March 15, 2020
Welcome to What’s Better This Week? Episode 5: More Superfluous Data & Pee
When we last left off, we covered what happens in the second assessment appointment, and we put our pinky toe in the water for how solutions focused counselors begin to address the concept of diagnosis with patients, while balancing out clinical requirements to New York State, the Office of Mental Health, the Office of Substance Alcohol and Substance Abuse Services, and payers like Medicare and Medicaid.
So what happens in our Third Assessment Appointment? During the third assessment appointment, we will again be gathering data that is less relevant for our work with our patient, and that benefits, on the whole, the Department of Health’s mission to gather statistics for the sake of gathering statistics: what is your Tuberculosis status? What is your Hepatitis Status? What is your HIV Status? If a patient really wants services they’re not necessarily going to be forthcoming with us, and they may not necessarily know, and even if we *give* them referral information they may take it and throw it in the trash which is why these screening questions are - at best - superfluous, and at worst a waste of time: I don’t want to say that this *isn’t* our job (I do believe in the “it takes a village” concept toward community health) but I do believe that we should be providing the services that patients have come to us for, not what we *think* they need. If a patient has come to me for counseling, it’s not to receive the Department of Health’s Statistical Questionnaire. We then provide our patients with printed information on all of the above without cause or concern for their ability to read and comprehend that information (more on that in a future episode, because we will be working with patients who have a variety of different cognitive abilities).
So it is VERY easy to see why our patients can think that we’re totally out of touch, and totally out to lunch…because here it is, week THREE, and we’re not doing counseling…we’re still asking them questions…and now we’re asking them healthcare questions…so it’s vital that we take a solutions focused approach to this: “I know that this information isn’t what you want to talk about today; and I apologize that we’re required to ask it. Let’s try and get through it efficiently so we can get to what’s really important: the reason why you’re here. I’ll absolutely work to save a good half an hour today so we can talk with one another.”
After asking these health questions, we will then ask some more questions about orientation, and identity, straight off the bat, with only two previous sessions of rapport built up, which can be terrifyingly forward for our patients (since we’re the one’s asking the questions, rather than eliciting information through a Solution Focused model) - but it’s there on an assessment form, and we have to provide a response: because if we don’t we’re not doing our duty to our agency, and we cannot simply respond with our own guess work, and we have to also respect the personal right of our patients to also choose to respond (or not) to their comfort levels to these assessment questions (and some are perfectly fine responding to any and all questions asked, having been socialized to do so).
After this, we’ll then ask intimate questions about their relationship with their partner or spouse or significant other, and then their relationship to their family as a whole.
Finally, we’ll ask them for information on their CPS connection, and then we’ll ask for legal information (criminal background, arrests, any criminal justice hearings pending, etc.).
Here’s the thing: in ANY Solution Focused Brief Therapy session…if ANY of this was at ALL relevant to the work that the patient wanted, or felt needed to be done…it would COME OUT, all on its own…so once we’re done with this display of superfluous data gathering for the sake of gathering data, then we have to go and get some pee. Why? There is a clinical justification for this…but it doesn’t flow with Solutions Focused work. The clinical justification is that the DSM-V (you know, the one with poor interrupter reliability? The one that no one else but the United States uses? Yeah, that DSM-V…that masterpiece brought to us by the American Psychiatric Association) is always asking clinicians to rule out substance use before making a diagnosis…because they don’t want a clinician to diagnose for say…Bipolar Disorder when it’s really Cocaine Use. Fair enough…but what if, like I do, we don’t find diagnosis generally beneficial or necessary in order to treat the patient (especially when the interrupter reliability is so low…and it’s just so unnecessary)…well, then, we’re just engaging in this process because, again, it somehow appeases an outside force, not because it’s in the best interest of our patient.
If Substance Use is impacting our patient’s lives, we will get there in an SFBT session - be sure of it; but because of regulations, we will collect a cup of pee, for this golden cup to act as a neutral arbiter of any “secrets” that our patients are keeping from us (which is their right to do, by the way).
So, now, hopefully, having gathered data that you as an SFBT practitioner will probably never look at again, now at last, you will at least have some time to talk with your patient - in a Solution Focused manner, have a good half hour, and make a real connection…because you’re going to need it…because the most important part (at least, the part that lets us justify and bring Solution Focused Brief Therapy to outpatient and inpatient Mental Health Settings in the United States) comes in the next session: it’s the Treatment Planning Session, which justifies funding, and has to be linked to in every single subsequent session…and this one we’ll cover in Episode Six, available next Sunday.
Thank you for listening. Please tune in again next Sunday, as we continue forward together down our solutions focused path. Comments, constructive criticism, feedback, and questions can be sent to email@example.com
t. Yes we’re on Social Media @WBTWCast on all of the platforms you’d think to look at. I’m @TheMattSchwartz, and it’s time for some self care with my cat, Akiva, who is patiently waiting for cuddles while I record this.
The music you’re listening to in the background today is Boston Landing on “Blue Dot Sessions" generously shared through a creative commons license. Please find more of their music at www.sessions.blue
, that’s w-w-w- dot s-e-s-s-i-o-n-s- dot b-l-u-e. I’ll see you next Sunday with more; until then, make good choices.