April 17, 2025 • 24 mins
Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.
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Episode Transcript
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Speaker 1 (00:32):
Thank you, okay, I am logged in.
Hey, I'm Dr Kate Walker andtoday we're talking about
questions that you can ask yourclients so that they may not
come back, and I'm with JenniferMarie Fairchild who's going to
ask me tough questions.
Like you mean, I pissed themoff, which is a good question.
(00:54):
No, no, we're not going to pissthem off.
We're not going to do it onpurpose.
But thank you for joining.
I'm so glad you're here so wecan bounce these ideas back and
forth.
Yeah, so you're ready to letpeople in?
Yep?
All right, let's do it.
All right.
So questions that can help yourclient get better immediately.
(01:20):
So that sounds like I'm sellingsnake oil, and Jennifer and I
were talking about this before Ihit record, because I was like,
oh no, no, we got to do this oncamera Because.
So, jennifer, what do you thinkof when you think of a question
that you can ask your clientand then they may never come
back, like I don't?
(01:42):
Like, okay, did I say somethingto offend them?
But like, what else do youthink of when, when you think
about that?
Speaker 2 (01:49):
I mean when I, when I think a solution, focus, like I
really go back to the basicsand it really is about like that
miracle question, like what,what would your life look like
if I waved my magic wand or hada crystal ball?
What would your life look likeif I waved my magic wand or had
a crystal ball?
And I think for some clientsthat opens the opportunity to
like, oh, I need to go down thispath and work.
(02:11):
But I think for some clientsthey're like either they look at
you like you're crazy, becausethey don't think that their life
will ever look like what thatmiracle solution is, or they
just I guess and it'sunreachable, or they just think
you're silly for even askingthat.
Like if I had a crystal ball,like I wouldn't be here.
So sometimes, yeah, I just kindof go back to the basics.
Speaker 1 (02:33):
I think that's really true and I think part of that
is our fault when we teach it incounselor education programs,
because I don't think a lot ofeducators really believe in a
solution-focused method.
Now, I know there are a ton andmany of my colleagues the
solution-focused conferencescoming up this and believe it or
not, this conversation isn'treally about even pushing
(02:56):
solution-focused, but I think aseducators we're like well, yeah
, you could ask themsolution-focused questions, but
for real counseling you've gotto go deeper, right?
And so this is where I want tothrow my disclaimer out.
You know, I'm not talking aboutbeing dismissive.
I'm not talking about pushingpeople out the door who have
complex trauma or chronicconditions or persistent mental
(03:19):
illness.
You know, certainly this is nota one-size-fits-all, and if
you've listened to me or watchedme or sat with me while I
taught a class, I will alwaystell you this is not.
I don't teach band aids.
This is something where if you,if you thought about OK, what
can I ask this client that wouldhelp them see that there is a
(03:43):
path forward, maybe withoutcounseling.
Like, what would that do to meas a counselor?
Like, would I get my feelingshurt?
You know what I mean.
Would I be like right, becausea lot of us even we talk about
this in the Texas counselorscreating badass businesses,
setting client retention ratesas a KPI, and I'm against that,
(04:05):
right, I'm against having andI'm sure I'm going to get
pushback and I welcome it.
As you know, this is a safespace for all kinds of pushback,
but the idea that keeping aclient is a key to, or a KPI
indicating you're beingsuccessful, a key to our KPI
indicating you're you're beingsuccessful.
(04:26):
Of course there is the clientthat's working on their
treatment plan and yay, they'resticking with it and they're,
they're powering through, and,oh my gosh, they're making so
much progress.
But then we also have an ethicalobligation not to overtreat
(04:48):
Right and.
And so I know you've seen thethreads, like I have, and you
know it's, it's tough, it's atough sell to counselors who are
trying to build their bad-asspractices that thrive to say,
yeah, don't worry about how longthey stay right, let's just
work.
Let's work on the marketing,let's work on that 10 minute
consultation, let's work, let'swork on that intake.
So I mean, like if I, if Icould give you a magic well, I'm
(05:09):
not going to say magic wand orcrystal ball, let's take off the
magic we're going to take,we're going to turn down the
sparkle.
What if I could give you aquestion that would make your
client and I'm choosing my wordson purpose that would make your
client better, and you had toopen a counseling practice
knowing that this questionexists that could make your
(05:30):
client better?
How would you feel?
Speaker 2 (05:35):
I feel like that's such a loaded question.
I mean, ultimately you're inthe business to help your client
see progress, whatever thatlooks like, and so if they're,
if they don't, I've had clientswho've had trauma and I've had
(05:56):
clients who didn't have a lot oftrauma.
They had a presenting issueissue Like if I had something
that would help them get betterquicker, as opposed to dragging
it out for the sake of draggingit out, absolutely yeah.
Speaker 1 (06:12):
So, as a business owner right, because you're
going to be a business ownerhere soon you know thinking
about okay, how do I base mybusiness then on this idea of
three or four sessions versus 10or 20 sessions?
