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English for Psychotherapy and Counselling: Handbook for Practitioners

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ISBN978-5-0068-9652-9

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UNIT 1.

INTRODUCTION TOPSYCHOTHERAPY





LEAD-IN:

Mental Health Professionals and Their Roles


Activity 1: What Do You Know?

Look at the list ofmental health professionals below and think about the questions:



Mental health professionals:

 Clinical psychologist

 Psychiatrist

 Counselling psychologist

 Psychotherapist

Think about:

 What do you know about each professional? What do theydo?

 How are they different? (education, methods, types ofproblems)

 Which specialist would you recommend for: anxiety, depression, relationship issues, serious mental illness?



Activity 2: Vocabulary brainstorm

Work insmall groups. You have 3 minutes towrite down as many words as you can related tomental health and therapy.

Example: therapy, counselling, treatment, session, assessment, diagnosis



Activity 3: Discussion questions

Discuss these questions with your partner:

1. What comes tomind when you hear the word psychotherapy?

2. Do you think psychotherapy is different from psychology?How?

3. What do psychotherapistsdo?

4. What is the difference between aclinical psychologist and other psychologists?

5. Why do people go totherapy?

6. Are there different types ofpsychotherapy? What do you know about them?



Key vocabulary for this unit:



Match the words with their definitions:

1. Psychology

2. Counselling

3. Psychotherapy

4. Psychiatry

5. Mental health

6. Clinical psychology



a)Medical specialty dealing with diagnosis and treatment ofmental disorders

b) The scientific study ofthe mind and behaviour

c) Treatment using psychological methods through regular interaction

d) Professional guidance tohelp people cope with specific problems

e) Apersons condition regarding their psychological and emotional well-being

f) Branch ofpsychology focused on assessment and treatment ofmental health disorders




READING:

Mental Health Professionals: Who Does What?


Pre-readingtask

Before you read, discuss:

1. What do you think is the main difference between these four professions?

2. What does aclinical psychologist do that other psychologists might notdo?

3. Which profession requires medical training?

4. Which focuses on short-term problems?

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Mental Health Professionals: Who Does What?

When people experience emotional difficulties, mental health problems, or simply want tounderstand themselves better, they often wonder: Who should Isee? The field ofmental health includes several types ofprofessionals, and while their work overlaps, there are important distinctions between them.

Psychology is the scientific study ofthe mind, behaviour, and mental processes. Psychologists are trained professionals who typically hold adoctoral degree (PhD or PsyD) inpsychology. They use evidence-based methods toassess, diagnose, and treat mental health conditions. Unlike psychiatrists, psychologists inmost countries do not prescribe medication; instead, they focus on psychological interventions and therapy.

Clinical Psychology is aspecialized branch ofpsychology that focuses on the assessment, diagnosis, and treatment ofmental health disorders and psychological distress. Clinical psychologists work with individuals, couples, families, and groups toaddress awide range ofpsychological issues, from mild adjustment problems tosevere mental disorders such as schizophrenia, bipolar disorder, and severe depression.

What makes clinical psychologists unique is their extensive training inpsychological assessment. They are skilled inusing various assessment tools, including clinical interviews, behavioural observations, and standardized psychometric tests. Aclinical psychologist conducts comprehensive psychological evaluations tounderstand the nature and severity ofaclients difficulties, considering biological, psychological, and social factors.

Clinical psychologists provide evidence-based psychological therapies and interventions. They work indiverse settings including hospitals, mental health clinics, rehabilitation centers, private practices, universities, and research institutions. Many clinical psychologists also conduct research todevelop new treatments and improve existing interventions. Additionally, they often supervise other mental health professionals and contribute totraining programs.

The work ofaclinical psychologist typically involves:

 Conducting detailed psychological assessments and diagnostic evaluations

 Developing individualized treatment plans based on assessment findings

 Providing various forms ofpsychotherapy (CBT, psychodynamic, family therapy, etc.)

 Monitoring client progress and adjusting treatment as needed

 Working collaboratively with other healthcare professionals

 Conducting applied research and contributing toevidence-based practice

 Providing clinical supervision totrainees and other professionals

Counselling Psychology is another branch ofpsychology that shares some similarities with clinical psychology but has adifferent focus. Counselling psychologists typically work with clients experiencing less severe psychological distress and focus more on personal development, life transitions, and adjustment issues. While clinical psychologists often work with severe psychopathology, counselling psychologists emphasize wellness, growth, and helping people function better intheir daily lives.

Counselling (as aprofession distinct from counselling psychology) is ahelping profession that focuses on specific problems or life transitions. Counsellors, who usually have amasters degree incounselling or arelated field, help clients cope with immediate issues such as career decisions, academic stress, grief, or relationship conflicts. Counselling is typically shorter-term than psychotherapy and more solution-focused. It emphasizes practical coping strategies and goals rather than deep exploration ofunderlying emotional patterns.

Psychotherapy, often called talk therapy, is atreatment intervention that uses psychological methods through regular personal interaction tohelp people change behaviour, increase well-being, and overcome problems. While clinical psychologists, counselling psychologists, and counsellors may all provide psychotherapy, the term psychotherapist often refers toprofessionals who engage inmore in-depth, long-term therapeutic work. Psychotherapy explores deeper emotional issues, past experiences, and unconscious patterns that influence present behaviour.

Psychiatry is amedical specialty focused on the diagnosis, treatment, and prevention ofmental, emotional, and behavioural disorders. Psychiatrists are medical doctors (MDs) who complete medical school followed byspecialized training inpsychiatry. Because oftheir medical background, psychiatrists can prescribe medication and may use biological treatments. While some psychiatrists provide psychotherapy, many focus primarily on medication management, especially incontemporary practice where they often work collaboratively with clinical psychologists and other therapists.



Three Main Approaches inPsychotherapy

Within psychotherapy (practised byclinical psychologists and other therapists), three major theoretical approaches have shaped modern practice:

Cognitive-Behavioural Therapy (CBT) is astructured, goal-oriented approach that focuses on the connection between thoughts, feelings, and behaviours. CBT therapists help clients identify negative automatic thoughts and cognitive distortions, then work tochallenge and change these patterns. This approach is typically short-term and emphasizes practical homework assignments and skills development. CBT has strong research support for treating anxiety, depression, and many other conditions. Clinical psychologists often use CBT because ofits evidence-based effectiveness.

Psychodynamic Therapy has its roots inpsychoanalytic theory and emphasizes the role ofunconscious processes, early childhood experiences, and relationship patterns. Psychodynamic therapists explore how past experiences shape current behaviour and help clients gain insight into recurring patterns. This approach pays particular attention tothe therapeutic relationship itself, including transference (when clients project feelings onto the therapist) and countertransference (the therapists emotional reactions tothe client). Psychodynamic therapy is usually longer-term than CBT and is often used byclinical psychologists working with complex personality issues and trauma.

Existential-Humanistic Therapy emphasizes personal growth, self-actualization, and the clients inherent capacity for healing. This approach, which includes person-centered therapy and Gestalt therapy, focuses on the here-and-now experience, authenticity, and the therapeutic relationship. Humanistic therapists provide unconditional positive regard, empathy, and congruence, creating asafe space where clients can explore their feelings and develop self-awareness. Rather than directive techniques, this approach follows the clients lead and trusts their inner wisdom.

Each approach has its strengths, and many modern clinical psychologists and therapists integrate elements from different schools ofthought, practising what is called integrative or eclectic therapy. The choice ofapproach often depends on the clients needs, the assessment findings, and the nature oftheir difficulties.



Comprehension questions:

1. What is the main educational difference between psychologists and psychiatrists?

2. What makes clinical psychology different from other branches ofpsychology?

3. According tothe text, how does counselling differ from psychotherapy interms offocus and duration?

4. What is the difference between clinical psychology and counselling psychology?

5. Which professional can prescribe medication?Why?

6. What are the three main approaches topsychotherapy mentioned inthe text?

7. Which therapeutic approach focuses on thoughts, feelings, and behaviours?

8. What does transference mean inpsychodynamic therapy?

9. Which approach emphasizes personal growth and self-actualization??




VOCABULARY:

Professional Terminology and Collocations


A. Find words inthe text that match these definitions:

1. Based on scientific research and proven methods

(paragraph 2): _______

2. Awide range ofpsychological issues and conditions that clinical psychologists assess (paragraph 3): _______

3. Acomplete evaluation ofsomeones psychological condition (paragraph 4): _______

4. Tests that measure psychological variables like intelligence or personality (paragraph 4): _______

5. Concentrating on finding practical answers tocurrent problems (paragraph 7): _______

6. Mental processes that happen without our awareness (paragraph 11): _______

7. Inborn, natural, existing from birth (paragraph 12): _______

8. Being genuine and true tooneself (paragraph 12): _______



B. Complete the collocations from the text. More than one answer may be possible:

1. mental health _______

2. psychological _______

3. evidence-_______ methods

4. _______ plans

5. _______ strategies

6. therapeutic _______

7. clinical _______

8. automatic _______

9. personal _______

10. assessment _______



C. Word families

Complete the table:








Discussion questions:

1. Inyour country, which mental health professional do people usually consult first?

2. What is the role ofclinical psychologists inyour healthcare system?

3. Do you think the distinctions between these professions are clear inyour language?

4. Which therapeutic approach appeals toyou most?Why?

5. Should all clinical psychologists be trained inall three approaches, or specialize inone?

6. What are the advantages ofseeing aclinical psychologist vs. apsychiatrist?




GRAMMAR FOCUS:

Present Simple for definitions and descriptions / Comparative structures


A. Present Simple for Definitions and Professional Descriptions

We use Present Simple todefine concepts and describe what professionalsdo:



Form:

 Affirmative: Subject + verb (+ s/es for he/she/it)

 Negative: Subject + dont/doesnt + mainverb

 Questions: Do/Does + subject + main verb?

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Examples from Psychology:

 Psychology studies human behaviour and mental processes.

 Clinical psychologists assess and treat mental health disorders.

 Psychotherapists help clients manage emotional difficulties.

 Apsychiatrist prescribes medication for mental health conditions.

 Counselling focuses on specific life problems.

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Exercise 1: Complete the sentences

Use the correct form ofthe verb inbrackets:



1.Clinical psychologists _______ (assess) mental health conditions using psychometric tests.

2. Psychotherapy _______ (involve) regular communication between therapist and client.

3. Clinical psychologists _______ (not prescribe) medication.

4. _______ (do) clinical psychologists conduct research? Yes, many ofthem _______ (do).

5. Humanistic therapy _______ (emphasize) personal growth and self-actualization.

6. Acounselling psychologist _______ (focus) more on life transitions than severe pathology.



B. Comparative Structures

We use comparative structures toshow differences and similarities between concepts:

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Structures:

 as + adjective + as (equally)

 more/less + adjective +than

 adjective + -er +than



Examples from Psychology:

 Psychotherapy is more intensive than counselling.

 Clinical psychology is as important as psychiatry inmental healthcare.

 Psychoanalysis is less directive thanCBT.

 Clinical psychology training is longer than counselling psychology training.

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Exercise 2: Compare the professionals

Complete the sentences using comparative structures:

1. Apsychiatrists training is _______ (long) than aclinical psychologists.

2. Clinical psychologists typically work with _______ (severe) mental health problems than counselling psychologists.

3. Aclinical psychologists assessment is _______ (detailed) than acounsellors initial interview.

4. Counselling sessions are usually _______ (short) than psychotherapy sessions.

5. Clinical psychology is not _______ (medical) as psychiatry.

6. Psychotherapy can be _______ (effective) than medication for some conditions.

7. Clinical psychologists do _______ (much) research than general counsellors.

8. Assessment skills are _______ (important) inclinical psychology than insome other areas.



Exercise 3: Correct the mistakes

Find and correct the mistakes inthese sentences:

1. Aclinical psychologist are working with complex mental health conditions.

2. Psychiatrist training is more longer than counselling training.

3. Does psychiatrists prescribes medication?

4. Apsychotherapist dont just provide therapy; they also works with emotions.

5. Psychological assessment is as important than medication inclinical practice.

6. What acounselling psychologist do during afirst session?

7. Clinical psychologists works inhospitals, clinics, and private practice.

8. Is clinical psychology more scientific than counselling psychology?

9. Acounsellor are helping clients with mild tomoderate difficulties.

10. Psychiatrists is medical doctors who can prescribe medications.

11. Does apsychotherapist needs adoctoral degree?

12. Counselling psychologists provides talk therapy and dont diagnose conditions.




COMMUNICATION: Understanding Mental Health Professionals: An Interview with Dr. Sarah Mitchell


Participants: Rebecca Williams (Reporter, Mental Health Today Magazine) and Dr. Sarah Mitchell (Clinical Psychologist, Private Practice)

Reporter: Good morning, Dr. Mitchell. Thank you for agreeing totalk with us today. Our readers are often confused about the differences between mental health professionals. Can you help us understand who does what?

Dr. Mitchell: Ofcourse! Im happy toclarify. Its acommon confusion, and its actually quite important tounderstand the distinctions.

Reporter: Lets start with psychiatrists. How are they different from psychologists?

Dr. Mitchell: Well, the main difference is their training and what they can do. Psychiatrists are medical doctors. They go tomedical school and can prescribe medication. They focus mainly on the biological aspects ofmental health things like brain chemistry and medications that can help with conditions like depression or anxiety.

Reporter: Isee. And what about clinical psychologists? Thats your specialty, right?

Dr. Mitchell: Yes, exactly. Clinical psychologists have adoctoral degree inpsychology, not medicine. We cant prescribe medication, but were trained todiagnose mental health conditions and provide therapy. We also do psychological assessments and testing tounderstand whats going on with apersons mental health.

Reporter: So, you both diagnose, but only psychiatrists prescribe?

Dr. Mitchell: Correct. And Ishould mention counselling psychologists too. Theyre similar toclinical psychologists, but they typically work with less severe issues like relationship problems, stress management, or life transitions. They focus more on helping people with everyday challenges rather than serious mental disorders.

