"REPORT" OR "BE CURIOUS"
Your 16-year-old Hispanic male client casually mentions his friends sometimes "jump" new kids in the neighborhood to "initiate" them. No names or specific plans are given.
What is "Be Curious"?
Explore context vs. imminent threat. This sounds like normative, if concerning, peer group description in some environments. Curiosity about his role, feelings, and safety is clinically indicated before determining if this meets mandatory reporting thresholds for violence.
An Indigenous client speaks passively about "not being here long," feeling like a burden to their community, and that "the ancestors are calling." They deny active SI plan.
What is "Assess Thoroughly"?
Passive SI and cultural/spiritual framing require sensitive, deep assessment. Don't dismiss due to language. Explore meaning, connectedness, and specifics of hopelessness. This is high risk needing clinical intervention.
A client presents with depressed mood, tearfulness, and anxiety that began within one month of a job loss.
What is
Adjustment Disorder with Depressed Mood
Key Differentiators
Onset: Within 3 months of identifiable stressor
Duration: Resolves within 6 months after stressor ends
Differentiates from:
MDD: fewer symptoms and less pervasive impairment
Clinical Pearl: Subthreshold symptoms + clear trigger
A 14-year-old contacts you directly for therapy for anxiety and family stress and specifically asks that their parent not be informed. The client is not suicidal, homicidal, or at risk of abuse. They ask, “Am I allowed to talk to you without my parent knowing?”
What is YES.
In Illinois, a minor age 12 or older may consent to outpatient mental health services without parental notification for up to 8 sessions (or 90 days, whichever comes first), unless there is a safety concern.
During art therapy, your 10-year-old African-American client shows you drawings of a familiar adult figure with exaggerated, red hands. When asked, she laughs nervously and says, "It's just Mr. Tom playing his tickle game. It's our secret."
What is "Report"?
This is a strong, ambiguous indicator of potential sexual abuse (secret-keeping, somatic focus). Err on the side of child safety. This warrants a call to child protective services for investigation. Your role is to report, not investigate.
A client in a manic episode, believing they are a prophet, states they must "cleanse" their gentrifying neighborhood by "setting purifying fires" tonight.
What is "911/Immediate Crisis Response"?
Acute mania + specific plan for serious property damage/homicide risk + impaired judgment = imminent danger. This requires emergency intervention for client and community safety.
A client reports sudden episodes of intense fear accompanied by heart racing, shortness of breath, dizziness, chest tightness, and a feeling of losing control. These episodes typically occur in crowded places or while driving and last about 10–15 minutes. The client reports avoiding certain situations due to fear of “another episode,” but also notes feeling generally on edge most days and frequently worrying about work, finances, and health. Symptoms have been present for approximately four months.
What is Other Specified Anxiety Disorder
Generalized Anxiety Disorder would fit if worry is constant with spikes;
Panic Disorder is episodic fear with recovery between attacks;
Social Anxiety Episodes occur mainly in social or performance settings, Fear centers on being judged, embarrassed, or observed, and avoidance is socially specific
A 10-year-old is brought to therapy by a parent who has already signed all required intake paperwork and provided legal consent for treatment due to concerns about the child’s behavior at school. During the first session, the child sits with arms crossed and states, “I don’t want to be here,” and refuses to answer questions. What do you need to ethically proceed with treatment given the child’s developmental level and expressed resistance.
What is Assent?
The parent has already provided legal consent, which is required for a minor. Because the client is developmentally incapable of legal consent, the therapist must seek assent.
Assent involves: Explaining therapy in age-appropriate language. Checking for the child’s willingness to participate. Respecting resistance and working to build engagement. Therapy should not proceed coercively, unless clinically or legally necessary (safety concerns).
Consent is legal. Assent is ethical.
An older aged client describes using traditional coining ("Cao Gio") on her grandchildren for fever, leaving temporary marks. She worries the school might misunderstand.
Skin Coining involves applying medicated, oily, or herbal oil to the skin, followed by rubbing a coin or similar object in a downward, linear motion on the back, neck, or chest to "release bad wind". This practice often produces red, linear bruises.
What is "Be Curious (and likely not report)"?
This is a culturally normative healing practice, not abuse. Be curious about her fears of systemic misunderstanding. Your role may involve psychoeducation or advocacy, not reporting. Distinguish between cultural practice and maltreatment.
