DSM Midterm with Dr. K

What are the three elements of the Therapeutic working Alliance? Know how could each influence the clinical interview

1) Active listening 2) empathetic response 3) feeling validation and other behavioral skills as well as cultural sensitivity and interpersonal attitudes leading to the development and maintenance of positive rapport.

Give an example of a non-directive and directive historical lead.

An example of the first term: "What do you remember about your childhood?" An example of the second term: "What's your earliest memory—the first thing you remember from your childhood?"

How is the initial summary best used during a clinical interview?

After you've listened to your client and sorted through symptoms for the first 5 to 15 minutes, your job is to make a list of primary problems and goals. This ... signals a transition from general nondirective listening to a more directive approach.

Informed Consent

All professional relationships involve an explicit agreement for one party to provide services to another party. In counseling or psychotherapy, it is called this.

2 advantages of structured and semi-structured clinical interviews?

Are standardized and the therapist systematically ask clients a menu of diagnostically relevant questions. Show better diagnostic reliability and validly then less structures methods.

What should be kept in mind regarding mistakes made during a clinical interview?

Because you are human, perfection is unattainable. The challenge is to recognize your mistakes, recover from them, and use them for continued learning and growth.

Describe why "I understand" or "I know how you feel" is misguided in clinical settings generally.

Because you don't! We try to understand. Clients may respond with: "No. You don't understand how I feel," and they would be absolutely correct. "I understand" is a condescending response that should be avoided. However, saying "I want to understand" or "I'm trying to understand" is acceptable.

How would you handle an ethical dilemma that arises during a clinical interview? (Be prepared to talk through your decision via an ethical decision-making model)

By utilizing the Counselor Values-Based Conflict Model (CVCM) to help students and clinicians engage in self-examination around values issues. This model includes the following steps: a. Determine the nature of the value-based conflict: Is the conflict personal or professional? b. Explore core issues and potential barriers to providing an appropriate standard of care: What personal (e.g., religious biases) and/or professional (e.g., skill deficits or countertransference) issues are affecting the counseling process? c. Seek assistance/remediation for providing an appropriate standard of care: This might involve consulting ethics codes, colleagues, or supervisors; obtaining necessary training; using ethical bracketing; obtaining personal counseling; and identifying methods for maintaining personal beliefs while providing effective treatment. d. Determine and evaluate possible courses of action: This might involve examining the rationale for a possible referral, assessing the usefulness of the remediation plan, and determining if referral to another provider is ethical. e. Ensure that proposed actions promote client welfare: This involves a reexamination of whether the clinician's action (to continue treatment or make a referral) is in the client's best interest.

Treatment planning items/issues to consider for the exam: developing measurable and attainable treatment objectives

Directly address measurable symptoms related goals or problems using concrete theoretically based or evidence-informed techniques.

Explain the difference between a personal and professional relationship with a client.

Effective mental health professionals are experts at being respectful, warm, and collaborative with clients while retaining the necessary professional distance and objectivity.

Under the notion of the "Intake Report", describe: What is the purpose of collateral information?

The purpose of this is to enhance assessment, diagnosis, and treatment planning.

Describe Clinician Cultural self-awareness

understanding and exploring your own cultural identity, be open to exploring your privileges and biases, and if you are a minority group member, be open to discovering ways to have empathy not only for members within your group but also for other minorities and for the struggles that dominant cultural group members might have as they navigate the denial and guilt sometimes associated with increasing cultural awareness.

Be able to provide a statement that would indicate an effective transition between each stage of Shea's stages of the clinical interview

(identify your own)

Describe Motivational Interviewing and the key elements of "change talk", "sustain talk", and it's two primary components (relational and technical).

MI is defined as a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. MI has four components of partnership, acceptance, compassion, and evocation. MI is a person-centered approach that helps develop rapport, helps enhances client motivation and works with the resistance a client has. MI says that most humans are ambivalent about making changes because they have competing motivations. MI frames resistance as stemming from natural ambivalence about change. Hypothesis for resolving client ambivalence and activating motivation and the fundamental dynamic in the resolution of ambivalence: It is the client who should be voicing the arguments for change. Change talk is when clients voice their won argument for change. Sustain Talk is when clients argue for things to stay the same unhealthy. Relational component: embracing Spirit of collaboration, acceptance, and empathy. Technical component: includes intentional evocation and reinforcement of client change talk. Relational and Technical components are more effective when they're delivered together anyway.

The clinical interview is the "entry point" for what?

