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3304 SAMPLE Assignment # 3 FALL, 2008 Gallant of 22

Running Head: Assignment 2

Assignment 2

XXYYM00ZZTXYZ

November 20, 2007

Dr. Gallant

47 304/211


Preparing

Due to the fact that this was a role-play and not an actual client, it was not possible to

engage in several aspects of preparation, which would have been relevant when working with an

actual client. I felt that the areas of preparation in which I was able to employ were strong points

and as such were very encouraging.

Preparatory Reviewing

The client, with whom I met, would have completed a telephone intake with the agency,

thus providing basic background information, prior to our session. In order to prepare for the

initial meeting with John, I felt that it would be imperative that I review the existing file in order

to familiarize myself with his current situation, as well as the resulting problems. Although the

information may not be in depth and by no means complete, the process of preparatory reviewing

would allow me to comprehend the substantial issues facing the client, as well as consider the

potential problems that may arise (Cournoyer, 2008). This process may also enable me to gain a

sense of the client’s general disposition and mood, as captured by the telephone intake worker.

However, as illustrated by Cournoyer (2008), it is important to accept this information at face

value due to potential bias on behalf of the interviewer. Establishing the primary reasons for the

meeting would provide the opportunity for effective time management during our session, as

well as making the client feel valued as a result of my prior knowledge.

Preparatory Exploring

Prior to my initial meeting with John I may meet with the intake worker who had

conducted the telephone interview in an attempt to gain further insight into the client. The intake

worker may provide additional information about the client, not recorded in the file, specifically

insights gleaned from their conversation. Based upon the additional information provided it


could become apparent that depression and suicide may indeed be issues present for this

particular client. It is paramount that after receiving this subjective information that I do not

mistake it for fact which could create a stereotype or fixed impression, as expressed by

Cournoyer (2008). Throughout this process it is important to remain open minded to all

information in regard to the client, and thus avoiding judgement.

Preparatory Consulting

In respect to the first meeting with John, I would engage in the process of preparatory

consulting. Do to my inexperience in the field of mental health; I would seek advice from my

immediate supervisor as to the methods employed when working with a client experiencing

depression, as well as suicidal thoughts. I feel that this process would greatly enhance my

knowledge and abilities as a social worker and thus the quality of our session (Cournoyer 2008).

By engaging in preparatory consulting I am fulfilling by ethical obligation to the client through

the maintenance of professional competency (OCSWSSW, 2000).

Preparatory Arranging

Preceding my session with John I felt that it was vital that I employ preparatory arranging

to ensure the greatest comfort for the client and as such placed myself in the client’s position. I

made certain that the interview was held in a private room, so that the client felt comfortable

sharing without fear of being overheard by others. The furniture was also rearranged, allowing

for direct eye contact without forcing it. This process was undertaken as per Cournoyer (2008) in

an attempt to facilitate open communication and thus foster the helping relationship.

Preparatory Empathy

The process of preparatory empathy was crucial before the initial meeting with the client.

This method provided me with the ability to truly understand what the client may be feeling and


experiencing, and as such intensify my sensitivity to the client (Cournoyer, 2008). My

preparatory empathy in relation to John involved attempting to understand how it would feel to

have just lost my ex-girlfriend to suicide, as well as how I might be coping with the situation.

Preparatory empathy enabled me to approach John, his feelings and situation as distinctive,

unique and ultimately complex. According to Cournoyer (2008) it is essential that I do not allow

this to become a fixed view of the client and ultimately a stereotype.

Preparatory Self-Exploration

Through the process of preparatory self-exploration I was able to speculate how I may be

affected by the client and situation. The specific situation presented by John conjured several

thoughts and feelings in relation to suicide and depression. In regard to suicide, my religious and

personal beliefs are against the act of suicide and thus may differ with the desire and experiences

of the client, which could result in conflict. However, I have personally experienced bouts of

depression, which could lead to hopelessness and ultimately suicide, thus I feel that I could be

quite sympathetic to John’s situation. It quickly became apparent that in order to manage my

feelings in relation to the client’s experiences and problems preparatory self-exploration is

necessary (Cournoyer, 2008). Preparatory self-exploration ensures that the feelings and values of

the social worker do not interfere with the helping relationship, which otherwise would result in

a direct violation of the Ontario College of Social Workers and Social Service Workers’ Code of

Ethics (2000).

