once can be overwhelming, and increase the likelihood of failing. If you’re not sure where to start, ask ‘If we could change just one of these, which would make the most impact on your life?' 
  • Consider including some work on confidence, especially around dealing with change, in your therapy, no matter what the presenting problem is.



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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi-accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision
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Imposter Syndrome is not really a syndrome at all because it’s not recognised by the medical profession as a psychiatric disorder, but it is a term in fairly common use, and can be associated with stress, anxiety, depression and low self-esteem, so it’s relevant to us as therapists if we’re seeing clients with those issues.

So if Imposter Syndrome doesn’t exist, what is it?Imposter Syndrome is frequently found in ‘high flyers’ and high achievers – those who have done really well in life and shouldn’t, at least on the face of things, have cause to doubt themselves.

Despite very real evidence that they are successful, those with imposter syndrome will feel inadequate and insecure. These feelings lead them to worry that, somehow, their success is not real, but the result of luck or coincidence, and that therefore the credit given to them by others is undeserved. Some people feel that, through this luck or coincidence, they have inadvertently deceived others into thinking that they are better at life than they are. All live in constant dread that one day ‘the truth will out’ and they’ll be discovered and shunned by friends, relatives or colleagues who will realise that the whole façade was a fraud.

Who suffers from Imposter Syndrome?It’s thought that 70% of us will experience Imposter Syndrome at some point in our lives. Valerie Young [1], basing her ideas on the work of psychologists Pauline Rose Clance, PhD, and Suzanne Imes, PhD, says that there are five main ‘competence patterns’ which can lead to this feeling:

  1. The Perfectionist, who sets excessively high goals for themselves, then worry if they don’t achieve them – they are rarely happy with success because they always believe they could have done better.
  2. The Superwoman/man, who overloads themselves in an effort to match up to friends and colleagues, who they see as much more effective and skilled than themselves
  3. The Natural Genius, a talented or intelligent person who often excels without much effort and therefore believes that if you have to work at something, you can’t be very good at it. Since they expect to get things right the first time, every time, they constantly feel like a failure if they can’t 
  4. The Rugged Individualist, who feels that asking for help indicates weakness, so they have to achieve everything alone.
  5. The Expert, who feels that because they are recognized as having some knowledge in an area, they should know everything about it. The expert will constantly attempt to shore up their knowledge base and is particularly vulnerable to the fear of ‘being found out’.

Many writers see Imposter Syndrome as mostly based on work and career issues but it can also be about being a good parent, partner, sibling, son or daughter, or even a good person generally.

Have you got imposter syndrome?Do you recognize yourself in Young’s list? You can complete a questionnaire HERE 

You could also ask clients to complete it or, with a bit of research, construct your own questionnaire to give them.

Effective steps to defeating Imposter SyndromeWhether you see Imposter Syndrome in yourself or your clients there are ways to combat it. Exactly how you work with this issue will depend on what type of therapies you offer – hypnotherapy, counselling, psychotherapy, or coaching for example. But I’ve included some ideas.

  1. What patterns do the doubts have – are they there all of the time, some of the time, only in specific circumstances? Do they get more or less intrusive at times? Use diaries, notebooks, or SUD scales with your clients to pin this down.
  2. What thoughts come with the doubts – be as specific as possible. Diaries or notebooks can be useful, and I like to ask ‘when you ‘hear’ those doubts in your head, do you recognize the voice that says them?’ If they do, it can give you ideas about where to take the therapy. And even if they don’t you can try asking the client to imagine it as another voice – one they couldn’t take seriously, like Donald Duck on helium gas. 
  3. What feelings come with the doubts? Where are they in your body? What name would you put to those feelings – fear, doubt, sadness, anxiety, depression or something else? (I’ve suggested a few ideas here, as examples only. Use clean language with your clients to find out what it is for them.) You will have techniques of your own to deal with whatever feelings the client identifies.
  4. Identify what the cause of the doubts is. Be as specific as possible. Is it a comment someone made, a new job title – what thoughts are involved? Any therapy techniques you know for identifying the source of negative thinking will help here, including parts work or regression.
  5. Challenge the doubts using any techniques you would use with other types of anxiety or negative thinking. 
  6. Help to identify and reduce whatever unreasonable demands the client is making on themselves, (it’s fine to shoot for excellence but perfect is rarely achievable), boost confidence and self-esteem, alleviate depression and anxiety.
  7. Help the client to focus on more positive thinking, and to recognize their own accomplishments. Point out that Imposter Syndrome is a sign of success – otherwise, they would have nothing to feel they have deceived people about. Ask them to make a list of five things they do well, or that they like about themselves, and start there.



