Cognitive Biblical
Therapy Coursework
Counseling Through God’s
Transformative Word!
Chapter 3 Topics:
a. Transference of Client
b. Discussing the Cost of Counseling and Scheduling the Next Session
c. Managing the Schedule
d. Ending the Session
e. Case Notes and Secure Storage
Important Note: Answering the section questions is a great way to prepare for the end of the chapter quiz.
Quiz Requirement: A score of 75% is necessary to continue to the next chapter.
Account Access: You must be signed into the coursework page (which is separate from the main CBT website) to take the quiz and advance.
Chapter 3
Continuing in the Initial Session
Transference of Client
Now at this point in the initial counseling process, you are still presenting the idea of CBT. Transference refers to the counselor directing the client to rely upon God, rather than earthly dependencies (relatives, friends, and/or counselor).The purpose of transferring this information about application to the client is because you are saying, “I don’t want to carry you, I don’t want to be a guru, that’s not appropriate. The whole idea is there is a living, real God who will empower you to be successful, not only in overcoming this presuming problem. But through this process, you will learn to deal with future problems in this life, prepare for the next, for being with God in heaven.” That is the beauty of CBT. Your whole purpose is to end the counseling as soon as possible, so that the person’s relationship to God enables them to live successfully by applying these principles and processes.
After you have explained to them about the basic steps in the CBT process, explain the use of the Analysis questionnaire (AQAL). In order to move on the client needs to select the next step: whether to continue with counseling or not. Ask the client, “What do you want to do now?” Since most counseling is not focused on God healing the person through the Holy Spirit, the client may need to think about being responsible for his actions or choices to bring about change and healing. The person has the power to be responsible for change. The responses vary due to the client’s relationship to God. He may need to learn more about God. If he is not a Jesus follower, you will need to present the gospel to him.
You will need to communicate three basic things to a client. First, you, as a counselor, are not responsible for his success in the process or the outcome. Secondly, that you want him to transition almost fully to the Holy Spirit of Jesus Christ rather than to be dependent on you as the counselor. And thirdly, you will be supportive, but his relationship to God has to be most important in the process.
A lot of times, all this personal, active relationship to God is so new, he may need to think about this type of counseling, where change comes through personal learning and dependence on the Holy Spirit. The client may need time to practice this type of relationship based on prayer and patience, analytical prayer, the Holy Spirit, and the Scripture. You may need to check with him often about the prayer practice. “Have you prayed and have you thought? What'd the Holy Spirit tell you?” The point is to have the client get to the place that he will explain what the Lord has shown him, and ask you to provide insight, correction, or affirmation. As you move through the process, it will get clearer how to work with God as an individual person. He has to face his own problems, learn to allow God to help him speak in a Christ-like way, even if he does not feel good, be cursed at, or feel hopeless. He will get stronger facing the reality of life.
I had a client one time who had been very, very emotional all of her life, and she had to separate from her husband. When she did that, the husband really took off on a tangent. He called the police, and he filed parental kidnapping charges against her. She called me an absolute wreck. I said, “Karen, it's like this. You have to think. You have to get facts. Turn on your brains, and tell your emotions to shut up. Ask God to give you grace and ask the Holy Spirit to help you think.” I said, “Now what are the facts? Tell me the facts.” What had happened was that the attorney we used to set up a legal separation could not get out of a court case soon enough to file the papers before the husband came home, but he filed them the next morning. The police officer who called her was able to contact the attorney. The papers were located, and all of the charges were dropped. But in her panic, she wanted me to be the Holy Spirit, and I refused.