Reporter: Thats helpful. What about psychotherapists? Where do they fitin?

Dr. Mitchell: Psychotherapist is actually amore general term. It can include clinical psychologists, counseling psychologists, and other professionals who provide talk therapy. The key is that psychotherapists use various therapeutic approaches tohelp people change their thoughts, feelings, and behaviours.

Reporter: Speaking ofapproaches, can you briefly explain the main types ofpsychotherapy?

Dr. Mitchell: Sure! There are three major approaches we commonly use. The first is psychodynamic therapy, which comes from Freuds work. It focuses on unconscious thoughts and how our past, especially childhood, experiences affect us today. Its often long-term therapy.

Reporter: And the second approach?

Dr. Mitchell: Thats cognitive-behavioural therapy, or CBT. This is very popular today because its practical and usually shorter. CBT helps people identify negative thought patterns and change them. The idea is that if you change how you think, youll change how you feel and behave. It works really well for anxiety and depression.

Reporter: Ive heard alot about CBT, and whats the third approach?

Dr. Mitchell: The third is humanistic therapy, which includes person-centered therapy. This approach believes that everyone has the potential togrow and solve their own problems. The therapist creates asupportive, non-judgmental environment where clients can explore their feelings and find their own solutions. Carl Rogers developed this approach.

Reporter: So different approaches for different people?

Dr. Mitchell: Exactly. Some people benefit more from exploring their past, others need practical strategies they can use right away, and some just need asafe space tofigure things out themselves. Many therapists today actually combine approaches based on what each client needs.

Reporter: That makes sense. One last question if someone is struggling with mental health issues, how do they know which professional tosee?

Dr. Mitchell: Good question! If you think you might need medication, start with apsychiatrist. If you want therapy and psychological testing, aclinical psychologist is agood choice. For relationship issues or life stress, acounselling psychologist or counsellor works well. And remember, many people see both apsychiatrist for medication and apsychologist for psychotherapy.

Reporter: Dr. Mitchell, thank you so much for making this clearer for our readers.

Dr. Mitchell: My pleasure. The most important thing is that people get the help they need, no matter which professional they choose!

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TASK 1: True / False / Not Mentioned

Instructions: Read the statements below about the interview. Decide if each statementis:

 TRUE (T) the statement agrees with the information inthe interview

 FALSE (F) the statement contradicts the information inthe interview

 NOT MENTIONED (N/M) the information is not given inthe interview

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Statements:

1. Psychiatrists go tomedical school and can prescribe medication.

2. Clinical psychologists work only inhospitals.

3. CBT is the oldest approach topsychotherapy.

4. Counselling psychologists typically work with serious mental disorders.

5. Dr. Mitchell has adoctoral degree inpsychology.

6. Psychotherapist is another name for psychiatrist.

7. Clinical psychologists can do psychological assessments and testing.

8. Dr. Mitchell thinks medication is more effective than therapy.

9. Psychiatrists focus on the biological aspects ofmental health.

10. Psychodynamic therapy focuses on childhood experiences and unconscious thoughts.

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Task 2: Personal Response

Discuss: which professional would you prefer tosee and why? Which therapy approach sounds most interesting toyou?



Task 3: Creating aComparison Chart

Try tocreate avisual comparison chart ofthe four professionals (education, what they can do, typical clients/patients, work settings).




PROFESSIONAL PRACTICE:

Self-Introduction as aPsychology Professional


Sample Introductions

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Counselling Psychologist

Hello, my name is Sarah Mitchell, and Im acounselling psychologist. Iwork with individuals and couples who are experiencing difficulties intheir personal relationships or facing challenging life transitions. My approach focuses on helping clients develop coping strategies and build resilience. Ispecialize instress management and career counselling. Ive been practicing for eight years, and Icurrently work at acommunity mental health center. Ibelieve increating asupportive, non-judgmental environment where clients feel comfortable exploring their concerns.



Psychiatrist

Good morning. Im Dr. James Chen, apsychiatrist at St. Marys Hospital. Iassess, diagnose, and treat mental health conditions from amedical perspective. My work involves evaluating patients symptoms, prescribing medication when appropriate, and monitoring treatment progress. Ispecialize inmood disorders and anxiety-related conditions. Inaddition tomedication management, Icollaborate with psychologists and therapists toensure comprehensive care for my patients. Icompleted my medical degree and psychiatric residency at Johns Hopkins University.



Clinical Psychologist

Hi, Im Dr. Emma Rodriguez. Im aclinical psychologist specializing inassessment and treatment ofpsychological disorders. Iconduct psychological evaluations, administer diagnostic tests, and provide evidence-based therapy for individuals with various mental health conditions. My areas ofexpertise include depression, trauma, and personality disorders. Iuse cognitive-behavioural therapy and psychodynamic approaches inmy practice. Iwork both inprivate practice and as aconsultant at alocal psychiatric hospital.



Psychotherapist

Hello, Im Michael Thompson, alicensed psychotherapist. Iprovide talk therapy tohelp people understand their thoughts, feelings, and behaviours. Iwork with clients dealing with anxiety, relationship issues, and personal growth challenges. My therapeutic approach is integrative, drawing from humanistic and existential traditions. Ive been inpractice for twelve years and currently see clients inboth individual and group therapy settings. My goal is tohelp people gain insight and make meaningful changes intheir lives.

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Useful Phrases for Self-Presentation



Stating Your Name and Title

 My name is, and Ima

 Im Dr./Mr./Ms. , alicensed/qualified

 You can call me Iwork asa



Describing YourRole

 Ispecializein

 My main focusis

 Iwork with clients/patientswho

 My area ofexpertiseis

 Iprimarily deal with



Explaining Your Approach

 Iuse/practice

 My approach is basedon

 Icombine with

 Ibelievein

 My therapeutic styleis



Mentioning Your Experience

 Ive been practising for years

 Ihave years ofexperiencein

 Icompleted my trainingat

 Ipreviously worked at/as



Describing Your Work Setting

 Iwork at/in

 Im currently basedat

 Imaintain aprivate practicein

 Isee clients both inand



Highlighting Your Goals

 My goal is tohelp clients

 Iaim tosupport peoplein

 Ifocus on helping patients

 Iwork towards

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Practice Exercises

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Exercise 1: Complete Your Introduction

Fill inthe blanks with information about yourself tocreate your own professional introduction.

Hello, my name is __________, and Im a__________. Iwork with __________ who are experiencing __________. My approach focuses on __________. Ispecialize in__________. Ive been practising/studying for __________, and Icurrently work/study at __________. Ibelieve in__________.



Exercise 2: Match and Complete

Match the sentence starters with appropriate endings, then write three sentences about yourself.

Sentence starters:

 My main focusis

 Ive been practisingfor

 My therapeutic approach is basedon

 Iwork with clientswho

 My goal is tohelp

Possible endings:

 are struggling with anxiety and stress

 cognitive-behavioural principles

 supporting people through difficult transitions

 five years invarious clinical settings

 working with children and adolescents



Exercise 3: Build Your Introduction (Step-by-Step)

Write one sentence for each category tobuild your complete introduction:

1. Name and title: _________________________________

2. Who you work with: _________________________________

3. Your specialization: _________________________________

4. Your approach/methods: _________________________________

5. Your experience/education: _________________________________

6. Your workplace: _________________________________

7. Your professional philosophy: ______________________________

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Exercise 4: Listening and Note-Taking

Listen toyour partners introduction and complete the information:

 Name and title: _________________________________

 Specialization: _________________________________

 Type ofclients: _________________________________

 Approach/methods: _________________________________

 Experience: _________________________________

 Current workplace: _________________________________




Vocabulary and collocations for Unit1





psychology 

counselling 

psychotherapy 

psychiatry 

mental health  

clinical psychology  

clinical psychologist  

psychiatrist 

counselling psychologist -

psychotherapist 

emotional difficulties  

mental health problems   

mental health professionals   

evidence-based methods ,   

prescribe medication  

psychological interventions  /

mental health disorders   

psychological distress  

adjustment problems  

severe mental disorders   

psychological assessment  

assessment tools  

clinical interview  

behavioural observations  

psychometric tests  

comprehensive psychological evaluation   

mental health clinics   

rehabilitation centers  

private practice  

treatment plans  

assessment findings  

monitor client progress   

adjust treatment  

healthcare professionals  

clinical supervision  

personal development  

life transitions  

adjustment issues  

cope with 

relationship conflicts  

coping strategies  

solution-focused  

underlying emotional patterns   

psychological methods  

change behaviourehavior  

increase well-being  

overcome problems  

unconscious patterns  

biological treatments   

negative automatic thoughts   

cognitive distortions  

unconscious processes  

childhood experiences  

relationship patterns  

gain insight / 

therapeutic relationship  

transference 

countertransference 

personal growth 

self-actualization 

inherent capacity  

unconditional positive regard   

self-awareness 

authenticity 

psychopathology 

mental health condition   





UNIT 2.

FIRST CONTACT AND BUILDING RAPPORT





LEAD-IN:

First Impressions and Creating aSafe Space


Activity 1: First Impressions Matter

Think about your own experiences. Reflect individually for 2minutes, then share with apartner:

What makes you feel comfortable when meeting someone new inaprofessional setting?

Can you remember atime when someone made you feel welcome immediately? What did theydo?

What might make aperson feel nervous about meeting apsychologist for the first time?

How quickly do you form an impression ofanew person? Do first impressions change?



Activity 2: Creating aSafe Space

Work insmall groups. Look at these scenarios and discuss: Which therapist behaviours help build trust? Which might create barriers?

Scenario A: The therapist greets the client warmly, offers them achoice ofwhere tosit, and begins bysaying, Im glad youre here. Take your time tosettlein.

Scenario B: The therapist immediately starts asking detailed questions about the clients problems without any introduction.

Scenario C: The therapist explains what will happen intodays session and checks if the client has any questions before beginning.

Scenario D: The therapist talks extensively about their own qualifications and achievements.



Activity 3: Think-Pair-Share

Think (1minute): What questions might aclient have when they first meet apsychologist?

Pair (3minutes): Share your ideas with apartner and add toyour list.

Share (5minutes): Groups share with the class. Create amaster list on the board.



Key vocabulary for this unit:

Match the words with their definitions:

1. Rapport

2. Therapeutic alliance

3. Confidentiality

4. Boundaries

5. Informed consent

6. Safe space



a)The agreement toprotect private information shared intherapy

b) Professional limits that define the therapeutic relationship

c) Atrusting connection between therapist and client

d) Permission given byaclient after receiving full information about treatment

e) The collaborative relationship between therapist and client working toward goals

f) An environment where aclient feels comfortable expressing themselves




READING:

The First Meeting with aClient: Building Trust and Therapeutic Alliance


Pre-readingtask

Before you read, discuss with apartner:

1. What do you think happens inthe first therapy session?

2. What information should atherapist provide for anew client?

3. How might aclient feel during their first meeting with apsychologist?

4. What makes agood first impression inaprofessional helping relationship?

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The First Meeting with aClient: Building Trust and Therapeutic Alliance

The initial therapy session is unlike any other professional encounter. For the client, it often represents asignificant step one that may have taken weeks or months ofconsideration before they finally picked up the phone tomake an appointment. Many clients arrive feeling anxious, uncertain, or vulnerable. They may be wondering: Will this person understand me? Can they really help? What if Im judged? For the therapist, the first session is an opportunity tocreate afoundation oftrust and safety that will support all future therapeutic work.



Creating the Right Environment

The first impression begins before any words are spoken. Research shows that the therapeutic alliance the collaborative relationship between therapist and client is often established inthe first session and remains stable throughout treatment. This means that what happens inthe initial meeting matters tremendously.

When greeting anew client, warmth and professionalism are equally important. Atherapist typically welcomes the client inthe waiting area, makes eye contact, offers awarm greeting, and invites them tofollow tothe therapy room. Some therapists offer abrief tour, which helps the client orient themselves and reduces anxiety. Simple gestures like offering the client achoice ofwhere tosit can give them asense ofcontrol and comfort.

The therapy room itself should feel safe and private. Comfortable seating, appropriate lighting, and the absence ofdistractions all contribute tocreating what therapists call asafe space an environment where clients feel they can speak freely.



The Opening Conversation

Once seated, the therapist typically begins byacknowledging that first sessions can feel uncomfortable. Astatement like, Iknow it can feel strange talking tosomeone youve just met about personal matters. Thats completely normal, and well take things at your pace, can immediately reduce anxiety.

Before diving into the clients concerns, the therapist explains what will happen during this first session. This might sound something like: Today, we have about 50minutes together. Well spend some time going over important information about confidentiality and how therapy works, and then Id like tohear from you about what brings you here. Do you have any questions before we begin?



Informed Consent and Confidentiality

Acritical component ofthe first session is discussing informed consent. This isnt just alegal formality its an ethical cornerstone that empowers clients and establishes transparency. Informed consent means ensuring the client fully understands what theyre agreeing tobefore therapy begins.



The therapist explains several key elements:

The nature oftherapy: What therapy involves, the approaches the therapist uses, and what clients can generally expect from the process.

Confidentiality: Everything discussed intherapy remains private and confidential. This principle is essential because clients need totrust that their information is safe inorder tospeak openly. However, there are important limits toconfidentiality that must be clearly explained:

If the client is at risk ofharming themselves

If the client is at risk ofharming someoneelse

If there is suspected abuse or neglect ofachild, elderly person, or dependent adult

If records are subpoenaed byacourt

If the client provides written permission toshare information

Most therapists say something like: What we discuss here is confidential, which means Iwont share this information with anyone without your permission. However, there are afew exceptions where Im legally required tobreak confidentiality, particularly if theres arisk ofharm toyou or someone else. Does that make sense? Do you have any questions about confidentiality?



Risks and benefits: while therapy is generally beneficial, it can sometimes be uncomfortable as clients explore difficult emotions or memories. The therapist discusses both potential benefits and any risks.

Practical matters: this includes session frequency, length, fees, cancellation policies, and what todo incase ofemergency.

