I am coming to a crossroads in my practice, I believe. Perhaps this is not a choice, not a path that leads to some separate destination. Rather, I am coming to realize the balaance on a spectrum between operationalizing therapy and keeping the practice flexible. As I have discussed once or twice before, a moderate approach to such dichotomies are almost always justified. But how does one choose when and how much to keep flexible or stick to some kind of stricter or regimented question/answer session.
At the very least on the side of operationalizing, there are some comments/topics that require certain answers, reflections, or questions. The default topic here is suicide. When suicide (or any kind of harm: homicide, child abuse, elder abuse, self-injury) is brought up, a risk assessment must be completed, comprised of a plan assessment capability, type of harm, etc. But there must assuredly be other "canned responses" to certain issues.
Continuing with familiar ground, there are certain responses that are appropriate for clients who present with issues involving drugs and alcohol. When a client mentions that he or she has used in the past week (or is "confessing" use to the therapist for the first time when the use was in the distant past), it is important to ask as many questions as possible to ascertain the setting, amount, feelings, impacts, and plans pertaining to the use.
- Setting: Where did you use? Were you with anyone? Was it a safe environment?
- Amount: What did you use? How much did you use? What symptoms did you experience during/after use?
- Feelings: How do you feel about the experience? Are there any lingering positive or negative feelings associated with it? Do you think you're going to continue to use in the future?
- Impacts: What have been some consequences of your using? What has changed/What is the same for you?
- Plans: How might this change things for you? How might this change your valuation of yourself?