Reflection is your best friend in developing clinical tools! Let me explain.

Some of the work I do is in an emergency room. If someone comes in with a mental health crisis, I help them out. Recently, someone came in with homicidal ideations. They had a plan to use a bomb to hurt a lot of people, and if that didn’t work, they were going to use guns. After receiving report from the triage nurse, I made some quick assumptions about what I was about to walk into: this person wasn’t safe, this person did not have good insight, this person was experiencing psychosis.

As I talked to the individual*, I learned that they had an extensive history in the military and had recently been in several tours of combat, where they were trained in and had many experiences killing “the enemy”. They explained how it had changed their worldview. How they could only see violence as a way to solve problems now. They felt tortured by their current perspective, but couldn’t figure out a way out of it. They said they had been disabled by their military injuries, and couldn’t find a way forward with more meaningful work. And they felt they were a burden on their family. They expressed a desire to be safe. To not act on their violent impulses. I realized that in context of their training, upbringing (physical abuse in childhood) and other information they shared, that they were indeed not psychotic, but acting in a way they had been taught. I realized they did have some insight, and a desire to be safe, but some confusion on how to learn safe behaviors again. And, I learned that at that very moment, they were not safe, and needed intensive support for at least a brief period of time while we could come up with a long-term plan to get them on a healthier path.

It was through reflection that I realized some of my initial assumptions proved true and helpful, while others weren’t. We all make quick assumptions or formulations; it’s normal, and it’s human. Assumptions are just unchecked beliefs, or put another way, untested hypotheses. If you’re up for it, take 3 minutes to jot down the assumptions that come to mind with a specific client or situation you’re currently involved in, with no evaluation or judgment of them.

You will find that by regularly reflecting on your work and starting to recognize natural assumptions, the quality of your work will improve. The process of providing services is a very satisfying, organic growth process that changes and evolves as you continue in your work. Stay tuned for part 2, where I’ll share an activity to help you further develop your reflection muscles.

*details have been changed to protect the privacy of the individual