Mental health treatment, case management, or any form of counseling.

What two primary elements of the clinical interview are emphasized by formal definitions of a clinical interview.

1) Assessment 2) Helping (including referral)

What are the 3 overarching objectives of an intake interview?

1) Identifying, evaluating, and exploring the client's chief complaint or problem (and associated therapy goals) 2) Obtaining data related to the client's interpersonal behavior and psychosocial history 3) Evaluating the client's current life situation and functioning

What are the two key ways to obtain client background and historical information?

1) The client's personal or psychosocial history 2) Observations and reports of client interpersonal behavior

3 interpersonal dimensions of multicultural humility

1) an other-oriented instead of a self-oriented perspective 2) respect for others and their values and ways of being 3) an attitude that includes a lack of superiority.

Describe elements involved in collaborative goal setting

A common clinical practice that should occur within the course of an initial clinical interview. The positive outcomes from this likely involve interactive discussions with clients, not only about specific problems and worries but also about personal hopes, dreams, and goals. Depending on the therapist's theoretical orientation, this process may rely more or less on formal assessment and diagnosis. From a CBT perspective, ​this is initiated when therapists work with a client to develop a problem list.

Clinical Interview

A common phrase used to identify an initial and sometimes ongoing contact between a professional clinician and a client.

Clinical Interviewing

A flexible procedure that mental health professionals from many different disciplines use to initiate treatment. A complex and multidimensional interpersonal process that occurs between a professional service provider and client.

Describe a Semi-structured clinical interview.

A predetermined series of questions, followed by unplanned questioning or an exploration period.

Be able to define and provide an example of how each could manifest during a clinical interview (statements/behavior/lack of either...) (Shneidman's Theory) Mental Constriction:

A problem-solving deficit that occurs when there is a narrowing of thought so that suicidal individuals cannot see beyond two alternatives: (a) continues psychache and misery or (b) cessation of life to eliminate psychache. "I just don't see any other way to stop the pain" "All I can think about is how hopeless it is"

Define transference (Be able to provide an example that could occur within a clinical interview)

A process that occurs when "the patient sees in his analyst the return—the reincarnation—of some important figure out of his childhood or past, and consequently transfers on to him feelings and reactions that undoubtedly applied to this model

Power differential

A professional is an authority figure with specialized expertise. Clients are in need of this expertise. This can be heightened when professionals are from the dominant culture and clients are from less dominant cultures or social groups. Clients might be vulnerable to accepting unhelpful guidance, feedback, or advice due to this.

Be able to define and provide an example of how each could manifest during a clinical interview (statements/behavior/lack of either...) (Shneidman's Theory) Perturbability:

A state of agitation or heightened arousal; it's characterized by an inner drive to act or "do something". When psychache is present, it drives clients toward stopping the associated pain and misery. "I'm going to make it stop one way or another" "I haven't been sleeping a lot lately. I've just been to upset"

Describe a Structured clinical interview.

A tight protocol wherein clinicians ask a series of predetermined questions, including predetermined follow-up questions. There's little or no opportunity for unplanned or spontaneous clinician questions or client responses.

What is the difference between treatment goals and treatment objectives?

A treatment goal is the overall plan of the treatment you are going to provider and Objectives are what the client is going to do to achieve the goals in the treatment plan.

What are the three dimensions of Bordin's working alliance?

A) Goal consensus or agreement B) Collaborative engagement in mutual tasks C) Development of a relational bond

Describe confidentiality and the limits to confidentiality

Confidentiality refers to both an ethical duty to keep client identity and disclosures secret and a legal duty to honor the fiduciary relationship with the client. It is primarily a moral obligation rooted in the ethics code, the ethical principles and the virtues that the profession attempts to foster. Limitations - in most states you can break confidentiality in the following situations: you have the client's permission, your client is a danger to self, the client is planning to engage in a behavior that's a serious and foreseeable danger to others, the client is a child and you have evidence that leads you to suspect that there's sexual or physical abuse or neglect, you have evidence suggesting that your client is abusing a minor, you have evidence suggesting that elder abuse is occurring or you have been ordered by the court to provide client information.

Consider the "congruence" guidelines and when you may utilize self-disclosure.

Congruence means that a person's thoughts, feelings, and behaviors match. we offer the following guidelines for self-disclosures: Examine your motives for the self-disclosure you have in mind. Is it more about you or more about your client? Ask yourself whether the disclosure is likely to be facilitative. Ask yourself whether the comment will keep the focus on the client or will distract from the client's process and issues. Consider the possibility of a negative reaction. Could your client respond in a negative or unpredictable manner? Remember, congruence doesn't mean you say whatever comes to mind; it means that when you do speak, you do so with honesty and integrity.