Client rights: clients have the right toask questions, refuse any intervention, seek asecond opinion, and end therapy at any time.

While many therapists provide written consent forms, the verbal discussion is equally important. The therapist should invite questions and check for understanding throughout this explanation.



Establishing Therapeutic Boundaries

Boundaries are the professional limits that define the therapeutic relationship. Clear boundaries create safety and help clients know what toexpect. Boundaries are established from the very first contact and are maintained throughout treatment.

Therapeutic boundaries include:

Session structure (length, frequency, location)

Contact between sessions (whether clients can call or email, and under what circumstances)

Social media policies (most therapists maintain strict boundaries around social media connections with clients)

Physical boundaries (professional, appropriate physical space)

Role clarity (the therapist is not afriend, but atrained professional providing treatment)

Boundaries are not meant tobe cold or distant. Rather, they create aconsistent, safe framework within which the therapeutic relationship can develop. Good boundaries actually build trust because clients learn that the therapist is reliable, consistent, and professionally committed totheir wellbeing.



Building Rapport

Once the administrative matters are addressed, the therapist invites the client toshare their story. This is typically done with an open-ended question such as, What brings you totherapy at this time? or Tell me abit about whats been going on for you.



Building rapport asense ofconnection and trust is the primary goal ofthe first session. The therapist does this through:

Active listening: giving full attention, avoiding interruptions, and showing through body language that theyre engaged

Empathy: trying tounderstand the clients experience from their perspective

Unconditional positive regard: accepting the client without judgment

Validation: acknowledging the clients feelings and experiences as real and understandable

Appropriate self-disclosure: occasionally sharing relevant professional experiences (but keeping the focus on the client)



Research consistently shows that the quality ofthe therapeutic relationship is one ofthe strongest predictors ofpositive therapy outcomes. Astrong therapeutic alliance means the therapist and client are working together collaboratively toward agreed-upon goals.



Collaborative Goal-Setting

Toward the end ofthe first session, the therapist and client begin discussing goals. What does the client hope toachieve through therapy? What would improvement look like for them? This collaborative goal-setting ensures that therapy is focused and meaningful.

The therapist might ask, If our work together is successful, what will be different inyour life? or What would you like tofocus on first?. These goals provide direction and help both therapist and client track progress over time.



Closing the First Session

As the session draws toaclose, the therapist typically summarizes what has been discussed. This might include acknowledging the main concerns the client has shared, highlighting any strengths noticed, and outlining the next steps.

The therapist provides encouragement, recognizing the courage it takes toseek help. They discuss the frequency offuture sessions and schedule the next appointment. Many therapists also check inabout how the client is feeling: How are you feeling about our meeting today? Do you have any questions or concerns?.

The goal is for the client toleave the first session feeling heard, hopeful, and clear about what toexpect moving forward. While one session cannot solve all problems, astrong first meeting creates the foundation for meaningful therapeutic work tocome.



Comprehension Questions

1. According tothe text, why do many clients feel anxious before their first therapy session?

2. Why is the first impression so important intherapy?

3. What is asafe space and why is it important?

4. What are the main elements that therapists explain during informed consent?

5. What are the limits toconfidentiality that therapists must explain?

6. How do therapeutic boundaries help clients?

7. What are the ways tohelp therapists build rapport with new clients?

8. What is the therapeutic alliance and when is it typically established?

9. Why is collaborative goal-setting important inthe first session?

10. What should happen at the end ofthe first session?




VOCABULARY:

Rapport, Boundaries, and Therapeutic Relationship Terms


A. Find words or phrases inthe text that match these definitions:

Easily hurt physically or emotionally (paragraph 1): _______

The person receiving therapy (used throughout): _______

Agreement and permission based on full information

(paragraph 5): _______

The quality ofbeing open and honest (paragraph 5): _______

Listening with full attention and engagement

(paragraph 11): _______

Understanding and sharing another persons feelings

(paragraph 11): _______

Acceptance without criticism (paragraph 11): _______

Working together toward acommon goal

(paragraph 13): _______

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B. Complete the collocations from the text:

1. therapeutic _______

2. _______ spaces

3. informed _______

4. _______ consent

5. build _______

6. establish _______

7. _______ listening

8. open-_______ question



9._______ regard

10. collaborative _______-setting



C. Word families

Complete the table:








D. Vocabulary incontext

Choose the correct word tocomplete each sentence:

1. The therapist showed great _______ (empathy / sympathy) bytruly understanding the clients perspective.

2. Clear _______ (borders / boundaries) help create asafe therapeutic environment.

3. The client felt _______ (vulnerable / week) sharing such personal information.

4. Therapists must _______ (establish / install) trust from the very first meeting.

5. The _______ (relationship / rapport) between therapist and client developed quickly.

6. _______ (Informed / Knowledgeable) consent ensures clients understand the therapy process.

7. The therapist practised _______ (active / busy) listening throughout the session.

8. Setting _______ (collaborative / collective) goals helps focus the therapy work.




GRAMMAR FOCUS:

Present Simple vs. Present Continuous / Question Formation


A. Present Simple vs. Present Continuous

We use different tenses todescribe different types ofactions intherapy:

Present Simple:

For regular routines, permanent situations, and general truths

For describing what professionals generallydo

Form:

Affirmative: Subject + verb (+ s/es for he/she/it)

Negative: Subject + dont/doesnt + mainverb

Questions: Do/Does + subject + main verb?

Examples from therapy practice:

Therapists explain confidentiality inthe first session.

Iwork with clients on Mondays and Wednesdays.

Clinical psychologists dont prescribe medication.

Do you feel comfortable discussing this topic?



Present Continuous:

For actions happening now, at this moment

For temporary situations

For describing what is currently happening inasession

Form:

Affirmative: Subject + am/is/are + main verb-ing

Negative: Subject + am/is/are + not + main verb-ing

Questions: Am/Is/Are + subject + main verb-ing?

Examples from therapy practice:

Iam listening carefully towhat youre saying rightnow.

The client is describing their recent experiences.

We are working together toidentify your goals today.

Are you feeling anxious at this moment?



Key differences intherapeutic context:








Exercise 1: Choose the correct tense

Complete the sentences with the correct form ofthe verb inbrackets:

1. Inour first session, we typically _______ (discuss) what brings you totherapy.

2. Right now, I_______ (explain) how confidentiality works.

3. Most therapy sessions _______ (last) between 45 and 60 minutes.

4. At this moment, the client _______ (share) very personal information.

5. Clinical psychologists _______ (assess) clients using various methods.

6. I_______ (listen) carefully towhat you _______ (say).

7. We _______ (not make) major decisions inthe first session.

8. _______ you _______ (feel) comfortable talking about thisnow?

9. Therapists _______ (build) rapport from the very first meeting.

10. I_______ (think) about what goals we should focuson.



Exercise 2: Correct the mistakes

Find and correct the mistakes inthese sentences:

1. Im usually working with adolescents and young adults.

2. Right now, Iexplain the limits ofconfidentiality tomy client.

3. Are you understanding what Im saying about boundaries?

4. The therapeutic relationship is building over time.

5. What do you feeling about starting therapy?

6. Im believing that the first session is very important.

7. We are typically discussing informed consent at the beginning.

8. The client is seeming nervous inevery first session.

9. Do you currently experiencing any major stressors?

10. Iwork on establishing rapport with you at this moment.

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B. Question Formation inTherapy

Asking the right questions is essential for building rapport and gathering information. Intherapy, we use both closed questions (yes/no answers) and open-ended questions.

Closed Questions (Yes/No):

Present Simple: Do/Does + subject + main verb?

Present Continuous: Am/Is/Are + subject + verb-ing?

Present Perfect: Have/Has + subject + past participle?

Examples:

 Do you feel ready tostart therapy?

 Are you experiencing anxiety rightnow?

 Have you been intherapy before?

Open-ended Questions (encourage detailed responses):

Use question words: What, Where, When, Why, How,Who

Examples:

 What brings you totherapy today?

 How are you feeling about being here?

 What would you like toachieve through therapy?

 How do you usually cope when things are difficult?

 What made you decide toseek help at this time?



Exercise 3: Form questions

Create appropriate questions for afirst therapy session using the prompts:

1. (you / ever / see / therapist before)

_______________________________?

2. (what / bring / you / here today)

_______________________________?

3. (how / you / feel / rightnow)

_______________________________?

4. (you / have / any questions / about confidentiality)

_______________________________?

5. (what / you / hope / achieve / through therapy)

_______________________________?

6. (how long / you / experience / these difficulties)

_______________________________?

7. (you / feel / comfortable / talking about this)

_______________________________?

8. (who / know / that you / come / therapy)

_______________________________?



Exercise 4: Open or Closed?

Identify whether these questions are open or closed. Then, rewrite the closed questions as open questions:

1. Do you have asupport system? __________

2. What does your support system look like? __________

3. Are you sleeping well? __________

4. Have you thought about your goals for therapy? __________

5. What brings you here today? __________

6. How are you managing stress? __________

7. Is this situation affecting your relationships? __________

8. Do you want totell me more about that? __________




COMMUNICATION:

Intake session


Setting: Dr. Maria Santos, aclinical psychologist, is meeting her new client, Robert, for the first time. Robert is a28-year-old man who has been experiencing anxiety.



Part 1: The Greeting and Opening

Dr. Santos: Hello, Robert? Im Dr. Santos. Its nice tomeetyou.

Robert: Hi. Nice tomeet youtoo.

Dr. Santos: Please, follow me. My office is just down this hallway. (They walk tothe office) Have aseat wherever youre most comfortable.

Robert: Thank you. (Sits down, looks abit nervous)

Dr. Santos: So, Iknow first sessions can feel abit awkward or strange youre talking tosomeone youve just met about personal things. Thats completely normal. Well take things at your pace today.

Robert: Okay, thats good tohear. Iam feeling abit nervous, actually.

Dr. Santos: Thats very understandable. Before we get into what brings you here today, Ineed togo over some important information about how therapy works and confidentiality. It might feel abit formal at first, but its important that you know what toexpect. Does that sound okay?

Robert: Yes, sure.



Part 2: Explaining Confidentiality

Dr. Santos: Great. So, first ofall, everything we discuss inour sessions together is confidential. That means Idont share what you tell me with anyone else without your written permission. This confidentiality is really important because Iwant you tofeel safe talking openly about whatever is on your mind.

Robert: Okay, thats clear tome.

Dr. Santos: However, there are afew limits toconfidentiality that Im legally required totell you about. If Ibelieve youre at risk ofharming yourself or someone else, or if theres suspected abuse ofachild or vulnerable adult, then Iwould need totake action toensure safety. Also, if acourt orders me torelease records, Iwill have tocomply. But inall ofthese situations, Iwould discuss it with you first whenever possible. Do you have any questions about confidentiality?

Robert: No, Ithink Iunderstand. Those exceptions make sense.

Dr. Santos: Good. And just so you know, you can ask questions at any time either today or infuture sessions. This is your time, and Iwant you tofeel comfortable.



Part 3: Discussing the Therapy Process

Dr. Santos: So, let me tell you abit about how we typically work. Sessions last 50minutes, and most people find that meeting weekly works well, at least initially. Well work together toidentify your goals and figure out the best approach tohelp you. My style is collaborative that means were working as ateam. Youre the expert on your own life, and Im here toprovide support, tools, and adifferent perspective.

Robert: That sounds good. Iwas worried you might just tell me what todo.

Dr. Santos:(Smiles) No, therapy is really acollaborative process. Ill offer suggestions and well explore different strategies, but ultimately, youre making the decisions about your life. My role is tosupport you, ask questions that might help you see things differently, and provide evidence-based techniques that might be helpful.

Robert: Okay, Ilike that approach.

Dr. Santos: Im glad. Now, Ido want tomention that therapy can sometimes be uncomfortable. When we talk about difficult experiences or emotions, it can bring up challenging feelings. Thats actually anormal part ofthe process, and it often means were working on something important. But Ill always check inwith you about how youre doing, and we can adjust our pace as needed.



Part 4: Exploring the Clients Concerns

Dr. Santos: So, Robert, tell me what brings you totherapy?

Robert: Well, Ive been struggling with anxiety for awhile now, maybe about six months. Its been getting worse recently, and its starting toaffect my work.

Dr. Santos: Iappreciate you sharing that. When you say anxiety, what does that look like for you? What are you experiencing?

Robert: Its mostly worry. Iworry about everything work performance, what people think ofme, whether Im making mistakes. And physically, Ifeel tense alot. My heart races sometimes, especially at meetings.

Dr. Santos: That sounds really challenging. It takes alot ofenergy tocarry that constant worry around. You mentioned its affecting your work. Can you tell me more about that?

Robert: Yeah, Im having trouble concentrating. Ikeep second-guessing my decisions. Ieven avoided apresentation last week because Iwas so anxious aboutit.

Dr. Santos: Ihear you. It sounds like the anxiety is limiting what you feel able todo. That must be frustrating.

Robert: It really is. Iused tobe more confident.



Part 5: Beginning Goal-Setting

Dr. Santos: Robert, if our work together is successful, what would be different for you? What change would you like tosee?

Robert: Id like tofeel calmer, more incontrol. And Iwant tobe able todo my job without this constant worry hanging overme.

Dr. Santos: Those are great goals. Feeling calmer, having more control, and being able toengage fully with your work. We can definitely work on those things together. Inour future sessions, well explore where this anxiety comes from and develop practical strategies tohelp you manageit.

Robert: That would be really helpful.

Dr. Santos:(Glancing at clock) Were coming toward the end ofour time today. Before we finish, Iwant tocheck in how are you feeling about our conversation today?

Robert: Ifeel good, actually. Iwas nervous coming in, but Ifeel like you understand what Im going through.

Dr. Santos: Im so glad tohear that. It takes courage totake this step and come totherapy, and Iwant you toknow that Im committed tosupporting you through this process. Lets schedule our next session for the same time next week. Does that work foryou?

Robert: Yes, that works.

Dr. Santos: Perfect. And Robert, if anything urgent comes up between now and then, you can call the office. But otherwise, Ill see you next week. Take care.