[1] Young, Valerie. (2011). The Secret Thoughts of Successful Women: Why Capable People Suffer from the Impostor Syndrome and How to Thrive in Spite of It Crown Business: United States.


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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi-accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision
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I am sure that you regularly think about your clients and how to help them but do you ever think about 'customer care' in a more business-oriented sense? No? You are not alone. Google 'customer care for therapists' and most of the sites that come up are aimed at physical therapists rather than psychological ones. But we are business owners, and it's something we need to consider. So, with that in mind, I thought I would share a story about customer care.


A story of customer careMy youngest daughter recently had a very unpleasant experience. She had been for a late evening gym session and, as she got changed, all the lights went out, leaving her in pitch blackness. Making her way out of the changing room, she discovered that all the staff had locked up and gone home.

She tried the door, which set off the burglar alarm, but she couldn’t get out. The gym was inside a shopping complex, but no-one from security came to investigate the alarm. She had no phone signal to call us, and there was no note of the security office number anywhere on reception; she finally dialled 999 using the gym's desk phone. The Police rang the security office and eventually, the guard turned up to open the door; altogether, she was trapped for 20 minutes with the alarm blaring loudly the whole time.

Naturally enough, she was very distressed. After a few health scares, she had begun to exercise to help manage her anxiety, and this experience had brought about a full-blown panic attack. The security guard’s response, as he left  her just outside the gym door to make her own way home, was ‘I don’t know why you’re still upset, you’re out now!’

She put in a letter of complaint and received an offer of compensation - a few free personal trainer sessions - which she was happy to accept. Unfortunately, they never materialised.  The trainer never got in touch as promised to arrange them, and they weren't added to her account so she could book them herself. After chasing them for a couple of months, she was forced to escalate things to Head Office and cancel her membership. So, an opportunity - and a previously happy customer - lost.


What is customer care?This got me thinking a lot about customer service, which is not just about providing effective therapy, or even dealing with complaints – it’s also about looking after customers (clients) well so that complaints don’t arise in the first place. And that means the practicalities as well as the therapy.

In my daughter's case, for example, a simple check by the last member of staff to leave (to make sure that everyone had gone) would have avoided the whole catastrophe. That was probably missed because it had started to snow, and no doubt those concerned were thinking about the weather, and their journey home. That's understandable, I suppose, but it shows how important a moment's inattention can be.

And, while you might never have been careless enough to 'incarcerate' a client, what about those small checks that you can do before you part? Is your attention on the client that's still with you, or the next one? Or even on your journey home?


Customer service tips for therapistsHere are my top tips to ensure your customers (clients) are happy with your service.

1. If you work with hypnosis, remember that immediately after trance clients may still be in a heightened state of suggestibility. It’s a good chance to get in a few waking suggestions or to summarise what you feel they’ve achieved this time. It can help to ensure that they leave you feeling amazing and looking forward to coming back.

2. Don’t let clients feel they are being rushed out of the door once they have paid! Asking if they have any questions or feedback on the session can alert you to any concerns they might have which can be rectified immediately if possible, or scheduled for discussion next time.
It can be a daunting process, especially if you're newly qualified or dealing with an issue for the first time, but feedback - even of the negative variety - is part of the process. It's better to know if the client feels things are not going as planned, so you can adapt your approach.

3. Give clients an opportunity to give feedback if they wish after the therapy is finished, perhaps through an online form. Make sure you read and respond to all feedback.
Reach out and thank the client if it’s positive.
If there are complaints or criticisms, respond without getting defensive. Consider if the comments are justified (especially if you get similar comments more than once). If they are, can you improve things next time, or for others? If not, ask the client to expand on what they’ve said, or give an example of what they mean. There may be a genuine misunderstanding you can clear up.