Like, how does that and I knowI'm putting you on the spot
(06:32):
right now, but you know how howwould you think about your
business then if, if you, if you, if you really flipped it to
okay, this is, this is how we'regoing to build it, we're going
to count on three or foursessions.
Speaker 2 (06:48):
I think that would change things a lot.
I think it would change yourmarketing perspective too and
the clientele that you target,because you're not going to
market yourself.
As you know a trauma informed,you know deep diving therapist,
because those people are comingto you looking for long-term
care.
I mean I'm not going to say Ispecialize in personality
(07:09):
disorders, because Right.
So I mean I think really Iwould focus more on the
marketing side of things so thatI could keep that constant
rotation and have a consistentclient base.
Speaker 1 (07:25):
That I wasn't stressing, me too, me too
Absolutely, me too, me too,absolutely.
And and it's funny because, uh,when I got into practice, it
was like 2007, 2008, when Ireally really, you know, said,
okay, this is what I'm going todo full time.
And then we had the recessionof like 2010, right, I mean, it
(07:45):
was literally like two yearslater and I was cash based and
all of a sudden, it dried up, itwas gone and I got on EAPs.
I got on like three insurancesand I am just going to own this
about myself.
I'm not cut out to be a personwho files insurance and does
(08:09):
that kind of thing and I endedup getting it was like a
clawback.
It was basically one of myclients who said, oh, guess what
?
You take my insurance now andthey had been paying me cash all
that time I was taking theirinsurance, so they had like a
credit for six months.
It was just.
(08:29):
I remember being a new businessowner thinking, oh, I am
terrible at this, I'm just awfulat this.
And I went to asolution-focused conference and
I don't even think it was afull-blown conference.
There were a lot of peoplethere, but it was really only
two or three days.
I remember listening to thepresenter talk about these
(08:50):
questions and how it could helpclients see a path forward
quickly, and so that was almostlike the I'm going to use magic
again.
It was like a magic momentbecause it was like I needed
something to help me shift mybusiness, because I had to get
(09:12):
out of the insurance business, Ihad to get back into cash and
help me create a business planbased on exactly what you're
talking about, jennifer aresource making sure I was
positioning myself as an expert,making sure that I was a go-to
person when people wanted totalk on this or a talk on that
(09:35):
at the PTO or the Kiwanis Club,and it made my name get out.
And so after a while it wasn'tabout whether this person was
going to stay for one session ortwo sessions or four sessions.
I was full period and soshifting to this model
especially and I'm going to kindof bring it back around to this
(09:57):
idea of finances what we haveseen a lot in the threads in our
groups is the economy'schanging and, with all of these
big companies coming around,it's almost like people who are
used to this time of year beingkind of in a surplus.
They're not seeing it, and itwas a thread recently I don't
(10:19):
remember if it was in the BadassGroup or the Texas Supervisor
Coalition and I thought, okay,here we are right, it's cyclical
, right.
These things go go around.
And now we are in a seasonwhere maybe our clients that we
would rely on with insurance orthat we would say are, are
(10:40):
appropriate for 10 to 20 to 30sessions.
Now they're only coming for afew or not coming at all.
So I thought I'd pull out theold solution focus thing again,
but I'm going to throw in a fewother things too.
So you already kind of alludedto what's your least favorite
solution focus question.
That would be the crystal ballmagic wand.
(11:04):
Back to basics yes, I'm going toread off a few that people
posted in the badass group.
Um, in this moment, what do yousense your body is needing?
Uh, what is stopping you?
Can you remember a time wherethis wasn't a symptom?
(11:27):
Tell me about it.
Uh, imagine how it would look,feel, feel and how others would
treat you if the symptom wasbetter.
How have you managed to make itthis far?
And so is that kind of what youthink of when you think of
solution focus questions.
How often do you feel like youuse them in your practice?
Speaker 2 (11:52):
Depending on the client, because I mean, like
we've talked about, I work at,you know, an IOP and the way
we're structured.
We have interns approval for ayear, so that gives me enough
time to kind of go through thetrauma aspect and kind of like
pull out the deep stuff.
But as we start nearingtermination I shift to solution
(12:14):
focus because I've got I know mytime is limited and I've got to
make sure that they're preparedfor this evidence like
discharge in a couple of months.
So I do switch to solutionfocus, probably about four
months before discharge, andthat gives me a solid give or
take with, you know,cancellations and no shows.
(12:34):
That at least gives me a solidfive to 10 sessions to like.
Is there any lingering thingsthat you want to, you know, work
through what, what, what do youneed so that when you leave
this program you feel equippedto go forth and prosper in the
world?
Speaker 1 (12:51):
So you and the client both have your eye on the exit
door at the same time, you bothrealize that counseling is
coming to an end, and so it'salmost like the counsel or the
the your client is working withyou like, okay, I will play the
solution focused game with youand I will play the solution
focused game with you and I willsuppose and I will imagine
(13:14):
possibilities instead of where Iwas maybe six months ago when I
was still in my trauma and itwouldn't have been appropriate
for back then.