You are going to teach a process. It's going to be the one the client will use in order to live his faith out. You will help each client to transition to the Holy Spirit as soon as is possible. So, you disengage yourself from their success and responsibility to problem solve with them. They transition to God, and you support them as a brother or sister. You want to get the client out of the counseling process and into the living process through Christ as soon as possible. To do that the client will learn to use his mind, so that the emotions become secondary, and the mind of Christ becomes the primary means by which they live. So, the principle of Biblical counseling that you are communicating is that he learns a dependence on God. His relationship to God depends on the Scripture, rather than the counselor, emotions, or another person. You can encourage them to ask supportive family, friends, and the church community to pray for them.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
What is the process of Transference of the client? Explain why this is so important for the client.
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Dr. Dan's Answer:
Transference is the counselor directing the client to rely on God instead of on earthly dependencies such as relatives, friends, or the counselor. The counselor is saying, in effect, "I don't want to carry you or be your guru. There is a living, real God who will empower you to succeed."
Transference keeps the client from becoming dependent on a person. It teaches a process the client can use to live out his faith for the rest of his life.
Discussing the Cost of Counseling and Schedule of Next Session
Now, back to the initial session setting, you can give the client a number of options for moving forward with counseling. He can begin the process by completing the forms and Analysis Questionnaire (AQAL), or think about it and can call you back. He can even schedule another session to ask questions, and decide after that. At this point, the first peripheral issue that needs to be discussed is the cost of the counseling. You will need to determine how clients will pay for your services. I learned quickly that I had to draft some billing policies (Explain Fees form) for clients to consider: full rate cost per session, or a sliding scale (fee depending on household income), charges for cancelations, self-pay or paid by someone else like the church or insurance. Once that policy is created, clients will be able to know what it will cost and be able to make a decision.
After their first contact, I send prospective clients a policy statement that lists my charges for sessions, charges for cancellations or not showing up without notice. The costs will be dependent on the market population you serve and your own expenses. People who want help are willing to pay me enough income so that I can meet my office expenses and have an income that is adequate. Now this might sound a little unfair or maybe mercenary. What I found is that if I am not as good a businessman as I am a counselor, then I will fail in my practice. Bills have to be paid, paper has to be bought, copying has to be done, brochures have to be sent out every four months so that my name is a known option for helping people. Pastors who refer clients move and do not pass on their referral contacts. Clients are a great referral source of course, and they will need a handy brochure to give friends. I can lose my ability to have consistency in referrals, if I don't do some things that are purely business. I pray over the brochures and letters that I write, but I am responsible for a level of business expertise that is critical to my ability to present biblical counseling.
When you think about fees, keep in mind what your cost needs are to preserve your ability to be in practice, which depends on your setting, and your need to be treated as a professional. To that end, I have a sliding scale fee that allows me to charge according to the client’s income. I charge insurance companies more because of the extra time required to file a form every session with a diagnosis, a DSM (Diagnostic and Statistical Manual of Mental Disorders) diagnosis, and we will talk about that later. Another policy is not allowing a client to have more than two unpaid sessions at any time. Most often, if you allow the client to run up a large bill, you will not receive your payment. Without these policies, I lost about $20,000 in uncollected fees over the first 5 years of counseling. Now that is a lot of money. This happened because I had no one to mentor me. I strongly suggest setting policy before you start to counsel, especially if you're going to be in a setting where you are trying to earn an income from your counseling. The Lord challenged me to provide 10% of my counseling fees as a gift. I do that partially out of gratitude to the Lord for the life he has given me, and my desire to help those that do not have the income to pay for their counseling. I found that if I charged too little for a session, I tended to get clients who had already talked to a lot of counselors, but really did not want to change: they just wanted an audience to hear their story again. They will not be faithful to the process or treat you as a professional.
It can be a very frustrating and discouraging after counseling thirty sessions in a week to find you collected less money than your expenses demand. You can border on feeling bitter and angry because you have genuinely tried extremely hard to help people. But the end result is you are exhausted, you were not paid adequately, and you feel frustrated. That is not the way to try to counsel successfully. You cannot have things in your own life that do not work, or a place of unrest or unhappiness, because it doesn't take very long for whoever you're working with to see that something's wrong in your life. And the next thought is, how can he or she help me if they don't even have their own life together?
