Related: [[020.300 Solution Focused MOC]] ---- **24 Nov 2023 Solution Focused Group Supervision** - YP - LRY - HK - G - SBR - ANS # ANS sharing  - Male client, 26 years old. Malay Muslim, Currently single. Living with family members. There are siblings. Parents officially separated. He is the eldest to support the family. (24-30 months with the service) - 2021 known to the service: (1) Auditory Hallucination (3)Talking to himself (4) Irrelevant speech (5) Forensic history - 2019-march 2021. Imprisonment for molestation - involving children. Touched a girl's thigh on a bus. (6) History of drug use, ex-drinker **CM Sharings** - Recently, the patient messaged the CM that he was having suicidal thoughts.  - The patient feels he has disappointed his family greatly.  - The patient’s replies to the Case manager were spaced out.  - The case Manager worries for him. - The patient is not ready for a phone call and prefers messaging.  - Schizophrenia is destroying his life and keeping him powerless and hopeless.  - He has been gambling and lost his entire savings.  - CM shared that he is responsible and wants to care for his family.  - Sense of guilt and responsibility towards family.  - The patient blames “this thing” for forcing him to gamble. Feel the urge to gamble. CM doesn’t think it’s passivity because gambling is complex.  - Psychologists think the patient externalises responsibility to symptoms/passivity.  - CM ask: I don’t know how to unpack this, (1) suicidal risks, (2) gambling addiction, (3) impact of schizophrenia. - CM assessed that the risk for suicide is low. Have plans to move on, living for family. # CM: How do we best engage him? - The patient said he felt uncomfortable. [[Engagement]] - How best can ANS engage the patient to open his gambling habits and the impact of schizophrenia, plus suicide assessment? - Also, I am concerned about not invalidating the patient and want the patient to feel in control. # Clarifying Questions 1. Is there a DUP? 2. 2018 Prison referred the patient to the hospital: No discharge medication was prescribed. 3. Self-Harm behaviour: Yes 4. What intervention was given to treat symptoms themes? 1. Psychotherapy since 2018, then see Derina (for what) 2. Medicine 1. Using distraction. ---- # Affirmation - Being aware of prejudices and biases. - Being able to endure anxiety - Rapport with the patient. He feels safe enough to contact you. # My Questions 1. What parts get triggered? What is the process that triggers the firefighter to copy by gambling? 2. Can confidentiality be breached, given safety? # My reflections/and feelings 1. At first, I felt sympathetic towards this client, but after hearing about forensic history, I now start to feel myself being judgemental and prejudiced towards this patient. 2. Sexual themes - I wonder what's up with that? # Reflecting one at a time 1. Attend to the grief, focus on the coping - how is he coping? 2. Meeting already, and then what will be the guiding intention of the conversations... 3. Cannot see the way out - It makes sense to him 4. Hold back on intervention and judgment being the "truth" behind the gambling behaviour. 1. IFS - No Bad Parts. (What triggers) 1. What is the bad parts 5. Focus on the grief and here and now. 6. Thank him for the trust, Invite him for a chat, 1. Here and now - 2. Ask, "*So what do you prefer instead?*..." standing beside and tapping on the shoulder. 7. [[ASIST Suicide Prevention]] Safety Planning Conversation - Who do you want in family to know? to help look out for it.