**When NOT to Confront client:
- First appointment/initial assessment
- The client is in a vulnerable/crisis state
**MAY confront client when:
- Time limit/brief therapy
- Acting out / not completing homework after seeing you for a while
- If issue arises during a session, FIRST be aware of the issue, move forward without bias
- NEXT, seek consultation or supervision
**If detect DUAL relationship risk:
- Bring it up and discuss with the client
- Do NOT avoid it. Never ask the client to terminate their relationship or terminate your existing relationship
- Acknowledge the client discretely if unexpectedly run into you outside of session, then discuss with the client in session. Don’t ignore client.
- REFER out if any family members of client want therapy with you
- If dual relationship far removed enough, the client still wants treatment, discuss with the client about the RISKS.
- NO-Secret agreement!
- If either partner/spouse called to confide, ask to bring up in therapy
- If the couple are not on the same page, BRING UP the differences
- If they got frustrated with each other due to assumptions, discuss COMMUNICATION skills
- Address any type of normal transition problems (new baby, new house, lost job, retirement, empty nest, etc.)
- NEVER see either partner individually if started out as a couple.
- Couple therapy is to treat the RELATIONSHIP, not individuals.
**For questions with depressive symptoms :
- If detect a sense of HOPELESSNESS, FIRST assess Suicide risk
- If RECENT ( < 6 months) STRESSORS were mentioned, think ADJUSTMENT DISORDER
- Before putting any MDD Dx, LOOK for DURATION of 2 weeks or more
- If MDD duration not mentioned/not met, and substance was there, think SUBSTANCE ABUSE (assess for/Dx)
- Don’t miss the obvious (In a clinical setting, do a psychosocial assessment, in non-clinical setting (school SW), talk to student INDIVIDUALLY, determine for symptoms of MDD before taking action )
** A few words about SCHOOL social work:
- If teacher referred a student, and the problem stated was vague, clarify with the teacher
- if already meeting with student, teacher’s report is specific, contact parents to gather more info.
- If you hear specific complaints from a teacher, MEET with student INDIVIDUALLY to access.
- If signs of abuse are suspected, report.
- Always consider family issues as a reason for acting out FIRST, before you consider possible eval for oppositional defiant disorder, ADHD, etc.
- Rule out learning disorder before ADHD/poor academic performance
**More SCHOOL Social Work – intervention
- SOCIAL SKILLS group/training is recommended for ADHD
- Applied Behavioral Analysis is an evidence-based treatment for Autism
- Provide psychoeducation for parents for “normal developmental crisis/ normal defiant behavior in adolescent”
- If physical/medical problem occurs, refer to a physician
- Unless question stem indicated that you are in school to do therapy, don’t try to diagnose or treat.
- ADVOCACY, ADVOCACY = SW takes appropriate action
- EMPOWERing Parents = encourage parents to take appropriate action
**Therapist seeing Parent + Child
- Ask about family function, any stressor at home
- Get parent/guardian’s consent to speak with a teacher for complete assessment
- ADHD: 2 settings, rule out learning disorder, home issue, abuse, trauma
- Refer to medical/physician if physical symptoms occur
- Always consider treat child as part of family, not as individual alone.
- If child’s privacy (diary, phone message) is violated, ask how the child feel about it in session.
**About LGBT minor:
- Work on processing issues with identity; validate, emotional support
- Work on understanding possible outcome, timing with the client before coming out to family (if family is not supportive)
- Coming out is the hardest /most stressful process
- Parents have the right to confidentiality
**Minor has sex with minor
- Educate about risk
- Not consider sexual abuse
**Questions about DSM Diagnoses: Always look for DURATION if suspect:
- Major Depression (2 weeks)
- Persistent Depressive Disorder (2 yrs-adult, 1-year children)
- Adjustment disorder (new stressor less than 6 months old )
- Brief Psychotic Disorder (0-1 month), Schizophreniform (1-6 mons), Schizophrenia (6 months)
- Acute Stress Disorder (less than 1 month), PTSD (1 month +)
- Generalized anxiety disorder (excessive worries 6 months +)