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Role-Play

Role-Play. Let’s assume that this is your third or fourth session; therefore a trusting relationship has been built and you both know in general what the focus of session is at this point. You can discuss before starting if you’d like.

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Role-Play

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  1. Role-Play • Let’s assume that this is your third or fourth session; therefore a trusting relationship has been built and you both know in general what the focus of session is at this point. You can discuss before starting if you’d like. • CLIENT: You are a client who is mildly depressed and/or anxious. You tend to blame your partner for “creating” the problem. The issue could be family, finances, substance use, etc. Please develop your character before class so your counselor will have several directions in which to take the session. Remember to keep blaming or keep trying to focus on your partner. As the session winds down, allow the counselor to make some progress on getting you to acknowledge your responsibility for your role/feelings. • COUNSELOR: Try to expand the client’s perspectives by examining areas beyond just what they present to you. You decide what areas might be relevant to explore & lead the client into those areas for discussion/exploration. Try to point out any discrepancies that come up. As the session winds down, try to get the client to admit some responsibility or, at minimum, come up with alternative interpretations.

  2. Chapter 13: Outcome Evaluation and Termination

  3. Evaluating the Effectiveness of Helping • How do we know we’ve helped a client? • Outcome research (formal, informal) • Our task: Determine which tx, by whom, will be most effective for THIS client • MUST be able & willing to adjust tx! • Stay informed of current research • What are some ways you can track YOUR outcomes?

  4. Basic Outcome Evaluation Methods • Progress notes (include vs. not include) • Global measure (BDI, OQ-45 etc) administer/track over tx • SUDS (subjective units of distress) indicate in prog notes • Friend/family member of client ? Can give client feedback (be careful) • Client satisfaction scales (how happy is client about tx received?) • Goal attainment measures (keep track of each goal & progress) • Program evaluation (evaluate a specific program being implemented)

  5. Preventing Premature Termination • No single client characteristic can predict dropout • Some correlation to poor therapeutic relationship • Clients expect shorter tx length than therapists Some possible ways to prevent early dropout: • Don’t make clients wait weeks for an appointment • Contract with clients on # sessions or small goals • Do your own intake/assessment interviews • Give client info on therapy (process, expectations, billing, etc..) • Use reminders for upcoming appts • Call client if they don’t show- discuss • If client does decide to terminate against your suggestion- leave it open and friendly so they can come back if needed

  6. When is Termination Needed? • Terminate when: all goals are met; no progress made after considerable time; signs that indicate client is dependent on therapist • Always make clients aware of alternate sources of help/ referrals • Have open door policy (when appropriate) for returning • Client not putting effort into the work (discuss/ be open to negotiate) Five questions to assess client’s readiness for termination • Is the presenting problem under control? • Has the client reduced the initial level of distress by developing better coping skills? • Has the client achieved greater self-awareness and better relationships? • Are life and work more enjoyable for the client? • Does the client now feel capable of living without the therapeutic relationship?

  7. Preparing Client for Termination • Sudden termination = not advisable • Many differing opinions on when to talk about it • Should be some period of preparation left to your judgment • At minimum: Review progress made, emphasize client strengths, end on positive note, discuss anything not resolved; discuss how client will deal with issues on his/her own & how to tell if they need to resume therapy. • Termination of a therapeutic relationship often feels like a loss: prevent, explore feelings by: • 1) Bring termination up early • 2) Opportunity for client to put new learning into practice • 3) Give client an idea of duration of therapy at beginning of relationship • 4) Fade: space out later sessions further apart • 5) Help client take responsibility for their successes in therapy • 6) Play up sense of accomplishment/independence (play down termination) • 7) Use reflective listening to allow client to express feelings of loss • 8) Be honest and give feedback “I have truly enjoyed working with you” etc.

  8. Your Reaction to Termination • You may have to let go of what seems like an incomplete project • Helpers may postpone termination because they don’t want to let the client go (for a variety of reasons) What reasons might a therapist have for delaying termination?

  9. Maintaining Gains after Termination • Follow-up • Fading • Social services • Self-help groups (know the group before recommending it) • Self-monitoring • Role-playing for relapse prevention (practice anticipated struggles) • Journaling • Community resources

  10. Exercise • In pairs Your client Sam has been coming to you for 2 years. He has a history of depression and relationship issues, for which he initially came to you. Over the two years Sam made significant progress in both areas. You have mentioned termination in the past, but Sam skates around the issue. Now you feel that Sam is ready to move on to more self-help and he doesn’t need weekly therapy. Practice with your partner what you would say to Sam. Be firm and fair, and remember to list the gains made; make up the details as you see fit. You may want to practice your “speech” more than once. Your client Sheila has missed almost half of her sessions over the 6-month period of time you’ve been treating her. Sometimes she calls ahead, but often she simply doesn’t show. You’ve discussed this with her before, but she makes excuses and in general does not put much effort into therapy- during session or between-session assignments. You feel that you’re the only one doing the work. At this point, you don’t see any benefit for Sheila to continue as your client, and you have a new-client waiting list. Practice what you would say to Sheila. Would you give her one more chance, with an ultimatum (ethically and kindly worded, of course)? Would you terminate therapy at this point? Discuss with your partner your different options and practice telling Sheila what your decision is. Make up the necessary details as you see fit.

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