Pragmatics

Question 1

What are the four basic tasks of counseling?

Answer 1

Establish and cultivate a therapeutic relationship.
Formulate an assessment and diagnosis.
Identify goals.
Plan and carry out treatment.

Question 2

How do you receive clients?

Answer 2

In a welcoming manner, exactly as they first present themselves, without attempting to help or change them.

Question 3

Why do we receive clients in a welcoming manner? (2 reasons)

Answer 3

1. To gather “baseline data” at the outset, which is used to formulate an initial assessment and to conceptualize the case. (science)
2. If clients feel accepted just as they are, without any pressure from us to change, they paradoxically ready themselves to make changes. (art)

Question 4

Why is a theory helpful?`

Answer 4

Information does not help us unless we understand what it means. We use this information (baseline data) to make an assessment and diagnosis.

Question 5

Definition of Theory

Answer 5

A system of interrelated hypotheses about reality – useful ideas about what is likely the case. (Theory is not fact. It is a story about how reality could be. Theories are continually evolving – they are living systems of thought. Because they are made up of hypotheses, we are always
testing them and correcting them as we learn more.)

Question 6

Definition of Diagnosis

Answer 6

A word or brief phrase that categorizes

presenting problems without particularizing or detailing them.

Question 7

Definition of Assessment

Answer 7

An assessment offers a much fuller description of a particular person with this
particular depression at this particular time. Assessments both describe and explain what is going on with clients from a particular theoretical viewpoint.

Question 8

What are assessment and diagnosis like throughout treatment?

Answer 8

They continue (and hopefully change) throughout the course of treatment.
Even at the final session, therapists are still on the lookout for diagnostic information to assess clients' status and progress.

Question 9

Why do we identify goals?

Answer 9

To “begin with the end in mind.” When the outcomes we are aiming for are clear, we are far more able to select (and defend to a managed care company if we had to!) an appropriate treatment strategy.

Question 10

Define Treatment Plan.

Answer 10

Brief map or plan of how to reach goals. The goals + interventions = treatment plan.

Question 11

What are the 3 aims of the intake process?

Answer 11

(1) familiarizing clients with the
therapist and therapy
(2) understanding the clients’ goals and concerns
(3) finding with clients a realistic
hope for a good outcome or good prognosis.

Question 12

What are the 3 tasks to complete at the initial session?

Answer 12

(1) welcoming and receiving clients as they present themselves, which is, perhaps, the highest priority task
(2) identifying the presenting problem(s)
(3) setting the therapeutic/professional ground rules, establishing a fee and clarifying what treatment/sessions will entail.

Question 13

What are the 3 tasks to begin the initial session?

Answer 13

Assessment, goal setting and initiating treatment only if there is time to do so.

Question 14

What is the first and highest priority in beginning an assessment?

Answer 14

To decide whether clients and

therapist ought to work together.

Question 15

What is the lowest priority of initial sessions? What’s the exception?

Answer 15

Initiating treatment. The exception is if someone is presenting with a crises or emergency

Question 16

Define Scope of Practice

Answer 16

The procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license.

Question 17

Define Professional System

Answer 17

A system that “professes” healing, healing of interpersonal systems and the individuals that comprise them.

Question 18

What is the cornerstone of the therapeutic relationship?

Answer 18

Confidentiality

Question 19

How is confidentiality enforced?

Answer 19

It is established by law and reinforced by the ethical code of our profession to
protect clients, not us.

Question 20

When does California law require and mandate mental health professionals to break confidentiality?

Answer 20

Child abuse
Dependent adult and elder abuse
And situations in which a client threatens serious physical violence to an identifiable victim (ex: homicidal intent).

Question 21

When does the law allow and permit the therapist to break confidence?

Answer 21

In cases where the client is suicidal and the

therapist believes disclosure is necessary to prevent the threatened danger.

Question 22

Can you say if someone has contacted you for therapy?

Answer 22

No

Question 23

If a client requests to disclose information, what do you do?

Answer 23

Get written permission first (the form: “Authorization for Release of Confidential Information”). Parents and legal guardians generally sign releases of information for minor children.

Question 24

Define Patient Privilege

Answer 24

It is the patient’s privilege to decide whether or not information is disclosed and to whom.

Question 25

Where and with whom can you discuss case conference?

Answer 25

In-house treatment team, with the door closed.

Question 26

What are the ethical principles that guide fee setting?

Answer 26

Clarity and fairness

Question 27

When do you clarify fee and payment policy?

Answer 27

On the phone, before first session

Question 28

What happens if a client can no longer pay (they have a sudden financial reversal)?

Answer 28

It is unethical to abandon them. The therapist presents options to the clients, and they choose the most preferable. The prudent therapist documents the clients’ choice in the record.

Question 29

Can you raise fees or charge higher fees?

Answer 29

Yes, as long as you are not exploiting client’s trust and vulnerability.

Question 30

What is a dual relationship?

Answer 30

Any situation where multiple roles exist between a therapist and a client. For example, the client is also a friend, family member, coworker, etc. Also if a client invites you to their wedding, out for coffee, etc.

Question 31

Why are dual relationships forbidden?

Answer 31

To prevent exploitation of clients and the undermining of therapeutic agendas by introducing other agendas that may present a conflict of interests, interfere with therapy,
injure the therapeutic trust, or sabotage the therapist’s professional objectivity.

Question 32

What do you do if someone has homicidal intent and named the victim?

Answer 32

Call the police, give them the name of the client and the name of the potential victims, then call the potential victims.

Question 33

Can you report a homicidal intent if they don’t name the victim?

Answer 33

No

Question 34

When do you tell the client your reporting responsibility?

Answer 34

First session

Question 35

If a client has financial hardship, what are options you can give them?

Answer 35

Cut down the fee, cut down the time slot, etc. If you say ‘sorry i can’t see you,’ give them 3 referrals (typically to a low-fee clinic) (Try not do this) Get everything in writing.

Question 36

What is our Sacred Trust?

Answer 36

First, do no harm.