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Ask clients stuck awaiting change to keep a prospective diary. An explicit account of life after the hoped-for change can help clients unstick themselves and start changing now.
Some clients (and some therapists) get stuck awaiting a single change which will solve all their problems at a stroke. “Once I’m rehoused…”, “Once I get my compensation…”, “Once you start taking your medication consistently…”.
A key feature of these hoped-for changes is that they are usually external to the person holding out for them: the client holds out for change at the Housing department or law court, the therapist holds out for change in the client. The implicit message is “it’s not my fault nothing is happening yet”.
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Prevent clients from panicking by keeping your room cool. Overheating clients can misinterpret a rise in room temperature as the onset of a panic attack.
Panic occurs when benign physical sensations are interpreted as threatening, leading to a surge of adrenaline which exacerbates the sensations and the perceived threat (eg: a cramped chest muscle causes anxiety and tension, increasing the pain from the muscle and increasing the worry that a heart attack is occurring).
Anxious clients entering a hot consulting room can misinterpret the rise in temperature as a rise in their own anxiety levels. Fearing that they will lose control in front of you, they will produce more adrenaline, further raising their body temperature and beginning the vicious circle of a panic attack.
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In celebration of three years of continuous publication, first as an email newsletter and now as a weblog, the British Psychological Society’s Research Digest has published a special edition.
The authors of seven psychology blogs have each provided an article detailing a psychology journal article from the last three years, one which inspired them or changed the way they think.
The topics range from the academic to the pragmatic: from whether psychology is a coherent scientific discipline to whether police officers can detect attempts to deceive them. Will Meek’s report on an investigation into maintaining happiness should be of particular interest to readers of this site.
Experience suggests that receiving compensation for physical or mental injury or distress is often followed by a significant improvement in the client’s symptoms. Many therapists decline to take on clients with ongoing compensation cases and some question the honesty of clients who make such recoveries.
Therapists who decline such cases may simply be unwilling to become embroiled in a legal battle (or fearful that a litigious client may turn on them) but those who doubt the client may be failing an empathy test. A client claiming compensation has a great deal to fear from their therapist.
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Deductions impress clients, but incorrect deductions can be disastrous. Deductive reasoning has its place in therapy, but only as a means of generating hypotheses on which you can work with clients.
A client who usually had bare arms arrived in a long-sleeved shirt on a hot day. When I noted the change, she showed me cuts on her wrists which had become infected. I asked her to consider getting the wounds treated and, at the end of the session, said how glad I was she’d decided to do so. She asked how I knew she’d made that decision and I pointed out that she’d rolled up her sleeves. She was impressed by my deductive abilities: I felt like Sherlock Holmes. I was an idiot.
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Disclosures requiring that confidentiality be breached are rare. A little preparation should permit you to focus upon supporting your client through the process, preserving your therapeutic rapport.
In part one, we considered how to react when a breach of confidentiality seems necessary, how to prepare for such an eventuality and what to say to the client.
Now we will consider how to continue your involvement with your client once you have had to breach their confidentiality. We will also consider how to proceed when your decision to breach confidentiality is reached outwith the session, whether independently, directed by your supervisor or required by law (eg: by a court order).
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