What Do You Do FIRST?
A new client tells the social worker,
"I haven't been sleeping well since my divorce."
The client begins crying.
Establish rapport and continue the assessment.
A client asks,
"Will you keep everything I say private?"
Explain confidentiality and its limits.
During a home visit, a client begins pacing and clenching his fists.
Assess immediate safety.
A client worries constantly about work, finances, and family for over one year.
Generalized Anxiety Disorder
A client says,
"Nobody likes me."
Reflect the client's feelings.
A client says,
"Sometimes I don't think life is worth living."
Conduct a suicide risk assessment.
A client's employer calls requesting information about treatment.
Do not confirm or deny treatment without authorization.
A client arrives intoxicated for therapy.
Assess the client's ability to safely participate in treatment.
Two weeks after witnessing a fatal accident, a client experiences nightmares and flashbacks.
Acute Stress Disorder
A client says,
"I know drinking is hurting me, but I'm not ready to stop."
Use Motivational Interviewing to explore ambivalence.
A mother becomes increasingly angry during a session and begins yelling at staff.
De-escalate the situation while maintaining safety.
A client admits she shoplifted yesterday.
Maintain confidentiality because it is disclosure of a past crime.
A child arrives at school with bruises in different stages of healing.
Make a mandated report based on reasonable suspicion.
A teenager repeatedly steals, destroys property, and hurts animals.
Conduct Disorder
A client repeatedly misses appointments.
Explore barriers before considering termination.
A client reports hearing voices for the first time during today's appointment.
Assess for safety and determine whether there is risk to self or others.
A subpoena requests client records.
Consult with a supervisor and determine legal obligations before releasing information.
A suicidal client has a detailed plan and access to a firearm.
Arrange emergency psychiatric hospitalization.
A client has hallucinations for eight months without mood episodes.
Schizophrenia
A client with Borderline Personality Disorder becomes angry because therapy will be canceled next week.
Maintain professional boundaries while validating the client's feelings.
A client says,
"When I leave here today, I'm going to shoot my ex-wife."
Assess seriousness, intent, means, and identifiable victim before taking protective action.
A 16-year-old reveals she is pregnant and asks you not to tell her parents.
Review state laws regarding minors and confidentiality before deciding on disclosure.
A client blocks the office doorway and refuses to let the social worker leave.
Prioritize personal safety and leave if possible.
A client sleeps two hours a night, maxes out credit cards, believes God chose him to save the world, and hears voices only during these episodes.
Bipolar I Disorder with psychotic features
A social worker feels unsure how to proceed after several sessions with a depressed client who is not improving.
Consult with a supervisor before changing the treatment plan.