Complex clients

Many of our clients have complex lives, and experience complex relationships and issues within these lives, and working with these clients can be a challenge for us.

Breaking down the main issues

I have always found it useful, especially in supervision, to separate out the key issues in diagrammatic form, and to include contributing factors to these issues, and then the impact of these issues on each other as we tease them out more.

An example of key issues

The client is a 34 yr old female who has two children (an 8 yr old boy and a 5 yr old girl) and separated from her husband 6 months ago after he had an affair. Her mother, who provided a lot of support, died unexpectedly of a heart attack 1 month ago, and the client was made redundant from her employment as an administration assistant when the company folded 2 weeks ago. She was diagnosed with Type 2 Diabetes a year ago and is currently addicted to cannabis  and regularly binge drinks alcohol. Her addiction history in unclear.

Initially the key issues could be summarised thus:

Adding contributing factors

Once these are added, our diagram may look like this:

Adding connections and impacts

These would be added to the diagram above which includes the contributing factors, but for the sake of simplicity I have deleted the contributing factors from the diagram below:

Making sense of the complexities

Now we can use the diagrams to consider possible hypotheses and additional areas to explore with the client. The history of addiction may not be as important to explore at this stage when the immediate impact of grief and separation is more relevant to address. And with this client it will be vitally important to work on building a relationship of trust with her.

I hope that you find this process as useful as I have.