Datasets:

michelleyunun

/

therapydata

like 15

11

reducing recidivism

client

Yeah, whatever, you know. It's California, no one cares.

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sustain

11

reducing recidivism

therapist

Yeah. Yeah. Yeah.

other

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11

reducing recidivism

client

How long is this gonna take?

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neutral

11

reducing recidivism

therapist

Yeah, we-- You know, we have about 15 to 20 minutes to talk today, total. Um-um, which certainly it's just the first of-of some sessions that we'll have together over the next six months. It'd be a natural question you'd wanna know how much time this will take, of course. Um, what else would you like me to know about you and your perspective that you think will help me work with you over this time?

therapist_input

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11

reducing recidivism

client

I just wanna get whatever I need to get done, done.

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neutral

11

reducing recidivism

therapist

Okay. You're more focused on what you need to do to get this behind you?

reflection

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11

reducing recidivism

client

Yeah

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neutral

11

reducing recidivism

therapist

.Okay, mm-hmm. Well, I'm wondering then if it's okay with you and-and I have a form that we can use if you'd like, um, just to put out some different ideas on an agenda that we could share as we're working together so that I-I can support you to be successful in getting this behind you. Would-would this feel like a natural time to-to move towards figuring out where we might go together?

question

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12

smoking cessation

therapist

Sarah, I'm so glad you came in for your well-woman exam today. I think we addressed a lot of your concerns. However, I would like to ask you more about your smoking. Would that be okay?

question

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12

smoking cessation

client

Yeah, I guess.

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neutral

12

smoking cessation

therapist

Okay. So about how much are you smoking over the course of a day? You had said it had increased over once or twice a day.

question

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12

smoking cessation

client

Yeah, um, normally, I'm smoking, you know, like once in the morning, uh, once during my lunch break and then in the evening maybe like five or six.

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neutral

12

smoking cessation

therapist

Okay. So about eight cigarettes. So over the course of a day, just under half a pack?

reflection

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12

smoking cessation

client

Yeah.

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neutral

12

smoking cessation

therapist

Okay. And that's changed over what period of time?

question

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12

smoking cessation

client

Um, honestly, it's probably been over the past year or so that I- I've been smoking a little bit more.

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neutral

12

smoking cessation

therapist

Okay. So over the past year, the smoking has increased. And that's been mainly in the evening?

question

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12

smoking cessation

client

Yeah. Um, I have a two-year-old son as I mentioned, so I try to never smoke around him. So I'm normally kinda waiting until he gets to bed.

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neutral

12

smoking cessation

therapist

Mm-hmm. Well, that's the time when you can relax and unwind.

reflection

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12

smoking cessation

therapist

Yeah, exactly. You know, I told you, my-my schedule is kinda crazy right now. I, um, I work full-time and I just started back at night classes. So, you know, all that combined, you know, I enjoy that time to myself in the evening.

other

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12

smoking cessation

therapist

Sure. Sure. Well, it's a time to relax and you've got a lot going on.

reflection

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12

smoking cessation

client

Mm-hmm.

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neutral

12

smoking cessation

therapist

So are there other things you do in the evening to relax?

question

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12

smoking cessation

client

Um, I mean, maybe I'll have like a drink or two.

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neutral

12

smoking cessation

therapist

Okay. A drink or two. So about how many drinks would you say you have over the course of a day?

question

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12

smoking cessation

client

Um, maybe like two max.

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neutral

12

smoking cessation

therapist

Two max. How many drinks would you say you'd have over the course of a week?

question

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12

smoking cessation

client

I don't know. I mean, I don't really get why you're asking me that. I mean, I just came here, you know, for a regular visit. I-I am not here to talk about my drinking.

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neutral

12

smoking cessation

therapist

No, I understand- I understand. And I'm certainly not here to tell you what to-to do, Sarah. I'm interested in hearing your thoughts and sharing some information with you, and what you do with that information is totally up to you. You've got a lot going on. You're a mother, you're working, you're going to school, and our healthcare team wants to make sure that you have all the resources available to you to meet your goals, including good health. And my job as your healthcare provider is to listen to you and to share information with you, including healthcare concerns associated with smoking and alcohol. Would that be okay with you?

question

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12

smoking cessation

client

Yeah, I guess.

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neutral

12

smoking cessation

therapist

Okay. Well, we do know that an increase in smoking and alcohol is associated with certain kinds of cancer; colon cancer, cervical cancer, breast cancer, lung cancer, and, um, also pancreatic cancer. It's also associated with liver and lung disease as well as heart disease, diabetes, and hypertension. So that's a lot of information, but I'm-

therapist_input

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12

smoking cessation

client

Yeah.

