Video 1: My initial observation was the body language. The clinician’s physical stance looked like she was in attack mode and matched the tone of her words, which in turn evoked a defensive response from the client. The conversation between clinician and client was not collaborative and the client was not the center of the conversation, the clinician made the Oscar the center of the conversation and showed a lack of empathy for the client’s feelings, referring to pets as “problems”. The clinician did not acknowledge the changes the client has already made and acted as the authority in the discussion by telling the client what his “next step” should be”. The therapist also did not acknowledge the client’s statement that the doctor was unsure whether it was Oscar, stress, or client’s drinking that was the cause of the client’s increased symptoms.
Video 2: The clinician asked the client open-ended questions beginning with “how” and “what”. She affirmed the client’s strengths by acknowledging the work the client has already done to change some behaviors and acknowledged that the doctor was uncertain whether Oscar was the cause of the client’s increased asthma symptoms. She reflected back the client’s feelings and acknowledged that the client had “big decisions” to make. The clinician summarized the client’s goals of “take the medication, keep Oscar, and feel better” to “You want to be healthy for your wife and baby”.
Example: “I feel ambivalent about doing my taxes”.
One Side of the Ambivalence:
“I have so little time , I’m tired when I get home from work, and have chores and errands that I have to get done on the weekend.”
The Other Side of Ambivalence:
The sooner I file my taxes, the sooner I get my refund, and they will be off my mind.”
“Diane, on the one hand you’re tired when you get home on week nights and have important things to accomplish on the weekends. On the other hand, it doesn’t take that long to do them, you could use the extra money and getting them done would be one less thing on your mind.”
Consumer-generated target behaviors:
1. Be more stable in my mental health
2. Be more consistent about visiting with my son.
3. Feel accepted by others
Clinician-generated target behaviors:
1. Engage in psychiatric medication management services and take medications as directed.
2. Develop positive supports in the community and engage in social activities.
3. Increase awareness of distorted thinking habits and increase sense of self.
The client admits to experiencing audio hallucinations since her “enlightening” experience of consuming MDMA. She is adamant that she does not want to engage in any type of substance use treatment. She is however willing to her work on her mental health and is willing to seek help from psychiatric provider. I believe she minimizes the severity of her symptoms. The client copes with her symptoms by isolating and fixating on researching various and specific topics on her computer for hours and days. She feels judged by her family members, feels that others do not accepted for who she is. The client admits that she has been inconsistent in maintaining a relationship with her son and believes she work on being more emotionally stable before she commits to a regular visitation schedule.
I like the idea of using the “dinner plate” example presented in the lesson and allow the client to choose and prioritize her own agenda. I don’t believe we are that far apart in generating target areas. I believe that this client would resist and disengage from services if her autonomy was not respected and she would feel like her clinician was treating her like everyone else in her life.