Robert: Thank you, Dr. Santos. See you next week.



TASK 1: Comprehension and Analysis

Answer these questions about the dialogue:

1. How does Dr. Santos make Robert feel comfortable at the beginning?

2. What does Dr. Santos explain about confidentiality?

3. What are the limits toconfidentiality that she mentions?

4. How does Dr. Santos describe the therapy process?

5. What type ofquestions does Dr. Santos use toexplore Roberts concerns?

6. What are Roberts main goals for therapy?

7. How does Dr. Santos show empathy during the conversation?

8. What does Dr. Santos do at the end ofthe session?



TASK 2: Identifying Communication Techniques

Find examples inthe dialogue where Dr. Santos uses these rapport-building techniques:

1. Normalizing the clients experience: _______

2. Asking open-ended questions: _______

3. Reflecting/validating feelings: _______

4. Explaining the collaborative nature oftherapy: _______

5. Checking inon the clients comfort: _______

6. Summarizing what the client said: _______

7. Acknowledging the clients courage: _______



TASK 3: Role Play Practice

Work inpairs. Student Ais the therapist, Student B is the client.



Scenario 1: Anew clients first session. The client is feeling depressed and withdrawn. Practice:

Greeting and creating comfort

Explaining confidentiality

Using open-ended questions

Building rapport



Scenario 2: Aclient who is anxious about confidentiality. Practice:

Addressing their concerns

Explaining limits clearly

Checking for understanding



Scenario 3: Afirst session with aclient who has been intherapy before (but with adifferent therapist). Practice:

Asking about previous experience

Discussing expectations

Collaborative goal-setting

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TASK 4: Discussion Questions

Discuss with apartner or insmall groups:

1. Why do you think the therapeutic alliance is so important?

2. What might happen if atherapist doesnt explain confidentiality clearly?

3. How can atherapist balance being warm and friendly while maintaining professional boundaries?

4. What cultural differences might affect how rapport is built inthe first session?

5. Why is it important togive clients choice and control from the first meeting?

6. How would you feel as aclient inyour first therapy session?




PROFESSIONAL PRACTICE:

Introducing the Therapeutic Framework and Informed Consent


Understanding how toexplain the therapeutic framework and obtain informed consent is acritical professional skill for all mental health practitioners.



Key Components toCover inaFirst Session

1. Welcome and Orientation

Create awarm, welcoming environment from the moment offirst contact. Your goal is tohelp the client feel safe and comfortable enough toshare personal information.

Sample language:

Welcome. Im glad youre here. Please, have aseat wherever you feel comfortable.

Iknow it can feel abit uncomfortable talking tosomeone new about personal matters. Thats completely normal, and well take things at your pace.

Before we begin, do you have any immediate questions or concerns?



2. Explaining Confidentiality

Sample language:

Everything we discuss inour sessions is confidential. This means Idont share what you tell me with anyone without your written permission.

Confidentiality is essential because Iwant you tofeel safe talking openly about whatever is on your mind.

However, there are some important limits Ineed totell you about

Explaining the limits:

If Ibelieve you are at serious risk ofharming yourself, Iwill need totake steps toensure your safety.

If Ibelieve you are at risk ofharming someone else, Ihave aduty towarn.

If Isuspect abuse or neglect ofachild, elderly person, or dependent adult, Im legally required toreportit.

If acourt orders me torelease records through asubpoena, Iwill have tocomply.

Inall ofthese situations, Iwould discuss it with you whenever possible.

Always ask: Do you have any questions about confidentiality?



3. Explaining the Therapy Process

Sample language:

Our sessions will last 50minutes, and most people find weekly sessions work well at first.

Therapy is acollaborative process. Well work together toidentify your goals and figure out the best approach.

My role is tolisten, ask questions, offer different perspectives, and teach you tools and strategies that might help.

Your role is tobe as open and honest as you feel comfortable being, and tolet me know if something isnt working for you.

Ishould mention that therapy can sometimes be uncomfortable. When we discuss difficult experiences or emotions, it can bring up challenging feelings. This is often anormal part ofthe process.



4. Discussing Boundaries

Sample language:

Our sessions will take place here at this office, at the same time each week if that works for you.

If you need tocontact me between sessions, you can call the office and leave amessage. Itypically return calls within 24hours.

For emergencies, Ill give you information about who tocontact.

Our relationship is aprofessional one, which means we wont have contact outside ofthese sessions beyond whats necessary for your treatment.



5. Collaborative Goal-Setting

Sample language:

What would you like toachieve through our work together?

If therapy is successful, what will be different inyour life?

What would you like tofocus on first?

These goals will help guide our work and help us track your progress.



6. Checking for Understanding and Comfort

Throughout the session:

Does that make sense?

Do you have any questions about what Ive explained?

How are you feeling about what weve discussed so far?

Is there anything youd like me toclarify?



7. Closing the Session

Sample language:

Were coming tothe end ofour time today. Let me summarize what weve discussed

Iwant toacknowledge that it takes courage tocome totherapy, and Iappreciate you sharing with me today.

How are you feeling about our conversation today?

Lets schedule our next session. Does the same time next week work for you?

If anything urgent comes up before then, please call the office.



Practice Exercises

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Exercise 1: Explaining Confidentiality

Write ashort explanation ofconfidentiality and its limits that you would give toanew client. Include:

The general principle ofconfidentiality

Why its important

The specific limits

An invitation for questions



Exercise 2: Responding toClient Questions

How would you respond tothese client questions?

1. Will you tell my family what we talk about?

2. What happens if Itell you Im thinking about hurting myself?

3. Can we be friends on social media?

4. Can Itext you between sessions?

5. How long will Ineed tobe intherapy?

6. What if therapy doesnt help?

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Exercise 3: Building Your Own Script

Create your own introduction for the first session. Include:

Greeting and creating comfort

Brief overview ofwhat will happen inthe session

Explanation ofconfidentiality

Description ofthe therapy process

Invitation toshare what brings them totherapy

Practice your script with apartner, then get feedback.



Exercise 4: RolePlay

Inpairs, practice afirst session. One person is the therapist, one is the client.



Therapist tasks:

Create awelcoming environment

Explain informed consent and confidentiality

Use open-ended questions

Practise active listening

Build rapport

Collaboratively set initial goals

Close the session appropriately



Client tasks:

Be yourself, or role-play aspecific scenario

Ask questions about confidentiality or the process

Share aconcern (real or imagined)

Give feedback tothe therapist afterward

After 1520minutes, switch roles.




Vocabulary and Collocations for Unit2





rapport , 

therapeutic alliance  

confidentiality 

boundaries 

informed consent  

safe space  

initial therapy session   

professional encounter  

make an appointment  

feeling anxious  /  

uncertain 

vulnerable 

foundation oftrust  

collaborative relationship  

first impression  

make eye contact   

warm greeting  

speak freely  

opening conversation  

at your pace  

legal formality  

ethical cornerstone   

empower clients   

establish transparency  

private information  

risk ofharming   

suspected abuse  

therapeutic boundaries  

professional limits  

session structure  

contact between sessions   

social media policies /  

physical boundaries  

role clarity  

build trust  

build rapport  

open-ended question  

active listening  

empathy 

unconditional positive regard   

validation 

appropriate self-disclosure  

therapeutic relationship  

positive therapy outcomes   

collaborative goal-setting   

track progress  

client 

collaborative 

establish boundaries  

verbal consent  

confide 

confidential 

comfortable , 

collaborate 

collaboration 

empower  

empowerment  

empowered  

sympathy 

borders  ()

knowledgeable 

collective goals //





UNIT 3.

INITIAL ASSESSMENT





LEAD-IN:

Information Gathering and Sensitive Questioning Skills


Activity 1: Role-play everyday information gathering

Work inpairs. Take turns asking personal questions inthese everyday situations:

Meeting anew neighbour who has just movedin

Interviewing someone for ashared apartment

Getting toknow acolleague at anewjob

Discuss: What questions did you ask? Which questions felt comfortable? Which felt too personal?



Activity 2: What information matters?

Look at the list below. When meeting aclient for the first time, which information is most important togather? Rank these from 1(most important) to10(least important):

Current problem/reason for seekinghelp

Family background

Medical history

Work/education history

Past mental health treatment

Current medications

Social support system

Childhood experiences

Current living situation

Hobbies and interests

Compare your rankings with apartner. Explain your choices.



Activity 3: Sensitive vs. direct questioningquiz

Which question is more appropriate for an initial assessment? Discusswhy:

1. a) Have you ever tried tokill yourself?

b) Have you ever had thoughts ofharming yourself or ending your life?

2. a) Tell me about your drinking habits.

b) Do you drink alcohol?

3. a) Why did you come here today?

b) What brings you here today?

4. a) Are you depressed?

b) How would you describe your mood lately?

5. a) Do you have problems with your family?

b) Tell me about your relationships with family members.

Note: Most questions require question marks. But inclinical practice open-ended alternatives using imperatives like Tell me about or Describe are also acceptable as questions, though they are technically requests rather than questions.



Key vocabulary for this unit:

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Match the words with their definitions:

1. Presenting problem

2. Intake interview

3. Chief complaint

4. Psychosocial history

5. Risk assessment

6. Mental status examination

7. Rapport

8. Confidentiality

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a) The main issue that brings aclient toseekhelp

b) First session designed togather comprehensive background information

c) Evaluation ofpotential danger toself or others

d) Systematic observation ofaclients psychological functioning

e) Information about personal, family, social, and cultural background

f) Atrusting, comfortable connection between therapist and client

g) The primary symptom or concern inthe clients own words

h) The principle that client information remains private




READING:

Understanding the Presenting Problem: Initial Assessment


Pre-readingtask

Before you read, discuss:

1. What do you think happens inthe first session with aclient?

2. What information should apsychologist gather during an intake interview?

3. Why is it important tounderstand the presenting problem?

4. What is amental status examination?

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Understanding the Presenting Problem: Initial Assessment

When aclient first contacts apsychologist, one ofthe most important tasks is conducting acomprehensive initial assessment or intake interview. This first session sets the foundation for the entire therapeutic relationship and treatment process. The psychologist gathers essential information, establishes rapport, and begins tounderstand the clients difficulties within the context oftheir life.



The Purpose ofInitial Assessment

The initial assessment serves multiple purposes. First, it allows the psychologist tounderstand why the client is seeking help what professionals call the presenting problem or chief complaint. This is the primary issue or concern that brings the client totherapy, described inthe clients own words. Second, the assessment provides comprehensive background information about the clients personal history, current life situation, and past experiences with mental health issues. Third, it helps the psychologist determine whether they can help the client or whether areferral toanother professional would be more appropriate.

The initial assessment is also the beginning ofthe therapeutic relationship. During this first session, the psychologist works toestablish rapport atrusting, comfortable connection with the client. Without rapport, clients may not feel safe enough toshare sensitive information or engage fully inthe therapeutic process. The psychologist demonstrates empathy, active listening, and respect while maintaining professional boundaries and explaining important concepts like confidentiality.



Gathering the Presenting Problem

The assessment typically begins with an open-ended question designed tolet the client tell their story intheir own way. Common opening questions include: What brings you here today? or Whats been happening that led you toseek help now? These questions invite narrative responses rather than simple yes/no answers.

As the client describes their presenting problem, the psychologist listens carefully and asks follow-up questions toclarify the nature ofthe difficulty. Important aspects toexplore include:

Onset: When did the problem begin? Was there aspecific event or trigger?

Duration: How long has the problem been present?

Frequency: How often does the problem occur?

Severity: How much does the problem interfere with daily functioning?

Previous attempts: What has the client tried toaddress the problem? What worked or didnt work?

Clients understanding: What does the client think is causing the problem? What are their expectations for treatment?

For example, aclient might say: Ive been feeling really anxious lately. The psychologist would then explore: When did the anxiety start? What situations trigger it? How does it affect your daily life? What have you tried tomanage it? This detailed exploration helps the psychologist understand not just the symptom, but the context surroundingit.



Taking the Psychosocial History

After exploring the presenting problem, the psychologist gathers information about the clients psychosocial history their personal, family, social, educational, occupational, and medical background. This comprehensive history helps the psychologist understand the client as awhole person and identify factors that may contribute tocurrent difficulties.



Key areas ofpsychosocial history include:

Developmental and family history: information about childhood, family structure, relationships with parents and siblings, significant early experiences, and any history ofabuse or trauma.

Educational and occupational history: school performance, level ofeducation, current employment status, job satisfaction, and any work-related stress.

Relationship and social history: current and past romantic relationships, friendships, social support network, and quality ofinterpersonal relationships.

Medical history: physical health conditions, current medications, past surgeries or hospitalizations, and any chronic illnesses.

Past psychiatric history: previous mental health diagnoses, past therapy or counselling experiences, psychiatric hospitalizations, and any history ofpsychotropic medicationuse.

Substance use: current and past use ofalcohol, tobacco, and other substances.

The psychologist uses acombination ofopen-ended and closed-ended questions togather this information efficiently while still allowing the client toshare their story. For example, aclosed-ended question like Are you currently employed? establishes afact, while an open-ended follow-up like Tell me about your work situation invites the client toprovide context and detail.



Conducting aMental Status Examination

An essential component ofthe initial assessment is the mental status examination (MSE) asystematic observation and description ofthe clients current psychological functioning. While some aspects ofthe MSE are observed naturally during the interview, psychologists may also ask specific questions toassess certain domains.

The MSE typically evaluates the following areas:

Appearance and behaviour: the psychologist observes how the client looks (grooming, clothing, hygiene) and behaves (eye contact, posture, motor activity, unusual movements).

Speech: rate, volume, tone, and any abnormalities inspeech patterns.

Mood and affect: mood is the clients subjective emotional state (how they say they feel), while affect is the observable emotional expression. Psychologists assess whether affect is appropriate tothe content being discussed, its range (restricted, normal, or labile), and its intensity.

Thought process: how the client thinks whether their thoughts are logical, organized, and goal-directed, or whether there are signs ofdisorganization, tangentiality, or circumstantiality.

