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Learning from Mistakes in Clinical Practice » (1st Edition)

Book cover image of Learning from Mistakes in Clinical Practice by Carolyn Dillon

Authors: Carolyn Dillon
ISBN-13: 9780534524012, ISBN-10: 053452401X
Format: Paperback
Publisher: Cengage Learning
Date Published: February 2002
Edition: 1st Edition

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Author Biography: Carolyn Dillon

Carolyn Dillon, LICSW, is a Clinical Professor at Boston University School of Social Work and a longtime clinician, supervisor, and consultant to practice agencies. She has received awards for teaching excellence from Boston University, from the School of Social Work's Alumni Association, and from the Massachusetts Chapter of the National Association of Social Workers. Carolyn has 35 years of practice experience with adults coping with mental illness, family breakdown, and health challenges. She is the author of LEARNING FROM MISTAKES IN CLINICAL PRACTICE and also volunteers as a teacher of English to speakers of other languages.

Book Synopsis

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.

Booknews

This guide for students, beginning clinicians, and allied health professionals employs multicultural vignettes in a variety of settings to describe some of the mistakes commonly made by therapists. Coverage includes how to avoid or repair the damage from mistakes such as breaches of confidentiality, steering around difficult topics, and minimizing signs of risk. Dillon teaches at the Boston University School of Social Work. Annotation c. Book News, Inc., Portland, OR (booknews.com)

Table of Contents

Prefacex
1Becoming a Professional1
The Dawning of a New Awareness1
Additional Complications in Clinical Roles2
The Professional Learning Curve3
At One with Clients, Yet Different from Clients5
Crises Around Learning to Be Deliberate6
Tending, Not Just Having, Relationships7
You, Too?8
Noting and Making Use of Parallels8
Reconciling with Strengths and Limitations8
Moving from Smart to Wise10
Will Anything Rule Me Out?11
2Early Successes and Derailments14
Defining and Identifying Mistakes14
How Can We Tell When Clinical Work Is On Track?15
Usefulness of Recordings15
General Characteristics of Effective Work16
Discerning Our Mistakes20
Common Worker Signals of Mistakes in Progress23
Frequent Sources of Derailment26
3Engaging With Clients and Getting Started39
True Engagement Is Hard Work40
Initial Challenges and Pitfalls41
Startup Conversation and Exploration44
Other Orientation Topics47
Hesitating to Discuss Worker--Client Differences48
Overlooking Fundamental Human Resources48
Problems with Technique in Engaging and Starting Up49
Asking Questions Closely Aligned with Where the Client Is49
Avoiding Rapid-Fire Questions50
Using Open-Ended Questions51
Asking Rather Than Assuming51
Leaving Time to Reflect After Each Segment of Discussion52
Purposeful Focusing52
Appropriate Timing and Dosage53
Carefully Working from the Outside In53
Overprotecting Clients54
Prejudice and Ignorance in Action54
Class Differences and Classist Behaviors Can Affect Engagement55
Attitude Taints Engagement56
Shifting Meeting Times Creates Bad Feelings57
Emergency Interruptions Can Derail Bonding and Work57
Emotional Overbooking Is Visible58
Missteps Around Confidentiality and Privacy58
Breaches of Confidentiality58
Inflexibility Regarding Confidentiality59
4Professional Relationships: Steps and Missteps67
Unique Features of the Worker--Client Relationship68
Worker Self-Disclosure as a Form of Relational Tending69
Empathy: Being Where the Client Is70
Conditions Conducive to Accurate Empathy71
Missteps in Trying to Empathize76
Trivializing via Excessive Universalizing78
Restoring Empathic Alignment81
Worker Concerns About Relating with Clients83
Shared Concerns About Relating with Other Agencies and Helpers84
Common Mistakes in Relating with Clients84
5Assessment and Contracting90
Assessment90
Observation Changes the Observer and the Observed91
Elements of Good Assessment92
Frequent Mistakes in Assessment96
Implications for Contracting with Involuntary Clients108
Mistakes in Contracting109
Larger Systems Issues116
6The Middle Phase of Work119
Common Foci for Work119
Techniques for Updating Unhelpful Thoughts128
Integrative Techniques for Working on Feelings and Behaviors138
Connecting the Past, the Present, and Hopes for the Future143
Going Home Again144
7When the Work Doesn't Work149
Not Resolving Important Conflicts over Plan or Methodology149
Not Helping Clients Obtain Needed Resources150
Getting Too Far Ahead of the Client150
Overestimating the Ease of Change150
Skipping the Middle Part151
Steering Around Topics or Feelings152
Not Challenging or Confronting the Client When Process Is Stuck153
Giving Up Too Soon153
Pushing the Client154
Using Inappropriate or Meaningless Strategies154
Showing Favoritism155
Taking Sides155
Defending Our Own Points of View156
Using Strategies That Embarrass the Client156
Skewing the Work157
Providing Inadequate Support and Reinforcement158
Scoutmaster Behavior158
Expressing Upsets with Clients159
Not Dealing in Supervision with Feelings About a Client160
"Should" and "Ought" Statements160
Misspeaking160
Ending Sessions Early Because the Client Is Silent161
The Client Is Testing and the Worker Doesn't See161
Blaming Clients for Failures in the Work162
Serious Mistakes, Serious Consequences162
Boundary Violations163
Funny Money: Improper Financial Dealings164
Working While Impaired165
Untruthful or Devious Behaviors165
Sexual Harassment in the Workplace166
Responding to Egregious Behaviors167
8Common Mistakes in Ending171
Factors Influencing Ending Process171
Steps in Ending178
Other Common Mistakes in Ending182
9Epilogue190
Questions That Haunt Us All from Time to Time190
Developing Important Capacities191
Where to from Here?193
References195
Index203

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