Submit to Clinician's Quandary!

Let Us Know How YOU Would Tackle This Sticky Situation in Your Practice...

Psychotherapy Networker • 7/9/2018 • 8 Comments

Ever heard about a tricky clinical scenario and thought, "I know exactly how I'd handle that"? In the spirit of sharing and community, we're introducing a forum called Clinician's Quandary, where you, the reader, offer your take on how you'd address a clinical dilemma from a real practice.

On the first Tuesday of every month, we'll pose a Quandary and collect responses. Top answers from the previous month will be posted that same day and shared with your colleagues worldwide. See below for submission details.

Here's this month's Quandary:

My client Jonathan is in his early 30s. He’d like to be in a long-term relationship but struggles with intimacy, which is why he came to me for help. We have a good rapport and he’s generally engaged in sessions, but if there’s ever the slightest pause, he slyly checks his phone for emails or updates, even though I’ve asked him not to on several occasions. The minute the session ends, his phone is out and he’s scrolling through Twitter. I suspect his phone use may be affecting his “real life” relationships and adding to his anxiety, but when I raise this with him, he insists that it’s not a problem and I’m just out of touch with the times. What should I do?

We want to hear from you:

  • Send your response in 300 words or less to info@psychnetworker.org. Include "Clinician's Quandary Submission" in the subject line.* Include your name and country, city, or state.
  • Please provide detail in your response that paints a picture of what your solution looks like in practice. Don't be afraid to get creative!
  • Please allow up to one month for our editors to review your submission. We'll let you know by email if your response is selected for publication.

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*Responses may be edited for clarity.

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Topic: Professional Development

Tags: case study | Personal & Professional Development | Professional Development

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8 Comments

Sunday, June 3, 2018 8:04:12 PM | posted by Mark Glat
I would approach this situation by asking D what she thought the meaning of her recently ended marriage had been for her. By suggesting that she was still in a period of “mourning” the end of this relationship I would urge her to consider what this relationship and its demise meant to her in terms of how she saw herself in relationship to the world and what it signified in terms of how she imagined her future unfolding. Leading her through this process of reflection and “re-consolidation” (of her “emotional thoughts” and their relationship to making decisions and undertaking actions) would hopefully allow her to be better able to see the significance and the implications of her current plans. Note that this approach combines elements of several different theoretical perspectives ( e.g. grief counseling, attachment theory, the cognitive triad, and CBT) and provides a coherent focus and a rich set of words and ideas that can be used to increase both mindfulness and intentionality as she approaches this critical "learning task” of how best to move forward in her life.

Saturday, June 16, 2018 4:32:58 PM | posted by David Stewart
I am glad to see this feature added to the otherwise very comprehensive array of articles and resources for the clinican's on-going clinical development. What I have often wondered is why there has not been a regular feature focusing on clinical supervision. The consultation section does not really use that kind of lens. Thanks for this, keep it up. David Stewart, Victoria, BC, Canada

Saturday, June 16, 2018 5:56:44 PM | posted by Carol Gross
My first reaction is that of helping the client to determine her personal safety in this new relationship. Recognizing that she wants to heal and move forward, also means she will take on the need for self care and all that this implies. Checking on the person’s character and whether the person is trustworthy by doing a background check is just common sense before moving across the globe. Meeting for a vacation, letting your friends and family know where you are going to be might be a good first step. Putting these ideas into the form of questions: have you thought about - would be my approach. Thoughtfully considering what happened in previous relationships and what she is looking for now that she is willing to take the risk to ‘own’ her own life - and her successes and mistakes- and to have a return plan if the person is not who she thought, would all be important treatment points.

Saturday, June 16, 2018 7:51:39 PM | posted by Crystal Daniels-Reyes
First, you should find out exactly when Diane is planning to get married. This will let you know approximately how much time you have to intervene regarding this. I would explore any negative thought/beliefs Diane may have about herself as it pertains to being divorced. I would also explore Diane's reasons for getting married to someone she has never met, and the significance being married has for her. Having her weigh out the pros and cons of marrying someone she has met online could also be done as well. In the end, the ball is always in our client's court regarding decisions they make, unless they have expressed plans to harm themselves or someone else, or there are other risk/safety concerns reported.

Sunday, June 17, 2018 10:59:36 AM | posted by Glenda - UK
Assuming a strong working alliance and trust between us, I'd invite D to tell me all about her online experience with this prospective spouse, her plans and expectations for moving abroad and how she feels it impacts her, as yet, unhealed divorce. Encouraging D to share her narrative of this choice can offer multiple opportunities for therapeutic interventions to help D consider her decision and whether it is a distraction from the pain and challenge of what she has yet to resolve relationally. As pulled as we are as therapists to "solve" what we see as our patient's mistaken choices, it is for su to offer our patients the non-judgmental safe space to see this IF they are ready to see it.

Sunday, June 24, 2018 6:53:06 PM | posted by Shea Karam
My first intervention with this client is to deeply hear her story (active and reflective listening) in all its dimensions: her plan, emotions, hopes, worries - paying attention to her words, tone, conceptualizations, body expressions. I would encourage, highlight and reflect the qualities of the experience separate from her plan such as: her hopes, yearnings, excitement and any fears or sadness. I would validate these larger more global emotional and cognitive impulses as well as validating her ‘solution’ (proposed plan) as a path to meet her needs and wants. All the while I would be listening for the ‘problem’ with the plan and open that up for consideration through empathic clarification so that she doesn’t feel the need to defend the plan, but rather can hold the dialectic of her yearnings, needs and wants with any cautions. I would incorporate somatic reflection asking where she feels the different emotional qualities and impulses in her body. "As you imagine this plan, what do you feel in your body?" And then I would ask questions eliciting her values in the context of this transitional time and place: "where does this plan take you in life? What are you leaving behind?" The goal of this intervention is (moving towards) congruence of her values, beliefs, emotions and body messaging. Where there are incongruencies we would respectfully explore until the client gets to a place of understanding and a directional sense of alignment. Outside of therapy I would encourage the client to meditate, journal or some other form of mindfulness and experiential expression to more fully align with Self. Overall, this intervention respects and honors the client in the way she is moving through a difficult life transition.

Monday, July 2, 2018 11:06:44 PM | posted by Cheri Armstrong
I'd just lay it on the table. I'd look at ;him quizzically and ask, "Are you asking what I'd THINK or FEEL in this type of situation, or are you asking me for a date?" And then let him answer. He'd probably be embarrassed, but I'd just deliver this with a smile, a bit flippantly. That would get it out in the open, perhaps displaying your discomfort, but in a convivial way. And then use it therapeutically, of course noting that going on a date with a client is not appropriate.

Saturday, July 14, 2018 3:34:31 PM | posted by Renee
I would respond by saying to him: "Well, because of the nature our relationship we cannot go to a movie together. But I hear a deeper question. I think you are trying to tell me that you are feeling close to me and you're wondering how I feel towards you".