Describe, to a client, how the ACA address counselor values.

Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor's values are inconsistent with the client's goals or are discriminatory in nature. To summarize, counselors can hold any personal values and belief system that they choose as long as they do not impose them on a client.

When is it appropriate for a counselor to disclose client information?

Counselors disclose information only with appropriate consent or with sound legal or ethical justification. Explanation of Limitations At initiation and throughout the counseling process, counselors inform clients of the limitations of confidentiality and seek to identify situations in which confidentiality must be breached. Serious and Foreseeable Harm and Legal Requirements. The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues.

Describe how and why you might modify your vocal tone and body language with different clients during an interview

Effective therapists use vocal qualities to enhance rapport, communicate interest and empathy, and emphasize specific issues or conflicts. As with body language, it's useful to follow the client's lead, speaking in a volume and tone similar to the client's. For example, speaking in a soft, slow, and gentle tone encourages clients to explore feelings more thoroughly, and speaking with increased rate and volume may help convince them of your credibility or expertise

Provide an example of how you could instill hope in a client during a clinical interview or treatment planning process.

Examples given include "you've made a wise decision to try counseling. I think this will help." And, "we'll be successful in our work together."

Describe the Central Focus of structured or semi-structured diagnostic interviewing.

Gathering reliable and valid data to support accurate mental disorder diagnoses.

Provide 2-3 examples of how you would work to build and maintain a strong therapeutic alliance with a client during a clinical interview (any stage)

Here's a cognitive-behavioral therapy (CBT) example: For the rest of today's session, we are going to be doing a structured clinical interview. This interview assesses a range of different psychological difficulties. It is a way to make sure that we "cover all of our bases." We want to see if social anxiety is the best explanation for your problems and also whether you are having any other difficulties that we should be aware of. Another example; In CBT, this includes making a problem list. Clinician: What brings you to counseling, and how can I be of help? Client: I've just been super down lately. You know. Tough to get up in the morning and face the world. Just feeling pretty crappy. Clinician: Then we definitely want to put that on our list of goals. Can I write that down? (Client nods assent.) How about for now we say, "Find ways to help you start feeling more up?" Client: Sounds good to me. Any example that shows engagement in collaborative goal-setting to achieve goal consensus is central to alliance building.

Describe how you will implement your instructor's statement (actually, Pederson's statement), that "all interactions are multicultural" as you engage in the clinical interview and treatment planning process, respectively?

I will engage in clinical interviewing and treatment planning process respectively by practicing Cultural humility allowing myself to embrace an other-orientation rather than focusing on my own values to hold high respect for diverse cultural values and ways of being. I will ask questions or get supervision when I don't understand or do not know if the behavior the client is displaying is abnormal or culturally accepted. I understand that every person has a cultural background that I must be respectful to and try to learn what I do not know on my own by continuing cultural education and when working with clients who are culturally different being respectful and inquisitive in learning about them to help with the diagnosis and treatment planning that will help them achieve the positive outcome they want from therapy. I will use culturally appropriate assessment tools and treatment goals that work for the unique culture of the client.

How would you deal with an "ambivalent" suicidal client?

I would first establish a positive therapeutic relationship by listening empathically using basic attending behaviors and listening responses which include paraphrasing and reflection of feeling to show empathy for the depth of the clients' emotional pain to create solid foundation of rapport. I would validate the feeling the client's is having. I would use MI to help in getting the client to develop change talk scaling the mood of the client to see where the client is at. I would normalize the suicidal thoughts and would begin to help the client discover that the pain they feel is what they want to treat and not to kill themselves. I would help the client discover hope for the pain to go away.

Appropriate and non-appropriate ethical referrals with examples.

If an initial assessment reveals that a therapist is unable to help a client a referral to a different therapist or agency may be provided. However, ethical referrals are typically offered when therapists are lacking skills or competence and not when therapists and clients have culture or values differences. Example: A client speaks a language I do not know and we cannot find an interpreter, I would refer this client to someone who either speaks that language or has experience with using interpreters. It would not be appropriate to refer the client because I do not understand the client's culture.

Name a time when a clinical interview may become a counseling session.

In a crisis situation, a mental health professional might conduct a clinical interview designed to quickly establish ... an alliance, gather assessment data, formulate and discuss an initial treatment plan, and implement an intervention or make a referral.

