Reasoning Strategies #2

**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

**Therapist’s Countertransference:

• 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.

**Couple therapy

• 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 +)