English for Psychotherapy and Counselling: Handbook for Practitioners. Английский для психотерапии и консультирования: практическое руководство

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

2. Explaining Confidentiality

Sample language:

• “Everything we discuss in our sessions is confidential. This means I don’t share what you tell me with anyone without your written permission”.

• “Confidentiality is essential because I want you to feel safe talking openly about whatever is on your mind”.

• “However, there are some important limits I need to tell you about…”

Explaining the limits:

• “If I believe you are at serious risk of harming yourself, I will need to take steps to ensure your safety”.

• “If I believe you are at risk of harming someone else, I have a duty to warn”.

• “If I suspect abuse or neglect of a child, elderly person, or dependent adult, I’m legally required to report it”.

• “If a court orders me to release records through a subpoena, I will have to comply”.

• “In all of these situations, I would 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 50 minutes, and most people find weekly sessions work well at first”.

• “Therapy is a collaborative process. We’ll work together to identify your goals and figure out the best approach”.

• “My role is to listen, ask questions, offer different perspectives, and teach you tools and strategies that might help”.

• “Your role is to be as open and honest as you feel comfortable being, and to let me know if something isn’t working for you”.

• “I should mention that therapy can sometimes be uncomfortable. When we discuss difficult experiences or emotions, it can bring up challenging feelings. This is often a normal part of the 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 to contact me between sessions, you can call the office and leave a message. I typically return calls within 24 hours”.

• “For emergencies, I’ll give you information about who to contact”.

• “Our relationship is a professional one, which means we won’t have contact outside of these sessions beyond what’s necessary for your treatment”.

5. Collaborative Goal-Setting

Sample language:

• “What would you like to achieve through our work together?

• “If therapy is successful, what will be different in your life?”

• “What would you like to focus 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 I’ve explained?”

• “How are you feeling about what we’ve discussed so far?”

• “Is there anything you’d like me to clarify?”

7. Closing the Session

Sample language:

• “We’re coming to the end of our time today. Let me summarize what we’ve discussed…”

• “I want to acknowledge that it takes courage to come to therapy, and I appreciate you sharing with me today”.

• “How are you feeling about our conversation today?”

• “Let’s 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 a short explanation of confidentiality and its limits that you would give to a new client. Include:

• The general principle of confidentiality

• Why it’s important

• The specific limits

• An invitation for questions

Exercise 2: Responding to Client Questions

How would you respond to these client questions?

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

2. “What happens if I tell you I’m thinking about hurting myself?”

3. “Can we be friends on social media?”

4. “Can I text you between sessions?”

5. “How long will I need to be in therapy?”

6. “What if therapy doesn’t 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 of what will happen in the session

• Explanation of confidentiality

• Description of the therapy process

• Invitation to share what brings them to therapy

Practice your script with a partner, then get feedback.

Exercise 4: Role Play

In pairs, practice a first session. One person is the therapist, one is the client.

Therapist tasks:

• Create a welcoming 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 a specific scenario

• Ask questions about confidentiality or the process

• Share a concern (real or imagined)

• Give feedback to the therapist afterward

After 15—20 minutes, switch roles.

Vocabulary and Collocations for Unit 2

rapport – раппорт, контакт

therapeutic alliance – терапевтический альянс

confidentiality – конфиденциальность

boundaries – границы

informed consent – информированное согласие

safe space – безопасное пространство

initial therapy session – первая терапевтическая сессия

professional encounter – профессиональная встреча

make an appointment – записаться на прием

feeling anxious – чувствующий тревогу/испытывающий чувство тревоги

uncertain – неуверенный

vulnerable – уязвимый

foundation of trust – основа доверия

collaborative relationship – совместные отношения

first impression – первое впечатление

make eye contact – устанавливать зрительный контакт

warm greeting – теплое приветствие

speak freely – говорить свободно

opening conversation – вступительная беседа

at your pace – в вашем темпе

legal formality – юридическая формальность

ethical cornerstone – краеугольный камень этики

empower clients – наделять клиентов полномочиями

establish transparency – установить прозрачность

private information – частная информация

risk of harming – риск причинения вреда

suspected abuse – подозреваемое насилие

therapeutic boundaries – терапевтические границы

professional limits – профессиональные ограничения

session structure – структура сессии

contact between sessions – контакт между сессиями

social media policies – правила/политика социальных сетей

physical boundaries – физические границы

role clarity – ясность ролей

build trust – выстраивать доверие

build rapport – выстраивать раппорт

open-ended question – открытый вопрос

active listening – активное слушание

empathy – эмпатия

unconditional positive regard – безусловное позитивное принятие

validation – валидация

appropriate self-disclosure – уместное самораскрытие

therapeutic relationship – терапевтические отношения

positive therapy outcomes – позитивные результаты терапии

collaborative goal-setting – совместная постановка целей

track progress – отслеживать прогресс

client – клиент

collaborative – совместный

establish boundaries – устанавливать границы

verbal consent – устное согласие

confide – доверять

confidential – конфиденциальный

comfortable – удобный, комфортный

collaborate – сотрудничать

collaboration – сотрудничество

empower – наделять полномочиями

empowerment – наделение полномочиями

empowered – наделенный полномочиями

sympathy – сочувствие

borders – границы (географические)

knowledgeable – осведомленный

collective goals – совместные/коллективные/общие цели

UNIT 3.

