Reasoning Strategies #1

**For questions pertaining the “therapeutic relationship”, I would prioritize:

1. Empathize/acknowledge feelings
2. Focus on the presenting problem /relationship
3. Address presenting problem
4. Client’s self-determination versus caregiver’s wishes (educate caregiver, advocate for patient)

**Questions about SAFETY, suicide, harm to others, DV, abuse

1. When signs of abuse is apparent, REPORT
2. When signs of abuse is ambiguous, CLARIFY FIRST, then report next
3. When dealing with DV, if client is still in DV situation, help formulate SAFETY PLAN
4. Never do couple therapy if DV is present, do individual therapy
5. If client verbalize vague SI, HI, CLARIFY FIRST (intention, plan), hospitalize (consider voluntary then involuntary), if those are not an option, notify authority
6. Self-determination on leaving the hospital does NOT apply when the client is INVOLUNTARY hospitalized/committed.

**Questions with “initial session”, “first meeting with”,

1. Address limits of confidentiality,
2. Ask for reason for visit
3. Conduct psychosocial assessment.
4. When encounter resistance, discuss it with client (don’t miss the elephant!)
5. if client is not mentally sound, get collateral info (family, caregiver, prior hospitalization record)

** When working with group

•  If group problem occurs, address within group
• It’s okay for a group to have conflict (part of group therapy stages), Let the group address it
•  If group members mentioned vague information of child/elder abuse, talk to client INDIVIDUALLY after group, then report.
• Report abuse

**About substance abuse:

• If substance abuse is mentioned in questions, address substance use first before any type of treatment
• Alcohol, gambling addiction is best treated in GROUP therapy.

**Community resources

• If client is referred to you because basic needs are not being met, address basic need first! (referral, giving resources)
• Make referral to resources before starting any type of treatment

**Safety of Children  & elder/ disabled adults

•  If client has a minor at home, client is unstable, make sure to consider child’s safety first (postpartum depression), then treatment for mom.
• Please, unless you are a social worker in CPS/APS, do NOT investigate.
• Do not confuse clarification with investigation
• If the question indicated that you are a child well-fare social worker, you will need to put on the CPS hat

**Court, attorney, custody, divorce:

• If received subpoena, SW must respond whether to respond just to assert privilege
• For Court order, respond by release records! 
• For Court subpoena, you may advocate on the client’s behalf to release limited info if providing all information would cause severe harm to client. If Court refuses your request, you MUST release records. 
• Subpoena from lawyer other than of client’s, you FIRST assert privilege
• Know what privilege communication is
• Example of Assert privilege – if a law office, other than client’s lawyer’s, called requesting info, do NOT release without consulting client. Consulting client first.
• When social worker got sued by the client, SW does NOT have to protect client’s confidentiality
• In divorce battle, always refer to parent with legal custody for consent/discussion, pertaining anything to do with the child
• Do not give out any information, or recognize the client is being treated in your practice, if a person who is not aware of patient’s treatment status called to inquire about client’s status.
• If they know patient is in treatment with you (ie. spouse, mother), address confidentiality limits, need consent from client first.
• Gray area: If caregiver/spouse is aware of the client’s treatment with you and wants to discuss their concern with you, you MAY gather information from them but NOT disclose anything about the client’s treatment progress, unless consent is signed by the client.