Trigger Response Drill Cards

Depressed mood, severe fatigue, and unexplained/effortless weight loss

Encourage/refer the client to see an MD first to rule out organic/medical causes

Stabilized bipolar client arrives decompensated, sleep-deprived, and asking for social favors

Assess for compliance with medication first

Sexual dysfunction/impotence linked to situational performance anxiety

Consider Sensate Focus (graduated touching to reduce performance pressure)

Older adult with suspected early Alzheimer’s or cognitive changes needs biopsychosocial assessment

Interview the client himself first; do not bypass the client for family or doctors unless incapacity is proven

Neglected young foster child who is emotionally withdrawn, lacks positive affect, and does not seek/respond to comfort

Consider Reactive Attachment Disorder (RAD)

First-time parents facing unexpected, severe infant birth defects in the hospital

Explore the parents’ emotional reaction to having a baby with special needs

Unemployed parent facing imminent eviction and food insecurity seeks financial help

Complete an eligibility assessment for immediate concrete assistance first

Hallucinations/delusions lasting between 1 and 6 months (4months)

Schizophreniform Disorder (under 1 mo = Brief Psychotic; over 6 mos = Schizophrenia)

Pervasive inability to accept statements/actions or trust others across work, social and therapeutic settings

Unresolved Trust vs. Mistrust (Erikson’s infancy stage)

Cognitive therapist setting treatment focus for anxiety and self-blame

Work with the client to change their distorted sense of self/cognitive distortions (not defense mechanisms or childhood origins)

Client with suicidal history excessively flatters therapist while trashing all past providers

Pay close attention to Boundaries (managing splitting and idealization/devaluation)

Therapist discovers outside overlap/coincidence

Share the information with the client and discuss the impact openly in session

Vulnerable ongoing client loses job and cannot afford therapy

Arrange for a reduced fee / sliding scale based on income to maintain continuity of care

Employee Assistance Program (EAP) referral for caregiver burnout with limited 6 sessions

Provide information about services and how to obtain them (short-term assessment and resource linkage)

Client states they are “disinterested in discussing emotional material” when approaching termination

Recognize this as resistance/avoidance, NOT a valid sign of termination readiness

Supervisee reports colleagues are struggling with clients and doesn’t know how to address it

Explore the specific concerns the supervisee has before directing action or intervening

Two treating providers (MD and Psychiatrist) give conflicting placment recommendations

Schedule a conference with both professionals to achieve clinical consensus first

Discrepancy between school behavior and home behavior in an 8 year old

Obtain a signed release to gather collateral information from the school before individual child therapy

Member intimidates peers or monopolizes a therapy group

Encourage group members to share their feelings about the behavior (use the group process)

Client with multiple past treatment failures enters therapy saying “nothing works”

Help the client identify barriers to success in previous treatment attempts first

Involuntary psychiatric hold patient demands discharge and refuses care

Remind the client that the hospitalization is not voluntary

Parents of an 18-year-old entering rehab declare they are cutting off all contact

Meet with the parents to discuss their decision first to inform discharge and care planning