Thought content: what the client thinks about including any delusions, obsessions, preoccupations, or suicidal/homicidal ideation.

Perception: whether the client experiences hallucinations (seeing or hearing things that arent there) or other perceptual disturbances.

Cognition: assessment oforientation (awareness oftime, place, and person), attention, concentration, memory, and general intellectual functioning.

Insight and judgment: the clients awareness oftheir condition and their ability tomake sound decisions.

The MSE provides asnapshot ofthe clients mental state at the time ofthe assessment and helps identify symptoms that may indicate specific mental health conditions.



Risk Assessment

Acritical component ofany initial assessment is evaluating risk particularly the risk ofself-harm, suicide, or harm toothers. Psychologists must directly but sensitively ask about these concerns. Contrary tocommon fears, asking about suicidal thoughts does not increase the risk; instead, it demonstrates care and creates an opportunity for the client todiscuss difficult feelings.

Risk assessment questions might include: Have you had any thoughts ofharming yourself? Have you had thoughts ofending your life? Do you have aspecific plan? If aclient endorses suicidal thoughts, the psychologist assesses the frequency, intensity, duration, and whether the person has means and intent tocarry out aplan. Protective factors, such as reasons for living, social support, and future orientation, are also explored.



Formulating and Planning

At the conclusion ofthe initial assessment, the psychologist integrates all the information gathered todevelop apreliminary understanding ofthe clients difficulties. Many psychologists use aformulation framework called the FourPs:

Predisposing factors: background factors that make the person vulnerable (e.g., family history ofmental illness, early trauma)

Precipitating factors: recent events or stressors that triggered the current problem (e.g., job loss, relationship breakup)

Perpetuating factors: factors that maintain or worsen the problem (e.g., poor coping strategies, lack ofsocial support, avoidance behaviours)

Protective factors: strengths and resources that can aid recovery (e.g., supportive relationships, resilience, motivation for change)

This formulation guides treatment planning and helps the psychologist and client work collaboratively toward meaningful goals.



Comprehension Questions

1. What is the purpose ofthe initial assessment?

2. What is the difference between presenting problem and chief complaint?

3. Why is rapport important inthe first session?

4. What are the five key aspects toexplore when gathering information about the presenting problem?

5. What types ofinformation are included inapsychosocial history?

6. What is the difference between mood and affect intheMSE?

7. Why do psychologists ask about suicidal thoughts during initial assessment?

8. What are the Four Ps informulation?

9. According tothe text, what is the difference between open-ended and closed-ended questions?

10. What areas does amental status examination cover?




VOCABULARY:

Assessment Terminology and Mental Status Examination


A. Find words inthe text that match these definitions:

1. The main problem that brings aclient totherapy (paragraph 2): _______

2. Arelationship based on empathy and respect between therapist and client (paragraph 3): _______

3. The beginning or start ofaproblem (paragraph 4): _______

4. How often something happens (paragraph 4): _______

5. Information about personal, family, and social background (paragraph 5): _______

6. Aclients subjective description oftheir emotional state (paragraph 8): _______

7. The observable emotional expression (paragraph 8): _______

8. Awareness ofones condition (paragraph 8): _______

9. False beliefs not based on reality (paragraph 8): _______

10. Factors that maintain or worsen aproblem (paragraph 10): _______



B. Complete the collocations from the text:

1. initial _______

2. intake _______

3. presenting _______

4. mental _______ examination

5. psychosocial _______

6. risk _______

7. _______ rapport

8. _______ confidentiality

9. treatment _______

10. protective _______

11. coping _______

12. therapeutic _______

13. follow-up _______

14. open-ended _______

15. suicidal _______

?

C. Word families

Complete the table:








D. Match the MSE terms with descriptions:

1. Affect

2. Thought process

3. Orientation



4.Delusion

5. Hallucination

6. Insight

7. Labile affect

8. Tangentiality

?

a) Observable emotional expression

b) False belief firmly held despite evidence

c) Awareness ofones condition

d) Rapidly changing emotions

e) Awareness oftime, place, and person

f) Perceiving something that isnt there

g) How thoughts are organized and connected

h) Going off-topic when speaking

?

Discussion Questions

1. Inyour country, how is the first psychology session typically structured?

2. What cultural factors might influence how clients describe their presenting problems?

3. How can psychologists establish rapport with clients who are reluctant toshare personal information?

4. Do you think its appropriate toask about suicidal thoughts inevery initial assessment? Why or whynot?

5. What challenges might arise when gathering psychosocial history from clients ofdifferent cultural backgrounds?

6. How would you feel about asking personal questions during an intake interview?

7. Which area ofthe mental status examination do you think is most important?Why?

8. How might the Four Ps formulation help inunderstanding aclients difficulties?




GRAMMAR FOCUS:

Past Simple and Past Continuous for Client History / Question Forms


A. Past Simple for Completed Events inClients History

We use Past Simple toask about and describe completed events, experiences, and situations inaclients past:



Form:

Affirmative: Subject + verb + -ed (regular) / irregularform

Negative: Subject + didnt + mainverb

Questions: Did + subject + main verb?

Wh-questions: When/Where/Why + did + subject + main verb?



Examples from Assessment:

? When did your symptoms first start?

? The client experienced anxiety attacks for the first time in2020.

? She didnt seek help until last month.

? Did you have any support during that time?

? How did you cope with the loss?

? He received therapy three yearsago.



Time expressions with Past Simple:

yesterday, last week/month/year, ago, in2020, when Iwas, at thattime



Exercise 1: Complete the intake questions

Use the correct form ofthe verb inbrackets:

1. When _______ (do) you first notice these symptoms?

2. How long _______ (do) the symptoms last?

3. _______ (you/try) any strategies tomanage the problem?

4. What _______ (happen) after you lost yourjob?

5. How _______ (you/feel) when that happened?

6. The client _______ (not/experience) depression until recently.

7. He _______ (have) several panic attacks last month.

B. Past Continuous for Background and Context

We use Past Continuous todescribe ongoing situations or actions inthe past that provide context for events:



Form:

Affirmative: Subject + was/were + main verb +-ing

Negative: Subject + wasnt/werent + main verb +-ing

Questions: Was/Were + subject + main verb + -ing?



Examples from Assessment:

? What were you doing when the panic attack started?

? She wasnt sleeping well during that period.

? Were you experiencing any stress at work?

? He was going through adifficult divorce when the symptoms began.



Using Past Simple and Past Continuous together:

We often use both tenses toshow how events relate toeach other:

? Iwas driving towork when Ihad my first panic attack. (Past Continuous for background + Past Simple for main event)

? While she was dealing with her mothers illness, she started having sleep problems. (Past Continuous for context + Past Simple for specific problem)



Exercise 2: Past Simple or Past Continuous?

Choose the correct form:

1. When (did the symptoms start / were the symptoms starting)?

2. What (did you do / were you doing) when you felt the anxiety?

3. She (didnt cope / wasnt coping) well with the stress at that time.

4. While he (studied / was studying) for exams, he (developed / was developing) insomnia.

5. (Did you experience / Were you experiencing) any major life changes before this?

6. The problems (began / were beginning) when I(worked / was working) at my previousjob.

7. (Did she take / Was she taking) medication when she (came / was coming) toseeyou?

8. They (had / were having) financial difficulties when their relationship (broke down / was breaking down).

C. Question Forms: Open-ended vs. Closed-ended

Closed-ended questions require yes/no or brief factual answers:

? Do you have any children?

? Are you currently employed?

? Have you been hospitalized before?

? Did you finish high school?



Open-ended questions encourage detailed, narrative responses:

? What brings you here today?

? How would you describe your relationship with your family?

? What happened when you lost yourjob?

? How have you been coping with these feelings?



Wh-questions for assessment:

What = specific information about problems, situations, thoughts

When = timeline, onset, duration

Where = location, context, settings

Who = people involved, support system

How = manner, coping strategies, severity

Why = reasons, motivation (use carefully can sound judgmental)



Exercise 3: Rewrite as open-ended questions

1. Are you stressed at work? ?_______

2. Do you have agood relationship with your parents? ?_______

3. Did something bad happen inyour childhood? ?_______

4. Are you sleeping well? ?_______

5. Do you drink alcohol? ?_______

6. Are you worried about anything? ?_______



Exercise 4: Correct the mistakes

Find and correct the mistakes inthese assessment questions:

1. When was happening the problem?

2. What you were doing when you felt anxious?

3. Did you was experiencing stress at that time?

4. She wasnt cope well with the situation.

5. Were you felt depressed last year?

6. What did happened after you lose yourjob?

7. He didnt was sleeping well during that period.

8. While Iworking, Ihad apanic attack.




COMMUNICATION:

Conducting an Initial Assessment: Sample Interview Excerpts


Excerpt 1: Opening and Presenting Problem

Psychologist: Good morning, Maria. Thank you for coming intoday. Before we begin, Id like toexplain that everything we discuss is confidential unless theres arisk ofharm toyourself or others. Do you have any questions about that?

Maria: No, thats clear. Thankyou.

Psychologist: Great. So, what brings you here today?

Maria: Well, Ive been feeling really anxious for the past few months. Its getting worse, and Im having trouble concentrating at work.

Psychologist: Isee. When did you first notice these anxiety symptoms?

Maria: It started around March, Ithink. Iwas working on abig project at work, and Ibegan having trouble sleeping.



Psychologist: And you mentioned its been getting worse. Whats been happening recently?

Maria: Last week Ihad what Ithink was apanic attack. My heart was racing, Icouldnt breathe properly, and Ithought Iwas having aheart attack. It was terrifying.

Psychologist: That sounds very frightening. Where were you when this happened?

Maria: Iwas at work, inthe middle ofameeting. Ihad toleave the room.

Psychologist: What did you do after you left the meeting?

Maria: Iwent tothe bathroom and tried tocalm down. Acolleague found me and sat with me until Ifelt better. Thats actually when she suggested Ishould talk tosomeone.

Psychologist: Its good that you had support. Before this panic attack, had you experienced anything like that before?

Maria: Not tothat extent, no. But Ive been feeling on edge for monthsnow.



Excerpt 2: Psychosocial History

Psychologist: Maria, Id like tounderstand more about your background. Tell me about your family.

Maria: Well, Im 32years old. Ilive alone, but my parents and younger brother live inthe same city. Were quite close.

Psychologist: How would you describe your relationship with your family?

Maria: Its good, mostly. My parents are supportive, but they can be rather demanding. They have high expectations, especially about my career.

Psychologist: And you mentioned you have ayounger brother. How is your relationship withhim?

Maria: We get along well. Hes five years younger than me, so we werent that close growing up, but now we talk regularly.

Psychologist: What about your social life outside offamily? Tell me about your friendships.

Maria: Ihave afew close friends from university. We try tomeet up regularly, but with work being so busy, its been difficult lately. Ive actually been avoiding social activities because Ifeel so anxious.

Psychologist: You mentioned work several times. Tell me about yourjob.

Maria: Im amarketing manager at atech company. Ive been there for four years. Iused tolove the job, but lately the pressure has been intense. We had layoffs last year, so those ofus who remained have much heavier workloads.

Psychologist: That sounds stressful. Were you working there when the anxiety started?

Maria: Yes, the anxiety definitely got worse after the layoffs. Ikept worrying that Imight be next.



Excerpt 3: Past Psychiatric History and SubstanceUse

Psychologist: Have you ever experienced symptoms like this before, Maria?

Maria: Not really. Imean, Ive always been abit ofaworrier, but nothing like this.

Psychologist: Have you ever sought help for mental health concerns before?

Maria: No, this is my first time seeing apsychologist. Ialways thought Icould handle things on myown.

Psychologist: Have you ever been prescribed medication for anxiety or any other mental health condition?

Maria: No, never.

Psychologist: Is there any history ofmental health issues inyour family?

Maria: My mother has always been anxious too, but shes never gotten treatment. She just says its her personality.

Psychologist: Isee. Now Ineed toask you some questions about substance use. Do you drink alcohol?

Maria: Yes, socially. Maybe aglass ofwine with dinner once or twice aweek.

Psychologist: Has your alcohol use changed recently?

Maria: Actually, yes. Ive been drinking more inthe evenings tohelp me relax. Maybe three or four glasses afew times aweek.

Psychologist: And do you use any other substances tobacco, cannabis, or anything else?

Maria: No, just alcohol.



Excerpt 4: Risk Assessment

Psychologist: Maria, Ineed toask you some important questions about how youve been coping. Have you had any thoughts ofharming yourself?

Maria: [pause] Sometimes Ifeel so overwhelmed that Ijust wish Icould disappear. But Ihavent actually thought about hurting myself, if thats what you mean.

Psychologist: Thank you for being honest. When you say you wish you could disappear, what do you mean bythat?

Maria: Ijust mean Iwant abreak from all the pressure and anxiety. Iwant tofeel normal again.

Psychologist: That makes sense. Have you had any specific thoughts about ending your life?

Maria: No, nothing like that. Iwould never do that tomy family.

Psychologist: Thats important toknow. What helps you get through difficult moments?

Maria: Talking tomy best friend helps. And sometimes Igo for walks toclear my head.

Psychologist: It sounds like youve found some helpful strategies. Im glad you have some support and coping methods inplace.



TASK 1: True / False / Not Mentioned

Read the statements below about Marias interview. Decide if each statementis:

TRUE(T) the statement agrees with the information

FALSE (F) the statement contradicts the information

NOT MENTIONED (N/M) the information is not given



Statements:

1. Marias anxiety symptoms began inMarch.

2. Maria had her first panic attack at home.

3. Maria has seen apsychologist before.

4. Marias mother has been treated for anxiety.

5. Maria lives with her parents.

6. Marias workplace had layoffs last year.

7. Maria has been avoiding social activities recently.

8. Maria drinks alcohol everyday.

9. Maria has suicidal thoughts.

10. Maria finds that talking toher best friend helps her cope.



TASK 2: Comprehension and Note-Taking

Read the interview excerpts carefully. Complete Marias intake form:



Client IntakeForm

Name: Maria

Age: _______

Presenting Problem: _______

Onset: _______

Recent Crisis Event: _______

Living Situation: _______

Family: _______

Occupation: _______

Work-related Stressors: _______

Past Mental Health Treatment: _______

Family Mental Health History: _______

Substance Use: _______

Current Coping Strategies: _______

Suicidal Ideation: _______

Protective Factors: _______



TASK 3: Analyzing Question Types

Review the interview excerpts. Identify five open-ended questions and five closed-ended questions the psychologist asked. Discuss why each type was used at that moment.



