As the need continues to rise for increased accessibility of services, there are more options available for using telehealth. Since telehealth counselors are not in the same location as their clients,

As the need continues to rise for increased accessibility of services, there are more options available for using telehealth. Since telehealth counselors are not in the same location as their clients, it is important to obtain a client’s current physical location if safety concerns come up during a session.

Read transcript excerpt from a telehealth intake assessment with a client who has experienced significant trauma and loss. The client has reached out to her employee assistance counselor after being urged by her supervisor to seek help. Please do not provide a lot of internet or book references.  Although a reference is needed.

How are you Randall? How are you today? I’m doing okay.

What brings us together today? It’s kind of embarrassed thing.

My supervisor asked me to give you guys a call because I’m just kinda coming on glued.

I haven’t been sleeping.

Haven’t really been eating for the past, like week.

I lost my house to a house fire, something stupid my roommates did caused me to lose like everything.

Okay, so is this a recent event.

Yeah, it happened last week.

Last week, okay.

You Randall, since we are on telehealth, I need to ask a couple of questions.

What is your actual physical address in case I would need to send help to you? I need to know what your actual physical address is for this session.

So like where I am right now? Right now, right.

I’m at work, which is at 265, Cardinal Street.

265, Cardinal Street, okay.

It’s in Downtown Phoenix.

Okay, okay.

And are you in an office suite or are you in an apartment? I am in an office suite.

It’s on the third floor, room 316.

Okay, thank you.

And from my office, I don’t have anyone around me.

This is soundproof and HIPAA compliant, Okay But from what you are, is there anyone who is an earshot that you are uncomfortable hearing any conversations that we may be having? No, my boss, let me use his office so I could have total privacy.

So no one else is in here.

Okay, perfect.

With counseling, have you been in counseling before? No, so this is like totally weird for me.

Okay, well, I’m going to make this as comfortable as possible, but I do want you to know that everything we’d say is confidential with the exception that if you do tell me that you are suicidal or homicidal, or that there’s some significant event of abuse in your life, that’s happening, I would have to break that confidentiality.

Do you understand that, okay? Yeah, yeah, I understand.

Wonderful, okay, with that being said, you have disclosed that you had a house fire a week ago.

Yeah.

Displaced, and that now at work, you’re really experiencing a lot of nervousness, anxiety, depression, what’s the…

Yeah, I mean, I’m sad.

I’m anxious, like I really haven’t slept.

‘Cause every time I close my eyes, I smell smoke.

‘Cause the fire, like the smell of the smoke, it’s what woke me up.

So like going to sleep is just terrifying for me because I feel like it’s just a nightmare that I keep reliving.

Right, so as far as sleep, have you spoken to a medical professional? Have they talked to you about anything to help was in the moment? I talked to my doctor, so my doctor’s still out of state, so he couldn’t prescribe me anything, but he suggest that I take melatonin.

So I’m gonna get some today to try to see if that helps.

Okay, do you have any kind of past history of emotional disorders of depression, anxiety, any previous PTSD trauma, any previous post traumatic episodes? Not that I’ve been diagnosed with, like I am a pretty anxious person anyway, but it’s something that I’m able to do usually have a really good handle on.

Okay, so you have coping techniques that you use for your anxiety to keep it in check? Yeah, yeah, I usually like exercise and stuff, but like all of my stuff kind of went up in smoke for a lack of better words.

Yeah, no pun intended.

Yeah.

It sounds like a little bit of humor.

Yeah, that kind of helps me cope too, ’cause I mean, it’s nothing I can do about it.

Luckily, no one was hurt.

Like all this stuff can be replaced ’cause it’s stuff.

But I moved out here like a month ago to take this new job, so like I’m here and like my support systems aren’t so it’s really, really hard ’cause I have like, even this shirt that I have on, it’s not mine.

Like the only thing that I have is the pajamas that I was wearing when I ran out the house and the jewelry that I have on like, that’s pretty much it.

So I’m having to get like new ID cards and just like everything.

So it’s just really stressful and trying to be at a new job where I don’t time to take off ’cause I just started.

Right.

So safety factors, do you have a safe place to stay? Right now, the Homeowners Insurance put me in a temporary living situation until like the investigation and all that stuff is done.

So, I mean, I’m somewhere safe, yeah.

Somewhere safe , okay.

Someone that is helping you from the insurance end of things to acquire new necessary items for living.

Yes.

So we are free to focus on just your emotional wellbeing and how you’re coping through this crisis in your life.

Yeah, yeah everything else is like, kind of on, it’s underway the process for like claims and everything has started.

So just like helping me, hold it all together, I guess is what I’m looking for, yeah.

What emotions are you experiencing the most right now? Oh, like anger, because like, I feel like it’s my roommate’s fault because they were shooting fireworks and then just kind of, after they finished cleaning everything up, put it in the trashcan and that caught fire.

So it was like, hey, if you guys think a little bit, we could have probably avoided it.

I’m like really, really angry with them, for that piece.

And like, I’m sad because like all my stuff is gone, stuff that I worked really hard for.

And I don’t know is this so many different emotions right now.

I don’t, like I’m overwhelmed, I’m stressed, I’m anxious.

This is so many different things running through me.

So everything is just kind of combined…

and to manage that and still go to work and to have this job that’s brand new for you.

And now where am I going to live and how am I going to cope with stuff…

Yeah, exactly.

Alright, coping skills, you said in the past you’ve used things like humor, you do some deep breathing, you use maybe it’s sounded to me like maybe, you know how to meditate a little bit in the moment.

What other coping skills do you have, that you’ve used in the past when you…

Working out helps.

So, I mean, since now I don’t have access, I’ve just been trying to take some walks, but then in doing that I’m getting inside my head and just like getting more angry.

That’s like some of the things that I did before are not working like meditating in a moment, but when I’m closing my eyes, it’s like reliving everything all over again, smelling the smoke and running out of the house and seeing that flame, so all of that is just keeps coming back.

‘Cause I can’t even focus to meditate.

Right, so you’re going to have to learn some new coping skills, but also we really have to just process through all these emotions and the event that happened itself, the losses and change in your life.

Absolutely.

Okay, do you feel like this Telehealth Modality works okay for you? Yeah, because during my lunch I get an hour for lunch, but it doesn’t give me enough time to like go anywhere and see someone, and so my boss said that I could use his office, so this is perfect.

Okay, well…

‘Cause I don’t have like a computer or any of that stuff at home.

So being able to do it here is great.

Excellent, okay, well let’s go ahead and plan on doing some regular sessions.

We’ll come up with a treatment plan and really just focus on how to kind of debrief and get through all of this crisis and all these emotions that you’re dealing with now, does that sound like a good plan? That sounds good, yeah.