Anyway, right, because theywere nowhere near the exit door,
correct.
Speaker 2 (13:30):
Okay.
Speaker 1 (13:31):
So then this may turn some people on their ear a
little bit, because what we'redoing is we're looking at each
session as the last session.
And I'm talking to you, privatepractice owner.
I'm talking to you, standalonepractice owner, who's not
working in an agency or an IOP.
I'm not talking to you who areworking with personality
(13:52):
disorders and persistent mentalillness.
I'm talking to you, privatepractice owner, when you've got
somebody who's coming to you andthis may be the one and only
time you'll see them right.
In fact, I remember my professorat Sam Houston State University
, my I love this guy Dr Dr Bruin, and he's not practicing
(14:13):
anymore, but he was such aninfluence on me and he told the
class he goes guess what theaverage number of sessions is
for a client and we're allthrowing out numbers and he
looks at us and he goes one oneand I remember thinking, oh my
gosh, that's so much pressure,like I got to hit it out of the
ballpark with this person.
I've got one session, but ithelps.
(14:36):
You think, okay, if this is theday that I work myself out of a
job, what are the words that Ican tell this person?
So that dot, dot, dot, right,and we talk about that in the
10-minute consultation a lot too.
It's like, okay, tell me what Ican expect in the first session
, tell me what I can expect inthe second session, so
(14:57):
solution-focused questions.
But I came up with three more,so I'm going to throw this at
you, jennifer, so do you askmedical questions in your intake
?
Speaker 2 (15:10):
Ask medical questions in your intake, so like when
I'm just doing myself, yes, I doask basic, you know, are you in
on any sort of like anxiety,depression medications?
Do you have like a history ofserious health conditions?
Are you under a doctor's care?
You know, and if you are like,is it family medicine or you
know psychiatric stuff?
(15:31):
So yes, because I do feel likethat information is important.
Speaker 1 (15:35):
Absolutely yes, and I'm going to throw it at you as
a way to get them to not comeback to your office tomorrow.
Perfect, okay.
So in private practice,sometimes we'll get somebody who
and you you probably know thistoo they sit down and you say,
okay, well, when was your lastphysical, when was your last
(15:55):
blood draw?
And they're like never, oh, allright, or they're going.
You know you're asking all thequestions.
You get to this part and theysay, well, I had a heart attack
recently and now I'm on all thismedication.
You're like, oh, so I or I'm,I'm diabetic, but I'm, I don't
(16:17):
monitor it.
Well, so you're, you're hearingall these things.
Uh, or thyroid is another right, someone who's who has thyroid
issues.
Or or, like you know,approaching menopause, something
like that issues, or, like youknow, approaching menopause,
something like that.
And you can say to them stop,do not pass, go, do not collect
$200.
Before you come to your nextsession with me, go to the
(16:47):
doctor and get a blood draw,right, I mean because you and I
can talk our ears off and mymouth off and if you are still
not addressing the underlyingmedical thing going on with you,
whether it's endocrine or it'ssomething to do with the
medication that you're onbecause of your recent heart
attack or who knows right?
I mean, has that ever happenedto you in practice, where you're
(17:07):
just like wait what You'venever had a blood draw A?
Speaker 2 (17:11):
couple of times and you're like, oh, or the last
time you went to the doctor Iwas probably 10 years ago, and
I'm like, right, yeah, andthey'll tell you I'm healthy.
But you know, they also say,but I'm pretty sure my blood
pressure is high, or you knowI'm overweight, or I'm not
sleeping at night.
Not sleeping is a big one, notbeing able to stay asleep once,
(17:35):
falling asleep, and if we, ascounselors, would.
Speaker 1 (17:40):
We're not going to practice medicine, so MDs, put
your, put your phones down.
But if we, as counselors, couldbecome familiar with the
symptoms of sleep apnea, right,the symptoms of, you know,
unchecked diabetes, right?
So those types of things youknow, like a UTI, urinary tract
(18:04):
infection with older people,right, that can often mimic
dementia, you know we get alittle loopy, right.
And so, as counselors, if youcan just become familiar with
the symptoms of a physicalailment that mimic and duplicate
(18:27):
and exacerbate the symptoms ofdepression and anxiety, and
sometimes I mean, I worked withso many couples, you know you'd
ask one person and the other onewould go, be honest, and then
they look at you and go shedoesn't sleep.
Or well, he's got a glucosemonitor but he doesn't wear it.
Or yeah, I can tell his bloodsugar.
Speaker 2 (18:49):
He's got a seat nap and he doesn't wear it.
Or, yeah, I can tell his bloodsugar he doesn't see it happen.
He doesn't use it.
Yes.