Centering

Immediately before my session with John I employed a centering technique in order to

personally prepare myself for the meeting. Specifically, I engaged in a relaxation technique of

deep breathing, which allowed me to become calm and focused. Although the breathing exercise


did not rid me of any personal issues, it did allow me to set them aside to be dealt with at a later

time (Cournoyer, 2008).

Beginning

The beginning phase of the session was a positive experience as well as a strong point;

however, it did present several areas for improvement. I felt that the beginning phase provided

the client with the opportunity to become familiar with me and the agency as well as the social

work relationship, becoming comfortable with all. Due to the information provided to the client

in regard to all aspects of the helping relationship, the beginning stage is absolutely essential

(Cournoyer, 2008).

Introducing Yourself

Upon commencement of my session with John I promptly greeted him with a smile and

“Hello John, welcome to Canadian Mental Health.” I felt that providing a friendly greeting was

essential in establishing a positive atmosphere as well as assuring the client that I was

approachable, open and un-intimidating (Cournoyer, 2008). I immediately introduced myself as a

social worker with Canadian Mental health, to ensure that the client understood who I was, my

qualifications and my role within the agency. My personal introduction was quite strong;

however, I did not provide any information or insight into the agency and what was offered, a

course of action that would have provided the client with knowledge on the available resources

and supports.

Seeking Introductions

According to Cournoyer (2008) during an initial meeting the social worker should

encourage the client to both say and pronounce their name to guarantee that the social worker

uses the proper pronunciation. During the role-play I did not seek an introduction from my client,


instead assuming that he was indeed John and potentially causing offence. However, I initially

addressed my client by name as I felt that this was an acknowledgement of the client as an

individual, not a number or just another face in the crowd. Cournoyer (2008) also notes that it is

of great importance to ask the client the manner in which they prefer to be addressed, in order to

avoid a cultural faux pas. Once again I did not ask how the client preferred to be addressed, an

action that is a sign of respect, not to mention consideration of their cultural background.

Seeking introductions is an aspect of the beginning phase that I truly need to practice and

implement during classroom activities and placement interviews.

Describing an Initial Purpose

When meeting with a client for the first time it is crucial to establish the initial purpose

for the meeting as plainly and concisely as possible (Cournoyer, 2008). In the case of John it was

important for me express the purpose for our meeting both clearly, “to help you deal with some

issues regarding your girlfriend’s death,” to make certain that I understood the client’s needs

before continuing. I felt that by presenting my view on the initial purpose for the meeting

immediately after introductions, the client had the opportunity to correct me and add to the

process, becoming an active participant, a method stressed by Timberlake (2002). Addressing the

initial purpose for the interview was a relative strength of mine; however, I need incorporate all

issues in a succinct manner.

Orienting Clients

Orienting clients to the helping relationship is integral to active client participation.

Cournoyer (2008) emphasizes the benefits that client orientation provides, specifically preparing

the client for the process, associated activities and thus reduce client drop-out. Despite its value, I

did not engage in client orientation during my session with John, a process that I should have


discussed. I feel that if I had presented my client with an orientation to the helping relationship,

he may have felt more confident and comfortable in the process, something that I will provide in

the future. Client orientation allows the client to be more comfortable with the client-worker

relationship, encouraging them to become an active participant and engage in self-determination,

a fundamental aspect of the Ontario College of Social Workers and Social Service Workers Code

of Ethics (2002).

Discussing Policy and Ethical Factors

As a social worker, the discussion of policy and ethical factors with clients is crucial

during the initial encounter, as it fosters an honest and trusting relationship (Cournoyer, 2008).

During my first session with John I explained the policy of confidentiality, what he said during

our sessions would remain confidential unless he provided written consent to the contrary, as

outlined in the Ontario College of Social Workers and Social Service Workers Code of Ethics

(2002). I also clarified my ethical duty as a social worker to report self harm and harm to others,

a possibility due to the client’s suicidal ideation, despite the policy of confidentiality, as

established by the Code of Ethic (OCSWSSW, 2002). Depending upon the agency other policy

and legal issues may be discussed with the client. I felt that I provided an adequate discussion of

confidentiality and my duty to report to the client; however I need to incorporate further

information in regard to policy and legal obligations during interviews.

