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Practice Insights: Eliza Petrova

Rapport & Therapeutic Alliance

Strength / Effective Technique

Collaborative Stance: Excellent use of collaborative language when setting the agenda and explaining the process. Checking in with the family ("Does that sound okay?") fosters partnership.
"Does that sound okay as a plan?"

Strength / Effective Technique

Empathic Validation: Strong examples of validating both Eliza's internal experience ("really tough," "uncomfortable") and the parents' struggle ("incredibly challenging," "takes a huge toll"). This likely helped build safety and trust quickly.
"That sounds really, really tough... That must be exhausting..."

Strength / Effective Technique

Clear Introduction & Confidentiality: Provided a clear, age-appropriate explanation of the session structure and confidentiality limits, addressing both the child and parents effectively.

Observation

Managing Multiple Perspectives: The session involved three participants (Eliza, Elena, Ivan). Observationally, you balanced time and attention well, ensuring each person had space to share their perspective early on.

Session Structure & Pacing

Strength / Effective Technique

Logical Flow: The session followed a clear, logical progression: introductions → goal setting → information gathering (child symptoms, family context) → summarizing & conceptualization → treatment rationale & planning → wrap-up & next steps.

Strength / Effective Technique

Effective Time Management: Covered a significant amount of ground for an initial assessment within the likely time constraints, balancing depth with breadth.

Strength / Effective Technique

Structured Transitions: Used clear transitional statements to guide the conversation and signal shifts in focus (e.g., moving from information gathering to summary/plan).
"Okay, before we wrap up, I want to quickly summarize what I've heard..."

Information Gathering & Clinical Inquiry

Strength / Effective Technique

Detailed Symptom Exploration: Skillfully probed for specific details of Eliza's anxiety experience, including physical sensations, cognitive aspects (feared consequences), and behavioral responses. Used open-ended questions effectively.
"Can you tell me a little bit more about what that feels like in your body?"

Strength / Effective Technique

Linking & Summarizing: Effectively linked the trigger event (stomach bug) to symptom onset and used summarizing statements to check understanding and synthesize information gathered from different family members.
"So, it sounds like this worry about throwing up started getting much bigger after you had that stomach bug last year..."

Area for Reflection / Growth

Opportunity: Functional Analysis Depth: While safety behaviors (washing, checking, avoidance) were identified, consider probing *slightly deeper* into the specific *function* or *feared consequence prevented* by each behavior in Eliza's view. This can further clarify the distinction between phobic avoidance and potential OCD rituals (e.g., "What feels like it might happen if you *didn't* check the date?").

Area for Reflection / Growth

Opportunity: Father's Direct Perspective: While Mother reported Father's views, directly inviting his perspective (even if brief, acknowledging his potential skepticism) could provide valuable firsthand information and potentially increase his engagement. E.g., "Ivan, Elena mentioned you might see things a bit differently. I'm wondering what this has been like for you?"

Conceptualization & Psychoeducation

Strength / Effective Technique

Clear & Accessible Formulation: Provided a concise, understandable case conceptualization linking the primary phobia to related symptoms (GAD, Social Anxiety, OCD features) and the rationale for the proposed treatment (CBT/ERP).

Strength / Effective Technique

Age-Appropriate Language: Used child-friendly language and metaphors (e.g., "worry monster," "false alarm") when explaining anxiety concepts to Eliza.

Strength / Effective Technique

Emphasizing Parent Role: Clearly articulated the essential role of parents in the treatment process, particularly for ERP, setting expectations early.

Area for Reflection / Growth

Opportunity: Visual Aids: Especially when working with children, incorporating simple visual aids (e.g., drawing the anxiety cycle, a 'fear ladder', a 'worry thermometer') during psychoeducation can enhance understanding and engagement. Consider having materials ready for future sessions.

Handling Systemic Dynamics

Strength / Effective Technique

Normalizing & Reframing Conflict: Directly addressed the parental disagreement sensitively, normalized it as common, and reframed it positively (stemming from shared concern) rather than critically.
"It sounds like you both love Eliza very much and want to help, but maybe disagree sometimes on the best way to do that... That's actually very common..."

Strength / Effective Technique

Validating Both Parents: Acknowledged the validity of both parents' experiences and perspectives regarding the challenges and their differing instincts (protection vs. pushing).

Area for Reflection / Growth

Opportunity: Explicitly Link Parent Anxiety to Coaching: When discussing parent coaching, explicitly connect managing *parental* anxiety (especially Elena's reported history) to their ability to effectively support Eliza's ERP. Frame it as a skill that helps *them* help *her*.

Area for Reflection / Growth

Opportunity: Concrete Next Step for Alignment: While alignment was named as a goal, consider ending with a more concrete micro-step related to this for the *next* session. E.g., "Next time, perhaps we can start by mapping out one specific situation where you disagree, and brainstorm together how you might approach it as a team."