2 Flashcards
(42 cards)
Although the cancellation policy was clearly explained at the onset of therapy, the client continuously fails to call in advance to cancel. When confronted, the client minimizes the problem and accuses the therapist of having unreasonable expectations. How should the therapist initially respond to the client?
Confront the client about his perception of the problem and discuss how to move forward.
A mother brings her 15-year-old daughter to therapy after learning that her daughter is pregnant. The mother informs the therapist that an abortion is out of the question because of their religious beliefs, but she does not think the daughter should keep the baby. The mother tells the therapist she wants to place the baby for adoption because she is in ill health and cannot help her daughter raise the baby. How should the therapist initially address the daughter’s pregnancy?
Meet with the daughter separately to explore her feelings about the pregnancy and provide clients with appropriate referrals.
Brian, age 34, and Kim, age 30, are referred by Kim’s co-worker for therapy. Kim shares that she recently caught Brian cheating on her and even though he says it’s over, she doesn’t know whether she trusts him. Brian says “I know I messed up. It won’t happen again. I don’t know why we have to keep dwelling on this.” How should the therapist proceed with the initial assessment in this case?
Invite them to share how they met and what keeps them together.
A family of three presents for treatment after being referred by a family friend. Lucas, 42, states that he has recently announced to the family that he is transgender and would like to begin his transition in the near future. His wife, Amelia, 35, tells the therapist that she has been completely numb since receiving her husband’s news, unable to imagine what her life is going to be like. Their son Ethan, 14, reveals his latest involvement with oxycodone. “Once kids at school learned about my dad, the ridicule has not stopped. And my parents are so preoccupied with their own problems that nobody even notices that I am high most of the time.”
Assess Ethan for suicidal ideation and intervene accordingly; provide Lucas with appropriate referrals to support his transition; assess Amelia for symptoms of depression.
therapist has been seeing a client intermittently for two years, and they have a strong relationship. The client is often fearful and suspicious of new situations. The focus of interventions has been to promote client’s independence and personal decision-making. The client recently learned of an opportunity to move into a group home that offers better social support than the current living arrangement. The client is reluctant to discuss the new housing option and reports being worried about making a change. The therapist asks the client to tour the home and see what it is like before rejecting it. Because he trusts the therapist, the client agrees. What are the ethical implications of the therapist’s actions in this case?
The therapist is acting ethically by using the therapist/client relationship as an intervention tool.
32-year-old client seeks therapy to address relationship issues. She has two young children and recently left an abusive relationship. She was married for 7 years and states that the last 5 years included verbal and emotional abuse. She reports depressive symptoms, trouble in dealing with separation, low self-esteem and difficulty parenting her children. What interventions would a Structural Family therapist utilize in the middle phase of treatment to strengthen the parental hierarchy between the client and her children?
-rearrange chairs to show parental hierarchy
A 19-year-old client seeks treatment for relationship issues. The client shares that he is attracted to both women and men and he doesn’t know how to explain it to his parents. Three months into treatment the client is unexpectedly laid off from his job and leaves a message that he can’t afford therapy. He declines to attend termination sessions because of concerns about spending money while unemployed. How should the therapist clinically manage the ethical issues in this case?
Offer a termination session at a reduced fee to enable the client to process the termination and provide referrals to low fee servic
Jim, age 31, and Tina, age 32, seek therapy for intimacy issues. Tina tearfully tells of Jim’s lack of affection over the past year. He can’t control the amount of time he spends on the Internet at work or at home. Tina says angrily, “I can’t keep living like this! He is spending all our money on porn sites. You can fix him right? What will our friends and family think if they knew that we have to come to therapy?” Tim looks out the window as she speaks. What clinical issues should the therapist address with the couple in this initial session?
-expectations of therapy, feelings about seeking help
A 42-year-old female client seeks therapy at the urging of her partner. The client is late to the first session and appears disheveled. The client begins crying and reports that she is distraught about the recent loss of her 82-year-old mother. How would a Client Centered therapist proceed in this case:
-reflective listening to explore reaction to her mothers death
Michael, a 25 year-old African-American man, is court-ordered to therapy after being released from prison, where he spent time for selling drugs. Michael states that he is only there because he is required to come. Under his breath he says, “The whole system is rigged against the black man.” How should the therapist respond to the client in this case?
“I imagine you’ve experienced a lot of racism.”
A 45-year-old woman comes to therapy. She has a history of cutting herself when feeling overwhelmed and reports that in recent times she has felt so stressed by her life, the isolation caused by COVID, and all of the societal problems, that she has contemplated suicide. How would a Dialectical Behavioral therapist initially proceed? Ok, let’s look at the answers:
Validate client’s feelings and further assess current level of risk
Kim places the figure representing herself far from the other kids in the tray. They decide that “making friends” would be an appropriate goal for treatment. What interventions would a solutions-focused therapist utilize to reach this goal?
Use puppets to play imaginary games together; Use puppets to practice how to play with friends at school; Describe times when Kim did play successfully with other kids at school.
