Schizophrenia spectrum and other psychotic disorders.

Nina a 32 year old woman, has presented to session at your local community mental health agency, CMHA, as she wishes to start ongoing treatment in hopes of getting custody of her son back. From intake paperwork, you know that child protective services were contacted by the school and her son was removed after nina spent almost nie weeks in an inpatient psychiatric hospital. This is her first session in your intensive outpatient program, IOP. And she has been stable for two weeks on her new medication plan with the psychiatrist in your CMHA. ALTHOUGH YOU KNOW THAT SHE HAS experienced symptoms of psychosis, you have not seen an initial diagnosis.

Social worker: Hi, Nina, welcome. Would you like a glass of water or anything before we get started?

Nina: Hi, I am fine.

Social worker: Okay well if you change your mind please just let me know, okay? So Nina just a few reminders before we get started. I know you discussed confidentiality and reporting with the intake coordinator. And I only know a bit about whats going on. From the intake information, I know that you had been at helping hospital for several weeks, nine I think?

Nina: Yes.

Social worker: Okay and that your son is currently living with your sister and brother in law.

Nina: nods and cries.

Social worker: I cant imagine how you must be feeling right now. I guess it sort of feels as if your whole world has been shaken and turned upside down.

Nina: Yeah, it really has.

Social worker: So my job is to help you make some movement forward. And my role is to report back to your case manager progress as it relates to being in a more stable place. This means that some of what we talk about I do have to report back to her. But remember this is all for the purpose of reunifying with your son, okay?

Nina: Okay yes I really want that and I am just so scared. I miss my son hes my world. And I just can not believe that I ever could have done anything to hurt him.

Social worker : That is very understandable given what you have experienced. And I just want to commend you for being here and continuing to try and put one foot in front of the other particularly given what you have gone through. It takes a lot of courage to show up and you were doing that to be the mom you want to be. So if you dont mind sharing, tell me about what was happening before you went to helping hospital.

Nina: Okay yeah. Well I have always been a hard worker and work is really important to me, but I started having a stalker show up at work several times and say some really scary things to me and it scared me bad. I started hiding in the break room a lot , but no one ever saw him or heard him except me. This went on for several months. But then I started getting in trouble at work. Because they kept saying he was not real. And I mean we worked on this a lot in helping hospital and I know I have been told he was not real and it was a hallucination but it felt so real.

Social worker: I can only imagine, Nina.That does sound scary especially if it felt so real and threatening.

Nina: Yes, and it started several years ago actually. I mean this man would be around and say things to me but I was able to just ignore him because it was not that often. And I did not wanna make him upset. You know? We would run into each other at different times and places, but then I knew he was gonna hurt my son. So I just started running to the break room more and more so I could count in the pattens like he liked so he would not hurt my son.

Social worker: So when you say that it started several years ago, do you know exactly how long ago that was?

Nina: At least four years ago but a lot more than last years I think.

At this point in the scenario, Nina has indicated some symptoms of psychosis. The therapist will now also want to assess for any mood stability issues as well. Let's take another look.

Social worker: So this has really been something you have had to handle for a long time, and I am assuming maybe even had to handle it alone?

Nina: Yeah its been a lot.

Social worker: Well nina I really appreciate you telling me about this and being transparent about whats been going on. Again its my job to work with you as you make progress forward. And its much easier for us to do that when we work together.

Nina: Okay thanks.

Social worker: So Nina tell me about any previous experiences where you may have felt really sad or just really helpless.

Nina: I mean here recently I felt that way since being in the hospital and them giving me medicine to try and help me, but I really am just trying to focus on doing better not just staying sad all the time. I just want to see my son.

(For example, Student A is the social worker, Student B, the client, and Student C is the observer.)

In your role-play, you need to demonstrate the ability to engage the client (you must utilize the Nina scenario), and assess at least three pieces of information related to their presenting issue/problem. For example, the frequency, duration, impact etc.. of the issue(s).

Illustrate a script of social worker and Nina.