It is best to send them a policy statement or speak to them about it over the phone when they make the initial contact, and set up a session. At the end of the initial session, you want to review the cost policy and collect payment for the first session. Most clients know their income and will be honest in reporting it to you. I found that most people will overpay you, rather than underpay you. They may need to postpone counseling for a few weeks if the income is too tight or an emergency prohibits them from paying. That is a hard thing to do, but you will find that in the long run, you are better off. People feel guilty because they do not pay you, which can hinder their progress. If you are counseling in a church setting or a pastor refers clients, the church might pay for the client’s counseling or provide some of your income. There are obviously many issues to consider.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
Explain why it is important to communicate the costs of counseling early in your time with a client, and the effects of not collecting enough fees on the counselor and practice.
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Dr. Dan's Answer:
Clients need to know what counseling will cost so they can make an informed decision about whether to begin, and understand the expectations they will need to follow with regular payments and keeping sessions. Uncollected fees cost the counselor income needed to pay expenses and puts the practice at risk of failure. Collecting less than expenses demands leaves the counselor exhausted, frustrated, discouraged, and even bitter or angry -- which can show up in the counseling sessions.
Managing the Schedule
You can never make the decision for any client to receive counseling. It is best to tell the client at the beginning of the session that you will ask them at the end of the session to make a decision about counseling: to continue by making a second appointment, take the material that I've given them to review, and take it to their pastor, friend, or counselor to review. If they do that, they will need to call back later to tell me if they want to continue to counsel. The reason for all these options is because you will really never help anybody who does not want to receive help. If you sense any hesitancy, then do not try to schedule. When I first started to counsel, I spent a lot of time begging people to get help, to return, trying to convince them; I wore myself out. There are too many people who want help. In time you will have enough to do without trying to convince anybody that they need help. If they choose to counsel, you'll know it's because they have initial interest and they will receive help.
You will also need to make a schedule of office hours. I have found that afternoons and evenings provide the best time for people to be available. My schedule started at one or two o'clock, for 55 minutes with a 5-minute exchange break between clients. The last session of the day began at 7:00 pm. I try to keep one hour in the afternoon free to return calls and do office work for Monday through Thursday. On Friday, I just have sessions from one until five pm. I do not work on Saturdays or Sundays. If you do not set the hours, people will set them for you. And what that will mean is you may go in at seven o'clock one day and be there until 10 o'clock the next night. You have to have clearly established counseling hours. If a client does not make a decision to counsel with you in the initial session, you need to make them aware that waiting reduces the options for future sessions at that time.
If you have a busy practice, your times will open and close like quicksand. For example, I see an average of 50 to 70 different people every month, and I have a minimum of about 100 sessions every month. I've worked this way for about six years. So, if I have an evening which is a premium, say a Tuesday night at six, and I see somebody on that night, and they think they might want that session, I cannot guarantee it will be open the next week. It is common for me to have three or more calls every day from clients wanting to schedule a session. Before I had a secretary, I used an answering machine to take those calls. You have to work with people according to when they call, so first calls get first choice. When I have tried to hold a session for a day or two, I discovered that people make decisions with emotions. It will absolutely destroy your schedule. Also, it will keep you from being sensitive to God's leading in who to help. You have to control when you work, with fairness to how you fill your schedule. Having a person to help with scheduling reduces a great deal of stress for you.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
Explain the importance of setting fees in advance for clients, and establishing a weekly schedule for sessions and process for scheduling clients for counseling sessions.
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Dr. Dan's Answer:
Setting policy before you begin counseling means clients know what to expect and can decide freely, and the counselor is treated as a professional. Clear hours protect the counselor's health and family, which leads clients to seek the Lord for their own process of healing. The counselor demonstrates a deep faith and trust in relying on God's Spirit and Word, rather than an unhealthy dependency.
