Steps taken to build rapport with client and make Laurel comfortable in confiding
1a. Steps taken to build rapport with client and make Laurel comfortable in confiding:
To conduct and start assessment process with Laurel and provide a preliminary diagnosis of according to The Diagnostic and Statistical Manual of Mental Disorder (DSM) criteria, the first step that will be important will be to build rapport with clients. Building rapport with client is an important component of client-professional relationship as it develops trust and foster client’s willingness to disclose important information to therapist or case manager (Abbe & Brandon, 2014). The main goal of rapport building during assessment process will be to develop a sense of connectedness with client and get all the necessary information from client needed for diagnosis. The following steps will be followed during the first session of rapport building with Laurel:
- Being well-prepared for the session and developing safe environment for client: The first step for rapport building is to closely review the client notes and clearly understand the factors troubling Laurel. This will be necessary to plan and make a safe trusting environment for Laurel during the assessment process. From the Vignette, it is understood that even after five years of being raped, she always panic whenever she go close to someone. She also has trouble socializing. Hence, in such situation, it will extremely crucial to make client feel safe in the counseling room. This will make the client proactive (Timulak, 2010). I plan to do this by making the setting appealing and everything clutter free. I will also ensure the client during the introductory conversation that we are meeting to solve the problem she is facing and there is no threat or harm to her by this conversation both in terms of confidentiality or any harm caused to her.
- Assessing and responding to client by monitoring gestures and body language: The next strategy will be to determine communication method with clients by observing Laurel’s body language and gestures and matching them accordingly improve interaction with client. Observing postures, eye contact, breathing patterns, skin tone, voice tone, facial expression and eye movement can give idea about patients comfort level during the session (Lavik et al., 2017). Hence, this can be used to create appropriate discussion with Laurel
- Active listening and using mirroring strategy: As Laurel has been mentally and emotionally affected by rape experience, the focus during assessment process will be to just listen and be non-judgmental. It will be ensured that unconditional positive regard is given to her. As a forensic case manner, I will initially try to be patient with Laurel as she may find it hard to talk about rape. The initial strategy will be just to listen, be empathetic towards her. I will try not to provoke the client and try to solve the issue at that very moment. This strategy is in relevance with the Carl Roger’s person-centered theory as it states that every person has the capacity and desire for personal growth (Silani, Zucconi & Lamm, 2013).Hence, non-judgmental and empathetic approach will empower and motivate Laurel so that she trust and disclose all information to case manager. This state will lead to psychological contact with Laurel which is a necessary factor for growth in the Rogerian theory.
Hence, the above mentioned strategy will be a good foundation to build rapport with Laurel and ensure that she is comfortable while confiding her issues to Forensic case manager.
After the initial process of rapport building the next three-four session will be essential to question client and find out all symptoms in clients that is necessary to match and compared with the DSM-V diagnostic criteria for mental illness. The assessment process can be continued with Laurel by taking the following steps:
After building rapport with Laurel in the first session, it will be necessary to clarify the goal of the session during second visit (Corey, 2015). Such conversation would be like-‘We are meeting with you so that we can get all detailed about the issues you are currently facing. As I mean to genuinely help you so that you overcome the challenges you face, I would like you to cooperate during the session and give honest answer to all my questions’. Such form of communication will be good to get detailed information from Laurel.
Informal questionnaires will be used to assess the client’s appearance, attitude, activity, moods, emotion and cognition during the counseling process. Firstly, the cognitive state of Laurel will be examined by conducting Mini-Mental State Examination (MMSE) test. This tool has set of questionnaires with maximum score of 5 and minimum score of 1. The completion of the questionnaire and score obtained helps in categorizing the disorder and finding out severity of cognitive impairment (Trzepacz et al., 2015). This will also help to understand Laurel’s ability to think or concentrate. This information will be a cue for diagnosis of mental disorder in client as diminished ability to think is one of the symptoms mentioned in DSM-V criteria for classification of mental disorder.
