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Something I’ve noticed over the years– Clients in addiction programs, inpatient and (often) outpatient, feel cheated when it comes to individual counseling.

That’s based on my unscientific review of all those Client Satisfaction Surveys you’ve been collecting. In many programs it’s the clear number one complaint– not enough time spent one-to-one with the primary clinician.

Quality seems to be less important than quantity. Even when the therapists themselves draw praise, the program can still be downgraded on the grounds that the client doesn’t get to spend enough time with them.

Lots of group therapy doesn’t seem to make up for a perceived lack of individual sessions. I’m not alone in noticing this– we’re now seeing the appearance of programs that advertise individual sessions only. They usually charge more, of course.

That’s simple economics. A program that has to live with lower fees– from managed care contracts, for instance, or limited public sector funds– will face barriers when it comes to providing more individual sessions. They’ll need additional qualified clinicians, usually with smaller caseloads, seeing one client at a time rather than ten in a group. In many areas, we’re already facing a growing shortage of addiction counselors. That can translate to staff vacancies that restrict your census, and your program’s revenue.

We wind up with  a conflict between what clients want and what the clinic can afford to provide. You can guess which usually wins out. Satisfaction is important, but so is staying in business.

By the way, I’ve never seen any research that suggests individual counseling produces better outcomes than group work. This is not about results. It’s about attention. Our clients want to feel as if somebody’s actually listening to them. And groups don’t always provide that.

It’s the same in any service business. The customer expects a certain degree of personal attention, and isn’t satisfied with less. The treatment atmosphere just increases those expectations.

Turns out there are a number of ways to meet them without dramatic increases in staffing:

  • First, it depends on hiring the right sort of employee, in support positions as well as clinical.
  • Second, it’s about creating a culture that values good communication with clients and families.
  • Third, and perhaps most important, it means an organization-wide culture that focuses on customer service.

Unfortunately, we don’t have a long history of that in addiction treatment. In fact, many of our programs in the past have bordered on the punitive.

So: What are some ways to create a customer service culture? See some of the articles below, and we’ll take a closer look at the issue in future installments.