Seeking Feedback

Perhaps the most important aspect of the beginning phase is that of seeking feedback, as

it provides the client with the opportunity to comment on the information presented (Cournoyer,

2008). Essentially the process of seeking feedback confirms the clients’ understanding of all

information presented, as well as providing the opportunity for the client to ask for clarification


(Cournoyer, 2008). During my session with John, I asked if he understood everything I had said

in regard to the purpose for the meeting, policies and my role, as well as any questions that he

might have. I felt that it was vital to ensure that there were no misunderstandings between myself

and the client, prior to continuing with the meeting, as well as conveying that the helping

relationship was a reciprocal process. Although this aspect was strong during the interview

process, I felt that I could have been more diligent in seeking feedback from the client.

Exploring

Asking Questions

Throughout the exploring phase, asking questions is an essential process in eliciting

valuable information, such as facts, feelings and ideas, from the client (Cournoyer, 2008).

Asking questions allows both the social worker and the client to gain valuable and mutual

understanding of the issue and is used for the process of assessment among other things

(Cournoyer, 2008). The process of asking questions was an aspect of my interview that was quite

strong, as I was able to yield a large amount of information concerning thoughts, feelings and

facts related to the client’s situation, without the client experiencing a barrage of questions which

could make the exploration process feel like an interrogation.

The most effective and useful questions when exploring the client’s situation are open-

ended, as they require the client to provide an in-depth answer, as opposed to a simple “yes” or

“no” (Timberlake, 2002). The open-ended question produced a tremendous amount of

information during my interview with John. For example when I asked John how the suicide of

his girlfriend was affecting him, I was able to find out that he was suicidal, information that I

may not have received through a closed-ended question. Due to the high value of open-ended


questions I must continue to employ them to gather information, while at the same time avoiding

interrogation-like techniques.

Closed-ended questions are also useful during the exploring process, as they provide

specific facts (Timberlake, 2002). They also allow for a large amount of data collection in a short

period of time, as they usually require a one word answer such as “yes” or “no” (Cournoyer,

2008). Throughout the role-play process, closed-ended questions provided confirmation of facts,

but provided some surprisingly detailed responses. I felt that my use of closed-ended questions

were appropriate, however, I feel that I could have limited their use with well placed open-ended

questions.

Seeking Clarification

Seeking clarification is an attempt by the social worker to extract an explanation or an

elaboration of a statement made by the client (Cournoyer, 2008). Clarification questions are

specifically employed when the client states something vague or ambiguous and the social

worker needs to ensure they are correct in their understanding (Timberlake, 2002). I feel that

seeking clarification is vital, as during my interview with John a clarification question confirmed

not only suicidal ideation but a detailed plan, from a statement that vaguely implied suicide

“stepping off the edge.” Based upon my analysis of the interview I employed clarification

questions appropriately, aiding in my understanding of the client’s issues, feelings and thoughts,

bringing me true insight into the client’s mind.

Reflecting Content

The skill of reflecting content provides the social worker with the ability to communicate

to the client your understanding of the information relayed (Cournoyer, 2008). Through content

reflection the helping relationship is furthered as a joint partnership between the social worker


and client, enhancing a positive relationship (Cournoyer, 2008). I found content reflection

greatly enhanced the helping relationship with John, specifically when he explained how he

viewed a prior overdose, as it allowed the client to feel truly understood. Despite being a relative

strength, I require further practice in the skill of content reflection to avoid parroting the client’s

words, which results from panic to prevent prolonged silence while I gather my thoughts and

thus discomfort.

Reflecting Feelings

The reflection of feelings is one of the most important empathic skills used by social

workers. It allows the social worker to communicate comprehension of the feelings that the

client expresses (Cournoyer, 2008). In order to effectively express understanding the social

worker must experience the emotions of the client through the art of empathy (Cournoyer, 2008).

It is paramount that while reflecting the client’s feelings that the social worker retains the

primary emotion expressed by the client, or else the client may feel misunderstood. In the course

of the session with John, such as reflecting his difficulty to speak of suicide, feeling reflection

was an indispensable tool. I felt that I definitely need further practice in this skill as during this

interview I had difficulty identifying and discussing the underlying emotion presented by the

client, although I am more effective at doing so during my placement and in-class role-plays.

