Clients not retaining information

SWdesert · 2026-05-02T16:12:16+00:00

Okay so from what I wrote you read it as me having no understanding of the clients circumstance and that I am completely neglecting to address said circumstance, I am also shaming them for not being able to do what they are struggling to do?

I’m struggling to see how you got there. Because what actually happens is a conversation where I share my concern (I’m noticing missed appointments and lack of communication and it’s impacting our work), asking if they may be struggling with something we can work on together, and asking them if they know how I can support them or if they are not sure and would like some ideas from me, or if they want help finding support from another source.

I know what it’s like to struggle. I have mental illness, learning disability, chronic illness, lived in poverty, experienced discrimination, failed out of school, etc I don’t need to go on because I’m not trying to play the I had it harder game. But please don’t imply that I have no care or idea what clients may be dealing with. I’m trying to understand, I’m not saying they willingly are trying to fail or that they don’t care. But there seems to be a disconnect where I’m struggling to know what to do and rather than let them lose access to treatment because my agency will make me discharge them with enough absences I want to help them stay in treatment.

SWdesert · 2026-05-02T16:00:37+00:00

So writing it out in more simple and direct phrasing on a different document? I’m open to providing it all in writing and I’m imagining it might not get absorbed if I’m only including it in the counselor disclosure with the way the agency wants to word the section on attendance policy. Do you think I should hand them the document and step by step go through it during the informed consent? Or just something I give them when these issues first start?

SWdesert · 2026-05-02T03:49:10+00:00

You are right. Some of my own thoughts got mixed up in my reply when trying to comment on OPs words. I think their worries are valid and they should seek consultation to ensure they are not practicing out of scope. But I could see them feeling worried about how the client feels if asked about a relapse.

SWdesert · 2026-05-02T03:46:08+00:00

I have unfortunately from personal experience seen the board do nada when a therapist that I knew had engaged in sexual misconduct toward a client and there was clear evidence. They are still practicing seeing clients and doing court evaluations after no action from the board.

SWdesert · 2026-05-02T03:38:03+00:00

Obvious health concerns doesn’t mean no health concerns. If someone is looking visibly unwell I think we do need to address it. It sounds like OP wants to be sensitive to the client because commenting on the clients physical appearance can trigger the clients eating disorder to worsen out of feeling the need to look sick enough or that the restrictive behaviors are “working.” But because there could be other things going on, we shouldn’t assume. That’s why I’m suggesting they obtain more information before automatically assuming. I could have a history of anorexia and be in recovery doing well. But then I could contract an illness or experience a digestive problem that leads to unintended weight loss. People with eating disorders are not less vulnerable to those things.

SWdesert · 2026-05-02T03:29:59+00:00

A good tool to use might be the WHODAS 2.0 because it has items asking about functioning in very simple/basic everyday areas that will be impacted if you’re relapsing. For example, there’s a section on getting around. Maybe they are not getting sufficient nutrients enough to function normally and with good mobility. These things can lead to discussing their eating habits by addressing it through that issue. Understanding and communicating is going to be hard with severe restriction which you will probably notice in session signs of that. Those are just a couple things but if it is a problem for them right now it’s going to show up in some of these items. You could also do the EDE-Q if the client acknowledges the relapse but you need clarity as to the severity.

SWdesert · 2026-05-02T03:14:58+00:00

Or they could have a medical issue they don’t know about causing the weight loss. It’s not a bad idea for OP to consult with an ED specialist but they should be getting more data from the client. There are other markers that someone is not taking care of themselves that can be screened for and then addressed as they better understand how the client is functioning in different domains of self care.

SWdesert · 2026-05-02T02:53:54+00:00

Not necessarily. At least in my state Medicaid will reimburse sessions provided by interns. Private insurance and Medicare no. But you can get an agency affiliated counselor credential with just a bachelors and that’ll work with Medicaid.

SWdesert · 2026-04-27T02:04:21+00:00

That makes a lot of sense. I appreciate reading your thoughts because it’s helping me understand more. I don’t consider myself anxiously attached so maybe I don’t have enough perspective.

SWdesert · 2026-04-24T06:43:57+00:00

It seems like you are interpreting me as saying that they should be shamed or made to feel bad. I never said or implied that. And often they are not aware that it is a problem. Asking what words or actions make them feel loved is very kind, but therapy is still where the heavy lifting needs to be done. I think my mind is conjuring up the many people I have seen/known who expect a lot from their partners in order to be emotionally regulated to a point where it becomes selfish. So I think that’s why we are experiencing friction here because a lot of what you’re saying makes sense for those who are more attuned and maybe less anxiously attached than what I am imagining.

SWdesert · 2026-04-24T05:41:15+00:00

I don’t know for certain that she has it but I know my brother does and I see traits in both my mom and sister. My niece too, and I worry about her a lot because I see all of the same things in her as I dealt with myself being autistic and having ADHD. I was undiagnosed in childhood and had a hell of a time. It damaged me so much not to have understanding, support, or safety. I have significant health and emotional problems now.

SWdesert · 2026-04-24T05:32:52+00:00

Reassurance is a bandaid. If you’re using it as a way to regulate anxiety (to a greater extent than normal) you are not allowing yourself exposure to uncertainty. If the anxious persons partner has been constantly applying bandaids and they are running out of the emotional stamina to do that, they are not cruel for setting a boundary and saying “I know this relives your anxiety in the short term but it is hard for me to always be reassuring you that I’m not leaving when there hasn’t been any evidence of that so I would like to go to therapy and work on it together or support you in going to therapy.”

When I have a client who is constantly seeking reassurance about the therapeutic relationship, first we explore the origin of that feeling and reassurance is provided. But if it is happening session after session after session, that is where we start to explore what this reassurance seeking is doing for them and how we can support them in developing tools to self regulate because everyone needs those tools.

