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LOSING SIGHT OF THE GOAL

Client: Todd W., 46-year-old white man, employed full-time as an insurance adjuster. He initially sought therapy six weeks ago after his primary care provider referred him for anxiety, poor sleep, and frequent panic episodes related to work stress.

Clinician: Miriam B., 33-year-old Black woman, LCSW, trained in CBT and solution-focused therapy. She values structured treatment planning but also prioritizes building strong therapeutic relationships.

Session Summary:
It’s the seventh session. In their early work together, Todd and Miriam collaboratively identified three goals:

1. Increase coping skills for managing work-related anxiety

2. Improve sleep hygiene and reduce panic symptoms

3. Re-engage in previously enjoyed activities

However, over the last few sessions, Todd has begun using the hour to talk at length about frustrating coworkers, politics, and his broader dissatisfaction with the “state of the world.” While Miriam recognizes the importance of making space for emotion and meaning, she notices these sessions feel increasingly diffuse. He frequently jumps from topic to topic, and she struggles to redirect without feeling intrusive. At the end of today’s session, Miriam reflects privately that she’s not sure they’re making progress on any of the agreed-upon goals. She worries she may be prioritizing rapport at the expense of structure and wonders:

Is Todd avoiding the original focus of treatment?

Is she hesitating to challenge him out of fear of rupture?

Should she be more directive in revisiting the treatment plan?

How might Miriam explore this shift in session content with Todd in a way that is collaborative rather than corrective?
What strategies can help realign sessions with treatment goals without dismissing what the client brings into the room? How can a social worker differentiate between avoidance, meaning-making, and a need to revise the goals themselves?

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LOSING SIGHT OF THE GOAL

Client: Todd W., 46-year-old white man, employed full-time as an insurance adjuster. He initially sought therapy six weeks ago after his primary care provider referred him for anxiety, poor sleep, and frequent panic episodes related to work stress.

Clinician: Miriam B., 33-year-old Black woman, LCSW, trained in CBT and solution-focused therapy. She values structured treatment planning but also prioritizes building strong therapeutic relationships.

Session Summary:
It’s the seventh session. In their early work together, Todd and Miriam collaboratively identified three goals:

1. Increase coping skills for managing work-related anxiety

2. Improve sleep hygiene and reduce panic symptoms

3. Re-engage in previously enjoyed activities

However, over the last few sessions, Todd has begun using the hour to talk at length about frustrating coworkers, politics, and his broader dissatisfaction with the “state of the world.” While Miriam recognizes the importance of making space for emotion and meaning, she notices these sessions feel increasingly diffuse. He frequently jumps from topic to topic, and she struggles to redirect without feeling intrusive. At the end of today’s session, Miriam reflects privately that she’s not sure they’re making progress on any of the agreed-upon goals. She worries she may be prioritizing rapport at the expense of structure and wonders:

Is Todd avoiding the original focus of treatment?

Is she hesitating to challenge him out of fear of rupture?

Should she be more directive in revisiting the treatment plan?

How might Miriam explore this shift in session content with Todd in a way that is collaborative rather than corrective?
What strategies can help realign sessions with treatment goals without dismissing what the client brings into the room? How can a social worker differentiate between avoidance, meaning-making, and a need to revise the goals themselves?

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PAUSES, LULLS, AND SILENCE

Client: Devin R., 31-year-old biracial (Black/white) nonbinary person, recently began therapy to explore ongoing depression, persistent feelings of disconnection, and unresolved grief after the loss of a parent two years ago.

Clinician: Alyssa T., 36-year-old Latina woman, LCSW, relational psychodynamic orientation. She values depth work and believes strongly in “holding space,” but has also noticed she becomes self-critical when sessions feel stagnant.

Session Summary:
This is Alyssa and Devin’s fourth session. After a brief check-in, Devin shares that they had a hard time getting out of bed over the weekend and didn’t return some friends’ texts. When Alyssa gently asks what that felt like for them, Devin shrugs and says softly, “I don’t know… it just is.” Then, silence. Alyssa nods once and waits. Ten seconds pass. Then twenty. Devin doesn’t look up. Alyssa feels her internal temperature rise. Her mind begins racing: Should I say something? Did I ask the wrong question? Are they shutting down? Are we stuck? She considers filling the silence with another prompt but wonders if the silence is the work—that maybe something is happening beneath the surface that words can’t yet reach. Still, the uncertainty is hard to sit with, and the silence stretches on.

What are the possible meanings of silence in this session?
How might Alyssa stay present, attuned, and responsive without rushing to fill the space? What countertransference reactions might she be experiencing, and how can she use them to inform rather than derail the therapeutic process?