For example, at the end of the initial session, the counselor explains that the client will choose to schedule a second appointment, take the materials home to review (perhaps with a pastor or friend), or call back later. Holding times for people who decide based on emotion destroys the schedule and keeps the counselor from being sensitive to God's leading for taking new clients.
Ending the Session
Another procedure that you need to establish is how to collect the fee. This was troublesome to me when I first started to council. It was awkward. It was almost embarrassing. I felt like I am working for the Lord here, and this almost seems mercenary, and this is not right. What I learned to do with folks at the end of the session is, tell them that there are two things that we need to do. One is we need to pray, and the other is I need to collect the fee. A couple of things I found that makes that a little easier is when I get down to the end, if I mention prayer, then that takes some of the edge off of the fee. In other words, I do not sound so much like I am there for the money. Honestly, that's part of it. I have to earn a proper living. I have to have a sense of personal self-respect. But that is not my primary reason for counseling. I do not use the word money. I will say, “Have I spoken to you about cost?” If they have forgotten, which isn't unusual, or they don't have enough money. I will give them a return envelope so they can send me the cost for this session.
The principle behind this whole idea of the cost is that you are worthy of proper payment. The scripture talks about you being worthy of your hire. If a person is not willing to pay for your counsel, he does not value what you are saying. Also, if there is no payment, there will be no consistency in counseling. They have to feel what you are saying is valuable. They have to be paying something for it, then they value it and have a greater commitment to receiving help. This commitment will show up in an effort to work on the tasks set before them. The client is more likely to do homework, more likely to listen to you, and show up on time. So, the payment serves a lot of purposes.
The second important thing is prayer. That is why you are there. You believe that there is a God, and you are in a relationship with him. How you maintain that relationship is through prayer. At the end of this session, I will say to people, “Let’s pray together? I will pray for you, or you can pray.” Sometimes clients will pray, but most of the time they prefer that I pray. Some may be new to this whole thing of prayer, or too embarrassed to pray in front of you. But what you do is you encourage the client when they hear you pray. They know that you are genuinely concerned about them. You encourage their faith. You demonstrate your own faith, and most of all, you ask Jesus to be involved in the process. Through prayer you invite God to be included in this whole adventure.
Make sure they complete the Analysis Questionnaire (AQAL) as soon as possible, so that it gets back to you at least the day before their next session. They also need to fill out the initial Session Information, (ISI) inventory. Have it ready on a clipboard so that you can give it to them at the beginning of the first session or finish it at the end of that first session. They can also complete it after the session is over, so we don't use that valuable time. They can leave it in my office mailbox, so that I can get that information right away.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
Name at least 3 important things to include in the ending of a session and explain why each is important.
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Dr. Dan's Answer:
1. Collecting the fee. The counselor gently yet confidently asks, "Have I spoken to you about cost?" Paying for the counseling service also helps the client value the counsel and be committed to their healing process.
2. Prayer. The counselor invites the client to pray together: "I will pray for you, or you can pray." Prayer is why the counselor is there. It shows genuine concern for the client, encourages the client's faith, and invites Jesus into the process.
3. Completing the forms and the Analysis Questionnaire. The client should complete the Initial Session Information (ISI) inventory, along with the Analysis Questionnaire (AQAL), the day before the next session -- because the counselor needs this information to prepare for the next session.
Case Notes and Secure Storage
Case notes are especially important for you to keep track of issues, observations of client’s issues and personal characteristics. I often keep a piece of paper there, and say to the people in the session, “I'm going to write notes and ask you questions, so that I don't forget anything. Everything that you are telling me is important, and I want to remember each topic of our conversation.” There are a series of forms you can use for case notes (Acquisition Counseling Record). And in your case notes, try to catch the highlights, family history, past, experiences, social activities, schooling, and college. Record how they cope with things, any important life experiences, or when their problems began, and how they manage them. Try to keep track of the personality. If a couple, note which one seems to be real, open, or a problem solver. Are they both like that? Are they both passive? The case notes form parallel the steps of the process. There will be one kind of case note record form for the initial session, the analysis, and another for the acquisition of these Biblical norms. Because there are distinct characteristics and patterns that people have as they go through each phase, you will be able to identify, predict, and understand the ways they're acting and why.