Define case formulation

Integrating assessment information with a theoretically supported or evidence-based approach to guide subsequent therapeutic work. Whereas the treatment plan focuses on what you and your client will do together to address client problems; this is the explanation for why you've chosen your particular treatment plan.

Unstructured Clinical Interview

Involve a subjective and spontaneous relational experience. This relational experience is used to collaboratively initiate a counseling process.

Be able to define and/or describe each of the following elements and provide a question (or two) you would ask a client to assess each element: Suicidal Intent

Is defined as how much an individual wants to die by suicide. Is usually evaluated following a suicide attempt. Higher suicide intent is linked to more lethal means, more extensive planning, a negative, reactions to surviving the act, and other variables. "How do you distract yourself from your thoughts about suicide?" What strengths or inner resources do you tap into to fight back those suicidal thoughts?"

How does a treatment plan connect with a diagnosis?

It is the initial step in developing an individualized treatment plan. Clients come in for an interview, they talk about symptoms and problems as they talk clinicians listen, question, observe, assess, and analyze client symptoms and problems in order to translate what the client is experiencing into a coherent set of symptoms or syndrome. Once you make a diagnosis you'll need to transform it into specific client-based symptoms, problems, and goals using concrete theoretically based or evidence-informed techniques.

Define and note how Kinesics and Proxemics could play a role in a clinical interview.

Kinesics has to do with physical features and physical movement of any body part, such as eyes, face, head, hands, legs, and shoulders. Proxemics refers to personal space and environmental variables such as the distance between two people and whether any objects are between them.

Under the notion of the "Intake Report", describe: What are at least 2 ethical issues associated with report writing?

(a) collateral information and informants, (b) using nondiscriminatory language, and (c) sharing reports with clients.

Describe unearned assets. (be able to relate them to your future work doing clinical interviews/diagnosis/treatment planning/counseling

Individuals from dominant cultures tend to be unaware of and often resistant to becoming aware of their invisible and unearned culturally based advantages. often referred to as white privilege.

Describe what is meant by "client as expert"

It's important to acknowledge and affirm that clients are their own best experts on themselves and their experiences. This is so obvious that it seems odd to mention, but, unfortunately, therapists can get wrapped up in their expertness and usurp the client's personal authority. Although idiosyncratic and sometimes factually inaccurate, clients' stories and explanations about themselves​​ and their lives are internally valid and therefore should be respected.

Why must you always ask about previous suicide attempts?

Previous attempts are considered the strongest of all suicide predictors

What is a doorknob statement? Be able to describe how you might effectively handle such a statement that included a statement referencing a negative self-concept.

Statements that clients make just as they're getting up to leave or as they walk out the door.

Definition and example of Multi-cultural humility

Multicultural competence implies that clinicians can reach a culturally competent endpoint. In fact, it seems that as soon as clinicians grow too confident in their abilities to relate to and work with diverse peoples, they often lose their cultural sensitivities. Cultural humility is viewed as an overarching multicultural orientation or perspective that...springs from the idea that individuals from dominant cultures often have a natural tendency to view their cultural perspectives as right and good and sometimes superior...cultural competence is not enough...Clinicians need to be able to let go of their own cultural perspective and value the different perspective of their clients.

Be able to respond in a professional and ethical manner to a client who inquires about wanting to hug you after a session in which they felt better after talking about their concerns.

No specific examples given. Know your boundaries and motivations whenever touching a client.

Describe the difference between directive and non-directive listening

Nondirective listening behaviors are primarily designed to facilitate client self-expression. Directive listening behaviors are (action-oriented interventions) they are advanced interviewing techniques that encourage clients to examine and possibly change their thinking or behavior patterns or choose new stories to tell about themselves. They can be used for assessment, exploring client issues, and facilitating insight.

Be able to provide an example (i.e., a statement) of an appropriate use of reflection/confrontation/paraphrase/summary/immediacy/closed & open question during a clinical interview. Define the previous listed items.

Paraphrasing involves restating or rewording another person's verbal communication. The paraphrase is sometimes referred to as a reflection of content or, more simply, a reflection. A summary is an expanded paraphrase. It demonstrates accurate listening, enhances client and therapist recall of major themes, helps clients focus on important issues, and extracts or refines the meaning behind client messages. Depending on how much your clients talk, you will summarize intermittently throughout a session and again at the end.