A Black mother, after describing horrific racism at work, says through tears, "I just want to disappear. I can't take it, but my babies need me."
What is "Assess, but Lean on Trust & Support"?
This is acute distress with a protective factor (her children). Assess for plan/intent, but the intervention is likely validating, crisis planning, and mobilizing support, not involuntary hospitalization, which could be re-traumatizing.
A client reports recurrent, intrusive thoughts about causing harm or making serious mistakes, which they describe as unwanted and distressing. To reduce anxiety, the client engages in repeated checking behaviors (rereading emails, verifying doors are locked, reviewing work multiple times), often feeling temporary relief followed by renewed doubt. The client states these behaviors are time-consuming and interfere with work efficiency and daily routines. Symptoms have been present for several years and occur across multiple settings. The client reports feeling “anxious” most days but notes the anxiety intensifies specifically when they try to resist the checking behaviors.
What is Obsessive-Compulsive Disorder (OCD)
**Why This Is OCD
Presence of intrusive, unwanted thoughts (obsessions)
Compulsive behaviors performed to reduce distress, not for pleasure
Anxiety is triggered by obsessions and worsens when rituals are resisted
Behaviors are time-consuming and impair functioning
A 16-year-old presents for therapy. Parents are separated and share joint legal custody. One parent consents and schedules sessions; the other parent is unaware. Are you able to see the client?
What is NO
The therapist must review the custody agreement (not accept verbal report). If parents share joint legal decision-making, consent from both parents is required before initiating treatment.
Your Black teen client, who has history with the school-to-prison pipeline, says his teacher "is always on him," and he "feels like busting his jaw sometimes." He has no plan, means, or history of violence.
What is "Be Curious"?
This is an expression of frustration within an oppressive system. Assess risk, but recognize the systemic context. Reporting could cause disproportionate harm. Explore his experience, coping skills, and empowerment strategies.
A Latino teen client jokes about suicide on social media, using memes. In session, he says, "Relax, it's just jokes. Everyone posts that stuff."
What is "Assess Seriously"?
Never ignore SI references, even as "jokes." This is a common way youth, especially youth from diverse cultural backgrounds, test the waters. Assess directly for ideation/plan. Normalize the conversation about distress behind the humor.
A client reports emotional dysregulation, fear of abandonment, unstable relationships that "usually go this way", identity disturbance, and recurrent impulsive behaviors. These patterns have been present since early adulthood and occur across settings.
What is Borderline Personality Disorder?
Onset: Early Adulthood but the behaviors, emotional patterns are not new or sudden as indicated by the reports that "it's always been like this".
Pervasive, Trait-Based, Relational Instability: patterns show up across many areas of life (work, friendships, romantic relationships, family).
are consistent over time, not just during stressful periods
Relationships tend to be intense, unstable, and emotionally charged
Clinical Pearl:
A mood episode (like in bipolar disorder):
Lasts longer
Happens even when nothing specific is going on
A client with a disability describes a specific plan to harm a identifiable staff member at their group home next Tuesday, using a weapon they have access to.
What is "Report (Duty to Warn/Protect)"?
This meets the Tarasoff criteria: specific threat + identifiable victim + means + intent. You must report to the intended victim and law enforcement. This is non-ambiguous.
Your client, a veteran with PTSD, says they are having vivid, intrusive thoughts of harming their abusive former commander. They are horrified by the thoughts, have no plan or means, and insist they would never act on them.
What is "Assess
Distinguish between homicidal ideation with intent vs. ego-dystonic intrusive thoughts. The latter are anxiety-driven, cause distress, and have no plan. This requires therapy, not 911. Assess for insight and impulse control.
(Likely OCD/Intrusive Thoughts)"
A client reports chronic difficulty sustaining attention, frequent forgetfulness, poor time management, and a pattern of starting tasks but struggling to complete them unless under significant pressure. They describe feeling “anxious” and overwhelmed due to missed deadlines and disorganization. Symptoms have been present since childhood and occur across work, home, and interpersonal settings. The client reports periods of intense focus when highly interested or facing an imminent deadline.
What is Attention-Deficit/Hyperactivity Disorder (ADHD)
Why This Is ADHD
Cross-setting impairment (not situation-specific)
Core issue is executive functioning, not mood or fear
Hyperfocus under pressure is characteristic of ADHD