Open-ended questions:

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________



Closed-ended questions:

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

?

TASK 4: Role-Play Practice

Work inpairs. Student Ais the psychologist; Student B is the client.

Scenario 1: Client presenting with sleep problems and work stress

Scenario 2: Client presenting with relationship difficulties and lowmood

Scenario 3: Client presenting with social anxiety and isolation



Psychologist tasks:

Open the session and explain confidentiality

Ask about the presenting problem using open-ended questions

Explore onset, duration, frequency, and severity

Gather brief psychosocial history

Ask appropriate risk assessment questions

Client tasks:

Create abrief background story for your character

Respond naturally toquestions

Provide enough detail but also some ambiguity that requires follow-up questions

After the role-play, switch roles and try adifferent scenario.




PROFESSIONAL PRACTICE:

Structuring an Initial Assessment Session


Sample Assessment Structure

Atypical initial assessment session (usually 6090minutes) follows this general structure:

1. Introduction and Informed Consent (510minutes)

Introduce yourself and explain yourrole

Explain confidentiality and its limits

Discuss the structure and purpose ofthe session

Answer any questions the clienthas

Establish initial rapport



2. Presenting Problem (1520minutes)

Use open-ended questions tounderstand why the client is seekinghelp

Explore onset, duration, frequency, severity

Identify triggers and patterns

Understand the clients perspective on the problem

Explore previous attempts toaddress the issue



3. Psychosocial History (2030minutes)

Developmental and family background

Educational and occupational history

Relationship and social history

Medical history

Past psychiatric history

Substanceuse



4. Mental Status Examination (Ongoing throughout session)

Observe appearance, behaviour, speech

Assess mood and affect

Note thought process and content

Evaluate cognition, insight, and judgment



5. Risk Assessment (510minutes)

Assess suicidal ideation, intent,plan

Assess risk ofharm toothers

Identify protective factors



6. Summary and Next Steps (10minutes)

Summarize key information gathered

Share preliminary impressions (when appropriate)

Discuss treatment options and recommendations

Schedule follow-up appointment

Answer questions



Useful Phrases for Conducting Initial Assessment

Opening the Session:

Thank you for coming intoday.

Before we begin, Id like toexplain how our session will work.

Everything we discuss is confidential, with afew exceptions Ill explain.

Do you have any questions before we start?

Im here tolisten and help you understand whats been happening.



Exploring the Presenting Problem:

What brings you here today?

Tell me whats been happening.

When did you first notice this problem?

How has this been affecting your daily life?

What have you tried so far toaddress this?

What made you decide toseek helpnow?



Gathering History:

Id like tolearn more about your background.

Tell me about your family.

How would you describe your childhood?

Walk me through your work history.

Have you experienced mental health difficulties before?

Is there any family history ofmental health issues?



Asking Sensitive Questions:

Ineed toask some important questions that Iask everyone.

These questions might feel uncomfortable, but theyre important for understanding your situation.

Have you had any thoughts ofharming yourself?

Have you had thoughts ofending your life?

Tell me about your alcoholuse.



Showing Empathy and Building Rapport:

That sounds very difficult.

Ican understand why that would be distressing.

Thank you for sharing that withme.

It takes courage totalk about these things.

Youre not alone inexperiencing this.



Clarifying and FollowingUp:

Can you tell me more about that?

What do you meanby?

Help me understand

Can you give me an example?

How did that make you feel?



Transitioning Between Topics:

Now Id like toask about adifferent area

Lets talk about your work situation

Id like toshift todiscussing your family background

Moving on toanother topic



Closing the Session:

Were coming tothe end ofour time today.

Let me summarize what Ive heard

Based on what youve shared, Ithink we can workon

What questions do you have forme?

Lets schedule our next appointment.



Practice Exercises

Exercise 1: Create Your Opening Statement

Write your opening statement for an initial assessment session. Include:

Introduction

Explanation ofconfidentiality

Structure ofthe session

Invitation for questions



Exercise 2: Sequence the Assessment

Put these assessment components inthe most logical order:

a) Risk assessment

b) Introduction and informed consent

c) Psychosocial history

d) Mental status examination

e) Presenting problem

f) Summary and treatment planning



Exercise 3: Open-Ended Question Practice

For each closed-ended question, write an open-ended alternative. There may be more than one variant:

1. Do you get along with your family?

2. Are you stressed?

3. Did you like school?

4. Do you have friends?

5. Are you taking any medications?

?

Exercise 4: Case Formulation The FourPs

Read this brief case and identify the FourPs:

Tom is a28-year-old software developer presenting with symptoms ofdepression. His father had depression, and Tom experienced bullying inhigh school. Three months ago, Toms long-term relationship ended, and shortly after, he began experiencing low mood, loss ofinterest, and sleep problems. Tom has been isolating himself from friends, spending most evenings alone, and has stopped exercising activities that previously helped his mood. However, Tom has asupportive sister, astable job, and expressed motivation tofeel better.



Predisposing factors: _______

Precipitating factors: _______

Perpetuating factors: _______

Protective factors: _______



Exercise 5: Role-Play Assessment Practice

Work ingroups ofthree: Psychologist, Client, Observer.



Instructions:

Psychologist: Conduct a10-minute initial assessment focusing on presenting problem

Client: Use one ofthe scenarios provided or create yourown

Observer: Note down question types used, rapport-building techniques, and areas that could be explored further

After the role-play, the observer provides feedback.




Vocabulary and Collocations for Unit3





presenting problem  

intake interview  

chief complaint  

psychosocial history  

risk assessment  

mental status examination (MSE)   

rapport 

confidentiality 

initial assessment  

comprehensive background information   ()

therapeutic relationship  

treatment process  

gather essential information   

establish rapport  

sensitive information / 

engage fully  

maintain professional boundaries   

open-ended question  

closed-ended question  

narrative responses  

follow-up questions  

onset 

duration 

frequency 

severity (ofsymptoms)  ()

daily functioning  

previous attempts  

developmental history  

family history  

family structure  

educational history  

occupational history  

employment status  

job satisfaction  

work-related stress   

relationship history  

social history  

social support network   

interpersonal relationships  

medical history  

current medications  

chronic illnesses  

past psychiatric history   

psychiatric hospitalizations  

psychotropic medication  

substance use  

systematic observation  

psychological functioning  

appearance and behaviour   

eye contact  

motor activity  

speech patterns  

mood 

affect 

emotional state  

observable emotional expression   

labile affect  

thought process  

thought content  

delusions

obsessions /

suicidal ideation  / 

homicidal ideation  

perception 

hallucinations 

perceptual disturbances  

cognition 

orientation 

attention 

concentration 

memory 

intellectual functioning  

insight /

judgment 

self-harm 

suicide 

harm toothers  

suicidal thoughts  

specific plan 

protective factors  

reasons for living 

future orientation  

preliminary understanding  

formulation framework   

predisposing factors  

precipitating factors  

perpetuating factors  

early trauma  

recent events  

stressors 

job loss  

relationship breakup  

poor coping strategies   

lack ofsocial support   

avoidance behaviour  

supportive relationships  

resilience 

motivation for change  

treatment planning  

tangentiality 

circumstantiality 

vulnerable 

informed consent  

transparency 

active listening  

empathy 

unconditional positive regard   

collaborative 

coping strategies  





UNIT 4.

TREATMENT PLANNING AND THERAPEUTIC SESSION





LEAD-IN:

Session Structure and Goal-Setting


Activity 1: Ordering therapy session stages

The stages ofatypical therapy session are jumbled below. Put them inthe correct order (16):

___ Working section (exploring issues, applying techniques)

___ Check-in (reviewing the week, current state)

___ Closing and homework assignment

___ Agenda setting (deciding session focus)

___ Summary ofprogress and key points

___ Bridge from previous session

Activity 2: Brainstorming From the first session totermination

Work insmall groups. You have 5minutes tobrainstorm and write down:

Components ofafirst session (intake)

Components ofregular sessions

Components ofafinal session (termination)

Share your ideas with the class.

Example components:

First session: building rapport, gathering history, setting initial goals, explaining the therapeutic process

Regular sessions: check-in, agenda, interventions, homework review

Final session: reviewing progress, relapse prevention planning, saying goodbye



Activity 3: Discussion questions

Discuss these questions with your partner:

1. Why is structure important inatherapy session?

2. How can atherapist and client determine if therapy is working?

3. What does measuring progress mean inpsychotherapy?

4. Should every session follow the same structure, or should it be flexible?

5. When should therapy end? How do you know?

6. What is relapse prevention?



Key vocabulary for this unit:

Match the words with their definitions:

1. Check-in

2. Agenda setting

3. Treatmentplan

4. SMART goals

5. Intervention

6. Termination

7. Relapse prevention

8. Homework

?

a) Astructured document outlining objectives, methods, and expected outcomes oftherapy

b) Brief opening discussion about the clients current state and recent experiences

c) Goals that are Specific, Measurable, Achievable, Relevant, and Time-bound

d) Collaborative process ofdeciding what tofocus on during the session

e) The planned ending ofthe therapeutic relationship

f) Therapeutic technique or strategy used toaddress clients difficulties

g) Strategies tohelp clients maintain gains and avoid returning toproblematic patterns

h) Tasks or practice activities assigned between sessions




READING:

Managing Sessions and Planning Treatment: From Structure toGoals


Pre-readingtask

Before you read, discuss:

1. What do you think should happen at the beginning ofevery therapy session?

2. Why might clients need homework between sessions?

3. What makes agood therapy goal?

4. How should therapyend?

?

Managing Sessions and Planning Treatment: From Structure toGoals

Effective psychotherapy requires both skilled therapeutic intervention and careful planning. Whether working with clients experiencing depression, anxiety, trauma, or relationship difficulties, psychologists must structure their sessions thoughtfully and develop comprehensive treatment plans that guide the therapeutic process from the first meeting tosuccessful termination.



The Therapeutic Frame and Session Structure

The concept ofthe therapeutic frame refers tothe consistent boundaries and structure that provide safety and predictability intherapy. This includes the regular time and place ofsessions, duration (typically 4560minutes), confidentiality agreements, and the overall format ofeach meeting. Aconsistent therapeutic frame helps clients feel secure and allows them tofocus on their inner experience rather than worrying about unpredictable elements.

Each therapy session, whether it is the second meeting or the twentieth, generally follows arecognizable structure that includes several key components. This structure provides organization while remaining flexible enough torespond toclients immediate needs.

The session typically begins with acheck-in, abrief opening where the therapist asks about the clients current state and experiences since the last meeting. During check-in, clients might share how their week went, whether they experienced any significant events, or how they are feeling inthe present moment. This helps the therapist assess the clients immediate emotional state and determine if any crisis or urgent issue requires immediate attention. For example, atherapist might ask, How have things been since we last met? or Whats been on your mind this week?

Following the check-in comes agenda setting, acollaborative process where therapist and client decide together what tofocus on during the session. The therapist might say, What would be most helpful towork on today? or Lets think about what we want toaccomplish inour time together. Agenda setting empowers clients bygiving them voice intheir treatment and ensures that sessions address their most pressing concerns. The agenda might include reviewing homework from the previous session, discussing arecent difficult situation, practicing anew skill, or exploring alongstanding pattern.

The working section forms the main body ofthe session, where the therapeutic work takes place. This is when atherapist and aclient engage with the chosen agenda items using various therapeutic techniques and interventions. InCBT, this might involve identifying and challenging negative automatic thoughts. Inpsychodynamic therapy, it might mean exploring unconscious patterns or discussing transference. Inhumanistic therapy, the therapist might reflect the clients feelings and help them explore their experience more deeply. The working section is flexible and responsive towhat emerges during the conversation.

As the session approaches its end, the therapist initiates closing and summary. During this phase, the therapist and client review what was discussed, highlight key insights or progress, and ensure the client feels grounded before leaving. The therapist might ask, What are you taking away from todays session? or How are you feeling right now? This is also the time for homework assignment therapeutic tasks that help clients practice new skills or continue therapeutic work between sessions. Homework might include keeping athought diary, practicing relaxation techniques, or trying new behaviour inareal-life situation.

Research shows that clients who complete homework assignments between sessions make faster progress and achieve better outcomes. Homework bridges the gap between the therapy room and real life, allowing clients toapply what they learn insession totheir daily experiences.



Treatment Planning: Creating aRoadmap for Change

While individual sessions follow apredictable structure, the overall course oftherapy requires comprehensive treatment planning. Atreatment plan is astructured document that outlines the clients presenting problems, diagnosis (if applicable), therapeutic goals, specific objectives, planned interventions, and methods for measuring progress. Treatment planning typically begins after the initial assessment and may be revised as therapy progresses.

Effective treatment plans are collaborative. Rather than the therapist imposing goals on the client, both parties work together toidentify what the client wants toachieve and how they will get there. This collaboration increases client motivation and investment inthe therapeutic process. When clients feel ownership oftheir goals, they are more likely towork actively toward achieving them.



SMART Goals: Making Objectives Measurable

One ofthe most important elements oftreatment planning is setting SMART goals. SMART is an acronym that standsfor:

Specific: goals should be clear and well-defined, not vague. Instead offeel better, aspecific goal might be reduce panic attacks.

Measurable: goals should be quantifiable so that progress can be tracked. For example, reduce panic attacks from 5per week to1per week is measurable.

Achievable: goals should be realistic given the clients resources, abilities, and circumstances. Setting impossibly difficult goals sets clients up for failure.

