Learning from Mistakes in Clinical Practice

by Dillon, Carolyn

• ISBN13: 9780534524012
• ISBN10: 053452401X
• Edition: 1st
• Format: Paperback
• Copyright: 2002-02-14
• Publisher: Brooks Cole

Summary

This text is a virtual handbook of classic mistakes to anticipate, work through, and grow from. It identifies, discusses and re-frames classic mistakes that beginning interviewers and clinicians are likely to make in practice by illuminating a myriad of mistakes through the use of first-hand vignettes, in-text exercises, and a systems framework. This book uses a strengths-perspective, and can serve as a companion text or as a stand-alone primer because of its elaboration of the phases, principles, strategies and methods used in the helping process.

Table of Contents

Preface	x
Becoming a Professional	1	(13)
The Dawning of a New Awareness	1	(1)
Additional Complications in Clinical Roles	2	(1)
The Professional Learning Curve	3	(2)
At One with Clients, Yet Different from Clients	5	(1)
Crises Around Learning to Be Deliberate	6	(1)
Tending, Not Just Having, Relationships	7	(1)
You, Too?	8	(1)
Noting and Making Use of Parallels	8	(1)
Reconciling with Strengths and Limitations	8	(2)
Moving from Smart to Wise	10	(1)
Will Anything Rule Me Out?	11	(1)
Conclusion	11	(1)
Exercises	12	(1)
Recommended Reading	13	(1)
Early Successes and Derailments	14	(25)
Defining and Identifying Mistakes	14	(1)
How Can We Tell When Clinical Work Is On Track?	15	(1)
Usefulness of Recordings	15	(1)
General Characteristics of Effective Work	16	(4)
Discerning Our Mistakes	20	(3)
Common Worker Signals of Mistakes in Progress	23	(3)
Frequent Sources of Derailment	26	(11)
Conclusion	37	(1)
Exercises	37	(1)
Recommended Reading	38	(1)
Engaging with Clients and Getting Started	39	(28)
True Engagement Is Hard Work	40	(1)
Initial Challenges and Pitfalls	41	(3)
Startup Conversation and Exploration	44	(3)
Other Orientation Topics	47	(1)
Hesitating to Discuss Worker-Client Differences	48	(1)
Overlooking Fundamental Human Resources	48	(1)
Problems with Technique in Engaging and Starting Up	49	(1)
Asking Questions Closely Aligned with Where the Client Is	49	(1)
Avoiding Rapid-Fire Questions	50	(1)
Using Open-Ended Questions	51	(1)
Asking Rather Than Assuming	51	(1)
Leaving Time to Reflect After Each Segment of Discussion	52	(1)
Purposeful Focusing	52	(1)
Appropriate Timing and Dosage	53	(1)
Carefully Working from the Outside In	53	(1)
Overprotecting Clients	54	(1)
Prejudice and Ignorance in Action	54	(1)
Class Differences and Classist Behaviors Can Affect Engagement	55	(1)
Attitude Taints Engagement	56	(1)
Shifting Meeting Times Creates Bad Feelings	57	(1)
Emergency Interruptions Can Derail Bonding and Work	57	(1)
Emotional Overbooking Is Visible	58	(1)
Missteps Around Confidentiality and Privacy	58	(1)
Breaches of Confidentiality	58	(1)
Inflexibility Regarding Confidentiality	59	(5)
Conclusion	64	(1)
Exercises	65	(1)
Recommended Reading	66	(1)
Professional Relationships: Steps and Missteps	67	(23)
Unique Features of the Worker-Client Relationship	68	(1)
Worker Self-Disclosure as a Form of Relational Tending	69	(1)
Empathy: Being Where the Client Is	70	(1)
Conditions Conducive to Accurate Empathy	71	(5)
Missteps in Trying to Empathize	76	(2)
Trivializing via Excessive Universalizing	78	(3)
Restoring Empathic Alignment	81	(2)
Worker Concerns About Relating with Clients	83	(1)
Shared Concerns About Relating with Other Agencies and Helpers	84	(1)
Common Mistakes in Relating with Clients	84	(4)
Conclusion	88	(1)
Exercises	88	(1)
Recommended Reading	89	(1)
Assessment and Contracting	90	(29)
Assessment	90	(1)
Observation Changes the Observer and the Observed	91	(1)
Elements of Good Assessment	92	(4)
Frequent Mistakes in Assessment	96	(12)
Implications for Contracting with Involuntary Clients	108	(1)
Mistakes in Contracting	109	(7)
Larger Systems Issues	116	(1)
Conclusion	117	(1)
Exercises	117	(1)
Recommended Reading	118	(1)
The Middle Phase of Work	119	(30)
Common Foci for Work	119	(9)
Techniques for Updating Unhelpful Thoughts	128	(10)
Integrative Techniques for Working on Feelings and Behaviors	138	(5)
Connecting the Past, the Present, and Hopes for the Future	143	(1)
Going Home Again	144	(1)
Conclusion	145	(1)
Exercises	145	(2)
Recommended Reading	147	(2)
When the Work Doesn't Work	149	(22)
Not Resolving Important Conflicts over Plan or Methodology	149	(1)
Not Helping Clients Obtain Needed Resources	150	(1)
Getting Too Far Ahead of the Client	150	(1)
Overestimating the Ease of Change	150	(1)
Skipping the Middle Part	151	(1)
Steering Around Topics or Feelings	152	(1)
Not Challenging or Confronting the Client When Process Is Stuck	153	(1)
Giving Up Too Soon	153	(1)
Pushing the Client	154	(1)
Using Inappropriate or Meaningless Strategies	154	(1)
Showing Favoritism	155	(1)
Taking Sides	155	(1)
Defending Our Own Points of View	156	(1)
Using Strategies That Embarrass the Client	156	(1)
Skewing the Work	157	(1)
Providing Inadequate Support and Reinforcement	158	(1)
Scoutmaster Behavior	158	(1)
Expressing Upsets with Clients	159	(1)
Not Dealing in Supervision with Feelings About a Client	160	(1)
``Should'' and ``Ought'' Statements	160	(1)
Misspeaking	160	(1)
Ending Sessions Early Because the Client Is Silent	161	(1)
The Client Is Testing and the Worker Doesn't See	161	(1)
Blaming Clients for Failures in the Work	162	(1)
Serious Mistakes, Serious Consequences	162	(1)
Boundary Violations	163	(1)
Funny Money: Improper Financial Dealings	164	(1)
Working While Impaired	165	(1)
Untruthful or Devious Behaviors	165	(1)
Sexual Harassment in the Workplace	166	(1)
Responding to Egregious Behaviors	167	(1)
Conclusion	168	(1)
Exercises	168	(1)
Recommended Reading	169	(2)
Common Mistakes in Ending	171	(19)
Factors Influencing Ending Process	171	(7)
Steps in Ending	178	(4)
Other Common Mistakes in Ending	182	(5)
Conclusion	187	(1)
Exercises	188	(1)
Recommended Reading	189	(1)
Epilogue	190	(5)
Questions That Haunt Us All from Time to Time	190	(1)
Developing Important Capacities	191	(2)
Where to from Here?	193	(2)
References	195	(8)
Index	203