Why Waiting Lists?

There’s nothing like finally making the decision to pursue counselling, only to be met with a waiting list. Or two. Or three. Or more. I’ve actually been there myself as a counselling client on more than one occasion, and it was disappointing to say the least. Wind officially gone out of my sails.

Because I’ve been there, I feel especially uncomfortable with the fact that I am a counsellor with a waiting list. My first instinct is always to apologize to potential counselling clients; a common response that I receive is “But that’s good for you!” And then I reply, uncomfortably, “yes, I am grateful but I regret that I can’t meet with you right away.”

I thought it might be an interesting exercise to explore possible reasons why counselling waiting lists exist and how to work with them.

Clinic / Private Practice Factors

Not All Waiting Lists Are The Same

The structure of waiting lists will vary and depends on factors such as where the counselling is being offered, whether the counselling is private or publicly-funded, and the amount of counsellors working at the location.

For example, is the counselling clinic a group practice where more than one counsellor is available to work with new clients? Or is it a private practice where there is only one counsellor available to see clients?

Is the counselling being offered at a clinic where the client has to pay out-of-pocket or is the client needing a subsidized option? It can’t be said enough that there is a profound need for affordable counselling in this country, and I would suggest particularly in Vancouver, where the cost of living is so high, and as such, there is enormous demand placed on non-profit agencies offering professional counselling. Waiting lists can be notoriously long.

Demand Exceeds Supply

As alluded to above, how many self-referrals or referrals from others (former clients, physicians, mental health professionals etc.) is the counsellor or clinic receiving? How many counsellor hours are available for counselling clients?

Clinical and Administrative Load

Does the counselling practice or agency have administrative support or is a private practice situation where the counsellor is solely responsible for all aspects of running their practice efficiently and helpfully for clients? There are many ‘behind the scenes’ and unseen activities which combined, can comprise up to a few hours of a counsellors’ day: responding to messages, consultations, clinical documentation, bill paying, writing, website management, office supply management, cleaning, professional development, and even managing the waiting list! All of these essential activities, and more, reduce the amount of time that counsellors are available for direct 1:1 work.

Policies

Is the counselling being offered at a clinic or agency which caps the amount of sessions that can be provided to clients? Shorter caps will yield sooner intakes for the next client on the list. Does the agency or service have a mandate for responding to first-time clients within a certain time period, that must be honoured? This is often a feature with crisis services or employee assistance programs (EAPs). Does the clinic or counsellor have guidelines around when a client’s file is closed and one for a new client opened?

Practice Location

Is the counselling practice or clinic in an easy-to-get-to location that is convenient to home or work? Is it walkable? Is there bike or car parking available? “Counselling near me” is a popular search term in Google.

Rural vs. Urban

In major centres there will likely be many therapists offering counselling. Some will have waiting lists, some will not. Often times potential counselling clients will need to contact several to find someone they like that is accepting new clients. I sometimes liken this to a temporary part-time job! For clients in rural areas seeking counselling, who are willing to see someone in their community, there may be waiting lists be the simple fact that the therapist may be the only game in town.

Time of Day / Day of the Week

If you have limited time in the day where you can come in for an appointment, the amount of sessions available to you will, of course, be reduced. Many times clients are in need of evening or weekend appointments. Most counsellors offer these appointment times but typically these sessions are limited. They are also the most frequently requested, adding to the demand on these sessions.

Counselling Factors

The nature of therapy is such that counselling clients complete their counselling at different rates. There can be a number of reasons for this including: the nature of the issue at hand, each client’s goals, therapeutic work done in-between sessions, other factors in clients’ lives which compete for time/attention given to therapy, new issues being brought up in counselling and gains, or personal wins made in counselling sessions. Also, clients may have been in therapy previously and have made significant strides but are re-engaging for a ‘tune up’ so that the therapy requested may be briefer this time round. Or not. It depends.