Speaker 1 (18:53):
And suddenly you're like, oh my goodness, they're
about to spend a lot of money oncounseling when they could fix
this by going to the doctor,right.
So here we are, counselor ingood conscience, kind of blowing
up our KPI and saying please goto the doctor first before you
come to the next appointmentwith me.
And usually they're excited.
(19:14):
I find they're like, oh my gosh, I didn't even think about that
, and that's wonderful.
And then they come back withall of these results and and
it's, it's very helpful.
So two more questions.
The first one Okay, I'm goingto pretend like you're my client
, jennifer.
If you came and sat down andwe're like, hey, how are you
(19:34):
doing?
Ok, and I looked at you and Isaid, ok, how can I help you
today?
Silence, silence, silence.
As a client, how would you feel?
Speaker 2 (19:45):
Like I was put on the spot and I would probably do
what I do every time I go to thedoctor, because we are, we are
conditioned as a society and aswomen to be fine and nice and,
you know, congenial.
And so I go into the doctor andthey're like what brings you
here today?
How are you feeling?
I'm fine, I'm fine, and I justsmile and act like I'm just in
(20:07):
the bit old, knowing that I havea list of a million things that
I was supposed to talk to themabout.
So I would tell you that I'd belike I'm fine and I'd start to
wonder why I even made theappointment to begin with.
Speaker 1 (20:20):
Yes, did you know, pavlov's dog, that our clients
can actually get cued to becomeproblems focused by our very
office, by the act of pushingthe button to go on to Zoom
right?
And we know that we learnedthat in Behavioral Therapy 101,
right Ring the bell, thePavlov's dog salivates.
(20:42):
And so if you can start toshift that first 30 seconds,
first two minutes of yoursession to how can I help you
today?
And they recognize, or whatwould make this a great session
today?
What do you need from me today?
And I normalize a client sayingnothing, I'm good, I just
(21:04):
didn't want you to charge me thefull session because I canceled
late.
Right, I mean, I've had thathappen before.
I'm like, oh, so sorry, youwant to play cards?
No, but right, I mean, becauseif you went to a counselor and
they constantly said constantly,and you knew you were
conditioned that every sessionyou would be greeted with how
(21:27):
can I help you today?
What would make this a greatsession?
And again, I feel like I need toput the disclaimer out there
we're not talking aboutpervasive and persistent mental
health issues, right, we'retalking about folks who just
come in and they're wanting towork some things out and they
answer well, not much.
Would you congratulate them?
(21:48):
I would, yeah, right, it's likeamazing, you don't need me
today, right?
No-transcript, I'm not goinganywhere.
(22:21):
But if they say no, I'm goodand we say, yay, good job you.
You know that's I mean, that'sempowering, that's empowering,
that's what we're here for.
Okay, my last question If youwere my client and I looked at
you and I said, okay, do youwant to come back?
Speaker 2 (22:43):
I would.
I don't know.
I mean, I would probably feellike I needed to say yes, but if
if you made me feel like I,like, had the tools already, I
just didn't realize it no, Imight not come back and I'd
probably save that fee.
Speaker 1 (22:59):
And again we're back to Pavlov's dog, right?
Because so many of us, whenthey're done with the session,
we kind of pivot our chair, wereach for the calendar, we open
it up on a okay, what same timenext week.
And if we looked at our clientsat the end of a session and
said, so do you, do you thinkyou need to come back, Do you
(23:19):
want to come back?
Again, it's going to beshocking the first time, just
like, oh crap, you mean, it's upto me, you're the doctor, I'm
not a doctor, right?
So no, it's really up to you,client, it's really up to you.
And do you want to come back?
And if they say, well, I don'tknow, maybe in a month, great.
(23:41):
Now I will say I have toldpeople I think you need to come
back sooner and we'll reviewtheir goals.
We'll review the treatment planand I'll say if it, especially
with addiction and some morepersistent issues, I'll say
things like look, if you, if youcome to see me every once a
month for the thing you'redealing with, you're wasting
(24:03):
your money Like this, this won'twork, right?
So we always default to ourclinical judgment, our theory,
our knowledge of the client'sissue and we preserve their
autonomy.
That's all we're doing withthese questions is we're
preserving their autonomy, we'rereminding them, we're
(24:24):
conditioning them to remember.
Hey, you've got a say in thistoo, so I mean, not too bad
right, we had solution-focusedquestions, medical questions how
can I help you today?
And do you want to come back?
Are there any you can think of,jennifer, Questions that might
make your client not want tocome back?
I guess not.
Speaker 2 (24:47):
I can't think of any.
Speaker 1 (24:49):
Okay, do you think you would ever use these in
private practice?
Speaker 2 (24:53):
Absolutely.
Speaker 1 (24:56):
Cool, cool.
That's a good endorsement.
That means a lot coming fromyou.
All right, I'm going to open itup to questions.
So pause.
Speaker 2 (25:05):
I think Kathy's saying something Uh-oh.
