Building Psychological Safety in Assessment · Clinical Exercise

Say It Out Loud

Nine pairs of questions. Each pair is two ways of asking the same clinical thing, and you pick the one you would actually say. The difference is usually one word, and in several pairs both versions are things experienced clinicians say routinely.

What this exercise practises

Producing the wording, not recognising the principle. Normalising before asking, making permission to decline usable, avoiding assumptions about bodies and relationships, keeping trauma inquiry open rather than leading, and responding to a client who opens by telling you it is probably not a big deal.

The gap this targets is the one between knowing what good assessment language looks like and generating it in the moment, which is where it actually gets decided.

Estimated time to complete this exercise: 20 minutes

1Nine pairs
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Before you begin

How this one works

Nine pairs. Each pair is two ways of asking the same clinical question, and you pick the one you would actually say.
The difference between the two is usually small, often a single word, and in several pairs both versions are things experienced clinicians say routinely.
You get the reasoning on every pair whichever one you choose, and a running tally. Read the reasoning on the ones you get right as well, because the point is the mechanism rather than the score.
Nothing is graded and nothing is recorded. Reloading starts it again.

Clinician discomfort with sexual content is rarely conscious. It shows up as brevity, as topic avoidance, as hedging, and as wording that apologises for the question being asked. Clients read all of it accurately, and it is the main reason an assessment produces incomplete information.

References

  1. Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services, 87(1), 43–52. https://doi.org/10.1606/1044-3894.3483
  2. Hays, P. A. (2016). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy (3rd ed.). American Psychological Association.
  3. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. U.S. Department of Health and Human Services.