INITIAL ASSESSMENT

LEAD-IN:

Information Gathering and Sensitive Questioning Skills

Activity 1: Role-play everyday information gathering

Work in pairs. Take turns asking personal questions in these everyday situations:

• Meeting a new neighbour who has just moved in

• Interviewing someone for a shared apartment

• Getting to know a colleague at a new job

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 a client for the first time, which information is most important to gather? Rank these from 1 (most important) to 10 (least important):

• Current problem/reason for seeking help

• 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 a partner. Explain your choices.

Activity 3: Sensitive vs. direct questioning quiz

Which question is more appropriate for an initial assessment? Discuss why:

1. a) Have you ever tried to kill yourself?

b) Have you ever had thoughts of harming 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 in clinical 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 a client to seek help

b) First session designed to gather comprehensive background information

c) Evaluation of potential danger to self or others

d) Systematic observation of a client’s psychological functioning

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

f) A trusting, comfortable connection between therapist and client

g) The primary symptom or concern in the client’s own words

h) The principle that client information remains private

READING:

Understanding the Presenting Problem: Initial Assessment

Pre-reading task

Before you read, discuss:

1. What do you think happens in the first session with a client?

2. What information should a psychologist gather during an intake interview?

3. Why is it important to understand the “presenting problem”?

4. What is a mental status examination?

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Understanding the Presenting Problem: Initial Assessment

When a client first contacts a psychologist, one of the most important tasks is conducting a comprehensive 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 to understand the client’s difficulties within the context of their life.

The Purpose of Initial Assessment

The initial assessment serves multiple purposes. First, it allows the psychologist to understand 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 to therapy, described in the client’s own words. Second, the assessment provides comprehensive background information about the client’s 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 a referral to another professional would be more appropriate.

The initial assessment is also the beginning of the therapeutic relationship. During this first session, the psychologist works to establish rapport – a trusting, comfortable connection with the client. Without rapport, clients may not feel safe enough to share sensitive information or engage fully in the 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 to let the client tell their story in their own way. Common opening questions include: “What brings you here today?” or “What’s been happening that led you to seek 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 to clarify the nature of the difficulty. Important aspects to explore include:

• Onset: When did the problem begin? Was there a specific 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 to address the problem? What worked or didn’t work?

• Client’s understanding: What does the client think is causing the problem? What are their expectations for treatment?

For example, a client might say: “I’ve 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 to manage it? This detailed exploration helps the psychologist understand not just the symptom, but the context surrounding it.

Taking the Psychosocial History

After exploring the presenting problem, the psychologist gathers information about the client’s psychosocial history – their personal, family, social, educational, occupational, and medical background. This comprehensive history helps the psychologist understand the client as a whole person and identify factors that may contribute to current difficulties.

Key areas of psychosocial history include:

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

Educational and occupational history: school performance, level of education, 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 of interpersonal 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 of psychotropic medication use.

Substance use: current and past use of alcohol, tobacco, and other substances.

The psychologist uses a combination of open-ended and closed-ended questions to gather this information efficiently while still allowing the client to share their story. For example, a closed-ended question like “Are you currently employed?” establishes a fact, while an open-ended follow-up like “Tell me about your work situation invites the client to provide context and detail”.

Conducting a Mental Status Examination

An essential component of the initial assessment is the mental status examination (MSE) – a systematic observation and description of the client’s current psychological functioning. While some aspects of the MSE are observed naturally during the interview, psychologists may also ask specific questions to assess 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 in speech patterns.

Mood and affect: mood is the client’s subjective emotional state (how they say they feel), while affect is the observable emotional expression. Psychologists assess whether affect is appropriate to the 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 of disorganization, 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 aren’t there) or other perceptual disturbances.

Cognition: assessment of orientation (awareness of time, place, and person), attention, concentration, memory, and general intellectual functioning.

Insight and judgment: the client’s awareness of their condition and their ability to make sound decisions.

The MSE provides a “snapshot” of the client’s mental state at the time of the assessment and helps identify symptoms that may indicate specific mental health conditions.

Risk Assessment

A critical component of any initial assessment is evaluating risk – particularly the risk of self-harm, suicide, or harm to others. Psychologists must directly but sensitively ask about these concerns. Contrary to common fears, asking about suicidal thoughts does not increase the risk; instead, it demonstrates care and creates an opportunity for the client to discuss difficult feelings.

Risk assessment questions might include: Have you had any thoughts of harming yourself? Have you had thoughts of ending your life? Do you have a specific plan? If a client endorses suicidal thoughts, the psychologist assesses the frequency, intensity, duration, and whether the person has means and intent to carry out a plan. Protective factors, such as reasons for living, social support, and future orientation, are also explored.

Formulating and Planning

At the conclusion of the initial assessment, the psychologist integrates all the information gathered to develop a preliminary understanding of the client’s difficulties. Many psychologists use a formulation framework called the Four Ps:

• Predisposing factors: background factors that make the person vulnerable (e.g., family history of mental 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 of social 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 of the initial assessment?

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

3. Why is rapport important in the first session?

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

5. What types of information are included in a psychosocial history?

6. What is the difference between mood and affect in the MSE?

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

8. What are the “Four Ps” in formulation?

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

10. What areas does a mental status examination cover?

VOCABULARY:

Assessment Terminology and Mental Status Examination

A. Find words in the text that match these definitions:

1. The main problem that brings a client to therapy (paragraph 2): _______

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

3. The beginning or start of a problem (paragraph 4): _______

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

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

6. A client’s subjective description of their emotional state (paragraph 8): _______

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

8. Awareness of one’s condition (paragraph 8): _______

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

10. Factors that maintain or worsen a problem (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 _______

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C. Word families

Complete the table:

D. Match the MSE terms with descriptions:

1. Affect

2. Thought process

3. Orientation