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Rumena Pervin availability

My availability

Working in my private practice is my sole job and I actively manage my diary so that I can be as flexible as possible for existing clients within sensible boundaries, whilst maximising my availability for new clients.

 

I try to help as many people as possible and to provide a customer-centric service, but inevitably there are limits and with client demand so high, it is important to set some basic expectations.

Visibility and active management of my diary

I am very active in managing my diary and I maintain a visualised view of my current availability covering both weekly and fortnightly slots.  I attach this view to emails but it is not published here as it gets updated too often for that to be practical.

The tightening of my diary over time

With my practice having grown, I am often showing very limited availability for re-scheduling existing slots, undertaking free pre-assessments and allocating recurring slots to new or returning clients.

 

I am frequently asked whether the following week's diary will be clearer and typically the answer is that it will be broadly the same if not busier.  This is because most clients take the default option of a weekly session in a fixed time slot and so as each week passes and I take on more clients, the gaps and flexibility in my diary are reducing.  Cancellations and re-scheduling only create temporary gaps that don't provide a basis for confidently scheduling regular and sustained (and therefore clinically effective) therapy.

The practical limits of my flexibility for volatile diaries

In principle I will always try to flex appointments if required, but as my practice has grown, my diary has become more congested and so being flexible is now more difficult.

For existing clients, this means that being able to re-schedule sessions to avoid cancellation is increasingly rare.

 

For prospective clients, this means that I need to re-emphasise the need to commit to a recurring slot at a fixed time of day, recognising that there will be the odd occasion when life gets in the way.  I realise that for some clients, for example those in senior corporate roles or on highly changeable shift rotas, making such a commitment is simply not possible and for those cases, my practice is not a realistic option.

Additional flexibility for free pre-assessments

The free no-obligation pre-assessment sessions that I conduct are run once per client (or twice if I am meeting each half of a couple) and are usually no more than 30 minutes long.  This means that even if my current availability does not enable a near-term pre-assessment, I can usually stretch to make it happen outside of my normal work patterns.  That said, this is only worth doing if there is a broader alignment of diaries such that full-length paid sessions can be scheduled shortly after the pre-assessment, assuming it is successful.

Supply and demand imbalance for evening and weekend appointments

I do work evenings and weekends but these appointments are in extremely high demand by, for example, full-time workers who cannot work from home and couples who otherwise be unable to reconcile two diaries.

With this being the case and with all of my clients in long-term therapy, the result is that evenings and weekends are usually (but not always) fully and continuously booked.

I do understand that this causes disappointment and it is quite common to not be able to proceed for this reason alone.

Why I don't operate a waiting list

Prospective clients are often kind enough to say they are willing to go onto a waiting list in order to be able to engage me, especially if they are reliant on having evening or weekend sessions.

Whilst I greatly appreciate these offers, I do not operate an open-ended waiting list because all of my clients are in long-term therapy and I would always prefer someone to get help elsewhere rather than waiting an indeterminate amount of time for me to have suitable availability.

That said, if a suitable slot cannot be identified but I have a reasonable expectation that there may be some fresh availability in the very near future, I will bear you in mind for newly available slots for a limited period of, say, 2 weeks, after which point I would hope/expect that you would have someone else anyway.  

The complex practical realities of fortnightly sessions

Weekly sessions are the norm and clinically this is the best option.  However, at any one point in time, a number of clients will be having (or seeking) fortnightly appointments.

Demand for fortnightly appointments arises from clients that:

  • Are constrained by their budget and/or their diary

  • Want to ease into therapy before committing to weekly sessions

  • Have been having therapy weekly and feel fundamentally better, but don't want to "cut the cord" abruptly and see a move to fortnightly sessions as a way to phase out support in a more gradual manner.

To make fortnightly slots work for me, I need to try and "pair up" fortnightly clients in a given diary slot, such that I see two clients in the same time slot, but on alternate weeks.  As you can imagine, this takes a lot of orchestration on my side especially with cancellations and vacations and so I am keen to minimise the number of diary slots that work in this way.