Be able to describe the difference (and give an example) of physical/neurovegetative symptoms/cognitive symptoms of suicidal ideation.

Physical/ neurovegetative symptom: symptoms related to eating and sleeping Cardinal features of biological depression. Cognitive symptoms: Negative cognitions are a hallmark of depression and often center around Beck's cognitions triad: negative thoughts about the self, others and the future. One of the important thoughts related to suicidality is hopelessness

how does unconditional positive regard manifest with clients you find agreeable and those you may find disagreeable for some (any) reason.

Positive, accepting feelings toward clients allow clients to feel safe enough to explore self-doubts, insecurities, and weaknesses. That idea not only jibes with common sense but also has research support. Rogers also emphasized that therapists sometimes experience conditional positive regard, or even negative regard for their clients—although when therapists feel negative regard, it's likely to be associated with ineffective therapy. Rogers's core message is that clinicians should strive toward experiencing unconditional positive regard, recognizing that it's impossible to constantly feel accepting toward your clients

Be able to respond in a professional and ethical manner to a client who inquires about the physical setting of your office.

Privacy is essential. Professional decor is also important. It's useful to strike a balance between professional formality and casual comfort. Do not lock door. You shouldn't sit between your client and the door. Avoid interruptions and manage necessary interruptions. Generally, we recommend between a 90-150 degree angle to each other.

2 disadvantages of structured and semi-structured clinical interviews?

Require considerable time for administrating. Are too structured and rigid, de-emphasizing rapport building and basic interpersonal communication between client and therapist. Extensive structure may not be acceptable for practitioners who prefer using intuition who emphasize the therapeutic relationship.

How you might handle a "rupture" in the alliance during any phase of the clinical interview/treatment planning phase

Rupture resolution skills: I.E.; self-disclosure/immediacy, gentle question, acknowledgement of an empathetic failure, and conceding to the client perspective.

Describe a good time (be specific) during an interview to use therapeutic silence. Why is this a good time versus other situations (consider both you and your client in your response)

Silence after a strong emotional outpouring can be therapeutic and restful for the client. In a practical sense, silence also allows therapists time to intentionally select a response rather than rush into one. When clinicians are silent, pressure is placed on clients to speak. When silence continues, the pressure mounts, and client anxiety may increase. In the end, clients may view their experience with an excessively silent therapist as aversive, lowering the likelihood of rapport and a second meeting. (There are additional examples)

Structured Clinical interviews

Standardized and involve asking the same questions in the same order with every client. Designed to gather reliable and valid assessment data. Virtually all researchers agree that if your goal is to collect reliable and valid assessment data pertaining to a specific problem (or psychiatric diagnosis), a structured clinical interview is the best approach.

Identify, define, and provide the key element of Stage 5 of Shea's stages of the clinical Interview.

Termination. Termination or the ending of the clinical interview occurs as both parties acknowledge that the meeting is over and may include escorting clients out along with a comfortable farewell ritual. Transitions may include a 'take care', 'see you then' or 'hang in there'. Tasks include watching the clock, observing for client's significant doorknob statements, guiding or controlling termination and facing termination.

Identify, define, and provide the key element of Stage 3 of Shea's stages of the clinical Interview.

The Body. The longest clinical interview stage where most of the assessment and helping activities are implemented. Tasks include transitioning from nondirective to more directive listening, gathering information, obtaining diagnostic information, applying appropriate interventions and shifting from information gathering or intervention to preparation for closing. There is no specific transition listed for moving into the Body stage.

Identify, define, and provide the key element of Stage 4 of Shea's stages of the clinical Interview.

The Closing. Consciously stopping gathering new information and may also allow opportunities for the client to begin the process of reflecting on the session even about halfway through the session. Tasks include reassuring and supporting the client, summarizing crucial themes and issues, providing an initial case formulation, instilling hope, guiding and empowering your client and tying up loose ends. A transition may begin about halfway through the session. I.E.; 'we're about half-way through our session, and I'm wondering how you're feeling about our time together so far?'. No other specific examples of transitions are given.

Identify, define, and provide the key element of Stage 1 of Shea's stages of the clinical Interview.

The Introduction. The introduction begins when the clinician and the patient first see one another. It ends when the clinician feels comfortable enough to begin an inquiry into the reasons the patient has sought help. The task is to put clients at ease, so they engage in an open and collaborative discussion. The introduction should include scheduling the interview, clinician introduction, ensure client knows how to get to the site, schedule at a time that is best for the client and repeating the time of the appointment along with a comment indicating the clinician's anticipation of the interview. This stage also includes the first face-to-face meeting which might include a hand shake, offer of tea or water and/or chatting about a neutral topic while walking to the office. There is no specific transition into the introduction

Identify, define, and provide the key element of Stage 2 of Shea's stages of the clinical Interview.