4. Be easy to contact, within reason. Most therapists work by themselves so being on call 24/7 isn’t healthy for you, or possible. But think about using automated responses on emails and social media, and a personalised voicemail message, so let clients know their message has been received and when they are likely to get a response.

5. Treat your client as you would like to be treated yourself, if your positions were reversed.

I hope this helps you, and would love to know your top tips for customer care. Please post them in the comments box.



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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision
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Many successful therapists will tell you that they get a significant number of clients via 'word of mouth' referrals, meaning that new clients are referred to them by previous ones. It’s a great system since it means someone else is doing your marketing for you - and for free - but when you’re new or trying to build your business it can be a challenge to get the ball rolling.
So this month I thought I would cover some tips to help you increase the number of word of mouth referrals coming into your practice.

 
Why don’t you already get 'word of mouth' referrals?
 
  • You assume satisfied clients will automatically recommend you - even though they rarely do.
  • You feel uncomfortable asking a client for help - you’re a therapist not a high-pressure sales person.
  • You don’t want to look as if you’re desperate for clients.
  • You worry there might be confidentiality issues around asking clients to tell people they have been to see you.
Regarding that last point, we must absolutely be respectful of confidentiality, of course. Similar worries lead some therapists to avoid ratings sites or testimonials, both popular 'word of mouth' type promotions in other fields.  
However, there are plenty of things you can do to increase referrals that respect your clients' privacy. So expand your comfort zone a bit - and take action!
 
 
Why are word of mouth referrals worth having?
 
  • 75% of people don’t believe advertisements, but 92% believe brand recommendations from friends
  • People are four times more likely to buy when referred by friends
  • Word of mouth generates twice as many sales as paid ads  [1]
 
Practical ways to get therapy client referrals
 
  1. Ask your satisfied customers. At the end of every successful course of therapy give your client two or three business cards; 'one in case I can help you with anything else in the future, and the others to pass on to anyone you know who might benefit from working with me'. This doesn’t put pressure on the client, they could throw the cards away as soon as they get home if they want to. But it does let them know you are willing and able to accept referrals.  
  2. Ensure you provide excellent customer service so clients think you're worth referring to - not just the therapy but a friendly and informative website and timely, efficient responses to telephone and email enquiries. 
  3. Answer questions openly and honestly. The highest number of referrals I ever had from one individual came from someone I didn’t ever work with. I was newly qualified and felt I didn’t have the right experience to work with him so I referred him on to someone who did. He kept telling people 'If she can’t help, she'll say so' and referred about a dozen people my way: I worked with all of them successfully.
  4. Public speaking can help people become comfortable with you. I used to chat to WIs and similar groups. Overt advertising was frowned on, but they were quite happy for me to leave a supply of leaflets on the table. Members often passed them on to members of their families. 
  5. Thank people who do make referrals: maybe even offer a free top-up or relaxation session if they send you a lot of work. Remember confidentiality and don’t mention the name of your new client in your thank you note, call or text. This could be via a specific programme (make 5 referrals and get a free session) or more informal. 
  6. Consider a reciprocal agreement with someone who provides a complementary service to your own. If you're a hypnotherapist who works with weight loss clients, for example, you might recommend your clients to a personal trainer, who in turn refers their clients to you. If you work a lot with stress or anxiety, set up an arrangement with someone who does aromatherapy massage, and so on. 
  7. If you're a specialist, network with other therapists and let them know you are an expert. Be explicit (but not pushy) about accepting referrals if they have a client outside their own area of expertise.
 
Effective ways to ask for therapy client referrals
 
Remember that you’re not just a therapist, you’re a business owner as well and that means promoting yourself. Asking for referrals in the right way doesn't make you look desperate or pushy, just professional.
  • If it’s hard for you to ask, remind yourself that the worst that can happen is the client says 'No'. If that happens, plan a response which makes it clear you are quite happy to respect their preferences. Avoid arguing or making flippant remarks like 'Oh well. Worth a try.' 
  • Don't ask for referrals just as you're taking money from the client. Separate the two things.
  • Ask face to face, don’t send an email or text after the client has left your office. It's more respectful and they’re more likely to say yes. 
  • Avoid putting undue pressure on clients by leaving them free to decide whether or not to act on your request. For example, at the end of every successful course of therapy give your client two or three business cards; 'one in case I can help you with anything else in the future, and the others to pass on to anyone you know who might benefit from working with me'.
 