This does not mean that fortnightly clients are not welcome as I have manybut it does have implications:
 

  • For those who wish to have fortnightly sessions, be they prospective clients OR existing weekly clients:  In the first instance I will be offering you any currently "un-paired" fortnightly slots that I have, in the hope that one of them can work for you.  If none of the available options work or if there are no "un-paired" slots at all, then if you are a new client you will be offered any other recurring slot that is available at that point and if you are an existing client, you will remain in your pre-existing slot.  However, if fortnightly slots become available later, you may be asked (but not forced) to move to one of those.

  • For existing fortnightly clients who wish to move to weekly sessions:  In the best case scenario, you will have been in an "un-paired" fortnightly slot in which case you can utilise your existing slot but on a weekly basis.  However, as my diary is highly optimised, there is a strong chance that you will have been occupying a slot that is "paired" with another client.  In that scenario it is not simply a case of staying in your existing slot and doubling the frequency of your sessions.  Instead, you will be asked to pick from whatever weekly recurring slots are available at that time.  If you cannot move slots, then subject to diary capacity, I will ask (but not force) the other client with whom you have been "paired" to take another slot so that you can use your pre-existing slot weekly.

  • For existing fortnightly clients who wish to have their scheduled appointment the following week instead and then reset their fortnightly cadence from there:  In the best case scenario, you will have been in an "un-paired" fortnightly slot in which case I can agree to this change, although I may ask you to consider re-scheduling to within a few days of when your appointment was due to occur, to enable your existing fortnightly cadence to be broadly maintained overall.  However, as my diary is highly optimised, there is a strong chance that you will have been occupying a slot that is "paired" with another client.  In that scenario, I cannot simply agree to that change as it would unfairly disrupt the diary of the other client with whom you have been "paired".  In this latter scenario, the backstop option is that we miss a session and wait for you to get back into your previously agreed cadence, but this is far from ideal clinically as it creates a long gap between the previous and next sessions.  In this scenario, there may be some ad hoc diary availability that we can use to avoid a long gap.

  • For existing fortnightly clients who wish to re-schedule their appointment within the same week:  In the first instance I will be offering you any currently "un-paired" fortnightly slots that I have, in the hope that one of them can work for you.  If none of the available options work or if there are no "un-paired" slots at all, then I will do what I can within my current diary capacity to accommodate the request.  If I can't arrange an alternative, the backstop option is that we miss a session and wait for you to get back into your previously agreed cadence, but this is far from ideal clinically as it creates a long gap between the previous and next sessions.  In this scenario, there may be some ad hoc diary availability that we can use to avoid a long gap.

  • For all fortnightly clients who deviate from their fortnightly cadence:  I value my weekly and fortnightly clients equally, but whilst having sessions missed by weekly clients is clinically unhelpful, it's even more serious for fortnightly clients as it creates such large gaps between appointments.  Consequently, I set a higher bar for attendance by fortnightly clients and if you are not holding to the fortnightly cadence to a very high degree, we will need to stop on ethical grounds as I will not take fees for a work pattern that I regard as non-therapeutic

 

It should also be noted that depending on how the days fall, transitioning from a weekly to a fortnightly slot can often involve going a couple of weeks without a session in order to make the pairing of appointments work.  In this scenario and as a one-off, we can potentially take a free slot elsewhere to bridge the gap.

Finally, over time, slots that were successfully "paired" become "un-paired" due to general diary movement and clients exiting treatment.  From time to time, I will seek to re-optimise my diary by conducting a survey of all my fortnightly clients in which I will ask them what fortnightly slots they can attend and their relative preference order.  Taking those preferences into account, I will then attempt to re-configure the pairs in whatever way maximises my diary's utilisation, so that I can help the maximum number of people in need.

Requests for sessions to occur less frequently than fortnightly

Recognising that there are times when fortnightly clients miss their scheduled appointment, the minimum planned frequency of sessions that I will agree to is fortnightly.  Weekly sessions are the ideal but I believe that meeting less often than fortnightly is not therapeutic.

The only exception to this is for clients with whom I have previously had an established relationship and who wish to re-engage on an ad hoc basis to address something specific.

The impact of British Summer Time on clients outside the UK

For some clients outside of the UK, there is the additional complication of the UK's clocks changing twice a year to account for daylight saving during British Summer Time.  This will occur next on 31st March 2024 when the UK's clocks will go forward by one hour.

 

In principle I will always try to meet client needs, but as my diary is so busy, it is likely that any non-UK client impacted by this will need to flex in terms of their local time so that I can maintain my diary.

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