Speaker 1 (25:07):
Kathy, I'm going to hit pause and pause.
Thank you, okay, I am logged in.
Hey, I'm Dr Kate Walker andtoday we're talking about
questions that you can ask yourclients so that they may not
come back, and I'm with JenniferMarie Fairchild who's going to
ask me tough questions.
Like you mean, I pissed themoff, which is a good question.
(00:54):
No, no, we're not going to pissthem off.
We're not going to do it onpurpose.
But thank you for joining.
I'm so glad you're here so wecan bounce these ideas back and
forth.
Yeah, so you're ready to letpeople in?
Yep?
All right, let's do it.
All right.
So questions that can help yourclient get better immediately.
(01:20):
So that sounds like I'm sellingsnake oil, and Jennifer and I
were talking about this before Ihit record, because I was like,
oh no, no, we got to do this oncamera Because.
So, jennifer, what do you thinkof when you think of a question
that you can ask your clientand then they may never come
back, like I don't?
(01:42):
Like, okay, did I say somethingto offend them?
But like, what else do youthink of when, when you think
about that?
Speaker 2 (01:49):
I mean when I, when I think a solution, focus, like I
really go back to the basicsand it really is about like that
miracle question, like what,what would your life look like
if I waved my magic wand or hada crystal ball?
What would your life look likeif I waved my magic wand or had
a crystal ball?
And I think for some clientsthat opens the opportunity to
like, oh, I need to go down thispath and work.
(02:11):
But I think for some clientsthey're like either they look at
you like you're crazy, becausethey don't think that their life
will ever look like what thatmiracle solution is, or they
just I guess and it'sunreachable, or they just think
you're silly for even askingthat.
Like if I had a crystal ball,like I wouldn't be here.
So sometimes, yeah, I just kindof go back to the basics.
Speaker 1 (02:33):
I think that's really true and I think part of that
is our fault when we teach it incounselor education programs,
because I don't think a lot ofeducators really believe in a
solution-focused method.
Now, I know there are a ton andmany of my colleagues the
solution-focused conferencescoming up this and believe it or
not, this conversation isn'treally about even pushing
(02:56):
solution-focused, but I think aseducators we're like well, yeah
, you could ask themsolution-focused questions, but
for real counseling you've gotto go deeper, right?
And so this is where I want tothrow my disclaimer out.
You know, I'm not talking aboutbeing dismissive.
I'm not talking about pushingpeople out the door who have
complex trauma or chronicconditions or persistent mental
(03:19):
illness.
You know, certainly this is nota one-size-fits-all, and if
you've listened to me or watchedme or sat with me while I
taught a class, I will alwaystell you this is not.
I don't teach band aids.
This is something where if you,if you thought about OK, what
can I ask this client that wouldhelp them see that there is a
(03:43):
path forward, maybe withoutcounseling.
Like, what would that do to meas a counselor?
Like, would I get my feelingshurt?
You know what I mean.
Would I be like right, becausea lot of us even we talk about
this in the Texas counselorscreating badass businesses,
setting client retention ratesas a KPI, and I'm against that,
(04:05):
right, I'm against having andI'm sure I'm going to get
pushback and I welcome it.
As you know, this is a safespace for all kinds of pushback,
but the idea that keeping aclient is a key to, or a KPI
indicating you're beingsuccessful, a key to our KPI
indicating you're you're beingsuccessful.
(04:26):
Of course there is the clientthat's working on their
treatment plan and yay, they'resticking with it and they're,
they're powering through, and,oh my gosh, they're making so
much progress.
But then we also have an ethicalobligation not to overtreat
(04:48):
Right and.
And so I know you've seen thethreads, like I have, and you
know it's, it's tough, it's atough sell to counselors who are
trying to build their bad-asspractices that thrive to say,
yeah, don't worry about how longthey stay right, let's just
work.
Let's work on the marketing,let's work on that 10 minute
consultation, let's work, let'swork on that intake.
So I mean, like if I, if Icould give you a magic well, I'm
(05:09):
not going to say magic wand orcrystal ball, let's take off the
magic we're going to take,we're going to turn down the
sparkle.
What if I could give you aquestion that would make your
client and I'm choosing my wordson purpose that would make your
client better, and you had toopen a counseling practice
knowing that this questionexists that could make your
(05:30):
client better?
How would you feel?
Speaker 2 (05:35):
I feel like that's such a loaded question.
I mean, ultimately you're inthe business to help your client
see progress, whatever thatlooks like, and so if they're,
if they don't, I've had clientswho've had trauma and I've had
(05:56):
clients who didn't have a lot oftrauma.
They had a presenting issueissue Like if I had something
that would help them get betterquicker, as opposed to dragging
it out for the sake of draggingit out, absolutely yeah.
Speaker 1 (06:12):
So, as a business owner right, because you're
going to be a business ownerhere soon you know thinking
about okay, how do I base mybusiness then on this idea of
three or four sessions versus 10or 20 sessions?