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PAUSES, LULLS, AND SILENCE

Client: Devin R., 31-year-old biracial (Black/white) nonbinary person, recently began therapy to explore ongoing depression, persistent feelings of disconnection, and unresolved grief after the loss of a parent two years ago.

Clinician: Alyssa T., 36-year-old Latina woman, LCSW, relational psychodynamic orientation. She values depth work and believes strongly in “holding space,” but has also noticed she becomes self-critical when sessions feel stagnant.

Session Summary:
This is Alyssa and Devin’s fourth session. After a brief check-in, Devin shares that they had a hard time getting out of bed over the weekend and didn’t return some friends’ texts. When Alyssa gently asks what that felt like for them, Devin shrugs and says softly, “I don’t know… it just is.” Then, silence. Alyssa nods once and waits. Ten seconds pass. Then twenty. Devin doesn’t look up. Alyssa feels her internal temperature rise. Her mind begins racing: Should I say something? Did I ask the wrong question? Are they shutting down? Are we stuck? She considers filling the silence with another prompt but wonders if the silence is the work—that maybe something is happening beneath the surface that words can’t yet reach. Still, the uncertainty is hard to sit with, and the silence stretches on.

What are the possible meanings of silence in this session?
How might Alyssa stay present, attuned, and responsive without rushing to fill the space? What countertransference reactions might she be experiencing, and how can she use them to inform rather than derail the therapeutic process?

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PRESSURE AND TIME CONSTRAINTS

Client: Terrence J., 50-year-old Black man, recently discharged from the hospital after a suicide attempt. He was referred for outpatient therapy as part of his discharge plan. He is reserved, appears guarded in demeanor, and has not previously engaged in therapy.

Clinician: Priya M., 29-year-old Indian-American woman, MSW, in her first year of clinical work. She is employed at a large community health clinic where she is expected to complete initial assessments within one or two sessions and move toward treatment planning quickly.

Session Summary:
It’s the end of the first session. Terrence has responded politely but minimally throughout, offering little detail about his mental health history. He expresses some trust in his doctor but says, “I don’t know if talking is really going to change anything. I’m not really the ‘therapy type.’” He mentions no acute suicidal ideation now, but gives vague answers about future outlook and plans. Priya glances at the clock—only six minutes remain, and she still needs to cover required risk screening and begin the treatment plan form in the EHR. She also knows that this client is flagged as “high priority” by her supervisor and that her productivity is being tracked this quarter.

She feels the pull of two internal voices:

One says: “Stick to the form. Get what you need. If he doesn’t talk, move on—this is what brief therapy looks like.”

The other says: “He needs time, trust, and safety. You can’t force a breakthrough to fit a 50-minute box. But you’ll fall behind on documentation and targets if you don’t move forward.”

Priya takes a breath and wonders: Is there a way to do both—be clinically present and meet the system’s demands?

How can Priya navigate the tension between systemic pressure (documentation, productivity, liability) and the relational needs of the client? What internal narratives or expectations might she need to challenge? What supervisory or structural support could help clinicians like her remain ethical, client-centered, and grounded?

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PRESSURE AND TIME CONSTRAINTS

Client: Terrence J., 50-year-old Black man, recently discharged from the hospital after a suicide attempt. He was referred for outpatient therapy as part of his discharge plan. He is reserved, appears guarded in demeanor, and has not previously engaged in therapy.

Clinician: Priya M., 29-year-old Indian-American woman, MSW, in her first year of clinical work. She is employed at a large community health clinic where she is expected to complete initial assessments within one or two sessions and move toward treatment planning quickly.

Session Summary:
It’s the end of the first session. Terrence has responded politely but minimally throughout, offering little detail about his mental health history. He expresses some trust in his doctor but says, “I don’t know if talking is really going to change anything. I’m not really the ‘therapy type.’” He mentions no acute suicidal ideation now, but gives vague answers about future outlook and plans. Priya glances at the clock—only six minutes remain, and she still needs to cover required risk screening and begin the treatment plan form in the EHR. She also knows that this client is flagged as “high priority” by her supervisor and that her productivity is being tracked this quarter.

She feels the pull of two internal voices:

One says: “Stick to the form. Get what you need. If he doesn’t talk, move on—this is what brief therapy looks like.”

The other says: “He needs time, trust, and safety. You can’t force a breakthrough to fit a 50-minute box. But you’ll fall behind on documentation and targets if you don’t move forward.”

Priya takes a breath and wonders: Is there a way to do both—be clinically present and meet the system’s demands?