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neutral

12

smoking cessation

therapist

-interested in what your thoughts are, Sarah.

question

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12

smoking cessation

client

Well, I-I'm just kinda surprised because, I mean, I don't smoke or drink that much. And I mean, compared to people I work with, you know, I-I smoke a lot less, and I feel like I've actually been trying to keep it pretty low.

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sustain

12

smoking cessation

therapist

So you're consciously trying to cut back.

reflection

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12

smoking cessation

client

Yeah.

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neutral

12

smoking cessation

therapist

I have a readiness ruler in my pocket here, 0 means not ready to stop smoking at all and 10 means absolutely ready to stop smoking. Where do you see yourself on that scale?

question

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12

smoking cessation

client

Um, maybe like a five.

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neutral

12

smoking cessation

therapist

About a five. So you're halfway there. So why did you choose a five rather than a four?

question

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12

smoking cessation

client

Well, I mean, you brought up some kinda scary stuff like, you know, cancer risk or other things like that. And you know, being a mother, I-I don't want something to happen to me obviously.

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change

12

smoking cessation

therapist

Right. Well, that's a lot of information to think about. So given, the fact that these healthcare concerns are a possibility, and that you're worried about your family and you certainly have goals you want to succeed at, where are you in your consideration to making a change? In other words, what steps would you consider taking for this number to move closer to a 10?

question

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12

smoking cessation

client

Well, I mean, I could maybe try to cut back in the evenings a little bit.

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change

12

smoking cessation

therapist

Okay, great. Let's quantify that a little bit. So how many cigarettes would that be?

therapist_input

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12

smoking cessation

client

Well, right now, if I'm having like five or six, I could try to smoke three in the evening plus, you know, still the couple during the day.

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change

12

smoking cessation

therapist

Okay. So you-- that's cutting back quite a bit. That's a big step. So since we're kind of running out of time here today, I'm wondering if we could-- would be willing to come back in about four weeks to review this plan?

question

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12

smoking cessation

client

Yeah. Sure.

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neutral

12

smoking cessation

therapist

Okay, good. So we can go over your laboratory results at that time, as well as review your plan. Now, would you like some information on smoking cessation?

question

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12

smoking cessation

client

Yeah, I-I think that would be very helpful.

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neutral

12

smoking cessation

therapist

Okay. Well, I've got a brochure here and this has-- it's a really good brochure. It has some distraction techniques in it in case you get those nicotine cravings. So it's-

therapist_input

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12

smoking cessation

client

Mm-hmm.

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neutral

12

smoking cessation

therapist

-been helpful, um, in-- with patients before. I'd also like to ask you, would you be willing to see one of our counselors?

question

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12

smoking cessation

client

Well, what-what for exactly?

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neutral

12

smoking cessation

therapist

Well, Dr. Kirtley is one of our counselors and he is an expert in-- at discussing the association between alcohol and stress. I want to share something with you. The National Guidelines recommend that women have no more than seven drinks of alcohol per week to-to stay at that low risk level, to avoid the healthcare concerns that we spoke of earlier.

therapist_input

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12

smoking cessation

client

Mm-hmm.

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neutral

12

smoking cessation

therapist

You've indicated that your alcohol consumption is a bit higher than that, putting you at risk. So that's why I asked if you'd be willing to talk to Dr. Kirtley.

therapist_input

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12

smoking cessation

client

I mean, I would like to talk about, you know, my stress, but I'm still not sure with the whole drinking thing.

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neutral

12

smoking cessation

therapist

Certainly, certainly. I'm glad you're willing to talk to him. So before you leave here today, we'll, uh, stop by the scheduler's desk and make an appointment for you to see me back in four weeks, as well as the appointment with Dr. Kirtley. And that way, before you leave, you're all set. So do you have any other questions for me, Sarah?

question

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12

smoking cessation

client

I don't think so.

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neutral

12

smoking cessation

therapist

Okay. Well, it's very nice to meet you. I'll see you in a month.

other

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12

smoking cessation

client

Okay.

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neutral

13

taking medicine / following medical procedure

therapist

Hi, Mrs. Smith. I wanted to let you know that at this appointment, we're gonna be giving Lilly some vaccines.

therapist_input

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13

taking medicine / following medical procedure

client

Oh, I-I don't know if I'm comfortable with that. I've been reading a bunch of stuff lately about them.