Like, how does that and I knowI'm putting you on the spot
(06:32):
right now, but you know how howwould you think about your
business then if, if you, if you, if you really flipped it to
okay, this is, this is how we'regoing to build it, we're going
to count on three or foursessions.
Speaker 2 (06:48):
I think that would change things a lot.
I think it would change yourmarketing perspective too and
the clientele that you target,because you're not going to
market yourself.
As you know a trauma informed,you know deep diving therapist,
because those people are comingto you looking for long-term
care.
I mean I'm not going to say Ispecialize in personality
(07:09):
disorders, because Right.
So I mean I think really Iwould focus more on the
marketing side of things so thatI could keep that constant
rotation and have a consistentclient base.
Speaker 1 (07:25):
That I wasn't stressing, me too, me too
Absolutely, me too, me too,absolutely.
And and it's funny because, uh,when I got into practice, it
was like 2007, 2008, when Ireally really, you know, said,
okay, this is what I'm going todo full time.
And then we had the recessionof like 2010, right, I mean, it
(07:45):
was literally like two yearslater and I was cash based and
all of a sudden, it dried up, itwas gone and I got on EAPs.
I got on like three insurancesand I am just going to own this
about myself.
I'm not cut out to be a personwho files insurance and does
(08:09):
that kind of thing and I endedup getting it was like a
clawback.
It was basically one of myclients who said, oh, guess what
?
You take my insurance now andthey had been paying me cash all
that time I was taking theirinsurance, so they had like a
credit for six months.
It was just.
(08:29):
I remember being a new businessowner thinking, oh, I am
terrible at this, I'm just awfulat this.
And I went to asolution-focused conference and
I don't even think it was afull-blown conference.
There were a lot of peoplethere, but it was really only
two or three days.
I remember listening to thepresenter talk about these
(08:50):
questions and how it could helpclients see a path forward
quickly, and so that was almostlike the I'm going to use magic
again.
It was like a magic momentbecause it was like I needed
something to help me shift mybusiness, because I had to get
(09:12):
out of the insurance business, Ihad to get back into cash and
help me create a business planbased on exactly what you're
talking about, jennifer aresource making sure I was
positioning myself as an expert,making sure that I was a go-to
person when people wanted totalk on this or a talk on that
(09:35):
at the PTO or the Kiwanis Club,and it made my name get out.
And so after a while it wasn'tabout whether this person was
going to stay for one session ortwo sessions or four sessions.
I was full period and soshifting to this model
especially and I'm going to kindof bring it back around to this
(09:57):
idea of finances what we haveseen a lot in the threads in our
groups is the economy'schanging and, with all of these
big companies coming around,it's almost like people who are
used to this time of year beingkind of in a surplus.
They're not seeing it, and itwas a thread recently I don't
(10:19):
remember if it was in the BadassGroup or the Texas Supervisor
Coalition and I thought, okay,here we are right, it's cyclical
, right.
These things go go around.
And now we are in a seasonwhere maybe our clients that we
would rely on with insurance orthat we would say are, are
(10:40):
appropriate for 10 to 20 to 30sessions.
Now they're only coming for afew or not coming at all.
So I thought I'd pull out theold solution focus thing again,
but I'm going to throw in a fewother things too.
So you already kind of alludedto what's your least favorite
solution focus question.
That would be the crystal ballmagic wand.
(11:04):
Back to basics yes, I'm going toread off a few that people
posted in the badass group.
Um, in this moment, what do yousense your body is needing?
Uh, what is stopping you?
Can you remember a time wherethis wasn't a symptom?
(11:27):
Tell me about it.
Uh, imagine how it would look,feel, feel and how others would
treat you if the symptom wasbetter.
How have you managed to make itthis far?
And so is that kind of what youthink of when you think of
solution focus questions.
How often do you feel like youuse them in your practice?
Speaker 2 (11:52):
Depending on the client, because I mean, like
we've talked about, I work at,you know, an IOP and the way
we're structured.
We have interns approval for ayear, so that gives me enough
time to kind of go through thetrauma aspect and kind of like
pull out the deep stuff.
But as we start nearingtermination I shift to solution
(12:14):
focus because I've got I know mytime is limited and I've got to
make sure that they're preparedfor this evidence like
discharge in a couple of months.
So I do switch to solutionfocus, probably about four
months before discharge, andthat gives me a solid give or
take with, you know,cancellations and no shows.
(12:34):
That at least gives me a solidfive to 10 sessions to like.
Is there any lingering thingsthat you want to, you know, work
through what, what, what do youneed so that when you leave
this program you feel equippedto go forth and prosper in the
world?
Speaker 1 (12:51):
So you and the client both have your eye on the exit
door at the same time, you bothrealize that counseling is
coming to an end, and so it'salmost like the counsel or the
the your client is working withyou like, okay, I will play the
solution focused game with youand I will play the solution
focused game with you and I willsuppose and I will imagine
(13:14):
possibilities instead of where Iwas maybe six months ago when I
was still in my trauma and itwouldn't have been appropriate
for back then.