How can Priya navigate the tension between systemic pressure (documentation, productivity, liability) and the relational needs of the client? What internal narratives or expectations might she need to challenge? What supervisory or structural support could help clinicians like her remain ethical, client-centered, and grounded?

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DISCLOSURE

Client: Angela D., 41-year-old Latina woman, divorced, working full-time while raising two teenagers. She has a history of anxiety and depression and is currently in therapy for support managing burnout, emotional exhaustion, and feelings of disconnection from herself.

Clinician: Rachel K., 39-year-old Filipina, cisgender woman, LCSW. Rachel has a calm, relational approach to therapy and values attunement and boundaries. She is a mother and has experienced caregiver burnout in the past but has never shared that with clients.

Session Summary:
In their sixth session, Angela appears more emotionally open than in previous weeks. She begins to speak about the unrelenting demands of her life—work, parenting, finances—and shares that she often feels like she’s “failing at everything.” She tears up and says:

“I just don’t understand how other women are doing this. I’m sure you’ve got it all together. You probably go home and do yoga and meditate and parent like you’re in a commercial. I feel like I’m falling apart and I hate that I’m the only one.”

Rachel feels a deep resonance with what Angela is describing. She remembers how isolated and overwhelmed she once felt in her own life when balancing similar responsibilities. For a moment, she considers whether a small, intentional self-disclosure about her own past struggles with burnout might help Angela feel less alone—or whether it might shift the focus too much or feel performative.

Should Rachel self-disclose in this moment? If so, how might she do it in a way that centers Angela’s experience and promotes connection rather than shifting focus? What ethical, clinical, and relational considerations should guide her decision?

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DISCLOSURE

Client: Angela D., 41-year-old Latina woman, divorced, working full-time while raising two teenagers. She has a history of anxiety and depression and is currently in therapy for support managing burnout, emotional exhaustion, and feelings of disconnection from herself.

Clinician: Rachel K., 39-year-old Filipina, cisgender woman, LCSW. Rachel has a calm, relational approach to therapy and values attunement and boundaries. She is a mother and has experienced caregiver burnout in the past but has never shared that with clients.

Session Summary:
In their sixth session, Angela appears more emotionally open than in previous weeks. She begins to speak about the unrelenting demands of her life—work, parenting, finances—and shares that she often feels like she’s “failing at everything.” She tears up and says:

“I just don’t understand how other women are doing this. I’m sure you’ve got it all together. You probably go home and do yoga and meditate and parent like you’re in a commercial. I feel like I’m falling apart and I hate that I’m the only one.”

Rachel feels a deep resonance with what Angela is describing. She remembers how isolated and overwhelmed she once felt in her own life when balancing similar responsibilities. For a moment, she considers whether a small, intentional self-disclosure about her own past struggles with burnout might help Angela feel less alone—or whether it might shift the focus too much or feel performative.

Should Rachel self-disclose in this moment? If so, how might she do it in a way that centers Angela’s experience and promotes connection rather than shifting focus? What ethical, clinical, and relational considerations should guide her decision?

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AUTHENTICITY AND VULNERABILITY

Client: Marcus B., 38-year-old Black man, employed in tech, seeking therapy after the death of his younger brother from a sudden cardiac event. Presenting concerns include insomnia, isolation, and difficulty concentrating at work.

Clinician: Elena P., 34-year-old white woman, LCSW, trained in CBT and narrative therapy. She practices from an anti-racist, trauma-informed framework and has been working with Marcus for three sessions.

Session Summary:
In their third session, Marcus speaks in more detail about his brother’s passing but remains emotionally restrained. Elena gently invites Marcus to describe how he’s been coping day-to-day, and he responds, “I’ve been doing what I’ve always done—keep it moving. People expect me to hold it together, and I’m good at that. I’m not here to cry in front of a white lady I just met.” Elena feels the words land hard—not because she is offended, but because she senses a deeper truth in them. She recognizes a power dynamic she hasn’t acknowledged yet, and that Marcus is testing whether she can really hold space for his experience, not just guide him through grief exercises. She considers shifting back to a structured intervention, but instead pauses. She recognizes this moment not as a clinical misstep, but as an invitation to respond with honesty and presence.

What would it look like for Elena to respond with authenticity and vulnerability in this moment—without centering herself or becoming defensive? How might she ethically acknowledge the power dynamics and the client’s truth, while continuing to build safety and trust?

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AUTHENTICITY AND VULNERABILITY

Client: Marcus B., 38-year-old Black man, employed in tech, seeking therapy after the death of his younger brother from a sudden cardiac event. Presenting concerns include insomnia, isolation, and difficulty concentrating at work.