Stanley, a 69-year-old Chinese man whose wife died four months ago, is referred by his doctor. He recently moved in with his son’s family. When Stanley arrives at your office, he does not make eye contact and walks with a limp. His Caucasian daughter-in-law, Nancy, brings him at her husband’s request. According to Nancy, Stanley has been “acting very strange for a while and he is less and less capable of taking care of himself.” Nancy stares at Stanley angrily and appears frustrated when Stanley tells you, “I don’t want to be a burden to anyone.” Nancy adds that her husband expects her to take care of Stanley.
How should the therapist proceed initially in this case?
Interview Stanley alone to assess elder abuse and suicide potential
Sylvia, a 68-year-old woman, is referred by her priest from her church after a below-the-knee amputation due to complications from diabetes. Sylvia begins to cry and shares that “life is too hard without her leg.” She lives alone and her daughter visits her once a week but she lives an hour away. She tells the therapist that her doctor wants her to take medicine for depression but she is scared. She adds, “I don’t think this talking stuff is going to help me.”
What factors require primary consideration by the therapist in formulating the initial treatment plan?
Premorbid coping skills; Sylvia’s motivation for treatment; Sylvia’s religious community
A 16-year-old girl is referred for therapy after a brief hospitalization for a suicide attempt. The client is adamant that she does not want her parents involved in her treatment. After obtaining signed informed consent, how would a psychodynamic therapist initially proceed with treatment?
-review her plan to stay safe from harm
A 16-year-old girl is referred for therapy after a brief hospitalization for a suicide attempt. The client is adamant that she does not want her parents involved in her treatment. After obtaining signed informed consent, how would a psychodynamic therapist initially proceed with treatment?
-review her plan to stay safe from harm
An elderly woman and her daughter seek therapy. The daughter reports that her mother can’t live on her own any more and wants the therapist to talk some sense into her. The mother reports that she is “doing just fine on her own” and doesn’t want to be put in a home. How would a Solution-Focused therapist approach the case?
Explore what they each see as an ideal outcome and identify resources.
A therapist is running a therapy group for adults with relationship issues. The group has been meeting weekly for two months. During a group therapy session, one of the members shares that he doesn’t feel like he is getting anything from the group and is thinking of quitting. How should therapist respond?
-explore group members reactions
Greg, a 42-year-old lawyer, and his 36-year-old wife, Gina, a stay at home mom, are referred by their minister for couples therapy. Greg starts the session by sharing, “The other day, I came home early and found Gina drinking vodka! I know she is stressed, but that is unacceptable.” Gina snaps back, “You work late, how am I supposed to take the edge off. You don’t know what it’s like being with a 1-year-old and a 3-year-old. If I don’t drink, I’ll lose it.” “I really need you to help my wife, I’ve been praying for her but I think she needs more than that.” What ethical responsibilities does the therapist have in the case presented in the vignette?
Respect couple’s religious belief system by not imposing therapist’s value system;
Monitor the safety of the children;
Inform couple of “no secrets” policy.
A therapist has been seeing a husband and wife for just over a year to address intimacy and trust issues following an affair. Between sessions, the wife calls the therapist because she tested positive for HIV . She tells the therapist, “I can’t tell my husband, he’s finally starting to trust me again and this will ruin it all. Please don’t tell him.” What action should the therapist take?
Assure her that confidentiality will be maintained and continue to explore her concerns about sharing her HIV status.
A 42-year-old client seeks therapy after losing his job as a sales manager three months ago. His wife has been supportive, but he can tell she is very stressed because they rely on his income and won’t be able to afford their mortgage. He shares that he is distraught and doesn’t know how to deal with something like this. After ruling out risk of suicide what intervention would a Solution-Focused therapist consider?
How they’re coping with the loss
Janet presents for therapy on the advice of her husband. Janet states that for the past six months she has suffered from headaches, irritability, frequent tearful episodes, and insomnia. To help her sleep she’s been regularly taking painkillers that her neighbor gave her. Janet sobs, “My husband can’t stand me this way, and I can’t stand to go on this way, either. We’ve even thought about separating. You can help me, right?”
What initial interventions should the therapist present to Janet?
Couples therapy to address relational issues; Referral to psychiatrist for a medication evaluation; Outpatient substance treatment to address client’s substance use.
therapist has been seeing a husband and wife for just over a year to address intimacy and trust issues following an affair. Between sessions, the wife calls the therapist because she tested positive for HIV . She tells the therapist, “I can’t tell my husband, he’s finally starting to trust me again and this will ruin it all. Please don’t tell him.” What action should the therapist take?
Assure her that confidentiality will be maintained and continue to explore her concerns about sharing her HIV status.
Tyler, age 39, his wife Grace, age 34, and their son Billy, age 9, are meeting with the therapist for the first time. They were referred by Billy’s school because he is bullying other kids. The father states angrily, “I’m tired of dealing with his crap. His mom is too nice to him. I’m the only one who’s willing to lay down the law.” The mother appears frightened and does not make eye contact with the therapist. Billy hits her on the arm. The dad grabs Billy roughly and says “I’m the only one who can do that.” What should the therapist do first?
Interview each family member separately; obtain a release to speak with Billy’s teacher; document the incident in the record