Relevant: goals should align with the clients values, needs, and overall life situation. They should matter tothe client personally.

Time-bound: goals should have aspecific timeframe. Within 12weeks or bythe end oftreatment creates urgency and allows for evaluation.

For example, avague goal like improve mood becomes aSMART goal when reframed as: Within 8weeks, reduce depression symptoms (as measured bythe PHQ-9: Patient Health Questionnaire-9)) from ascore of18tobelow 10through weekly therapy sessions and daily behavioural activation exercises.

Treatment plans distinguish between goals (the broader aims oftreatment) and objectives (the specific steps needed toachieve those goals). Agoal might be reduce social anxiety, while objectives would include learn and practice relaxation techniques within the first four sessions and engage inone social situation per week using coping strategies learned intherapy.

The treatment plan also specifies interventions the therapeutic techniques and approaches that will be used tohelp the client reach their objectives. Interventions might include cognitive restructuring, exposure therapy, mindfulness practice, family therapy sessions, or emotion regulation skills training. The choice ofinterventions depends on the clients diagnosis, goals, and the therapists theoretical orientation and training.



Measuring Progress and Outcomes

How do therapists and clients know if therapy is working? Outcomes refer tothe results oftherapeutic intervention the changes that occur inthe clients symptoms, functioning, and well-being. Measuring outcomes is essential for evaluating treatment effectiveness and making adjustments when needed.

Many therapists use standardized outcome measures or assessment scales totrack progress systematically. For depression, the PHQ-9provides anumerical score that can be tracked over time. For anxiety, the GAD-7(Generalized Anxiety Disorder-7) serves asimilar purpose. When aclients score decreases from 20to8over the course oftreatment, both therapist and client have concrete evidence that therapy is working.

Progress is also measured through regular check-ins during sessions. Therapists might ask, Are you noticing any changes? or How are you managing the situations that used totrigger your anxiety? Client self-reports ofimproved mood, better relationships, or increased coping abilities all indicate positive outcomes.



Termination and Relapse Prevention

All therapy relationships eventually end, and termination the planned conclusion oftherapy is an important phase that requires careful attention. Termination is appropriate when clients have achieved their treatment goals, learned skills for managing their difficulties, and feel ready tocontinue their progress independently.

Effective termination is not abrupt. Therapists typically begin discussing termination several sessions before the final meeting, giving clients time toprocess their feelings about ending therapy and toconsolidate their gains. The termination phase includes reviewing progress, celebrating achievements, and acknowledging the relationship that has developed.

Acrucial component oftermination is relapse prevention planning. While clients may have made significant progress during therapy, they remain vulnerable toreturning toold patterns when faced with stress or new challenges. Relapse prevention involves helping clients identify their warning signs, develop strategies for managing future difficulties, and create aplan for what todo if symptoms return.

Relapse prevention planning might include: identifying high-risk situations that could trigger old patterns; reviewing coping strategies learned intherapy; creating awritten plan for managing warning signs; discussing when toseek additional therapy inthe future; and ensuring clients feel confident intheir ability tomaintain their gains.

Research shows that structured therapies that include explicit relapse prevention planning help clients maintain their improvements long after therapy ends. Bypreparing clients for potential challenges and giving them tools tomanage independently, therapists set them up for lasting success.

From the structured framework ofindividual sessions tothe comprehensive roadmap oftreatment planning, effective psychotherapy balances organization with flexibility, always keeping the clients goals and well-being at the center ofthe work.



Comprehension questions:

1. What is the therapeutic frame and why is it important?

2. What happens during the check-in at the beginning ofasession?

3. What is agenda setting and why is it collaborative?

4. What is the purpose ofhomework intherapy?

5. What does SMART stand for inSMART goals?

6. What is the difference between goals and objectives inatreatment plan?

7. How can therapists measure whether therapy is working?

8. When is termination appropriate?

9. What is relapse prevention and why is it important?

10. Give an example ofaSMART goal for aclient with depression.




VOCABULARY:

Treatment Planning and SMART Goals Terminology


A. Find words inthe text that match these definitions:

1. The consistent boundaries and structure that provide safety intherapy (paragraph 2): _______

2. Abrief opening discussion about the clients current state (paragraph 4): _______

3. Process where therapist and client decide what tofocus on during session (paragraph 5): _______

4. The main part ofthe session where therapeutic work happens (paragraph 6): _______

5. Therapeutic tasks that help clients practice between sessions (paragraph 7): _______

6. Astructured document outlining problems, goals, and interventions (paragraph 9): _______

7. Tools or techniques used tohelp clients achieve their objectives (paragraph 14): _______

8. The results oftherapeutic intervention (paragraph 15): _______

9. The planned conclusion oftherapy (paragraph 17): _______

10. Strategies tohelp clients maintain gains and avoid returning toold patterns (paragraph 19): _______



B. Complete the collocations from the text:

1. therapeutic _______

2. check-_______

3. agenda _______

4. homework _______

5. treatment _______

6. SMART _______

7. measurable _______

8. relapse _______

9. outcome _______

10. session _______



C. Word families

Complete the table:








Discussion questions:

1. How structured should therapy sessionsbe?

2. Why is it important for clients toparticipate insetting their own goals?

3. What should atherapist do if aclient doesnt complete homework assignments?

4. How can therapists balance following atreatment plan with being responsive toclients immediate needs?

5. Should all therapy have aplanned ending, or can it continue indefinitely?

6. What are the risks ofnot having arelapse prevention plan?




GRAMMAR FOCUS:

Future Simple, going to, and Present Continuous for Plans and Timelines


When discussing treatment plans, session structure, and therapeutic goals, we use different future forms depending on the type ofplan or prediction.



A. Future Simple (will + main verb)

Use: predictions, spontaneous decisions, promises, and general future facts

Form:

Affirmative: Subject + will + mainverb

Negative: Subject + will not (wont) + mainverb

Questions: Will + subject + main verb?

Examples from therapy:

This intervention will help you manage anxiety better.

Therapy will take approximately 1216sessions.

The therapist will review your progress regularly.

Iwill support you throughout this process.

These coping skills will be useful instressful situations.



B. Going to + mainverb

Use: planned intentions, decisions already made, and predictions based on present evidence

Form:

Affirmative: Subject + am/is/are + going to+ mainverb

Negative: Subject + am/is/are + not + going to+ mainverb

Questions: Am/Is/Are + subject + going to+ main verb?

Examples from therapy:

We are going towork on your communication skills.

Iam going toassign homework topractise between sessions.

The client is going tokeep athought diary this week.

We are going tofocus on relapse prevention inour final sessions.

They are going toterminate therapy after achieving their goals.



C. Present Continuous for arrangements

Use: fixed arrangements and scheduled appointments

Form:

Affirmative: Subject + am/is/are + main verb-ing

Negative: Subject + am/is/are + not + main verb-ing

Questions: Am/Is/Are + subject + main verb-ing?

Examples from therapy:

We are meeting next Tuesday at 3PM.

Iam seeing my therapist this week.

The client is coming for their intake session tomorrow.

We are having our termination session next month.

They are not attending group therapy this week.



Exercise 1: Choose the correctform

Complete the sentences with the correct future form ofthe verb inbrackets:

1. Inour next session, we _______ (explore) your childhood experiences.

2. Ithink this treatment plan _______ (be) effective for your symptoms.

3. We _______ (meet) every Wednesday at 4PM for the next three months.

4. The therapist _______ (use) CBT techniques toaddress your negative thoughts.

5. Look at your progress! You _______ (achieve) your goals soon.

6. I_______ (assign) you homework topractise assertiveness skills.

7. Our termination session _______ (take place) on December 15th.

8. This relapse prevention plan _______ (help) you maintain your progress.



Exercise 2: Will vs. Goingto

Decide if each sentence should use will or goingto:

1. A: Ihavent decided which intervention touseyet.

B: I_______ (recommend) trying cognitive restructuring first.

2. We _______ (start) working on your social anxiety intodays session. (This was planned last week)

3. A: The client seems very distressed.

B: Dont worry. I_______ (check in) with him right away. (spontaneous decision)

4. According tothe treatment plan, therapy _______ (last) for 16weeks.

5. Ican see youre making great progress. You _______ (reach) your goals very soon. (based on evidence)



Exercise 3: Complete the treatment plan discussion

Complete this dialogue between atherapist and client using appropriate future forms:

Therapist: So, we _______ (work) together for approximately 12sessions. Inour first few sessions, we _______ (focus) on assessment and goal-setting.

Client: That sounds good. What _______ (happen) inthe later sessions?

Therapist: We _______ (use) various CBT techniques tohelp you manage your anxiety. I_______ (teach) you relaxation skills and cognitive restructuring.

Client: _______ (I/ have) homework?

Therapist: Yes, I_______ (assign) practice exercises between sessions. This _______ (help) you apply what we learn intherapy toyour daily life.

Client: When _______ (we / meet)?

Therapist: We _______ (meet) every Thursday at 2PM. Does that work foryou?

Client: Perfect. I_______ (see) you next Thursday, then!



Exercise 4: Correct the mistakes

Find and correct the mistakes inthese sentences:

1. We will meeting for our session tomorrow at 3PM.

2. Ithink the client is going achieve their goals soon.

3. The therapist going toassign homework next week.

4. Our final session will taking place inJune.

5. What we are going towork on today?

6. The treatment plan are going toinclude relaxation techniques.

7. Imeet my supervisor next Monday todiscuss this case.

8. Will the client going toattend group therapy?




COMMUNICATION:

ATherapeutic Session: Setting Goals and Creating aTreatmentPlan


Context: This is session 3. The client, James, is a37-year-old professional who came totherapy for anxiety and sleep problems. He has been intherapy for three weeks. The therapist is Dr. Roberts.



Dr. Roberts: Good morning, James. How have you been since we lastmet?

James: Hi, Dr. Roberts. Ive been okay, Iguess. Better than before Istarted therapy, but Istill have difficult days.

Dr. Roberts: Im glad tohear theres been some improvement. Can you tell me abit more about the difficult days? What makes them challenging?

James: Well, Istill feel overwhelmed at work quite often. And Im having trouble sleeping my mind just wont switch off at night.

Dr. Roberts: Iunderstand. These seem like important things toaddress. Today, Id like us towork on something specific creating clear treatment goals and developing aplan for our work together. Does that sound good toyou?

James: Yes, definitely. Ithink Ineed that. Sometimes Im not sure what were working towards.

Dr. Roberts: Thats very honest ofyou, and its exactly why setting goals is so important. Lets start with what youd like tochange. If our therapy together is successful, what would be different inyour life?

James: Iwant tofeel less anxious, especially at work. And Iwant tosleep better. Also Id like tofeel more confident ingeneral.

Dr. Roberts: Those are great starting points. Lets work on making them more specific so we can track your progress. You mentioned feeling less anxious at work can you describe what that would look like inpractical terms?

James: Isuppose Id be able topresent at team meetings without my heart racing. And Iwouldnt spend my lunch breaks worrying about what might go wrong inthe afternoon.

Dr. Roberts: Excellent. So, one goal could be about managing anxiety inspecific work situations. Lets make it even more concrete. How often do you present at meetings currently?

James: About once aweek, usually on Fridays.

Dr. Roberts: And how would you rate your anxiety level during these presentations right now, from 0to10, where 0means no anxiety at all and 10means extreme anxiety?

James: Probably an 8or 9. Its really high.

Dr. Roberts: Okay. So, lets create aSMART goal that means its Specific, Measurable, Achievable, Relevant, and Time-bound. How does this sound: Within 10weeks, Iwill present at weekly team meetings and reduce my anxiety level from 8/10to4/10, measured before and during the presentation.

James: That sounds challenging but possible, Ithink.

Dr. Roberts: Good. It should feel like astretch but not impossible. Now, what about sleep? What would better sleep look like foryou?

James: Falling asleep within 30minutes instead oflying awake for two hours. And maybe waking up feeling rested, not exhausted.

Dr. Roberts: How many nights per week are you having trouble sleeping currently?

James: Five or six nights. Its pretty consistent.

Dr. Roberts: Alright. Heres apossible goal: Within 8weeks, Iwill fall asleep within 30minutes on at least 5nights per week bypracticing sleep hygiene techniques and relaxation exercises.

James: That would make such adifference tomy life.

Dr. Roberts: Ibelieve it will. Now, you also mentioned confidence. Thats abit broader. Can you give me an example ofasituation where youd like tofeel more confident?

James: Social situations, Ithink. Iavoid going out with friends because Iworry Ill say something stupid or that people wont likeme.

Dr. Roberts: How often are you declining social invitations rightnow?

James: Almost always. Iprobably say no nine times out often.

Dr. Roberts: And realistically, how often would you like tobe able tosayyes?

James: Maybe half the time? At least at first.

Dr. Roberts: Thats arealistic target. So, our third goal might be: Within 12weeks, Iwill accept and attend at least 50% ofsocial invitations Ireceive, with aminimum oftwo social events per month.

James: Okay. These goals make it all feel more real. More manageable.

Dr. Roberts: Thats exactly the purpose. Now lets talk about how were going tohelp you achieve these goals. Based on what youve told me over our sessions, Ithink Cognitive behavioural Therapy would be very effective for you. Do you know anything aboutCBT?

James: Not really. What does it involve?

Dr. Roberts: CBT focuses on the connection between your thoughts, feelings, and behaviours. Well identify unhelpful thinking patterns that increase your anxiety and work on developing more balanced, realistic thoughts. Well also use exposure exercises togradually help you face situations youre avoiding.

James: Exposure exercises? That sounds scary.

Dr. Roberts: It will be gradual and at your pace. For example, we might start with smaller social situations before working up tobigger ones. And well teach you coping strategies first like relaxation techniques and thought challenging so you have tools tomanage the anxiety.

James: Okay. That sounds more manageable.

