Diagnosis and assessment
When symptoms start interfering with work, school, relationships, or everyday life, clinicians call this.
What is functional impairment?
A client says, “Sometimes I wish I could go to sleep and not wake up.” Your next step is this.
What is assessing suicide risk?
“It sounds like you felt completely alone when that happened.” This counseling skill communicates that you've heard the emotion underneath the story.
What is reflection of feeling?
A child throws things every time tablet time ends. Before calling the behavior “defiance,” you want to understand what the behavior accomplishes. This is called its _____.
What is function?
Your session starts in two minutes, your notes can wait, and your client just walked through the door. This is the most important thing you need to bring into the room.
What is being present?
Nightmares, intrusive memories, avoidance, and hypervigilance following a traumatic event should put this diagnosis on your differential.
What is PTSD?
Someone asks what your client told you during therapy. Unless an exception applies or you have permission, this protects that information.
What is confidentiality?
“What was this week like for you?” is this type of question because it can't be answered with just yes or no.
What is an open-ended question?
A client repeatedly misses appointments immediately after emotionally vulnerable sessions. Instead of assuming they don't care about therapy, you first look for this.
What is a pattern?
Your client asks something you genuinely don't know. Instead of making something up, the appropriate response starts with these three words.
What is “I don't know”?
A client reports suddenly needing very little sleep, having tons of energy, talking rapidly, and making unusually risky decisions. This mood episode should be assessed.
What is mania or hypomania?
You're unsure whether something a client disclosed meets mandatory-reporting requirements. Rather than guessing, you should do this.
What is consult your supervisor and applicable policy/law?
Your client has been talking for ten minutes and you're losing the thread. You briefly pull together the major themes you've heard using this skill.
What is summarizing?
A client says, “I know this relationship hurts me, but being alone feels worse.” Understanding what staying does for the client helps identify this underlying factor.
What is an unmet need/function?
You realize after session that you made a mistake. Hiding it protects your anxiety; bringing it here protects your development and your client.
What is supervision?
Two clients can have the exact same diagnosis but need completely different treatment because a diagnosis doesn't replace this individualized understanding of the client.
What is case conceptualization?
A client sends you a friend request on social media. Before clicking anything, you should consider the possible impact on this.
What are professional boundaries?
Your client says they desperately want to change but gives equally compelling reasons for staying exactly where they are. This experience is called this.
What is ambivalence?
A teenager becomes aggressive whenever they feel embarrassed. Aggression is the visible behavior; embarrassment is closer to this underlying experience.
What is the trigger/vulnerability?
You've been thinking about one client's situation all evening, feel unusually responsible for fixing their life, and are tempted to bend your normal boundaries. This is a sign you should examine your own _____.
What are emotional reactions/countertransference?
A client's symptoms look like anxiety, but you're not sure whether they come from trauma, substance use, a medical condition, or an anxiety disorder. Comparing these possible explanations is called this.
What is differential diagnosis?
A client wants to continue a treatment that you are trained to provide, but you recognize that your own strong emotional reactions are beginning to interfere with your clinical judgment. This phenomenon needs your attention and supervision.
What is countertransference?
Your client says, “You seem disappointed in me,” and you know you aren't. Instead of immediately correcting them, you become curious about what is happening between the two of you right now. You're attending to this.
What is the therapeutic relationship/process?
Your client understands exactly why they behave a certain way, can explain their childhood origins beautifully, and continues doing it every week. This is a good reminder that intellectual understanding does not automatically create this.
What is behavior change?
A client presents a problem you've never encountered, your supervisor isn't immediately available, and there is no emergency. Your best clinical move is not to improvise expertise. It is to recognize this professional limit and seek appropriate support.
What is scope of competence?