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3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 1 of 22
Running Head: Assignment 2
Assignment 2
XXYYM00ZZTXYZ
November 20, 2007
Dr. Gallant
47 304/211
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 2 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 3 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 4 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 5 of 22
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,
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 6 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 7 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 8 of 22
(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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 9 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 10 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 11 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 12 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 13 of 22
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.
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 14 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 15 of 22
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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 16 of 22
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?”
- seeking clarification
- 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)
- seeking clarification
- 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.
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 17 of 22
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
- seeking clarification
- 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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 18 of 22
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
- seeking clarification
- 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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 19 of 22
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?
- seeking clarification
- 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
3304 SAMPLE Assignment # 3 FALL, 2008 Gallant Page 20 of 22
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
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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
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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