Clinician: Elena P., 34-year-old white woman, LCSW, trained in CBT and narrative therapy. She practices from an anti-racist, trauma-informed framework and has been working with Marcus for three sessions.

Session Summary:
In their third session, Marcus speaks in more detail about his brother’s passing but remains emotionally restrained. Elena gently invites Marcus to describe how he’s been coping day-to-day, and he responds, “I’ve been doing what I’ve always done—keep it moving. People expect me to hold it together, and I’m good at that. I’m not here to cry in front of a white lady I just met.” Elena feels the words land hard—not because she is offended, but because she senses a deeper truth in them. She recognizes a power dynamic she hasn’t acknowledged yet, and that Marcus is testing whether she can really hold space for his experience, not just guide him through grief exercises. She considers shifting back to a structured intervention, but instead pauses. She recognizes this moment not as a clinical misstep, but as an invitation to respond with honesty and presence.

What would it look like for Elena to respond with authenticity and vulnerability in this moment—without centering herself or becoming defensive? How might she ethically acknowledge the power dynamics and the client’s truth, while continuing to build safety and trust?

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RAPPORT BUILDING

Client: Robert M., 44-year-old white male, recently divorced, former law enforcement officer, referred by his employer for mandated counseling due to increasing irritability at work and a recent verbal outburst during a staff meeting.

Clinician: Jordan L., 31-year-old nonbinary Latinx social worker, MSW-level, practicing from a trauma-informed, anti-oppressive framework.

Session Summary:
During the first three sessions, Jordan notices that Robert keeps his answers brief, often crosses his arms, and avoids eye contact. When Jordan uses inclusive language and explores how Robert defines well-being or support systems, Robert appears disinterested and at times skeptical. In a recent session, Jordan gently named the tension and asked if Robert had any hesitations about engaging in therapy. Robert replied, “I just don’t know how much of this I buy into. I’ve been told to show up, so here I am. I guess this kind of thing isn’t for everyone.” Jordan is finding it difficult to engage Robert in deeper work and is beginning to question whether their personal values—especially around social justice, emotional vulnerability, and identity—are creating a barrier to rapport. At the same time, Jordan wants to respect Robert's worldview and lived experience, without sacrificing authenticity in the therapeutic space.

What might be the next steps the clinician could take to build rapport with this client, while navigating differences in identity, worldview, and engagement style? Consider both micro-skills (e.g., communication strategies) and clinical self-awareness or supervision needs in your response.

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RAPPORT BUILDING

Client: Robert M., 44-year-old white male, recently divorced, former law enforcement officer, referred by his employer for mandated counseling due to increasing irritability at work and a recent verbal outburst during a staff meeting.

Clinician: Jordan L., 31-year-old nonbinary Latinx social worker, MSW-level, practicing from a trauma-informed, anti-oppressive framework.

Session Summary:
During the first three sessions, Jordan notices that Robert keeps his answers brief, often crosses his arms, and avoids eye contact. When Jordan uses inclusive language and explores how Robert defines well-being or support systems, Robert appears disinterested and at times skeptical. In a recent session, Jordan gently named the tension and asked if Robert had any hesitations about engaging in therapy. Robert replied, “I just don’t know how much of this I buy into. I’ve been told to show up, so here I am. I guess this kind of thing isn’t for everyone.” Jordan is finding it difficult to engage Robert in deeper work and is beginning to question whether their personal values—especially around social justice, emotional vulnerability, and identity—are creating a barrier to rapport. At the same time, Jordan wants to respect Robert's worldview and lived experience, without sacrificing authenticity in the therapeutic space.

What might be the next steps the clinician could take to build rapport with this client, while navigating differences in identity, worldview, and engagement style? Consider both micro-skills (e.g., communication strategies) and clinical self-awareness or supervision needs in your response.

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INITIAL QUESTIONS

As we begin this week's content, what questions, anxieties, or sticky points have come up for you so far in your assessments in practice? These can be practical, relational, or personal.

Practical can include things like time, not having clients yet, environmental concerns, etc. Relational could be related to rapport-building and connection. Finally, personal could include things like your own inner critic, imposter syndrome, etc.

# data[].attributes.body
INITIAL QUESTIONS

As we begin this week's content, what questions, anxieties, or sticky points have come up for you so far in your assessments in practice? These can be practical, relational, or personal.

Practical can include things like time, not having clients yet, environmental concerns, etc. Relational could be related to rapport-building and connection. Finally, personal could include things like your own inner critic, imposter syndrome, etc.