In additions, other informal questionnaire set will be prepared to inquire about the following from Laurel:
- Laurel’s mood throughout the day
- Her interest in activities
- Weight loss or weight gain information
- Presence of symptoms like insomnia, agitation, fatigue, worthlessness and recurrent thoughts of death.
- Impairment in social or occupation functioning of Laurel after rape experience
- Inquiry about use of any substance or other medical condition in client
- Episodes of manic episodes.
This will be done by framing present and future oriented question so that her condition and willing to improve symptoms can be understood.
While continuing with the assessment process, the last few session will focus on questions like ‘What you have done to come out of this situation?’. This will be essential to find out if anything worked for her or did she had the willingness to change herself. In case adapted any strategy, compliment questions will be used to assess how she did she used any coping strategy. This will be the conclusion to the assessment process. This strategy is also influenced by the solution-focused brief theory as this theory focused on method of conversation with client which is directed towards client’s vision of solution (Carrera et al., 2016). This will be effective in making the diagnosis and finding solutions for Laurel.
1c
i. As the diagnosis of mental disorder in Laurel is mainly focused on Axis I diagnosis according to DSM criteria, the assessment process has only investigated about acute symptoms hat need treatment. According to the assessment of client on the basis of critical symptoms, the diagnosis made for Laurel is that she is suffering from 296.32 moderate and recurrent Major depressive disorder.
ii. This diagnosis has been made because according to DSM-V criteria for major depressive disorder, at least 5 of the 9 symptoms from depressed mood, decreased interest in activities, weight change, insomnia, change in activity, fatigue, worthlessness/, concentration and suicidality must be present in client (Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes. (2017). . Laurel has symptoms of guilt, depressed mood, decreased interest and pleasure in activities, poor concentration and insomnia. Hence, Laurel’s diagnosis of major depressive episode was confirmed. Secondly, at least two or more major depressive episode must be present in client to confirm recurrent MDD (DSM-IV Diagnostic Categories 2017). Laurel was found to have at least two episodes as see suffered initially after rape and then five years after the incident too.
Reference:
Abbe, A., & Brandon, S. E. (2014). Building and maintaining rapport in investigative interviews. Police practice and research, 15(3), 207-220.
Carrera, M., Cabero, A., González, S., Rodríguez, N., García, C., Hernández, L., & Manjón, J. (2016). Solution?focused group therapy for common mental health problems: Outcome assessment in routine clinical practice. Psychology and Psychotherapy: Theory, Research and Practice, 89(3), 294-307.
Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes. (2017). DSM V Criteria for Major Depressive Disorder Retrieved 13 December 2017, from https://www.psnpaloalto.com/wp/wp-content/uploads/2010/12/Depression-Diagnostic-Criteria-and-Severity-Rating.pdf
DSM-IV Diagnostic Categories (2017). DSM Codes by Disorder. MHReference.org – Your Mental Health Reference. Retrieved 13 December 2017, from https://mhreference.org/dsm-codes/dsm-disorder/
Lavik, K. O., Frøysa, H., Brattebø, K. F., McLeod, J., & Moltu, C. (2017). The First Sessions of Psychotherapy: A Qualitative Meta-Analysis of Alliance Formation Processes.
Silani, G., Zucconi, A., & Lamm, C. (2013). Carl Rogers meets the neurosciences: Insights from social neuroscience for client-centered therapy. In Interdisciplinary Handbook of the Person-Centered Approach (pp. 63-78). Springer New York.
Timulak, L. (2010). Significant events in psychotherapy: An update of research findings. Psychology and Psychotherapy: Theory, Research and Practice, 83(4), 421-447.
Trzepacz, P. T., Hochstetler, H., Wang, S., Walker, B., Saykin, A. J., & Alzheimer’s Disease Neuroimaging Initiative. (2015). Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults. BMC geriatrics, 15(1), 107.
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