Clinical skills

Question 1

Is it important to document all offers of support made to the client and/or their family/carers?

Answer 1

Yes, it is very important for later reference, records of interventions and possible insight into other supports (individual CBT)

Question 2

What to do when clients do not want to come/are avoiding coming to sessions?

Answer 2

Employ assertive ourreach support

Question 3

What are some additional factors which have an impact in the therapeutic relationship?

Answer 3

1. History of neglect and abuse- Through relationship patters and dynamic, Problems in childhood attachment can alter brain structure, neurochemistry and connectivity, being victim of a crime leads to avoidance and lack of trust
2. Socio-economical status- some interventions we propose might require additional expenses + ‘poorest’ individuals 8x more likely to be diagnosed with Sch
3. Culture and Ethnicity - non-white ethnicities more likely to be diagnosed with Sch + diagnoser bias = perception of MH services/ effect on service user
4. Client feeling of paranoia - leads to untrustworthiness
5. A lot of negative symptoms- lack of engagement makes it hard to form a relationship= Impact on ability to relate and empathise.

Question 4

What is paranoia?

Answer 4

Paranoia: “is an interpersonal experience that can extend to the belief that other people intend or are currently causing severe physical, psychological or social harm” (Lawler, Hall & Ellett, 2014, p. 490)

Question 5

What are OARS?

Answer 5

OARS (taken from motivational interviewing)
1. Open questions (ones that you can’t answer with a ‘yes’, ‘no’ or some other one word answer) – encourage them to tell their story
How has all this impacted you? How are you coping? What would make things easier for you?

2. Affirmations (or validation)
   It sounds like you’ve been working really hard to figure out what’s going on…..This sounds incredibly stressful……It sounds like you’ve been coping really well, given how intense and distressing this has been.
3. Reflections
   So you feel X because it feels like they’re the ones who are out of order, but you’re the one having to come to appointments, where you feel like you aren’t being taken seriously.

4.Summaries
Let me just pause there and make sure I’ve understood you correctly…

Question 6

What are the goals of assessment?

Answer 6

1. Engage
2. Foster hope
3. Get a better idea of the key problems
4. What would the person like to change?
5. What are their goals?
6. What is currently stopping them from achieving their goals?
7. Work out how you might work together
8. Get broader understanding of the person

Question 7

What are some Outcome measures used in EIS?

Answer 7

1. DIALOG
2. The Questionnaire about the Process of Recovery (QPR)- can give a sense of what we are aiming for at the end of the treatment (functional and social recovery)

Question 8

Some facts about goals in therapy

Answer 8

Essential to take time to identify
May take several sessions for people who are hard to engage (guarded, feeling hopeless)
Cornerstone of collaborative work
Need to be achievable within context of therapy
Process of negotiation – setting the scene for collaborative work

Question 9

SMART(ER) goals

Answer 9

1. Specific
2. Measurable
3. Attainable
4. Reasonable (within therapy window)
5. Timely
6. Evaluated
7. Re-evaluated