Anyway, right, because theywere nowhere near the exit door,
correct.
Speaker 2 (13:30):
Okay.
Speaker 1 (13:31):
So then this may turn some people on their ear a
little bit, because what we'redoing is we're looking at each
session as the last session.
And I'm talking to you, privatepractice owner.
I'm talking to you, standalonepractice owner, who's not
working in an agency or an IOP.
I'm not talking to you who areworking with personality
(13:52):
disorders and persistent mentalillness.
I'm talking to you, privatepractice owner, when you've got
somebody who's coming to you andthis may be the one and only
time you'll see them right.
In fact, I remember my professorat Sam Houston State University
, my I love this guy Dr Dr Bruin, and he's not practicing
(14:13):
anymore, but he was such aninfluence on me and he told the
class he goes guess what theaverage number of sessions is
for a client and we're allthrowing out numbers and he
looks at us and he goes one oneand I remember thinking, oh my
gosh, that's so much pressure,like I got to hit it out of the
ballpark with this person.
I've got one session, but ithelps.
(14:36):
You think, okay, if this is theday that I work myself out of a
job, what are the words that Ican tell this person?
So that dot, dot, dot, right,and we talk about that in the
10-minute consultation a lot too.
It's like, okay, tell me what Ican expect in the first session
, tell me what I can expect inthe second session, so
(14:57):
solution-focused questions.
But I came up with three more,so I'm going to throw this at
you, jennifer, so do you askmedical questions in your intake
?
Speaker 2 (15:10):
Ask medical questions in your intake, so like when
I'm just doing myself, yes, I doask basic, you know, are you in
on any sort of like anxiety,depression medications?
Do you have like a history ofserious health conditions?
Are you under a doctor's care?
You know, and if you are like,is it family medicine or you
know psychiatric stuff?
(15:31):
So yes, because I do feel likethat information is important.
Speaker 1 (15:35):
Absolutely yes, and I'm going to throw it at you as
a way to get them to not comeback to your office tomorrow.
Perfect, okay.
So in private practice,sometimes we'll get somebody who
and you you probably know thistoo they sit down and you say,
okay, well, when was your lastphysical, when was your last
(15:55):
blood draw?
And they're like never, oh, allright, or they're going.
You know you're asking all thequestions.
You get to this part and theysay, well, I had a heart attack
recently and now I'm on all thismedication.
You're like, oh, so I or I'm,I'm diabetic, but I'm, I don't
(16:17):
monitor it.
Well, so you're, you're hearingall these things.
Uh, or thyroid is another right, someone who's who has thyroid
issues.
Or or, like you know,approaching menopause, something
like that issues, or, like youknow, approaching menopause,
something like that.
And you can say to them stop,do not pass, go, do not collect
$200.
Before you come to your nextsession with me, go to the
(16:47):
doctor and get a blood draw,right, I mean because you and I
can talk our ears off and mymouth off and if you are still
not addressing the underlyingmedical thing going on with you,
whether it's endocrine or it'ssomething to do with the
medication that you're onbecause of your recent heart
attack or who knows right?
I mean, has that ever happenedto you in practice, where you're
(17:07):
just like wait what You'venever had a blood draw A?
Speaker 2 (17:11):
couple of times and you're like, oh, or the last
time you went to the doctor Iwas probably 10 years ago, and
I'm like, right, yeah, andthey'll tell you I'm healthy.
But you know, they also say,but I'm pretty sure my blood
pressure is high, or you knowI'm overweight, or I'm not
sleeping at night.
Not sleeping is a big one, notbeing able to stay asleep once,
(17:35):
falling asleep, and if we, ascounselors, would.
Speaker 1 (17:40):
We're not going to practice medicine, so MDs, put
your, put your phones down.
But if we, as counselors, couldbecome familiar with the
symptoms of sleep apnea, right,the symptoms of, you know,
unchecked diabetes, right?
So those types of things youknow, like a UTI, urinary tract
(18:04):
infection with older people,right, that can often mimic
dementia, you know we get alittle loopy, right.
And so, as counselors, if youcan just become familiar with
the symptoms of a physicalailment that mimic and duplicate
(18:27):
and exacerbate the symptoms ofdepression and anxiety, and
sometimes I mean, I worked withso many couples, you know you'd
ask one person and the other onewould go, be honest, and then
they look at you and go shedoesn't sleep.
Or well, he's got a glucosemonitor but he doesn't wear it.
Or yeah, I can tell his bloodsugar.
Speaker 2 (18:49):
He's got a seat nap and he doesn't wear it.
Or, yeah, I can tell his bloodsugar he doesn't see it happen.
He doesn't use it.
Yes.
Speaker 1 (18:53):
And suddenly you're like, oh my goodness, they're
about to spend a lot of money oncounseling when they could fix
this by going to the doctor,right.