The Opening. A nondirective or unstructured interview stage lasting about five to eight minutes. The task is to listen and stay out of the way so that the client can begin telling their stories by working on rapport, focusing on the client's view of life, providing structure and support, helping clients adopt an internal rather than external frame of reference if culturally appropriate and evaluating how the interview is proceeding and thinking about what approaches might be most effective during the body. The transition to the opening stage begins with an opening statement such as "what brings you in today?" or the more detailed "Tell me what brings you to counseling at this time?".

What does each letter of the SOAP acronym mean?

The client's SUBJECTIVE descriptions of their distress, the therapist's OBJECTIVE observations, the therapist's ASSESSMENT of progress and the PLAN for next contact/progress.

Define the chief complaint.

The client's reason for seeking help. It usually consists of one or more emotionally painful or distressing symptoms. It's the answer to the question: "Why are you here?"

What is meant by the comment that, "resistance is all with the counselor"? Give an example illustrating your response within the context of a clinical interview/treatment planning scenario.

The comment comes from the perspective of the counselors that the client doesn't want to do what the counselor wants them to do. Resistance can develop through three main ways. (a) Resistance from client's beliefs, attitudes, ambivalence, or opposition to therapy. When resistance comes from the client they are not interested in changing (precontemplation) or have occasional thoughts of changing (contemplation). They don't believe in therapy or are being forced to do therapy. (b) resistance that therapist stimulates by using over use of confrontation or interpretation, rather than focusing on the clients' positive potential for change and can stimulate client resistance. Teenagers clients and culturally diverse clients. (c) resistance as a function of the situation viewed as a product of a difficult and uncomfortable situation, a situation that naturally triggers reactance (negative expectations and defensiveness) for many client's resistance to therapy should be framed as a natural situationally triggered behavior. My response in a clinical interview/ treatment where a client is resistant because he did not believe in therapy. I would embrace the client in how he feels in a way that shows them therapy is a collaboration, I would accept and have empathy for where the client is at. I would begin the interview positive, strength-focused, empathic, and nonblaming manners using goal-orientated opening questions. I would use nondirective interviewing skills to facilitate rapport with the client.

Define Medical Model

The diagnosis and treatment of illness. The approach focusing in on illness, identifying or naming it, and then applying treatments to make it go away is a good fit for many healthy conditions but not for suicide assessment or treatment.

Define Informed consent. (Be able to provide your own statement on how you would introduce this concept to a client during an initial interview)

The ethical and sometimes legal mandate to inform clients about the nature of their treatment.

Be able to respond in a professional and ethical manner to a client who inquires about your note-taking during a session

The example given, "I'm going to jot down a few notes to make sure I'm remembering everything correctly. Is that all right with you?". Don't allow note-taking​​ to interfere with interview flow or rapport, explain the purpose of note-taking, never hide or cover your notes, never write anything in your notes that you wouldn't want your client to read, offer to let them read our notes and explore their concerns if asked.

Be able to respond in a professional and ethical manner to a client who inquires about video/audio recording concerns

The example given, "The main reason I'm recording our session is so my supervisor can watch me working. It's to help make sure you get the best service possible and help me improve my counseling skills.". You must obtain your client's written and oral consent before turning on the equipment...and explain possible future uses of recordings and how they will be stored, handled and eventually destroyed.

Define the intake interview and it's 4 key elements (or clinical interview/assessment as sometimes noted by me in class)

The first meeting between client and therapist. It can be face-to-face, telephonic, or online. More formally, it is an assessment interview that involves gathering information to facilitate (a) problem identification (or diagnosis), (b) goal-setting, (c) case formulation, and (d) treatment planning.

Describe Culture-specific expertise

The need for clinicians to learn skills for working effectively with different minority populations. I.E.; affirmative therapy for LGBTQ clients, integrating spiritual constructs when working with African Americans, Latinos, Native Americans and traditionally religious clients. Scientific mindedness - forming and testing hypotheses about client culture rather than coming to premature conclusions. Dynamic sizing - a complex multicultural concept that guides clinicians on when they should and should not make generalizations based on an individual client's belonging to a specific cultural group. Filial piety involves honoring one's parents and ancestors, however, it would be naive to assume that all Asian people believe in or have their lives affected by this particular value.