 XX


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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook,both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision XX




 


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The simple answer is that yes, some of them do. Maybe even most of them, although, of course, there's no real way to tell. Or is there? 
 
A study of 547 clients done by Blanchard et al [1] showed that around 93% of them had lied to their therapists, on issues ranging from minimising the extent of their distress, exaggerating how well they thought the therapy was going, and hiding information even if they were asked a direct question about it. Martin [2] found that of  109 psychology students undertaking therapy, 37% admitted to lying.

I suppose the real questions is why that might happen, when you're in a place to offer them help, and lies, half-truths and omissions might get in the way.
 
 
Ten reasons that clients might tell lies to therapists
 
  1. To avoid confrontation or upsetting the therapist - for example, saying you think the therapy isn’t helping can be difficult
        
  2. Editing - to simplify or streamline their story: it can seem easier just to say 'no', especially if they believe the information is irrelevant to the presenting issue
        
  3. Denial - admitting the true extent of their alcohol intake, for example, would impact on their self esteem or self-worth, or mean admitting that their drinking is out of control
        
  4. Lying may be a self-protective or attention-seeking strategy they have used for years, and they find it difficult to stop
        
  5. To protect or avoid criticism of someone else, for example saying their partner is supportive, when they are actually disapproving / unaware of the changes the client wants to make
        
  6. To avoid the consequences of the truth - fearing that the therapist might judge them, or even refuse to work with them if they reveal something shameful or embarrassing
        
  7. Lack of trust - the relationship with the therapist doesn’t (yet) allow them to feel safe enough to reveal the truth, although they may do so later on
     
  8. They are afraid the therapist will go to the authorities instead of keeping the information confidential. This can happen in some cases under the Duty of Care provision, of course, although it’s relatively rare
        
  9. They’re afraid of the therapist putting pressure on them to have additional sessions
       
  10. They're giving the answers they think you want to hear
 
 
 How to help your client share anything
 
  • Offer unconditional positive regard, no matter what your client says, feels or has done; make your sessions a safe place to be vulnerable
          
  • Accept that sometimes it takes a while for the client to feel safe enough to reveal certain truths
       
  • Don’t become upset or judgemental if it becomes obvious your client has lied: if you feel you need to point it out, explore with them why they might have done so
       
  • Help them to develop more positive coping strategies
         
  • Don’t be afraid to ask direct questions, even about things you think the client may find difficult
     
  • Help them to face the truth if they are ready, accept that sometimes they’re not
       
  • Offer other ways of sharing information than simply talking to you - for example writing things down, or drawing them
       
  • Ensure they are aware of exactly when you are required to break confidentiality (under the Duty of Care) and when you are not
       
  • Never put undue pressure on your client, or unnecessarily extend the number of sessions they need
     
  • Use clean language and never suggest that there's a 'right' or 'expected' answer to your questions
 


If you have enjoyed this article, please use the share buttons on the grey bar (below the author details) to share it with others who might enjoy it too. Thank you.



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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook,both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision




References for this article:

 

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This is a topic that comes up regularly on social media and in discussion with other therapists, so I thought I would look this month at the issue of 'no shows' - clients who fail to turn up for their appointments, without giving you any notice.

GoodTherapy.org[1] cites studies which say that 20 to 57 percent of people in therapy do not return after the initial session (Lambert). Another 37 to 45 percent only attend therapy a total of two times (Schwartz), so if your stats are lower than this you may be doing better than you think.

But even so you might want to think about how you want to deal with this problem, to helps things stay on a professional level, and prevent your annoyance at being 'stood up' from getting in the way of your rapport with the client.

Why do clients fail to turn up?
 
