Request for Consideration Surrounding Desire to Switch Counselors

Request for Consideration Surrounding Desire to Change Counselors

Switch Counselors Questionnaire (SCQ)

Change, Inc. does not support transitioning between individual therapists (i.e., going from one individual therapist to another by simple choice). To explain, as you might imagine, clients have a wide variety of presenting struggles and motivations for entering therapy, and subsequently, for continuing or discontinuing their therapeutic work with a particular therapist. For example, a client who has family of origin struggles with a father-figure might balk at seeing a therapist who identifies as male, when in fact, the discomfort the client is seeking to avoid may precisely be what is necessary to help work through their historical struggle (NOTE: this is just an example, and an imperfect one). Of course, this is not always the case -- sometimes clients have simply decided that they'd like to work with someone else for reasons that are not problematic. Yet, because we can't always tell which is which, we generally refrain from allowing clients to "hop." So, we strive very hard to make a good fit on the first try, and ask clients to make good on their Informed Consent Agreement with us, which asks that you give us 90-days of treatment to determine effectiveness as early therapy jitters are often resolved. However, when clients present with a desire surrounding changing therapists, we do take those concerns seriously, and have developed a process whereby we evaluate making an exception to the above-policy. This form will help us gather the information we need to determine whether we can initiate that process.

Name*
First Last
Email*
Today's Date*
MM slash DD slash YYYY
Current Counselor Name*
Date You Began Seeing Current Counselor*
MM slash DD slash YYYY
Total Number of Sessions Completed Since Start Date*
Why did you come to therapy in the first place? What were you looking to work on?*
What has not gone the way you wanted? What is motivating you to want to see a different counselor? (NOTE: Please be specific -- transition requests are more likely to be approved when clients can concretely list the ways in which their current therapeutic relationship is not satisfactory)*
Have you shared your feelings from the previous question with your current therapist? Why or why not?*
Consent Regarding Confidentiality*
I agree to the following statements.
The information above has been provided voluntarily. I understand that it will be reviewed by the Clinical Direction Team at Change, Inc., as well as discussed with my current therapist in an effort to consider my request.
Consent Regarding Process*
I agree with the following statements.
I understand that the Clinical Direction Team will notify me once they've reached a decision about whether I'll be permitted to meet with the Transition/Triage team. If I am, I understand that the Transition/Triage team will then ask further questions and make a recommendation as to whether I should meet with a new therapist, return to my current therapist to discuss this impasse, or consider seeking therapy outside Change, Inc., and that it is not guaranteed I will be permitted to see another therapist at Change, Inc.
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