Reflecting Feeling and Meaning

The reflection of feeling and meaning is a skill used by the social worker to

mirror the information provided by the client as well as the associated feelings (Cournoyer,

2008). While reflecting feeling and meaning, it is imperative that the original meaning of the

message is not modified (Cournoyer, 2008). During my interview I attempted to reflect feeling


and meaning, however, I found that I tended to focus more on the content than the associated

feelings, yet I was quite adept at doing both during in-class role-plays.

Partializing

Partializing is the break down of several complex dimensions in relation to the person-

issue-situation, which could easily become overwhelming for both the worker and the client, into

components that are more easily managed (Cournoyer, 2008). While engaged in exploring with

John, I do not feel that I effectively used the partializing skill; instead I focused on the issues in

which the client placed the most emphasis. It is evident that additional rehearsal is required, as I

could quickly become overwhelmed by the numerous issues presented by the client, which could

be easily discouraging for the client.

Going Beyond

The skill of going beyond is utilized by social workers to minimally expand upon what

the client expresses (Cournoyer, 2008). The skill of going beyond is complex and involved, as

the social worker must pay close attention to verbal and non verbal cues from the client

(Cournoyer, 2008). Going beyond what the client says is of great value during the interview

process, as it can aid in the client’s feelings of truly being understood and enhance the

relationship, however, it is possible to go too far. I feel there were several opportunities during

my interview in which I could have employed the skill of going beyond, specifically in relation

to his family and friends, but I require further training for its effective use.

Sandwich Principle

Client interviews often have the potential to run long and can be difficult to end,

especially when the client’s issues are complex and the helping relationship is effective.

Utilization of the sandwich principle provides the social worker with the opportunity to end the


session in a caring manner, while simultaneously ensuring that the client’s issues have been

addressed. The sandwich principle involves reflecting upon the last statement of the client, prior

to informing them of the remaining time for the session, at which point the social worker reflects

the content and feeling expressed throughout the entire interview (Gallant, 2007). Once finished,

the client has the opportunity to express his/her views and opinions in regard to the issues

explored, making it a truly collaborative effort. At the close of my interview with John I

informed him that there was one minute left in session, summed up what was just said and then

recapped the entirety of the session, providing the client with the opportunity to express his

opinion. I feel that this is a strong skill in my possession and with additional practice I may be

truly proficient.

Empathetic Reflection and Responding

In order to be an effective social worker it is essential to reflect upon the both the content

and feelings expressed by the client during an interview. Through empathetic reflection and

responding the social worker illustrates to the client a clear understanding of the thoughts and

feelings they have shared. While in session with John, I employed empathic reflection and

responding on several occasions. Perhaps that best example occurred during our discussion of

suicide, in which I noticed that John became quite anxious when admitting that he was having

suicidal thoughts. I mentioned that he was looking down when speaking about suicide and that

he appeared to have extreme difficulty differentiating between suicidal thoughts and feelings of

hopelessness. Through this example and the others within the role-play it is clear that empathic

reflection and responding are of great importance in establishing an effective helping

relationship, a task which I feel I accomplished.

Values, Biases and Personal Needs in Relation to the Role-play


During the role-play involving the client John, several issues relating to personal values

and biases arose, specifically relating to substance abuse and suicide. Personally I do not engage

in substance use or abuse, nor do I condone it, however, I did not allow my personal beliefs to

affect the client-worker relationship. By doing so I was able to fulfill my ethical obligation to

remain non-judgmental, keeping the needs of the client as the central focus, not my own. In

relation to suicide, my religious beliefs forbid it as it is considered a sin, yet it was presented as a

possibility and desire for my client. Through the use of empathy I was capable of setting aside

my personal values, placing myself in the client’s position in order to understand the situation

and the associated feelings.

Overall Skill Analysis

In social work practice it is evident that the learning process is continual in order to

provide competent and effective professional assistance to clients, as mandated in the Code of

Ethics (OCSWSSW, 2000). Despite completing the assigned readings and participating in both

role-plays and a field practicum, it is apparent that I require additional training and education in

relation to client interviews. Through continued role-play, as well as seeking feedback it will be

possible for me to improve upon my interview skills and techniques, specifically seeking

introductions, client orientation, discussing policy and ethical factors, reflecting feelings and

meaning, as well as going beyond. Although this list appears daunting, maintaining a positive

outlook and thirst for knowledge will result in my ultimate success. I look forward to continuing

my social work education, improving upon and adding to my skills and finally achieving my goal

of becoming a competent and knowledgeable social worker, promoting excellence and enhancing

the reputation of the social work field.