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sustain

13

taking medicine / following medical procedure

therapist

Hmm. Can you tell me more about your concerns about vaccines?

question

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13

taking medicine / following medical procedure

client

Uh, yeah, well, I was just- I was reading that it's better to let them build up their immunity, like, naturally and stuff in their immune systems.

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sustain

13

taking medicine / following medical procedure

therapist

Okay, so you were thinking that maybe exposing Lily naturally to these diseases would be a better choice than using vaccines to help her get stronger?

reflection

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13

taking medicine / following medical procedure

client

Well, yeah. I mean, I had chickenpox as a kid, and now I'm immune. Right? So.

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sustain

13

taking medicine / following medical procedure

therapist

That's right. Having chickenpox as a child means that you are less likely to have chickenpox as an adult because you've developed a-a natural immunity. Uh, but is it okay if I offer you a little bit more information about the other vaccines that we're- we were going to give her Lily today?

question

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13

taking medicine / following medical procedure

client

Uh, okay.

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neutral

13

taking medicine / following medical procedure

therapist

Okay. So, uh, before vaccines were developed, often when children had a natural exposure to some of these diseases, they ended up with, uh, sometimes death, disability, measles caused brain damage and, uh, deafness and blindness. Polio caused, uh, paralysis in children. And so, allowing children to have natural exposure to these diseases, sometimes was a little bit of a gamble, it could be dangerous.

therapist_input

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13

taking medicine / following medical procedure

client

Wow, I didn't realize it was so dangerous. I've never heard of polio.

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neutral

13

taking medicine / following medical procedure

therapist

Hmm. Some of these things I've mentioned to you, you're-you're not familiar with. Uh, and I think that's because we've done such a good job of eliminating some of these diseases that a lot of people your age, and even my age, are unfamiliar with those things. Um, so having shared this information with you, what do you think about the idea of vaccines for-for Lilly?

question

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13

taking medicine / following medical procedure

client

Uh, I guess it's okay. I mean, I just I want her to be healthy and safe.

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change

13

taking medicine / following medical procedure

therapist

It's really important for you to make sure that she's protected and that you make good decisions and do your research before you make any medical decisions for her.

reflection

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13

taking medicine / following medical procedure

client

Yeah, I just want to do what's right.

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change

14

weight loss

therapist

So, again, I hear your overall goal is really, to not give up these things you'd like but to cut back on how much you have-

reflection

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14

weight loss

client

Yeah, I guess so.

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change

14

weight loss

therapist

-on that. All right. So, I'd like to ask you, uh, kind of a scaling question about this 'cause I'm hearing that this feels really important to you that you'd be way up there on the high- on the high end of importance.

reflection

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14

weight loss

client

Yeah.

n/a

change

14

weight loss

therapist

So, I'm gonna ask the question this way, on a scale of 0 to 10, where 0 is not at all confident, and 10 is like, "I'm very, very confident," where would you put yourself on a scale right now of confidence in starting this new plan?

question

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14

weight loss

client

Right now, I'm probably-

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neutral

14

weight loss

therapist

Mm-hmm.

other

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14

weight loss

client

-gonna say a six.

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neutral

14

weight loss

therapist

A six.

reflection

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14

weight loss

client

But I know when I go home and I see the food, it's probably gonna drop back down to a four.

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sustain

14

weight loss

therapist

Okay. All right. So, let's talk about that, um, so we should just assume we're gonna be at a four.

reflection

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14

weight loss

client

Right?

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neutral

14

weight loss

therapist

Okay?

question

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14

weight loss

client

I guess.

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neutral

14

weight loss

therapist

So, why are you at a four and not even a lower number? Why are you not like a zero or a one?

question

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14

weight loss

client

Because I've been wanting to do this for-for years, like-

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change

14

weight loss

therapist

Okay.

other

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14

weight loss

client

-ever since I started becoming conscious of my body.

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change

14

weight loss

therapist

Okay.

other

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14

weight loss

client

Like ever since I started being a teen, like this has always been a goal of mine, like, especially 'cause all my friends play soccer, and like-

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change

14

weight loss

therapist

Uh-huh.

other

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14

weight loss

client

-hike, and are like super stick-thin but really healthy and active.

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change

14

weight loss

therapist

Okay.

other

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14

weight loss

client

And so I'm just sort of like, well, I'm not.

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neutral

14

weight loss

therapist

Okay.

other

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14

weight loss

client

But I want to be like-- I don't want to be like stick-thin, but I really want to be like really healthy and really active.

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change