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

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Clinician's Quandary invites your take on how you'd handle tricky scenarios in practice! On the first Tuesday of every month, we'll pose a new Quandary and collect responses. Top answers from the previous month will be posted that same day and shared with your colleagues worldwide.

This month's Quandary:

When my clients cry in session, I'm never sure whether to pass them a box of tissues. I worry that they might interpret it as me trying get them to stop crying or rush through whatever they're dealing with. Yes or no to passing tissues? And if yes, what do you say, if anything?

Submission Details:

  • Send your response in 400-500 words to Include "Clinician's Quandary Submission" in the subject line. Include your name and country, city, or state in the email. Responses may be edited for clarity.

  • 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.

Check out our Clinician's Quandary archive here!

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Sunday, June 27, 2021 9:10:52 AM | posted by jim knutson
Clinicians quandary submission. My response to the statement "you are a bad therapist." Okay, maybe. (After all this isn't about me, so what if this person thinks I am a bad therapist, maybe I said something that wasn't so great. Do I need to apologize? If so, I will apologize, if not I will proceed). I like to be curious about what is happening with the patient, that is where the emotion/statement came from. Seems like they wanted a response to maybe hurt me, like they wanted to get personal with me. Let's not go there. Yes people will react in a hurtful way when they are hurting, that makes sense to me. Meeting them with curiosity, compassion and a sense of strength, by not being thrown off your center, might be helpful to you and the patient. Being curious about the pain behind the statement, might be where I need to be with them. The deeper level feeling is where I like to go if possible to discover what the pain is really about. When I am open and being vulnerable with the patient they also see my humanity. I think that is important in a therapeutic relationship. This is one way to build credibility and a sense of I can handle your "negative statements" and be okay. Thank you for allowing me to share some of what I have experienced.

Saturday, June 12, 2021 6:04:33 PM | posted by Johanna Efron
Clinicians Quandary Sumbission I’d start with, Your probably the first patient that’s said out right what others have wanted to say in the past but have not had the courage to say, so thank you for your honesty. Now to help us both out here, and your the patient and The care and support I have for all my patients is why I’ve chosen this career. So to better understand how we can shift this toward a positive please can you share how it is for you to be sitting here with me, and tell me more about the shit things about me that tick you off? I believe it’s really important for you and this treatment between us that I’m able to genuinely take this on board as constructive in that your honesty is welcome here It’s been on my mind since our last session Melbourne Australia

Sunday, June 6, 2021 8:09:34 PM | posted by Didi Rowland
Ouch! This would be painful for any therapist no matter their experience or level of self confidence. It's understandable that you "muscled through" the rest of the session. I imagine you were taken aback and felt unprepared to respond in the moment. You mentioned in your first sentence that this was a "difficult client" so it sounds like the relationship was already somewhat rocky. It may be that you don't want to continue with this client and you can refer them to a colleague. Or you may become curious and engage in a conversation with the client about what has not been working for them and, also perhaps what HAS been helpful thus far. I might bring up with them the importance of "fit" between client and therapist. You may want to add that the techniques that you've been using might not what they need. In any case a conversation between the two of you would probably be beneficial for both parties, regardless of whether you two decide to keep working together. You might investigate together this client's history with previous therapists and what worked or didn't work in those relationships. A helpful question might be, "What would a good therapist do or how would a good therapist respond to you?" Therapy is definitely a trained professional and a user of those skills, however it is also a collaborative process with communication on both sides. Another way to respond might be to say something like, "I'm glad you feel comfortable enough in our relationship to say out loud what you are feeling. I value your feedback and even if we decide not to continue to work together I feel that we'll both benefit from a discussion about what has transpired up until now." Our vulnerability is one of our greatest strengths and this applies to us as therapists, also. We can show our "humanness" with clients when it is appropriate. I hope you and this client learn a lot in your next session. Rooting for you both! Warmly, Didi Rowland, LCSW Austin, Texas

Friday, November 6, 2020 11:12:40 PM | posted by Ron MacKenzie
I've always enjoyed a challenge. In my encore career, at 60 years old, after being a therapist for 5 years, I bought an RV and went where I can serve underserved populations. That was more than 5 years ago. I am now happily serving others in rural California farm country. A side effect was that I'm over 65, love my work, and still employed. No small feat in our youth oriented society. I'm grateful.

Saturday, November 9, 2019 3:02:07 PM | posted by Toni Parker
I reading these articles about medications and whether she should take meds. There is one thing that really concerns me.. It is important to look at her nutrition and nobody is discussing that. All the research shows that nutrition plays a huge part on our moods and behavior.. especially sugar. I would like to see someone asking her what she eats and when and also about exercise.and her sleep.. It is important to look at the whole person. Is she eating lots of processed food that is full of sugar and chemicals? Please consider these factors when discussing medication and if you don't know about nutrition then work with one.. So much research about impact of food and exercise now that we as therapists need to take this into consideration.

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