References

Cournoyer, B. (2008). The social work skills workbook (5th ed.). Toronto, On: Brooks/Cole

Gallant, W. (2007). Class Discussion. Professional Communication in Generalist Social Work

Practice (Oct. 23, 2007).

Ontario College of Social Workers and Social Service Workers. (2000). Code of Ethics and

Standards of Practice Handbook. Ed. 1. Ontario; OCSWSSW.

Timberlake, E., Farber, M., & Sabatino, C. (2002). Generalist Social Work Practice: A

Strengths-Based Problem-Solving Approach. Boston, MA: Allyn & Bacon.

VIDEO ANALYSIS SAMPLE

CONTENT AFFECT COMMUNICATION SKILLS USED BY

SOCIAL WORKER

REFLECTION

Client I just didn’t want to feel the way I did.(client looks down, avoiding eye contact)

Client: affect may be shame.

Worker: I am feeling the client’s shame and embarrassment.

I have a sense the client is ashamed or embarrassed about the previous overdose and is unable to put into words the feelings behind it.

Worker Okay. So were you attempting to commit suicide?(client shrugs and roles eyes)

- seeking clarification

- closed ended question

I felt it was important to determine if the past overdose was intentional, as it would allow me to ascertain if suicide was an option. I should have asked for clarification of what he was feeling.

Client They seem to believe so. Client: affect appears to be resentment towards doctors.

Worker: I feel the client’s anger

I have a sense that the client disagrees with the diagnosis of attempted suicide by the doctors, but that he is unsure if it was indeed correct and


towards this conclusion.

fears that I may have been.

Worker Okay. - active listening I felt that it was important to illustrate to the client that I was listening and understanding what he was sharing.

Client When I look back on it now I just didn’t want to feel the way I did.

Client: affect may be that of justification and regret.

Worker: I understand the client’s desire to no longer feel the pain associate with loss.

I noticed myself identifying my situation with his. The resurfacing my issues and pain allowed me to effectively relate to the pain experienced by the client.

Worker Okay. So it was just an attempt to get rid of those feelings of, um, missing your friend and the sadness that followed with it?

- paraphrasing- reflecting

content - seeking

clarification- close ended

question- going beyond

I felt that I needed to clarify what he was feeling at the time of the overdose, as well as reflect the meaning that he placed on the overdose (not suicide attempt). Perhaps should have used open ended question to allow client to reveal how he felt.

Client Absolutely, yeah.(client looks down)

Client: affect seems to be that of sadness.

Worker: I feel the client’s pain, as he remembers the loss of his friend.

I felt as though the client is reliving the pain and grief he experienced at the loss of his friend. I also felt as though the client was appreciative of the identification of the overdose as something other than attempted suicide.

Worker Okay. So what about now and the suicide of your girlfriend? How is that affecting you?

-open ended question I felt it was important to establish how the client was feeling after experiencing another


suicide, especially one he was blamed for. I should have further explored feelings related to the overdose.

Client I just feel that it’s a cycle that I’m going through again. I’m in that same place where I’m ready to just step off the edge.

Client: affect seems to be hopelessness.

Worker: I felt sorry that he has returned to a situation that is painful.

I felt that the client was hopeless about the current situation and did not feel that it was likely to get out of it. It appeared that our relationship would determine his future.

Worker John, what do you mean by “stepping off the edge?”


- open ended question

I felt that I needed clarification of “stepping off the edge” as it appeared to be a reference to suicide.

Client Well, last weekend I took a backpack full of bricks or heavy objects and weights and stuff like that. And I contemplated, I was standing on the side of a bridge jumping off and the weights would take me down to the bottom and I wouldn’t be able to go back. Just because of the way I am feeling. (client speaks very softly and does not make eye contact)

Client: affect may be despair and desperation, but also shameful.

Worker: I was shocked, but did not show it.

I sensed that the client was desperate and was capable of doing anything to rid himself of the pain and guilt. At the same time he seemed to be embarrassed or ashamed of his feelings and actions.

