Introduction
This session will discuss Rameen’s case, the client’s concerns, and how to complete the duties required for a clinical interview. This article examines the introduction, opening, and early portions of a clinical session with Rameen. This article will focus on the ethical, legal, and cultural aspects of the case and on solutions to achieve compliance with these considerations. Evaluations that Rameen may benefit from, as well as discussions with the customer regarding them, will be reviewed.
Finally, this paper will examine the necessary activities for an intake interview and the potential obstacles that may arise throughout the intake process. Sommers-Flanagan and Sommers-Flanagan (2017) write that efficiently acquiring important information about a new customer while developing rapport can be complex. The proposed models will help to conduct a thorough assessment of the patient’s behavior and identify the specifics of the session, taking into account their religious and cultural affiliations.
Identification of Case and Summarization of Skills
Rameen, a 27-year-old woman, is pursuing a Master’s degree in physical therapy while working in her family’s medical practice for pay. Rameen is Muslim, was raised in a multigenerational household, and her parents are still married. She is currently debating her sexuality; she is privately dating a woman and going on dates recommended by her mother in public. Rameen is afraid her parents will disown her if they find out she is questioning her sexual identity. She has considered suicide as a more accessible option than revealing to her parents that she may be gay.
Rameen is upset because she cannot be herself and has no one to talk to about it, despite admitting she has close friends she sees on weekends; she is also concerned about her parents discovering her secret dating life. Rameen is unaware of her family’s mental health concerns, even though she occasionally witnesses her mother crying. Rameen’s present concerns include anxiety, despair, fear, sexuality struggles, self-acceptance, and a personal value conflict between religion and her affection for women. She also experiences unbalanced feelings within herself and poor communication with family and friends.
This study will focus on the body’s introduction, opening, and beginning phases, including assessments. Sommers-Flanagan and Sommers-Flanagan (2017) follow Shea’s model of the clinical interview, which includes an introduction, opening, body, closing, and termination. A collaborative relationship between a counselor and a client starts with the introduction. It continues throughout the process, as the clinician establishes rapport and obtains information from the client, to put the client at ease (Garey et al., 2020).
The introduction may take place over the phone to establish the initial face-to-face encounter. The phone call should be collaborative in selecting a time to meet and brief enough to confirm the meeting, beginning with a respectful greeting such as Ms., Mrs., or Mr. (Mohamed et al., 2020). The introduction during the first face-to-face contact should not take place in public.
The first sentence in a clinical interview should build rapport with the client. For example, the therapist should reassure the client that they are looking forward to working with them during the session (Sommers-Flanagan & Sommers-Flanagan, 2017). This is where a clinical mental health counselor might include their educational history, length of practice, and sometimes something personal, such as a hobby.
A CMHC could also comment on a gentleman’s baseball cap, building personal interaction with the client (Rudenstine et al., 2020). This is also the time to discuss the CMHC’s duty to report any threats to the client’s or others’ lives (Mohamed et al., 2020). The other four people in the office who may have access to the client’s files, such as the CMHC’s supervisor and supervisee, should also be named.
The body of the interview is where the CMHC develops a rapport with the client and attempts to ascertain why the client sought mental health therapy. The CMHC must be careful not to judge the facts presented by the client or to express an opinion on the client’s life choices (Garey et al., 2020). The most significant barrier to a client seeking mental health services is self-stigma, mainly if the client was or is in the armed services. Thus, a CMHC counselor must allow the client to self-affirm the reason for seeking mental health help, as this will serve as a strong foundation for rapport throughout the session.
The body of the interview is also where a CMHC assesses the client’s interpersonal skills and level of deviance. During this part, it should be clarified whether the client is experiencing any distress, whether the client is displaying signs of hostility, internalization, or externalization of issues, and whether the client has any coping skills (Rudenstine et al., 2020). The therapist should also clarify what theoretical orientation may be a good fit for this client’s presenting problem.
Exploration of Ethical, Legal, and Cultural Considerations
The first topic in ethical and legal considerations covers personal information and privacy. The therapist should ensure they do not disclose a client’s name or any genuinely unique or personal information outside a private setting, to avoid violating the privacy rule set by the American Counseling Association (ACA, 2014). Client confidentiality is protected by the Code of Ethics (ACA, 2014).
While there are a few exceptions to confidentiality, they are also specified for the CMHC. The first one is the case when there is an immediate danger to the client or a member of society, such as suicidal or homicidal ideation, that can be discussed with the client before reporting to appropriate authorities (Cioffredi et al., 2021). The second case is when the CMHC is currently in a supervisor-supervisee relationship, such as a student CMHC.
Rameen is a Pakistani American, and there could be a variety of reasons why seeking counseling is difficult for her. One is a reluctance to discuss personal issues that she has mentioned, which could stem from her upbringing, or a case of cultural stigma being trapped between Pakistani traditional beliefs and customs and the values of American society. Rameen’s culture is also heavily influenced by her Muslim religion, which dictates cultural norms for clothes, food, drink, and sexual identity. Another major problem for Rameen is that her mother has high expectations for Rameen’s dating life. Many non-Western marriages are considered recognized traditions that support family economies and kinship networks.
