The Perils of an Intake Model
Updates by Daryl Chow, MA, Ph.D.(Psych)
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The Perils of an Intake Model
By Daryl Chow, MA, PhD on Jul 03, 2018 04:58 pm
Here’s chapter two of the book, The First Kiss: Undoing the Intake Model…
The average number of sessions for an agency is about four to six.1
And if you’ve read the introduction, you’d know that the most frequent number of sessions attended by clients is one.2
What does this mean? First, averages can be deceiving. Statistician and essayist Nassim Taleb gives a useful example: “Say your average daily water consumption needs to be one liter a day and I gave you ten liters one day and none for the remaining nine days, for an average of one liter a day. Odds are you won’t survive…Someone who tells you ‘I drank one liter of water per day on average’ is not conveying much information at all; there needs to be a second dimension, the variations around such an average.”3
We may be inclined to say that the client may have benefited from the single session and did not see a need to return. This may be possible. But can you see how this sort of self-explanation strips us from any sense of agency? Evidence suggests that when clients experience some initial benefit, they are more likely to return for treatment. Besides, we cannot be of further help to someone if they do not show up!
Second, premature termination is a huge cost to the system. Perhaps the biggest unquantifiable cost may be demoralisation of the client who came and left without feeling helped.
Imagine if you are in a difficult place in your life. You broke through the shame attached to seeking help, and set aside some time and money to see a professional. You arrive at their office, and you are asked a bunch of questions. At the end of an hour or so, you were told that time is up and that you should come back next week for a subsequent appointment. What would that be like for you? (While I am writing this at a cafe, by sheer luck I overheard a man in his late 30s say to his father-in-law, “The psychologist just asked a bunch of questions and charged me 90 bucks. That’s simply dishonest.”)
While it’s important to ask questions to organise yourself and develop clinical formulations of your client, do not prioritise your intake.
Worry more about our client’s intake.
Clients expect at least something they can leave with, be it an idea, a different perspective, or even tangible doses of hope. For better or worse, we must recognise that we cannot not influence.
Ask ourselves, “What are we giving our clients in the first sessions?”
Footnotes:
1.Articles that cite the average number of sessions attended by clients:
Baldwin, S. A., Berkeljon, A., Atkins, D. C., Olsen, J. A., & Nielsen, S. L. (2009). Rates of Change in Naturalistic Psychotherapy: Contrasting Dose-Effect and Good-Enough Level Models of Change. Journal of Consulting & Clinical Psychology, 77(2), 203-211. doi:10.1037/a0015235
Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329-343. doi:http://dx.doi.org/10.1093/clipsy/9.3.329
2. I first learned about this from a workshop by Michael Yapko. Since then, when I examined the data of agencies I consult with who are on the cutting edge of measuring their own outcomes, I noticed this trend as well. And often, managers do not pick this up, as it is often not included in the analysis of effectiveness, because for those clients who come for only one session, they do not have a pre-post measure comparison.
3. See Nassim Taleb’s preliminary draft of Skin in the Game: http://www.fooledbyrandomness.com/minority.pdf This book has since been released.
Release date: 4th of July. Get the eBook available on amazon or on daryl’s website. Paperback available soon!
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