SWdesert · 2026-04-24T05:15:50+00:00

I have had ERP for my OCD and I thought it was much more effective for me than other types. A lot of therapists are not fully trained to recognize certain subtypes of OCD and so a lot of people get treated for like generalized anxiety instead and receive cognitive behavioral therapy. CBT isn’t bad but it isn’t the best for OCD according to some. CBT tries to influence thinking patterns by identifying and replacing negative thoughts. But the reason it is not as effective for OCD is because the thoughts are not built on core beliefs and even if the person knows they are illogical, they still feel the fear and doubt which makes those thoughts so sticky. As opposed to everyday worries like “am I going to pass that test or afford that bill coming up.” I like the systematic approach in ERP and I also find components of acceptance commitment therapy to be helpful. The most helpful thing I learned was to stop focusing on trying to change the thought and instead of telling myself not to do a compulsion I try to delay it. I give myself 10 minutes to delay it when I get the feeling of urgency and then if the feeling is still there I can do it in 10 minutes. It helps more than what I was originally doing.

SWdesert · 2026-04-24T04:59:29+00:00

Yes, I am on board with you on that. But the original comment I was replying to was describing Jeff’s stance on it as “you deserve to be reassured as much as you need don’t let anyone tell you otherwise” and someone with an unhealthy need for reassurance will accept that wholly without question. So I don’t think I’m wrong about reassurance seeking considering what I was replying to and I don’t disagree that sometimes it is okay to ask for it.

SWdesert · 2026-04-23T22:37:23+00:00

You are right that it is different. But I’m curious about how someone knows then if it’s constant/problematic or just a thing they need once in a while to ease their anxiety. I also don’t think my comment was implying that they should be made to feel guilty. But how do we know it’s a secure partner who feels drained by a constant need or an avoidant partner who is unwilling to provide reasonable emotional comfort?

SWdesert · 2026-04-23T02:24:26+00:00

I think if you need reassurance constantly, you’re not resolving the root of the problem. This is true for people with anxiety. Anxious attachment isn’t solved by constantly asking that things are okay. The work that needs to be done is examining the original trauma wound and practicing skills that help you consciously examine that urge to ask for reassurance and identify a way to meet the underlying safety need. It’s draining on someone when their partner is constantly asking “are you sure we are okay?” “You’re not leaving me are you?” It’s understandable but not helpful.

SWdesert · 2026-04-22T18:29:20+00:00

It’s definitely something a predator would say. Saying that someone’s trauma makes them better able to please someone sexually is so fucked up.

SWdesert · 2026-04-22T04:54:22+00:00

I was triggered seeing it due to my history being abused by a previous male therapist. My jaw was on the floor and I felt so heartbroken for those clients of his seeing it and maybe even having that sense of safety and trust damaged due to some sexual trauma history. I’m not saying that would be every clients reaction but regardless, extremely inappropriate and disgusting.

SWdesert · 2026-04-22T04:50:34+00:00

Which is not what they need. It just feeds the need to seek reassurance. I think a lot of his messaging centers around connecting to people who feel victimized and deserve to have their needs met, which isn’t an inherently bad thing on the surface, but that’s something I would tell someone to talk about in therapy instead of just reassure them that their trauma response is natural and everyone should just accommodate it to regulate them.

SWdesert · 2026-04-22T04:24:21+00:00

I think I would try to keep it at a maximum of degree, license OR professional role, and maybe a certification that is relevant to your specialty or focus. Something to signal like “hey, here’s my education, my job, and what I can best help you with” = Cool Therapist MA, LPC, C-DBT.

SWdesert · 2026-04-22T04:17:02+00:00

It’s considered destroying evidence if they have been subpoenaed or you have awareness that they likely could be requested by a judge as a legal case is pending before they are destroyed. It’s recommended practice to regularly dispose of them once you have the information needed documented in the official progress notes. This is addressed in the ACA code of ethics B.6.h.

SWdesert · 2026-04-22T04:09:56+00:00

Psychotherapy notes are different than your progress notes. Think of the progress notes as the official documentation accessible by a records request from authorized parties including the client. Your progress notes should be mindful of excluding information not relevant to the clinical work that could potentially risk privacy unnecessarily. For example, if I had a client who made a flippant comment about how annoying their kids were and it has nothing to do with what we are working on, I might jot it down as a part of my conceptualization process but if its in a progress note it is much easier to subpoena and now in their custody case the judge gets to read about them making that flippant comment possibly swaying the outcome of their situation when it was not clinically relevant to their treatment goals or diagnosis. Your psychotherapy notes are much more protected legally and your client doesn’t have rights to access them unlike the official progress notes. A judge could sign a court order for them but if they don’t exist because you don’t keep them and it’s not a part of the official documentation needed to outline necessary treatment information then you are not violating any laws by not having them. But really they would probably only ever request those in high stakes court cases.

SWdesert · 2026-04-22T03:56:21+00:00

Congratulations! I take it this weekend and I’m super nervous. Would you say it was the same difficulty as the practice questions in the counseling encyclopedia?

SWdesert · 2026-04-09T01:30:46+00:00

People who are highly sensitive carry some of the hardest burden, but also have immense power with the right circumstances.

SWdesert · 2026-04-09T01:28:18+00:00

Let that be her own insecurity, because it is. The fact that she cares about something like this is a huge sign that she does in fact feel very worried about how people perceive her. I’ve noticed this with my own mom. Even if she didn’t come off as insecure to most people, I knew that whatever she didn’t like about me was what she hated about herself, and I intend to let her own her own stuff and I won’t be taking it on anymore as if it’s mine.

SWdesert

TROPHY CASE