Worker So you are considering suicide then, right now?(client bows head and looks down)


- close ended question

I felt I needed a definite answer regarding suicidal intentions.

Client Well, I’m definitely having thoughts of it.

Client: affect may be that of realization and sadness of admittance.

Worker: I felt a sense of relief for finally establishing the

I felt that this was the first time that the client actually admitted to suicidal thoughts, so a revelation occurred. It appears as though the client is beginning to understand his feelings and the situation.


client’s intentions, however, fear that I would not be able to prevent self-harm.

Worker Okay, um, because I noticed when you were speaking about that, you were looking down a lot. It seemed to be very difficult for you to kind of decide whether it’s suicidal thoughts or if you were just feeling really hopeless right now. So, but at that point you also seemed to have quite a detailed plan, where you actually gathered what you needed to end your life. So, I’m just curious as to what made you decide not to jump.(client becomes quiet and looks down)

- going beyond- putting the

client’s feelings into words

- open ended questions


- reflection of content

- - reflection of feeling and meaning

I felt that it was important to reflect the non-verbal communication and cues expressed by the client in relation to the subject, as well as the confusion that he expressed. It was also imperative that I identified why he chose not to end his life. I should have reminded the client about my duty to report self harm, a policy/duty that I introduced at the beginning of the session.

Client Um, I’m not sure. Client: was hesitant to answer and seemed confused.

Worker: I was concerned that the client was uncertain as to why he didn’t jump.

I sensed that the client was having extreme difficulty identifying what kept him from committing suicide.

Worker Okay. - active listening I felt that I need to show the client that I was listening to him. I also recognized that he had more to say, before I responded.

Client I know it was cold that night. Uh… I just…I don’t know, maybe I started to feel better. I just kept rolling through the

Client: affect appeared to be that of intense grief and sorrow.

The client seemed hesitant and skirted identifying anything in particular that


scenario, what if? What if I would’ve answered the phone call that night?(client begins shaking head back and forth)

Worker: I was able to identify with the client’s constant rumination on “what could have been”

prevented his suicide, which I felt might hinder our progress, as he may not have anything to live for in his opinion.

Worker So, you’re kind of stuck in a cycle of questioning what would have happened if you’d been home or if you’d been able to pick up the phone, would she have decided not to commit suicide.

- reflecting content


- reflecting feeling and meaning

- - going beyond

I felt that the client presented a very important detail that influenced his depression and suicidal thoughts; as a result, I needed to ensure that this was the case. I missed reflecting on the response that “maybe he started to feel better,” I should have sought clarification.

Client Mm hmm. Definitely.(client nods head in agreement)

Client: agreed, no visible affect.Worker: I was unsure as to what I should focus on next, but I wanted to identify strengths that the client had.

I was concerned for the well-being of the client as he identified that his guilt was overtaking him mentally and emotionally.

Worker Um, with…with your friend’s suicide, other than the hospitalization, was there anything that helped you to get through this?

- seeking clarification and elaboration

Do to the client’s prior responses I felt that it was necessary to identify coping strategies, supports and strengths.

Client Um, well, I have a couple other friends that come and visit me sometimes but… (client looks down and away)I don’t really have a strong relationship with my family. So they really don’t help.

Client: appears to be upset about his lack of relationship with his family and is hesitant to speak about his friends.

Worker: I felt bad

The issue of friends seems to be delicate, as he does not complete his thought, quickly looking down and away. He then quickly changes the subject mentioning the relationship with his


for the client because he doesn’t appear to have very strong social supports.

family.

Worker So, um, have you been in contact with your friends lately?


- exploring- - close ended

question

I felt that there was an underlying issue regarding his friends and thus it was important to explore the issue.

Client Yep, yep. (client nods head several times) They sometimes call, but I get really disappointed when they, you know, break plans with me or…especially with the way I’m feeling, I just don’t want to be alone right now.

Client: affect appears to be frustration.

Worker: I understand his frustration and the strained relationship with his friends; I want to repair this damage.

I was once again surprised that a close ended question provided such a detailed response. I also noticed myself relating the client’s experience to my own. I am able to keep these experiences separate, while using my issues to empathize with his situation.

Worker Okay. So you’ve identified that you don’t want to be alone and that there is really not many support systems in place for you, but specifically friends. And you’re not really speaking to your family right now. Are you afraid that you are going to hurt yourself if you are alone?

