How Many Appointments?

Something I find very interesting is expectations around how many appointments someone will need when they approach the service I work in looking for help.

Referrers sometimes contact us ahead of initial appointments, with an expressed expectation such as “they clearly have a lot of problems, so will need a lot of support”. Clients are sometimes urged by referrers to “stay engaged”, and “maintain regular contact” with our service.

Clients themselves often have similar expectations when they self-refer; “I saw a counsellor all the way through year 11”, “I need ongoing support”.

Health care professionals also sometimes use phrases such as “complex”, “going to need a lot of input/ specialist intervention / intensive therapy”.

In a university setting, all of this happens alongside a general consensus that students need to turn difficulties around quickly and effectively in order to minimise the impact on their studies, or otherwise take a break of several months to a year, the expectation usually being that they will engage with professional help during that time, before returning to try again.

People generally know I’m a mental health nurse, sometimes know I’m not a counsellor, may have noticed my job title (‘wellbeing advisor’), may know I’m a solution focused practitioner if anyone’s mentioned it to them, but don’t often accurately know what to expect.

Three appointments or less seems pretty typical for any client seeing anyone working in our service. I recently did some number crunching and discovered that over the past year during which I have been applying the principles of Solution FocusedScreenshot_20180607-174607 Practice to my work, for clients who only I’ve seen, the average amount of appointments per client has been 1.8. This compares to 2.7 for the previous year, before I had received any training in Solution Focused Practice.

When I tell referrers and clients that most people see me once or twice, occasionally three or four times, it’s often met with surprise. Comments such as “Oh! Will I/they be able to see someone else afterwards?” or “would it be possible to see you more times than that if necessary?” abound. I usually explain they’re more than welcome to, but probably won’t need to, statistically speaking at least. I also assure them that it is absolutely no reflection on them if they do need to. If anything, it’s more a reflection on me! In reality it’s probably for all sorts of reasons.

Sometimes I see people for a lot longer. Even then, I regard every appointment as potentially the last. My preference is to imagine them living their lives doing the things they need to in order to achieve their best hopes, rather than sitting in my office talking about it!

Often people arrive for their second appointment and tell me something significant, miraculous even, has happened (to which my usual response is along the lines of “what did you do to bring this about?”). Occasionally, at the end of the first appointment people tell me they don’t feel they need another, and talk about being able to think more clearly, knowing what they need to do, feeling understood and accepted, feeling confident that they can get through without professional help. Comments such as “I haven’t felt like this for a long time”, “I feel like I’m back on track”, “I’ve remembered who I am” are commonplace.

How do I achieve this? The simple answer is that they achieve it, and I allow them to. My part in it is to ask carefully chosen questions for which there is no wrong answer, and the answers are the key to things getting better for them.

Perhaps as time goes by, expectations will change.

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