So here we are, counselor ingood conscience, kind of blowing
up our KPI and saying please goto the doctor first before you
come to the next appointmentwith me.
And usually they're excited.
(19:14):
I find they're like, oh my gosh, I didn't even think about that
, and that's wonderful.
And then they come back withall of these results and and
it's, it's very helpful.
So two more questions.
The first one Okay, I'm goingto pretend like you're my client
, jennifer.
If you came and sat down andwe're like, hey, how are you
(19:34):
doing?
Ok, and I looked at you and Isaid, ok, how can I help you
today?
Silence, silence, silence.
As a client, how would you feel?
Speaker 2 (19:45):
Like I was put on the spot and I would probably do
what I do every time I go to thedoctor, because we are, we are
conditioned as a society and aswomen to be fine and nice and,
you know, congenial.
And so I go into the doctor andthey're like what brings you
here today?
How are you feeling?
I'm fine, I'm fine, and I justsmile and act like I'm just in
(20:07):
the bit old, knowing that I havea list of a million things that
I was supposed to talk to themabout.
So I would tell you that I'd belike I'm fine and I'd start to
wonder why I even made theappointment to begin with.
Speaker 1 (20:20):
Yes, did you know, pavlov's dog, that our clients
can actually get cued to becomeproblems focused by our very
office, by the act of pushingthe button to go on to Zoom
right?
And we know that we learnedthat in Behavioral Therapy 101,
right Ring the bell, thePavlov's dog salivates.
(20:42):
And so if you can start toshift that first 30 seconds,
first two minutes of yoursession to how can I help you
today?
And they recognize, or whatwould make this a great session
today?
What do you need from me today?
And I normalize a client sayingnothing, I'm good, I just
(21:04):
didn't want you to charge me thefull session because I canceled
late.
Right, I mean, I've had thathappen before.
I'm like, oh, so sorry, youwant to play cards?
No, but right, I mean, becauseif you went to a counselor and
they constantly said constantly,and you knew you were
conditioned that every sessionyou would be greeted with how
(21:27):
can I help you today?
What would make this a greatsession?
And again, I feel like I need toput the disclaimer out there
we're not talking aboutpervasive and persistent mental
health issues, right, we'retalking about folks who just
come in and they're wanting towork some things out and they
answer well, not much.
Would you congratulate them?
(21:48):
I would, yeah, right, it's likeamazing, you don't need me
today, right?
No-transcript, I'm not goinganywhere.
(22:21):
But if they say no, I'm goodand we say, yay, good job you.
You know that's I mean, that'sempowering, that's empowering,
that's what we're here for.
Okay, my last question If youwere my client and I looked at
you and I said, okay, do youwant to come back?
Speaker 2 (22:43):
I would.
I don't know.
I mean, I would probably feellike I needed to say yes, but if
if you made me feel like I,like, had the tools already, I
just didn't realize it no, Imight not come back and I'd
probably save that fee.
Speaker 1 (22:59):
And again we're back to Pavlov's dog, right?
Because so many of us, whenthey're done with the session,
we kind of pivot our chair, wereach for the calendar, we open
it up on a okay, what same timenext week.
And if we looked at our clientsat the end of a session and
said, so do you, do you thinkyou need to come back, Do you
(23:19):
want to come back?
Again, it's going to beshocking the first time, just
like, oh crap, you mean, it's upto me, you're the doctor, I'm
not a doctor, right?
So no, it's really up to you,client, it's really up to you.
And do you want to come back?
And if they say, well, I don'tknow, maybe in a month, great.
(23:41):
Now I will say I have toldpeople I think you need to come
back sooner and we'll reviewtheir goals.
We'll review the treatment planand I'll say if it, especially
with addiction and some morepersistent issues, I'll say
things like look, if you, if youcome to see me every once a
month for the thing you'redealing with, you're wasting
(24:03):
your money Like this, this won'twork, right?
So we always default to ourclinical judgment, our theory,
our knowledge of the client'sissue and we preserve their
autonomy.
That's all we're doing withthese questions is we're
preserving their autonomy, we'rereminding them, we're
(24:24):
conditioning them to remember.
Hey, you've got a say in thistoo, so I mean, not too bad
right, we had solution-focusedquestions, medical questions how
can I help you today?
And do you want to come back?
Are there any you can think of,jennifer, Questions that might
make your client not want tocome back?
I guess not.
Speaker 2 (24:47):
I can't think of any.
Speaker 1 (24:49):
Okay, do you think you would ever use these in
private practice?
Speaker 2 (24:53):
Absolutely.
Speaker 1 (24:56):
Cool, cool.
That's a good endorsement.
That means a lot coming fromyou.
All right, I'm going to open itup to questions.
So pause.
Speaker 2 (25:05):
I think Kathy's saying something Uh-oh.
Speaker 1 (25:07):
Kathy, I'm going to hit pause and pause.
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