While Rameen is debating whether to remain a Muslim due to her deep affection for women, she is still pondering her sexual orientation. According to the Code of Ethics (2014), a CMHC must be mindful of the client’s culture, religion, and LGBTQ+ status when navigating multiculturalism. When a member of the LGBTQ+ community perceives oppression from a religious institution, it emerges as suicidal ideation, despair, self-mutilation, drug or alcohol addiction, and suicide completion.
Assessment Identification
Cultural sanctions are cultural behaviors that send messages about the acceptability of suicide or the guilt associated with life situations that may lead to suicide. In terms of a suicidal risk assessment with Rameen, this is the method that could be used because few suicidal assessments consider those in minority groups, let alone someone who identifies with two minority cultural groups (Garey et al., 2020). The assessment’s categories are divided into very concrete subpoints for people coping with minority status.
The first category includes idioms of distress, which are cultural variations that reveal a person’s propensity to express suicide, how suicide symptoms are communicated, or the manner or means used in a suicide attempt. The second category is minority stress, which refers to cultural experiences related to social identity or place in society, such as social disadvantages, discrimination, or acculturation challenges (APA, 2020). The third category is social discord, which includes dispute, alienation, or a lack of integration with one’s family, friends, or community, which can all contribute to suicide.
A biopsychosocial examination should be performed, as understanding the client’s worldview is critical to understanding the client. To do that, the CMHC must adhere to the Evaluation, Assessment, and Interpretation of the Code of Ethics (2014). This section addresses the practitioner’s ability to assess clients, the information acquired through assessments, and the client’s agreement to utilize assessments.
A thorough biopsychosocial assessment involves assessing the client’s values and beliefs and removing microaggressions and discriminatory language from forms. A biopsychosocial assessment also requires the therapist to be aware of labels used in verbal exchanges with the client (Mohamed et al., 2020). They should recognize both the LGBTQ+ community’s minority status and marginalization and religious privilege in the United States. During biopsychosocial assessment, both the LGBTQ+ and spiritual identities should be considered while developing a joint approach.
Exploration of Interview Tasks
Microaggressions limit the client’s trust in a therapeutic connection with many sexual minority clients. A CMHC who recognizes these microaggressions that may occur during the initial contact may irreversibly jeopardize the prospects of a collaborative partnership. As a result, a CMHC must continually utilize inclusive language, mainly when a sexual minority is not readily apparent (APA, 2020). This might be performed by asking the client whether they are having problems with their significant other or are involved in a relationship.
Another factor to evaluate is whether Rameen is a natural English speaker. Given her upbringing in a multigenerational household, there is a good chance that she is multilingual. Many diversity factors can influence a client’s responses during an intake or assessment, including cultural barriers, adaptation, social class, language, gender, family roles, sexual orientation, and religion (APA, 2020).
There is a tactic aimed at approaching the subject of a need for a suicide assessment and other clinical assessments with Rameen. Sommers-Flanagan and Sommers-Flanagan (2017) suggest normalizing some questions for her, which will help her feel more collaborative in the assessments. Discussing the minority stress model with Rameen may also make her feel more at ease taking the assessments and allow her to open up more (Rudenstine et al., 2020). The minority stress model states that systematic stressors and lack of emotional support are a risk for psychosocial distress in people of a sexual minority compared to heterosexual individuals.
To address the subject of a suicide evaluation and other clinical assessments, Rameen, Sommers-Flanagan, and Sommers-Flanagan (2017) recommend normalizing some questions for her. According to the minority stress model, systematic stressors and a lack of emotional support are more likely to cause psychosocial distress in sexual minorities than heterosexuals (Cioffredi et al., 2021). This will make her feel more like the assessments will be collaborative.
Conclusion
Rameen’s case is genuinely complex: with cultural differences, religion being a significant issue, potential language problems, and LGBTQ+ considerations, the entrance interview must be conducted as objectively as possible. Allowing Rameen to express her problems nonjudgmentally may encourage her to open up and work through her difficulties. This is a rather difficult patient, but using behavioral assessment models, the therapist can achieve results that will help the client cope with her depression, anxiety, and suicidal thoughts.
References
American Counseling Association. (2014). Code of ethics.
American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.).
Cioffredi, L. A., Kamon, J., & Turner, W. (2021). Effects of depression, anxiety and screen use on adolescent substance use. Preventive Medicine Reports, 13(58), 344-355.
Garey, L., Olofsson, H., Garza, T., Rogers, A. H., Kauffman, B. Y., & Zvolensky, M. J. (2020). Directional effects of anxiety and depressive disorders with substance use: A review of recent prospective research. Emotion and Addiction, 7(22), 344-355.
Mohamed, I. I., Ahmad, H. E., Hassaan, S. H., & Hassan, S. M. (2020). Assessment of anxiety and depression among substance use disorder patients: A case-control study. Middle East Current Psychiatry, 22(17), 31-35.
Rudenstine, S., Espinosa, A., & Kumar, A. (2020). Depression and anxiety subgroups across alcohol use disorder and substance use in a national epidemiologic study. Journal of Dual Diagnosis, 16(3), 299-311.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2017). Clinical interviewing (6th ed.). John Wiley & Sons.