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Examples for discussion Situation: 10 year old aggressive patientYou enjoy working with children, since your own kids are healthy and wonderful. They play sports enthusiastically and do well in school. Yet, your 9 year old middle child is a little shy and tends to be a little meek near the bullies. On several occasions, you had wished that this one had been more assertive when their locker was messed up by the bully, Jack, and his friends. One day at work, you are given an intake for a 10 year old for aggressive behavior. You quickly check the chart and notice it is not Jack, but Sam. OK, you do the intake and establish a great connection with Sam and his mother who brought him. You talk about getting the boy involved in healthy activities, and they are keen on the idea and note they had been toying with signing up for baseball and now are sure they will. You are sure the therapy will go well. Five days later, after the first ball practice, you find out that Sam has joined your elder child's ball team and rivals him for third base. You also find out that Sam is in your middle child's class (his age fits him the the older baseball group; but his problems held him back in school); you also discover that Sam was the bully in the most recent harassment of your middle child, and has been at Jack's side in every incident before. What now?
Situation: health careYou are getting your annual mammogram. After 20 minutes waiting in the cold waiting room, wearing what the hospital provides for fashion wear, you are escorted to the mammogram room. You see that the wife of a man you are treating for depression is your technician. "Just step over to the machine and slip your left arm out of..." What now?
Situation: couple fidelityYou are treating a couple for marital infidelity. The husband has had 3 affairs in two years and has lied repeatedly to the wife. With young children, she wants to work on saving the relationship but is at the end of her rope; this is his last chance. They are having a rough time but have made encouraging gains in the 3 months you have worked together. You have said you will not keep secrets from any individual sessions, and will be completely open with them, as you encourage them to do likewise with each other. You think therapy might just work out. On the weekend, you are out to eat with your spouse in a neighboring town. You see your patient - the husband, having a close dinner with another female patient of yours whom you are treating for compulsive promiscuity. What now?
Situation: businessYou are treating a business man who has told you he is suffering from forgetfulness and irritability, and has made some serious mistakes at work and has been almost arrested for his rages when confronted by his customers. You arrive home one evening to find that your spouse has just hired this man to excavate your foundation and replace your footing drains. He is due to begin work next week. What now?
Situation: teen groupYou are treating a group of teenagers for drug problems and coping with HIV. At home, your own teen announces they will be going on a date with one of the youth whom you know from your drug/HIV group. What now?
Situation: good deedYou belong to a particular religious group that recently did a good deed. You were recognized in the newspaper; and your religious leader praised you as being a great recruiter for your sect. You were embarrassed but happy nonetheless. A new patient brings this up during their intake, noting that they are against all religion and don't think that you could help them because they think you will be recruiting them to your religion in their therapy. You are well qualified to help their presenting symptoms and believe you can be of very positive assistance. What now?
Situation: divorceYour child has been difficult since your divorce in the last year; sibling rivalry has run high. Your child has been complaining that you are never on their side when in conflict with the sibling. This week things went very badly for your child. You child has been sent home from school and is not able to ride the bus because of temper and an incident with another child; your child was in a fight on the bus and drew blood in the incident. You find out that the victim was your child patient you have been seeing in therapy for a number of months. Now, the time for the parents to talk together at the principal's office draws near. What now?
Situation: family therapyYou have had success in family work with a complicated case in a large family. Another similar case is referred to you by your supervisor. You do the intake. They have substance abuse issues and anxiety; and you believe you can help this family. You take a history and genogram, and see that this family is a related to your recent large family case. You recall that the first family always said their un-named cousins were inbred and incestuous. What now?
Situation: school boardYou believe you can help your town by serving on the school board. You sign up to run. Soon thereafter, the estranged partner of a couple you had seen files to run against you. You know they were upset you had not saved their marriage. Your opponent says very harsh criticism of you and your views. It is a nasty campaign. What now?
Situation: community dinnerYou go to a community dinner with your spouse. It turns out that all of the tables have been pre-bought except one for walk-ins. You find this acceptable and get settled in. Just as you are ready to be served, another couple arrives. Your spouse is happy that the table won't be so empty. The new arrivals are a couple you have been doing sex therapy with for six months. You have been composed and non-revealing in this therapy, trying to be non-judgmental for their benefit. Your spouse launches into conversation with some funny personal stories. What now?
Situation: eating disorderYour are treating a woman for an eating disorder. She has made very good progress and feels comfortable being able to talk with someone, since she does not want her husband to know of her illness. One day she complains that her husband is being accused of sexual harassment and may lose his job. She indicates that the accuser is her own friend whom she had referred to you, and is seeing you in therapy. What now?
Situation: teen adjustmentYou are treating a teenager for adjustment issues related to foster care and life's upheavals. In therapy the teen tells you about their peers and their misdeeds, and how they disapprove. Among the stories you hear, you suspect and then are sure, that you are hearing a very naughty tale about your own teen child. What now?
Situation: adopted childrenTwo siblings were adopted from Africa. The elder sister cared for the younger brother at a very young age and shielded him from countless awful traumas. The sister is quite vulnerable and now is needing help with her PTSD while the brother is acting out, but seems generally healthy. The sister is extremely sensitive and critical of the brother, and is reactive as he triggers her PTSD repeatedly. In response, the brother is bewildered by her frequent negativity and becomes angry and depressed. You have been asked to see both children, because there are so few providers who handle these issues in your region. What now?
Situation: admissionA young mother you are treating is very depressed. She becomes suicidal and needs hospitalization. She consents to care, and in the arranging, you offer to help make phone calls to expedite the admission, since she is so low functioning at this point. She requests you to call so-and-so to pick up her child at school and take care of the child for her. You know that so-and-so is your colleague's patient and is also quite vulnerable and would be overwhelmed with the task. What now?
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training. Dr Deborah Warner may be reached at 603-444-1512 in Littleton, NH All material copyrighted ©2007 Dr Deborah Warner PLLC. All rights reserved. |
