Importance of Having Therapeutic Alliance with a Client and Adhering to Schedule

Please respond to the discussion post. All references 5years or less
Hello everyone!
Describe at least TWO elements your frame would include. Provide support from at least one scholarly source.
A part of having a fully functional therapeutic alliance with a client is built on provider and client’s understandings and respect of each other’s established boundaries. These boundaries have factors in the physical environment, both client and providers emotions, psychotherapeutic structures and lastly the relationship between client and provider (Admin, 2017). Discussing these boundaries with the client help create safety and expectations for empathy, projection, introjection, identification, and transference (Admin, 2017). One element that needs very set limits in my future practice as a PMHNP prepared provider includes adherence to a schedule and starting/ stopping on time.
Adhering to a schedule starts with how the provider wants their schedule to be set up. If knowing that to start clinic on time the provider would need to have adjustments in previous duties or change first patient start time to begin each day on time. Not overbooking appointments and trying to rush thought appointments. Crisis and emergent issues do arise. Offer apologies to previously scheduled patients on the delay offer to still see if they can wait, or offer if they would reschedule (Baum, 2021). If my clinic appointment is scheduled for 20 minutes long a patient has up to 10 minutes to be late before they are a “No Show”. Each no show the patient is sent a no show letter in the mail regarding their missed appointment, phone numbers to get rescheduled, as well as organization policy. After three no shows the patient is then moved to acute/ same day appointments only. Discharging the chronically late patient from care is after continued no shows, missed, or late appointments. This decision in my organization has suggestions but is provider specific.
I feel like both of these elements go hand in hand. Seeing a provider that is chronically late to appointments trains patients that they should just show up late (Baum, 2021). In my Family Practice we had a provider that constantly was 30-45 minutes late to each appointment. When his patients would make appointments with other provider’s they were use to showing up 20-30 minutes late to their appointments but still being “on time”. Starting and stopping on time from the initial meeting I like to address with the patient that their scheduled time is the out time together and the time before or after is either my time or another patient’s time. If they want their time to be respected than others time needs the same respect.
Describe how your frame might be altered for ONE of the following situations:
My practicum experience this session is with providers that are only providing telehealth services to patients via zoom appointments. There is a nurse that is controlling the meeting room that puts patients or staff into a “waiting room” until their appointment time and when the provider is ready to connect provider to patient. Telehealth appointments are not ideal but do work well for my rural area to help patients with mobility issues, transportation difficulties, and lack of community resources. The frame would need alterations to prioritize access to patients to ensure Wifi or cellular connection, private space, helping patients create a protected time without interruptions, ensure security and confidentially of the platform (Chartier & Kealy, 2021). One solution that my clinical site is using for some of the above frame recommendations and possible barriers to care with a private space with good connection is having patients present to their closest clinic in the same organization and be connected to the provider in that office by a nurse. Since there are so few psychiatric providers and so many locations and patients the providers are able to cover a wider area with utilizing this method. This also help patients with disabilities that are not tech savvy or not having the equipment to support a telehealth service.
Identify at least TWO strategies that meet the ethical and legal requirements for a client who frequently misses appointments without notice and has failed to pay for the last four sessions. The client has received psychotherapy for six months.
Have a discussed with the patient regarding reasoning for late or missed appointments. Review expectations on providers and each patient’s time being valuable. Also reviewing organizational policy for late/ missed appointment including changing to acute/ same day appointment as well as discharge from service. Sending written reminders for missed payments, options for payment plans, and who to contact. With the back payments to help direct the patient to the billing department (for larger organization) to help review charges, set up payment plans, as well as having to start pay for a percentage of services upfront (Garcia, 2022). If patient continue to not pay as the provider to stop seeing them if they are unable to provide payment plan, agreed upon copay, or start paying. Eventually missed payments can either build up enough and go to a collection agency or some organization’s will “write off” a portion of what’s due.
References
Admin. (2017). Techniques of psychotherapy: The function of the frame: It is how a good therapist makes their patient feel safe!. Control Mastery Therapy Center International. Retrieved from: http://cmtcenter(dot)net/techniques-of-psychotherapy-the-function-of-the-frame-it-is-how-a-good-therapist-makes-their-patient-feel-safe/Links to an external site.
Baum, N. (2021). Managing the chronically late patient. Physicians Practice. https://www(dot)physicianspractice(dot)com/view/managing-the-chronically-late-patientLinks to an external site.
Chartier, G. B., & Kealy, D. (2021). Frame Trade-Offs: On Some Therapeutic Implications of Telepsychiatry. Harvard Review of Psychiatry, 29(5), 337-339.
Garcia, S. (2022). What to do if a client won’t pay. NOLO. Retrieved from https://www(dot)nolo(dot)com/legal-encyclopedia/get-clients-pay-up-29988.html