Recognising and Responding to Dysregulation · Clinical Simulation

The Disclosure You Did Not Plan For

A client discloses a non-consensual first sexual experience inside the answer to a routine question, and keeps talking. Three turns, three options each turn, and the client's next response is written against whichever one you choose.

What this simulation practises

Receiving a disclosure that arrives in the wrong part of the interview, declining to name the experience for the client, staying clinical rather than drifting forensic, and bounding the session without closing the subject.

The paths genuinely diverge. What the client says on turn three depends on what you said on turns one and two, and you cannot go back inside a run. If you want to see another route, run it again.

Estimated time to complete this exercise: 20 minutes, and worth running more than once

1Turn one
2Turn two
3Turn three
4Where it ended
5Close

Before you begin

How this one works

This one runs as a simulation. Three turns, three options each turn, and the client's next response is written against whichever one you choose.
The paths diverge. What the client says to you on turn three depends on what you said on turns one and two, and the three endings are not the same ending with different wording.
You cannot go back inside a run. That is the point. If you want to see another path, run it again from the start.
Nothing is graded and nothing is recorded. Reloading starts it again.

Trauma disclosures do not arrive in the part of the interview you planned for them. A client may disclose while answering a routine question about their first sexual experience. What that does not mean is continuing the interview as though the disclosure did not occur.

References

  1. Courtois, C. A., & Ford, J. D. (2013). Treatment of complex trauma: A sequenced, relationship-based approach. Guilford Press.
  2. Leonard, L. M., & Follette, V. M. (2002). Sexual functioning in women reporting a history of child sexual abuse: Review of the empirical literature and clinical implications. Annual Review of Sex Research, 13(1), 346–388.
  3. Levenson, J. S. (2017). Trauma-informed social work practice. Social Work, 62(2), 105–113. https://doi.org/10.1093/sw/swx001
  4. Muskett, C. (2014). Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing, 23(1), 51–59. https://doi.org/10.1111/inm.12012
  5. 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.