- paraphrasing - reflecting

content- seeking

clarification

At this point it was I found it necessary to reflect on the content that he shared in order clarify the supports he has, as well as the potential for self harm.

Client Well, I’m alone a lot, but uh…I just think that, uh, if it gets to the point where my feelings are taking over…you know what I’m doing and what I’m thinking about, to the point where it drives me to the edge then, it’s a possibility. (client nods head in agreement)

Client: affect may be that of fear, dejection and loneliness.

Worker: I felt the client’s isolation, as well as pain.

I was surprised that my close ended question elicited such an in depth response, but it was apparent that it was difficult for him to share.

Worker Okay. From what you’ve said, I feel like there is good potential for you to get through this because you have had that

- reflection of content

- helping client see things in a

I felt that I needed to inject something positive into the conversation, as the


experience with your friend where you were able to get yourself through the mental illness, depression and suicide. So I really am very hopeful based on your past behaviour, that you are very strong and capable of getting through this again

new way- - pointing out

the positives

client appeared to be without hope and was showing signs of distress that could lead to suicide.

Client I don’t feel very strong right now.

Client: affect may be that of weakness.

Worker: I desire to point out his true inner strengths for overcoming his friend’s suicide.

I felt that the client is stuck in a cycle of negative thinking and is unable to view any aspect in his past or present as a positive.

Worker Well everybody goes through a point where they need help. You’ve done the best thing by coming forward and asking for it. So with me, I’m going to be able to provide you with the support and the help that you need to get through this right now. Okay?

- pointing out the positives

- establishing strengths

At this point it was crucial to ensure the client was aware of the support that I could provide, as well as the fact that he is not alone in what he is experiencing.

Client Okay. (client nods in agreement)

Client: affect appears to be that of understanding and possible appreciation of the help.

Worker: I felt that the client was appreciative for my assistance.

I thought that the client appreciated the support that I was offering and was hopeful that he may get through his current depressive and suicidal state.

Worker Okay?So, um, we have about a minute or so left. So I’d just like to kind of reflect on what you are saying. Um, you do, you’re not exactly hopeful

- sandwich principle

- paraphrasing- reflecting

content and feelings

As the session came to a close it was imperative that I reviewed the issues that the client presented, as well as


right now, but based on past experiences you have gotten through something similar. And you are also feeling very guilty about your girlfriend’s death and her parents continue to contact you, making you feel even worse.(client bows head and looks down)

- going beyond the feelings associated with them.

Client Mm hmm. (client nods head in agreement)

Client: no visible affect.

Worker: I felt that I addressed the topics presented by the client.

The client agreed with the topics reflected, which made me feel confident that the issues he presented were explored, although not resolved.

Worker Um, you’ve also identified that suicide might be an option. Even though you’re not exactly sure when or where, you have, um, overdosed previously in the past, but you recently had a backpack that was weighted and were contemplating jumping off a bridge into the water, okay? So is that correct.

- sandwich principle

- reflecting content

I felt that before the client left the session I had to readdress the issue of suicide, however, only in reflection.

Client Yep, mm hmm. (client nods head in agreement)

Client: affect appeared to be that of shame.

Worker: I noticed that although the client agreed upon the issue, he appeared sullen.

Upon the review of his previous suicide attempts, the client became quiet, mumbling his response, appearing embarrassed of his past behaviour.

Worker Well, what I’d like to do for our next meeting is um, kind of develop things further, look into strengths and supports and what we can do to help you get through this. Okay?

- establishing goals/agenda for our next meeting

I felt that it was important to establish an agenda for our next meeting at this time, so that there would be no surprises at a later date.

Client Okay. (client nods head) Client: no apparent affect.

Worker: I was

The client appeared comfortable with the goals for the next meeting, as well as


glad that the client was open to further meetings, as well as to the potential topics.

returning for further sessions.

Worker Thank you very much John. It was nice meeting you today.

- ending At the end of the session it was appropriate to thank him for his participation throughout the meeting.

Client Thanks. Client: affect appeared to be hopeful.

Worker: I felt the client had a valuable experience that aided in self-understanding.

The client appeared to be comfortable with ending the session.

document.docCreated on 21/08/2008 4:27:00 PMCreated by Dr. W. Gallant

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