Provide an example of effective and ineffective use of self-disclosure in a clinical interview

The purpose of self-disclosure is to build rapport - not build a friendship and it must be balanced and have specific therapeutic intention. Beginning an interview with too much self-disclosure or small talk can misguide the clients into thinking that the interview is a social encounter. (No specific examples are given)

What is the role of Stage of change in developing a treatment plan?

The role of Stage of Change in a developing treatment plan can be used to see where the client is currently at in their willingness to change. Which stage are they in, precontemplation​, contemplation, Preparation, Action, and maintenance. Each stage will affect how willing the client is for change and you need to adjust to that client's need making your treatment plan reflect where they are at. If the client is in Precontemplation or contemplation the goal must fit with what the client is willing to do, and you must use techniques that match the client's readiness of change. If the client is in Action and maintenance stage the goals will hopefully come from the client and the client may want more psychoeducation.

Be able to define and/or describe each of the following elements and provide a question (or two) you would ask a client to assess each element: Suicidal Plan

The way a client will commit suicide. Once rapport has been established and the client has talked about suicide ideation, it's appropriate to talk about if they have a plan to complete the suicide. Four areas of concern (1) specificity of the plan, (2) lethality of the plan, (3) availability of the proposed method. (4) Proximity of social or helping resource. "Do you have a plan of how you would complete the suicide?" "Do you have access to the way in which you want to complete the suicide?"

Describe Culture-sensitive advocacy

There is a general consensus that the dominant US culture consistently disadvantages, marginalizes and sometimes oppresses minority group members. Microaggressions are brief and commonplace daily verbal, behavioral and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory or negative racial, gender, sexual orientation and religious slights and insults to the target person or group...discrimination is disempowering...at a minimum, clinicians need to display empathy for clients discrimination experiences. Depending on clinicians' theoretical orientation, professional discipline, and other factors, it may be appropriate for them to take on an advocacy role within the context of a clinical interview.

Describe the role of "level of care" regarding Treatment planning items/issues

This is determined from the diagnosis Gordon Paul asked: What treatment, by whom is most effective for this individual with that specific problem, under which set of circumstances, and how does it come about? Using Empirically Supported Treatments constitutes one way in which diagnosis drives treatment selections. There are times when it's difficult to select an appropriate level of care when your client's diagnosis is unclear, comorbid conditions complicate treatment selection. Client preference also factors into treatment planning, Resistance and Reactance when clients are resistant to change, Religion/ Spirituality, Coping style, culture, evidence-based relationships, therapists skill or expertise, client's resources, and positive expectation are factors when considering the role of "Level of Care."

Define Suicidal Ideation (Be able to give an example of Suicidal Ideation)

Thoughts of committing suicide. These thoughts are primarily a means of communicating emotional pain and distress. When clients talk about suicide, they're articulating psychache and communicating a need for assistance and support. Viewing these as natural means of communicating distress allows both clinician and client to work more effectively on the problem leading to the suicidal impulse.

What is the primary purpose of assessment and diagnosis?

To aid in treatment planning necessary to help clients move from a problem state toward positive solutions or growth.

Be able to define and provide an example of how each could manifest during a clinical interview (statements/behavior/lack of either...) (Shneidman's Theory) Psychache:

To describe the intense personal pain, anguish, shame, and other negative emotions associated with suicidal crises. "I just don't want to live with the pain anymore, I can't take it anymore." Client's behaviors may be emotional or may lack any emotions at all. A client may sound hopeless in dealing with the pain.

Define "unconditional positive regard" and how it differs from cultural humility.

To the extent that the therapist finds himself experiencing a warm acceptance of each aspect of the client's experience... he is experiencing this... it means there are no conditions of acceptance, no feeling of "I like you only if you are thus and so." It means a "prizing" of the person, as Dewey has used that term... It means a caring for the client as a separate person. This term implies that clients are the best authority on their own experiences. Cultural humility is viewed as an overarching multicultural orientation or perspective that mental health providers may or may not hold. It springs from the idea that individuals from dominant cultures—or any culture—often have a natural tendency to view their cultural perspective as right and good and sometimes as superior.

Describe how the notion that "culture is ubiquitous" applies to clinical interviewing, making a diagnosis, and designing a treatment plan

Ubiquitous means "present, appearing, or found everywhere" and all humans are born to families or individuals embedded within a larger community and cultural context. Cultural humility and cultural competence are key terms that relate to this.

