Many great questions have been asked throughout my workshops. I want to take a moment to respond to some of them here.
- Will opening a walk-in counselling clinic shorten our wait list for services?
It is important that many agencies are opening walk-in clinics as a means to try to address wait list times for people however I don’t believe that should be the sole intention. To me, it is more of a choice based on organizational and practice ethics. It is ethically responsible to provide a diverse service menu which includes services that can be accessed at ones time of need. A walk-in counselling clinic alongside other services such as crisis response, short term counselling and long term counselling ensures people can have not one session more or less than they need or want. Secondly a walk-in clinic provides face to face services up front at which time circumstances where safety may be compromised can be named and addressed right a way. For instance what if children are sitting on a wait list while living in the midst of abuse, ongoing bullying, or poverty? Face to face contact at the beginning of service navigation can bring these aspects to the foreground. In regards to reducing wait lists- many clinics do find that wait list numbers do decrease which I feel is a bonus. It only makes sense that people should be able to flow in and out of services as needed.
- What are the contraindications for single session walk-in therapy?
One of the first to write about single session therapy was Moshe Talmon 1990. In his book he had listed criteria outlining who “is not likely to find SST sufficient” (p30). While there is some sensibility to those criteria they are not ideas that I subscribe to as a brief narrative therapist. My focus is on what might be possible in these conversations given people’s expressions of life. Whether people have been in services for a very long time, find themselves in great distress or are neurologically diverse it is my responsibility to facilitate a useful conversation. This is not to say that I do not give great consideration to the setting or context which may be most favourable to a useful conversation developing. I have noted in previous field notes conditions that require great consideration as to how to proceed such as with children whose parents are separating/divorced or for those experiencing bullying. Each meeting requires this attention to ‘how best to proceed’ given peoples expressions of life and the context of those expressions.
- What if people come back to the walk-in and don’t get the same therapist as before- do you worry about them having to tell their story over and over again?
About 1/3 of participants return to the walk-in clinic at a future date or time of need. If possible we will make an effort to match them to a previous therapist but it is not always possible. However I invite caution in the assumption that it does matter to people. Seeing another therapist does not mean the person will have to ‘start from the beginning’ or retell what they have already told. In single session practice we can begin in ‘the here and now' with what is the most pressing concern as well as what developments have occurred since the last walk-in conversation that are fitting with their preferences. This can lead to a myriad of offshoots to other preferred story lines that interest people.
- What if someone presents with a severe clinical disorder like depression or bipolar disorder?
As a brief narrative therapist I resist those descriptions of people’s expressions of their lived life. I understand that the naming of the problem can shape the expression of the problem so I take great care to assist people to name their own distress in their own words. Seeing people as ‘clinically depressed or bipolar’ risks supporting a single storied account of the person and can very strictly narrow the conversational territory to the point that the conversation will not be useful. Cautious of characterizations I know that there is much more lived experience that is outside the descriptions of disorder. As I continue to grow my skills to listen for and foreground those experiences, hopes, and intentions, the walk-in conversation takes on many useful possibilities.
Secondly I give attention to how we and the participant make sense of their decision to attend the walk-in therapy session? This initiative cannot be overlooked regardless of the distress expressed. Where problems have dominated people’s lives, attendance at the walk-in clinic may be the beginning of a growing defiance or straight up refusal to surrender to the problems will. This offshoot can provide for a very exciting conversation bringing further proposals for action forward.
- What if someone shows up intoxicated- do you still meet with them?
My interest lies in what ‘showing up’ intoxicated or not says about what the person wants different for the future. I believe we can have important conversations given these circumstances.
- How do you get staff to buy in to the Walk-in Clinic Service model?
Although it is not my intention to get staff to ‘buy in' I think working in this way can be enlivening and exciting. I do share that working a walk-in clinic for some may require a shift in how they think about people, problems, therapy, and change. There are so many ideas circulating about people, problems, therapy, and change and while some are well suited to the context of walk-in services others are not. As inspiration I invite you to consider many of the conversation you have had in your life and to tease out those that have provided a meaningful moment leaving you not in the same place as you were prior to the conversation. We have all had those kinds of conversations that assisted us to see things differently or to come up with ideas about how to proceed. Our project as professionals is to continue to shape our skills to facilitate these conversations with the people who consult to us.
In Curiosity,
Scot
Reference:
Talmon, M. (1990). Single Session Therapy: Maximizing the effects of the first (and often only) therapeutic encounter. Jossey-Bass, San Francisco
