Well that was a choice
A client comes on to a telehealth session and appears to be under the influence
check for safety and reschedule
A client routinely has nothing to discuss in session, but persists that they want and need therapy
Review treatment goals and discuss options of what type of things they could bring to session
client tells you they have feelings for you
transference- discuss strategies in supervision
Client presents with decreased mood, low appetite, and excessive sleeping.
MDD
A client arrives to in person session, lays down on the couch and starts snoring
Gently wake up and assess needs
Client repeatedly references an issue but rejects all strategies for improvement
explore the rejections!
Client came to therapy for depression and anxiety and is now showing signs of manic episodes. You haven't treated bipolar before but are open to learning more
Discuss in supervision
Client presents with increased worry, physical agitation and rumination
Anxiety
reiterate the importance of privacy in therapy and continue on
Client reports history of trauma with no desire to discuss things from their past
develop treatment goals on ways trauma is impacting them
Client comes to intake and shares an issue that you closely identify with and are working on in your own therapy.
referral may be best
Client presents with difficulty doing things 'out of order', not knowing future plans, and difficulty accepting changes
OCD- thought compulsions
Your client joins a tele health session and is in the back seat of a car while someone else is driving
check to see if they will be stationary soon, if not, reschedule
client emails between sessions whenever they are having a hard time, but then in session downplays as if it was not a big deal, saying they were just 'venting'
An in person client appears to have poor hygiene. Normally tolerable, but is starting to interfere with your ability to focus in session.
Have a discussion about personal hygiene and self care
Client indicated that they find homework to do in between sessions helpful, but rarely completes it
discuss why they find it helpful and the resistance to completing homework or why they aren't completing it