As we go through the next courses you see the important thing to take notes for in the process. Just remember that case notes are critical. Keep them in a safe place. Keep them locked up. Don't allow anybody else access to them because they are privileged and confidential information. Keep them alphabetized by client, so that you have access to them, because you are going to be taking case notes after each session as soon as possible, so that your memory doesn't fade, or lose information that was important.
Briefly, before ending this course, I would like to provide some guidance on the office set up. You may be in the process of setting up an office now before you get to Course Six where setting up and office is discussed in greater detail. The size of your office is particularly important. For example, if it is too big, people will feel lost, and you will seem distant and impersonal. If it is too small, they'll feel like you are getting too close too quickly. A room about two hundred square feet is adequate. Colors and décor are also important. Colors that are too dark can be depressing and feel closed in which works against counseling. Bright colors can be too exciting and distracting. It is best to have neutral or muted colors, because the atmosphere you want to create is one of comfort and of peace. A three-foot by five-foot desk is about the right size. It should be in decent shape, but not with a lot of chrome or glass which can seem cold and off-putting. If the desk is too big, you will look like you're looking down your nose at them. And if it is too small, you give the appearance of being too friendly or threatening. The type of chairs for your clients is important. They need to be comfortable enough to sit in for about an hour. It will be distracting if they are uncomfortable because the client will fidget or focus on their discomfort rather than participating in the conversation. If they are too comfortable, the client can get too relaxed and sleepy. It is best that the chairs have padded arms which makes them more comfortable. They need to be big enough so that they accommodate most people.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
Describe the way and reasons to take notes during the session and why and how to keep them in a safe place.
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Dr. Dan's Answer:
The counselor keeps paper ready so they don't forget important information shared by the client. There are forms to help with note taking. Notes should be completed as soon as possible after each session, before memory fades.
Notes also help the counselor keep track of issues, observations, and personal characteristics over many sessions and many clients, to guide treatment in the following sessions.
Case notes are privileged and confidential information. Keeping them secure protects the client's privacy and trust, as well as the counselor's professional integrity. They should be kept locked up in a safe place, and no one else should be allowed access.
You have almost completed Course 1, an overview of the Cognitive Biblical Therapy method, what is involved in the initial session, and introductory forms. You may be asking God, “where are you leading me in serving people who need your help?” Wherever you are in your faith journey be confident by faith through grace; He is guiding you in His desire for you to help people.
Some of you are not able to start Course 2, others are able and ready to begin the next course. No matter where you find yourself, we are thankful you have given Dr. Wilkinson and opportunity to introduce you to an initial understanding of Biblical counseling through CBT. If or when you are ready to start Couse 2, Dr. Wilkinson will lead you into an understanding of how to initiate the analysis phases of counseling, gather essential information, and explore the client’s spiritual maturity which is impacting his presenting problem. You will discover the basis for the Analysis Questionnaire for Agape Love (AQAL), how biblical word studies are the Biblical norms to understand the identified problem(s), and the goals for maturity in Christ Jesus; then what CBT tools are available to help clients.
Courses 3 and 4 will provide you with a much deeper knowledge and skill to use the CBT method to help people. If for some reason you are not able to start or take the next courses, please keep in mind that all of the CBT materials are copyrighted and you will need permission by the Biblical Christian Counseling Ministries, Inc. to use any of the materials. Further, CBT Coursework Certification is required to use the copyrighted material. See the copyright under each chapter’s text for the copyright information. For further information, feel free to reach out to: cbtcertification@gmail.com. Otherwise, when you are ready, complete the quiz below in order to move on to Course 2.
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