I don’t know about you, but I spend a lot of my time these days talking about costs. I’m often asked about cost even before I’ve started to explain our services – how we work and what the benefits to our clients are. But “how much does it cost?” (to have a helpline service, a session of counselling, an hour of webchat with a bereavement counsellor etc.) is still often the first question I’m asked.
Again, I don’t know about you, but I work in a profession where costs haven’t changed that much over the past few years. A profession where it’s hard to deviate much from the standard price norms, either because our internal costs (largely skilled people) are fairly fixed, or because the market has many a skilled person offering something fairly similar at plus or minus 10% of what we charge. As I often observe to our customers with only a tiny degree of rancour, there’s no money in counselling. And genuinely, there isn’t.
I’m not complaining though, we try to make a profit through other services – training, consultancy or other offerings with a higher net gain and to some degree that works OK. You’ll notice that a huge amount of counselling is delivered either by very large providers (hint: they sell these services, or even give them away as freemium deals on the back of high-income insurance products) or by charities or community groups. This is no coincidence; the commercial model of being a small, high-quality counselling service simply doesn’t work on its own. Even most private practitioners, however highly trained or business savvy (and most are the former rather than the latter) struggle to make ends meet without a steady second income – which accounts for the fact that most highly skilled and experienced therapists are women and men in their middle years or beyond – people who have already had good careers and have retrained, or have a partner with an income sufficient to support them through the fluctuations of client numbers through the seasons. It’s also very expensive to train to be a counsellor which in itself discounts a good number of younger people or those who need to support a family from entering the profession in the first place.
So cost is important, of course. What it costs us to provide high quality, reliable therapists to support vulnerable people is inevitably passed on to those clients who choose to use us to provide staff counselling, or bereavement counselling, or other professional support services. And what these services cost our clients is (rightly) under constant scrutiny and review. But enough about cost, what about value? Nobody ever talks about the value of good therapy. They can probably tell you the cost, but ask anyone what the value of good therapy is and see if you get a satisfactory answer. Yet anyone who has ever had good therapy will tell you very clearly why they valued it and what it did for them, just as the people who had poor quality therapy will tell you how useless it was! Value is much harder to quantify than cost. We want hard outcomes, evidence, proof that what we do ‘works’ – yet sometimes it is in the intangible qualities of what we can do for people at difficult times that is at the heart of the value of therapy. For those people who are mired in their pain, or who cannot separate themselves from sadness, or who can’t speak to their trauma or unburden themselves of their guilt, counselling can be utterly invaluable. Counselling is not about putting a grieving person back together, but is about helping the bereaved person to find all of their pieces and work slowly and carefully to build a new version of themselves; the person they are after loss. Counselling doesn’t stop people from falling apart – but it offers a gentle safety net to catch all the fragments of our broken selves and the skills and space to find the courage to repair ourselves the best we can. Bereavement counselling isn’t about making things better – it’s about offering the space to look for an alternative future – the one without what we had before we were bereaved.
So how do you value this? Sure, you can take measurements. You can use psychological testing scales to find out how distressed someone is before and after counselling and use that to ‘prove’ that they have moved forward in their grief. We can even measure the socio-economic benefits of grief support: fewer GP visits, less reliance on coping mechanisms such as drugs or alcohol which negatively affect our health and could impact further on the NHS, greater likelihood of a successful return to work, improved ability to parent our grieving children – all of these can be measured and counted with a little scientific effort. But do these outcome measures actually demonstrate value? I think not. Which is why any of us who devote our time to supporting people through counselling and therapy will tell you that it is easy to count costs, a little harder to evidence outcomes but almost impossible to demonstrate value. Happily, most of us who listen to our clients hear the value every day. We hear stories of breakthroughs and rescues and many thank you’s. But before you ask me about cost, consider this: how do you value good bereavement care?