There are probably as many answers to this as there are clients who don’t show, but we can make a guess at the most likely answers. For example
  • there is a miscommunication between you - somehow you and the client have different times or days in your diaries, or your cancellation policy hasn’t been made clear
  • they genuinely forget - especially likely if there is a long time between appointments, or the appointment is a different time or day from usual
  • there's a last minute emergency or logistical issue - children get poorly, work turns manic so they can’t get away, traffic hold-ups cause delays
  • the client feels better and doesn’t want to continue therapy
  • the client doesn’t feel therapy is helping - and they may be wary of contacting you in case you try to persuade them otherwise
Some clients will get in touch even if it’s at the last minute, but others don't. Especially in the case of emergencies they are probably too caught up in their situation to think of contacting you.
 
How should you respond?
 
How you deal with this situation probably depends on a number of factors, such as
  • if you pay for your room by the hour, whether or not the client turns up
  • if you have a waiting list, made longer by frequent no-shows
  • how often you get clients who don’t turn up
  • how much it bothers you
  • why the client didn’t show up
But here are some ideas.
 
Communicate clearly
  • Make sure your terms and conditions clearly state how much notice you need for cancelled appointments, and what payment is due if you don’t get it. Ask every client to sign a copy for your records, and give them a copy to take copy home.
  • Remind them verbally as well when you book the next appointment.
  • Make regular checks on how well the client feels things are going, and how happy they are with the therapy.
Prevention can be better than cure
  • Write everything down - don’t rely on your client's memory, or your own.
  • Consider a routine text, call or email to remind the client they are coming, and asking them to contact you if they are unable to attend. One study showed a 25-28% reduction in missed appointments by simply using text-message reminders! [2]
  • Consider taking a deposit or full payment when you book an appointment, so at least the cost of your room is covered.
Have a system to follow if people don’t show up
          For example,
  • If the client is ten minutes late, send a text  along the lines of  'I have you down for an appointment at [time] today - are you on your way?' As this is friendly and non-confrontational, in genuine cases of misunderstandings, forgetfulness, or emergency they'll get back to you and you can go from there.
  • If you don't hear from them after 24 hours invoice them for the missed appointment, referring back to your terms and conditions. (A short delay allows the client time to get in touch with you if they're going to, even in a genuine emergency.)
  • If this isn't paid, send a reminder which tells them you will consider legal action if they fail to pay this time. Whether you actually do this is entirely up to you - sometimes it’s easier to just write it off - but it's simple and all done on line now if you want to follow through.
Yes, this is tough, but it's fair and professional. It’s likely the client will not want to work with you again if you threaten legal action, but as they have already ignored two reminders that's on the cards anyway.
I sometimes waive non-attendance fees in cases where the client has genuinely forgotten or had a problem on the day, but many clients offer because they are aware of my cancellation policy.
 
Persistent non-attenders
  • Think about why the client has recurring problems getting to appointments. Is it linked to the reason you are working with them? Do they have motivation issues, emotional or physical difficulties leaving the home etc? If so, you may need to address those issues before things improve.
  • It might help to offer appointments at a different time or on a different day of the week, or to ask them if they can set up a 'buddy system' with a friend who can help them arrive on time.  
  • If you feel the client isn’t able to prioritise or value the therapy enough, it may be best for you to part ways. Discuss this with them directly, and perhaps offer a referral. If the two of you decide to continue, ask them to pay for sessions in advance, even if this isn't your usual policy.
  • Use reflective practice and/or supervision to  decide if you could change any of your routines to help prevent this happening again.

And a final tip, always have something with you that you can do if a client doesn’t show. Brainstorm blog titles, answer some emails, or even just play scrabble on your phone. It will do wonders for your stress levels if you don’t feel the time was 'wasted', and you'll be calm and collected when the next client arrives.

Please do post below if you can suggest other ways of dealing with this issue - I’d love to hear them.





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[1] https://www.goodtherapy.org/blog/why-do-clients-leave-therapy-prematurely-0627137
[2] http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201100211

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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook,both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision
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'Compassion fatigue is caused by empathy. It is the natural consequence of stress resulting from caring for and helping traumatized or suffering people'
Dennis Portnoy [1]
You might also find compassion fatigue referred to as 'Caregiver Fatigue', 'Vicarious Stress' and 'Secondary Traumatic Stress', and it most often appears in those who help others, provide them with support and/or listen to their upsetting or traumatic stories.
Compassion fatigue is not an illness or a medical condition, it's more a set of signs and symptoms which happen because of your circumstances, and how effectively you cope with them.