Identify the "3 v's and a B" of attending behavior and how these skills could guide how you address a client during a clinical interview.

V- Visual/Eye Contact: Should maintain contact most of the time within considerations of culture. V- Vocal Qualities: Match your client's or tone your client's down using your vocal quality. Used to enhance rapport, communicate interest and empathy, and emphasize specific issues or conflicts. V- Verbal Tracking: Occasionally repeating keywords and phrases. Involves "pacing the client" by matching their volume and tone and sticking closely with client speech content. B- Body Language: attentive. Positive attentive body language. Engaged in what is being said.

Describe the notion of verbally tracking a client and give an example of how this is useful and potentially detrimental during a clinical interview.

Verbal tracking involves, maintaining the focus on what clients are talking about, for therapists to self-reflect on what they are choosing to verbally track, and to selectively attend or not attend to client verbal content. Verbal tracking involves restating some portion of the content of your client's speech. This is useful to follow what the client is trying to communicate but can be detrimental with a very talkative client for time management-may get you off track in the interview-the client may want to delve deep into their early childhood which you will not have time for in that session. You can also be distracted by your own thoughts.

What is the role of Stage of change in developing a treatment plan and with utilizing counseling skills during the interview

When clients are in the precontemplation or contemplation stage you should use nondirective listening skills to stimulate motivation for change. There are (a) attending behaviors, (b) paraphrasing, (c) clarification, (d) reflection of feeling, and (e) summarizing. Many questions, especially open questions and solution-focused or therapeutic questions, also may be appropriate for clients who are in precontemplation or contemplation stage. Your best strategies will be based on person-centered, solution focus, and MI approaches.

Under the notion of the "Intake Report", describe: What is your response to a client who asks, "Hi, I'd like to have a copy of my intake interview and report by this Friday (it's Monday)".

When clients request their records, remain calm, acknowledge their rights, and follow your records-sharing procedures. Most clients will be satisfied if you treat them with compassion and respect and if your records are written in a compassionate and respectful manner.

Under the notion of the "Intake Report", describe: Who is your audience for the intake report?

When you write this, are you writing it for yourself, your client, your supervisor, or your client's insurance company? The answer: All of the above.

What would any self-respecting clinician never do.....?

Would never consider diagnosing a client without conduction a clinical interview.

Give an example of when and how you might utilize MI during a clinical interview.

You could use this with Substance abuse clients or someone that is doing self-harm to themselves by helping them to develop Change Talk in their treatment. For the substance abuse example: when someone wants to keep drinking because they think their life is not worth it to stop.

What are the primary goals of Clinical interviewing and how are they acheived?

a) Assessment and b) Helping. To achieve these goals, individual clinicians may emphasize structured diagnostic questioning, spontaneous and collaborative talking and listening, or both. Clinicians use information obtained in an initial clinical interview to develop a case formulation and treatment plan.

Define countertransference (Be able to provide an example that could occur within a clinical interview)

a) Classical. This is Freud's view. Client CT triggers analysts' unresolved childhood conflicts. This triggering results in analysts' acting out in ways consistent with the unresolved conflicts. This CT is negative and should be "overcome." b) Totalistic. This CT refers to all reactions the therapist has toward the client. These reactions are meaningful, and should be studied, understood, and used to enhance therapy process and outcome. c) Complementary. This CT emanates from specific client interaction patterns that "pull" therapists to respond in ways that others (outside therapy) respond to the client. Good therapists inhibit their reactive impulses, seek to understand the nature of the transaction, and use this knowledge to frame interventions to modify the client's maladaptive relational style. Relational. This CT is constructed from the combination or integration of the unmet needs and conflicts of both client and therapist.

Describe each element of assessing a suicide plan. a) Specificity b) Lethality c) Availability d) Proximity

a) refers to the plan's details b) how quickly a suicide plan can result in death c) availability of the means d) proximity of social support

Describe Multicultural knowledge

a. actively educating yourself regarding diverse cultural values, behaviors and ways of being. It is not appropriate to be passive in this professional domain. It is also not acceptable to rely on clients to educate you about specific minority issues...to become multiculturally sensitive and competent, you'll also need experiential learning.

Be able to define and/or describe each of the following elements and provide a question (or two) you would ask a client to assess each element: Suicidal Ideation.

is directly linked to potential suicide behavior. "Have you had thoughts about death or suicide?" "When was the last time you had thoughts about suicide?"

White Privilege (or any other form of privilege)

see unearned assets