Dr. Roberts: Good. So, heres our treatment plan: Well meet weekly for approximately 1214sessions. Each session, well check on your progress, review any homework exercises, learn and practice new skills, and plan what towork on between sessions. For your work anxiety, well use thought records toidentify and challenge anxious thoughts. For sleep, well implement asleep hygiene plan and teach you progressive muscle relaxation. And for social confidence, well create an exposure hierarchy starting with less anxiety-provoking situations and gradually buildingup.

James: And the homework you mentioned what would that involve?

Dr. Roberts: Between sessions, youll practice the skills we work on here. For example, keeping thought records, practicing relaxation exercises daily, or gradually completing exposure tasks. The homework is where most ofthe change happens our sessions are for learning and planning, but youll do the real work outside this room.

James: That makes sense. Im nervous but Im ready totry.

Dr. Roberts: Thats agreat attitude. Remember, well review your progress regularly. Every few sessions, well check whether these goals still feel relevant and whether we need toadjust them. This plan isnt set instone its aworking document well adapt as needed. How are you feeling about everything weve discussed?

James: Honestly? Abit overwhelmed, but also relieved. Its good tohave aclear direction.

Dr. Roberts: Thats avery normal reaction. For next week, Id like you tostart monitoring your anxiety and sleep patterns. Im going togive you asimple diary sheet where you can record your anxiety levels indifferent situations and note what time you go tobed and fall asleep each night. This will give us baseline data and help you become more aware ofpatterns.

James: Okay, Ican do that.

Dr. Roberts: Excellent. Lets summarize what weve agreed today. Weve set three main goals: reducing your anxiety at work presentations to4/10within 10weeks, improving your sleep byfalling asleep within 30minutes at least 5nights per week within 8weeks, and accepting 50% ofsocial invitations within 12weeks. Well use CBT techniques including thought records, relaxation exercises, and gradual exposure. Does that sound right?

James: Yes, that coversit.

Dr. Roberts: How helpful was todays session foryou?

James: Very helpful. Ifeel like Iunderstand what were doing now and where were headed.

Dr. Roberts: Im glad tohear that. Ill see you next week, at the same time. And remember tobring your anxiety and sleep diary.



TASK 1: True / False / Not Mentioned

Read the statements below about the therapeutic session. Decide if each statementis:

TRUE the statement agrees with the information

FALSE the statement contradicts the information

NOT MENTIONED the information is not given



Statements:

1. This is Jamess first therapy session with Dr. Roberts.

2. James is having difficulty sleeping because his mind wont switch off at night.

3. Dr. Roberts plans touse Cognitive behavioural Therapy with James.

4. James currently rates his anxiety during presentations as 8 or 9 out of10.

5. James has been diagnosed with panic disorder.

6. James accepts most social invitations he receives.

7. The treatment plan includes approximately 1214 weekly sessions.

8. Dr. Roberts will adjust the treatment plan if needed as therapy progresses.

9. James needs topractice relaxation exercises twice aday.

10. Dr. Roberts assigns James an anxiety and sleep diary for homework.

?

TASK 2: Answer the Questions

1. How is James feeling compared tobefore he started therapy?

2. What are the three main issues James wants toaddress intherapy?

3. What does SMART stand for ingoal-setting?

4. What is Jamess first SMART goal about work presentations?

5. How often is James currently having trouble sleeping?

6. What percentage ofsocial invitations does James want tobe able toaccept?

7. What three main techniques will Dr. Roberts use tohelp James?

8. What is Jamess homework assignment for next week?

?

TASK 3: Personal Response

Discuss:

1. James feels overwhelmed but also relieved after setting goals. Why do you think clear goals can create both feelings at the same time?

2. Dr. Roberts says, The homework is where most ofthe change happens. Do you agree that practice outside therapy sessions is more important than the sessions themselves? Why or whynot?

3. One ofJamess goals is toattend at least two social events per month. Do you think this is realistic for someone with social anxiety? Would you set the goal higher or lower?



TASK 4: RolePlay

Work inpairs. One person is apsychotherapist, the other is aclient.



The clientpresents with:

Chronic stress from work overload

Frequent headaches and muscle tension

Difficulty saying no toadditional responsibilities

Feeling burned out and exhausted



The psychotherapistshould:

Ask questions tounderstand the clients difficulties

Help the client formulate 23SMART goals

Suggest appropriate interventions (e.g., stress management techniques, assertiveness training, relaxation exercises)

Assign homework for the comingweek

Summarize the treatmentplan



Time: 1015minutes



After the role play, discuss:

Was it easy or difficult tocreate SMART goals?

Did the goals feel realistic and achievable?

What interventions seemed most appropriate for this clients problems?




PROFESSIONAL PRACTICE:

Creating Effective Treatment Plans


Sample Treatment Plans



Treatment Plan 1: Depression

Client: 32-year-old female with major depressive disorder

Presenting Problems: Low mood, loss ofinterest inactivities, difficulty concentrating, sleep disturbance

Treatment Approach: Cognitive-behavioural Therapy

Goal: Reduce depressive symptoms and improve daily functioning within 12weeks



SMART Objectives:

1. Within 4weeks, client will identify and challenge 3negative automatic thoughts daily using thought records

2. Byweek 6, client will engage in3pleasurable activities per week (behavioural activation)

3. Byweek 12, client will score below 10on PHQ-9* (currently18)



Interventions:

Cognitive restructuring

behavioural activation

Sleep hygiene psychoeducation

Homework assignments (thought records, activity scheduling)



Outcome Measures: PHQ-9administered every 3sessions

Planned Duration: 1216weekly sessions

Relapse Prevention: Identify warning signs, maintain activity schedule, know when toseek additional support



* PHQ-9(Patient Health Questionnaire-9)   -9



Treatment Plan 2: Social Anxiety



Client: 25-year-old male with social anxiety disorder

Presenting Problems: Fear ofjudgment, avoidance ofsocial situations, physical anxiety symptoms

Treatment Approach: Cognitive-behavioural therapy with exposure

Goal: Decrease social anxiety and increase participation insocial activities within 16weeks



SMART Objectives:

1. Within 4weeks, learn and practise relaxation techniques with 80% successrate

2. Byweek 8, attend one low-anxiety social situation per week using coping strategies

3. Byweek 12, give apresentation at work (previously avoided)

4. Byweek 16, report anxiety insocial situations decreased from 8/10to3/10



Interventions:

Cognitive restructuring ofsocial anxiety thoughts

Progressive muscle relaxation training

Graduated exposure hierarchy

Social skills practice

Homework: weekly exposure exercises



Outcome Measures: GAD-7*, subjective anxiety ratings, behavioural tracking

Planned Duration: 16weekly sessions

Relapse Prevention: Continued gradual exposures, recognition ofanxiety warning signs, maintenance ofcoping strategies



*GAD-7(Generalized Anxiety Disorder-7)   7       



Useful Phrases for Treatment Planning

Describing Presenting Problems:

The client presents with

Primary concerns include

The client reports experiencing

Main difficultiesare



Setting Goals:

The overall goal oftreatment isto

The client aimsto

We will work toward

Treatment will focuson



Writing SMART Objectives:

Within [timeframe], the client will

By[date], the client will be ableto

The client will demonstrate [number] times per [period]

Bythe end oftreatment, the client will achieve



Describing Interventions:

Treatment will include

Therapeutic techniques will consistof

We will utilize

The approach combines

Sessions will incorporate



Measuring Outcomes:

Progress will be measured using

We will track

Outcome measures include

Success will be indicatedby



Planning Termination:

Termination is plannedfor

Treatment will conclude when

We will begin discussing termination

Relapse prevention will include



Practice Exercises

Exercise 1: Identify SMART Elements

Look at these goals and identify which SMART criteria each one meets or lacks:

1. Client will feel better

2. Within 8weeks, client will practise relaxation exercises 5times per week

3. Client will reduce panic attacks from 5per week to1per week within 10weeks as measured bydaily tracking



Exercise 2: Convert Vague Goals toSMART Goals

Rewrite these vague goals as SMART goals:

1. Vague: Client will have less anxiety

SMART: _________________________________

2. Vague: Client will improve relationships

SMART: _________________________________

3. Vague: Client will cope better with stress

SMART: _________________________________



Exercise 3: Match Interventions toGoals

Match each goal with the most appropriate intervention:



Goals:

1. Reduce frequency ofpanic attacks

2. Improve communication with apartner

3. Decrease depressive symptoms

4. Manage anger more effectively



Interventions:

a) behavioural activation and cognitive restructuring

b) Couples therapy and active listening skills training

c) Interoceptive exposure and breathing techniques

d) Anger management techniques and cognitive reappraisal



Exercise 4: Create aSession Structure

You are meeting aclient for the third time. They have been practising thought records as homework. Create an outline for todays session including:



Check-in: _________________________________

Agenda setting: _________________________________

Working section: _________________________________

Summary: _________________________________

Homework: _________________________________



Exercise 5: Write aMini TreatmentPlan

Create abrief treatment plan for this scenario:

Client: 28-year-old female experiencing work-related stress, sleep problems, and difficulty saying no toextra responsibilities



Your treatment plan should include:

One overallgoal

Two SMART objectives

Three specific interventions

One outcome measure

Planned duration



Exercise 6: Relapse Prevention Planning

Aclient with depression has achieved their treatment goals and will terminate therapy intwo sessions. List 5elements you would include intheir relapse prevention plan:

1. _________________________________

2. _________________________________

3. _________________________________

4. _________________________________

5. _________________________________




Vocabulary and Collocations for Unit4




check-in  ,  

agenda setting  

treatment plan  

SMART goals -

intervention /

termination  

relapse prevention  

homework  

building rapport  

gathering history  

setting initial goals   

therapeutic process  

regular sessions  

homework review   

reviewing progress  

relapse prevention planning   

measuring progress  

therapeutic frame   ()

session structure  

consistent boundaries  

confidentiality agreements  

current state  

experiences since the last meeting    

significant events  

present moment  

immediate emotional state   

urgent issue  

immediate attention  

collaborative process  

most pressing concerns   

working section  

therapeutic techniques  

negative automatic thoughts   

unconscious patterns  

transference 

closing and summary  

key insights  

homework assignment   

therapeutic tasks  

thought diary  

relaxation techniques  

real-life situation   

complete homework assignments   

make faster progress  

achieve better outcomes   

comprehensive treatment planning   

presenting problems  

diagnosis 

therapeutic goals 

specific objectives 

planned interventions  /

measuring progress  

initial assessment  

client motivation  

investment inthe therapeutic process   

specific 

measurable 

achievable 

relevant 

time-bound  

reduce panic attacks   

vague goal 

broader aims  

treatment goals  

objectives 

specific steps 

reduce social anxiety   

learn and practise  

coping strategies  

engage in 

cognitive restructuring  

exposure therapy  

mindfulness practice  

family therapy sessions   

emotion regulation skills   

theoretical orientation  

outcomes 

therapeutic intervention  

treatment effectiveness  

standardized outcome measures    

assessment scales  

track progress systematically   

PHQ-9(Patient Health Questionnaire-9) PHQ-9(  -9)

GAD-7(Generalized Anxiety Disorder-7) GAD-7(:   -7)

numerical score  / 

concrete evidence  

regular check-ins  

client self-reports  

improved mood  

better relationships   

increased coping abilities   

positive outcomes  

planned conclusion  

achieved treatment goals   

learned skills  

independently /

effective termination  

abrupt 

process feelings  

consolidate gains  

celebrating achievements  

acknowledging the relationship   ()

warning signs  

returning toold patterns   

high-risk situations   

trigger old patterns    ()

written plan 

seek additional therapy   

maintain gains  

structured therapy  

explicit relapse prevention planning    

maintain improvements  

lasting success  

baseline data  

sleep hygiene 

progressive muscle relaxation   

exposure hierarchy  

thought records  

behavioural activation  

depression symptoms  

daily functioning  

major depressive disorder   

low mood  

loss ofinterest  

difficulty concentrating  

sleep disturbance 






pleasurable activities  / 

social anxiety disorder   

fear ofjudgment  

avoidance ofsocial situations   

physical anxiety symptoms   

low-anxiety social situation   

subjective anxiety ratings   

behavioural tracking  

continued gradual exposures   

recognition ofwarning signs   

maintenance ofcoping strategies   





UNIT 5.

MAJOR SKILLS OFAPSYCHOLOGIST





LEAD-IN:

Professional Skills and Competencies


Activity 1: What makes an effective psychologist?

Read the list ofprofessional skills below. Think about each skill and complete the tasks:



Professional skills:

Active listening understanding what the client really means

Building rapport creating trust with clients

Ethical decision-making knowing what is right indifficult situations

Teamwork collaborating with other professionals

Assessment skills gathering and analyzing information about clients

Cultural sensitivity working with people from different backgrounds



Tasks:

1. Number the skills from 1 to6 (1 = most important, 6 = least important foryou)

2. Circle TWO skills you alreadyhave

3. Underline ONE skill you want todevelop further

Be ready toexplain your choices.



Activity 2: Skills brainstorm

Work insmall groups. You have 3minutes towrite down as many professional skills as you can that psychologists need intheir practice.

Example: active listening, assessment, empathy, critical thinking, communication skills



Activity 3: Discussion questions

Discuss these questions with your partner:

1. What do you think are the three most important skills for apsychologist?

2. Are some skills more important incertain settings (hospital vs. private practice)?

3. Can all professional skills be taught, or are some innate?

4. Whats the difference between clinical skills and interpersonal skills?

5. How do psychologists maintain their professional boundaries?

6. What role does research play inpsychological practice?

?

Key vocabulary for thisunit:

?

Match the words with their definitions:

1. Competency

2. Assessment

3. Intervention

4. Case formulation

5. Professional boundaries

6. Clinical judgment

7. Ethical decision-making

?

a) The ability tomake informed professional decisions based on evidence and experience

b) The process ofgathering and evaluating information about aclients psychological state

c) Clear limits that protect both psychologist and client inthe professional relationship

d) Aspecific skill or ability required for professional practice

e) Making choices that align with professional ethical codes and standards

f) An action or treatment designed tohelp resolve apsychological problem

g) Acomprehensive understanding ofaclients problems, their causes, and maintaining factors




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