Outside Factors

Community Need

If a community has experienced a traumatic event, the demand for counselling increases, as people search for ways of coping. For others, regular engagement with the news can prove overwhelming and contribute substantially to anxiety. Further, social issues and realities may leave us feeling frightened or worried. It is normal to seek support.

The Unexpected

As I discussed above, at times unexpected events in our lives may also force us to quit counselling unexpectedly or engage suddenly. Events can range from a crisis, to something positive like a last-minute vacation. Suddenly a counsellor may have availability in their schedule to see a new client or two. Or alternatively, they may suddenly become booked up.

Counsellor Factors

The Practice of Therapy

Sometimes I am asked the question, “How do you do it? I couldn’t listen to all those problems!” And while I always respond that counselling is the best job in the world (for me, this is unequivocal!) I know that for it to remain the best job in the world, I need to pace myself. Many counsellors cannot actually work full time. And by full time, I mean full-time counselling (in-session-with-a-client) hours. The nature of what counsellors are trusted to hear requires a dedicated, regular self-care routine. A common strategy for counsellors is to reduce working hours to allow adequate time for other non-counselling related activities/time with others. While this does contribute to counsellors’ mental wellness, as well as doing heaps for the quality of counselling that clients receive, it does reduce the amount of counselling hours available.

Most counsellors also take vacation time each year, often at several points during the year. If you are searching for an initial counselling session over the winter holidays, however, you may struggle to find a therapist who is available in short order.

Counsellor Life Factors

Like the clients they serve, counsellors deal with the same life issues as the rest of the human race. And stuff comes up that might make counsellors take time off such as a death in the family, an ailing relative, educational leave, childcare issues, divorce/separation, personal health problems, accidents and more.

Therapist Specialization

How many therapists are there in town who work in the area that you are requesting help with? Certain problems, like relationship issues and anxiety concerns are relatively common, and many professional therapists will have experience in these areas. Other more specific concerns will have few and sometimes no therapists in town who do this work. Emetophobia is an example of this.

Therapist Credentialing

At times clients may be seeking a counsellor with a specific credential: sometimes this is a philosophical choice, at other times this is related to the fact that they are only covered for a specific counselling discipline. If there are few practitioners with this credential in town, and more clients asking for it, this will limit counselling supply.

Therapist Reputation

Some local therapists are sought after and there is a demand for specific counsellor in the community. This may be related to ‘word on the street’ former clients telling their friends and loved ones about a therapist, physicians and health professionals hearing good things from their patients who see the therapist and the therapist being helpful to members of the public whom they do not end up working with directly.

Waiting List Tips and Tricks

  • If you have the choice, make sure it’s a waiting list, or lists, you want to be on: Use my New Therapist Checklist to help you narrow down your search.
  • If you don’t have the choice, such as when finances are a barrier or counselling options are limited in the community, add yourself to several waiting lists to maximize the chances of your name coming up sooner.
  • If you are being referred by a friend or health professional, ask the clinic or practice if this makes a difference for your position on the waiting list.
  • Take advantage of any free consultations so you can at least talk with the therapist beforehand to help you assess if they would be a good therapy fit for you. It could be very frustrating to wait on a waiting list only to find out much later that the therapist and you do not jive.
  • Does the counsellor or agency have a cancellation list? In my practice, many of my new clients get seen sooner this way. If so, ask how to add yourself to this list and how you will be notified of cancellations.
  • Is the counsellor or agency open to you contacting them periodically for a status report? This helps you stay engaged with your (upcoming) therapy, reminds the counsellor that you want to work with them and helps you make decisions about whether you want to stay on the list, given how it’s progressing. Of course, there is a balance between periodic check-ins and persistent contact which may come across as pestering.
  • Is no waiting list better? This is not an easy answer and could be related several factors such as: counsellors who are new to practice, a professional profile that is not resonating for potential clients or a recent expansion of the counsellor’s schedule, for example. Of course, if a counsellor’s reputation is poor, their practice will also suffer and they will have availability. And…some therapists are gems but struggle with getting their message out. This does not mean that they are ‘bad.’ Have that initial free consultation and trust your guts.