Compassion fatigue is thought to have three main elements and it’s how they interact that can cause problems. The elements are:

  • job satisfaction - the joy and positivity you get from doing your job well
  • exposure to risk - how often you are exposed to people's problems, and how severe or traumatic these are
  • stress levels - partly those from your job (including exposure to risk, above) but also family issues and problems which have an effect on your wellbeing

Essentially when the three elements are balanced, you have all the resources you need to cope with the demands that life has placed upon you. Generally things are pretty good. But if your pleasure in helping people is undermined for some reason, or your risk or stress levels increase, there is an imbalance. Over the short term this might be manageable, but if it persists, it will start to impact upon both your physical and emotional health.
 
Symptoms of compassion fatigueThese can include
  • physical and emotional exhaustion or feeling overwhelmed
  • sadness, anxiety, fearfulness, depression, anger
  • poor concentration, memory and/or sleep patterns
  • feelings of detachment and/or persistent negativity
  • physical illness, such as headaches
  • avoidance of situations we perceive as being difficult to cope with
If you are a therapist who deals with stressed, depressed or anxious clients you'll probably recognise this list. What it shows is that you are not immune to the pressures and stressors that affect your clients. Accept it - you are only human.
 

Risk factors for compassion fatigue
 
Those most at risk are
  • perfectionists
  • those who consistently put others' needs before their own
  • those who have low levels of social support
  • those who have high levels of stress in their personal lives
  • those in the caring professions
Up to 85% of healthcare workers, 25% of ambulance paramedics, 34% of hospice nurses, and a 2011 study showed that up to 72% of mental health professionals working with Hurricane Katrina victims suffered anxiety or other symptoms of STS[2].

Although I couldn't find any specific figures for hypnotherapists, it seems reasonable to consider that they come under the 'caring professions' and are at risk.  
 

Compassion fatigue: prevention and cure
As you might have guessed, there is no 'cure' as such, but stress management and relaxation techniques plus effective self-care programmes help in reducing and preventing the symptoms. These include breathing exercises, guided meditation, self-hypnosis and exercise. You also need to establish firm professional boundaries and an effective support network.

Of course, having an effective support network when you offer a confidential service to your clients can be tricky. You can’t come home and unload about your day to your family or friends, as most people can. In this context, a support network has to be professional and that means good supervision throughout your career. Although supervision is often thought of as 'where you go when you don’t know what to do', it should also (among other things) ensure that you have self-care protocols in place and that they are working.
  

Tips to help therapists avoid and reduce compassion fatigue
  • Be aware of how you're feeling and accept that you might sometimes need help
  • Recognise your stress triggers, at home and at work
  • Use the good advice you’d give to a client in the same situation
  • There's nothing wrong with having high standards or seeking to improve things, but accept that now and then you need to give yourself a break
  • Keep work and home separate
  • Set time aside for yourself, do something you enjoy regularly
  • Look for practical solutions to difficult situations and put them in place; get help with this too if you need it
  • Delegate, and learn to say no (if you need help with this, ask for my information sheet on how to gracefully say no - and mean it)
  • Be realistic about how many clients you can help at times when your stress levels at home are high, and vice versa
  • Get a good supervisor and use their services regularly
Resources:
  • I run a facebook group where therapists can swap their skills with other local therapists to improve their self care regimes.
  • Need a hypnotherapy supervisor? - I offer supervision in person or by phone all over the world, or if you're looking for someone local to you, please ask me for a referral.
  • Want to be a hypnotherapy supervisor and offer support to others? I offer accredited training which will help you offer the best service to your supervisees

 
References:
[1] Portnoy, Dennis (2011) 'Burnout And Compassion Fatigue: Watch For The Signs' in Health Progress July - August 2011 pp. 46-50 on http://www.compassionfatigue.org/pages/healthprogress.pdf
[2] cited on https://en.wikipedia.org/wiki/Compassion_fatigue


If you have enjoyed this article, please use the share buttons on the grey bar (below the author details) to share it with others who might enjoy it too. Thank you.



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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook,both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision
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