A Hypothetical First Session

By: Joe Vanny Perez, LMSW

(After introductions, I sit down with the client and begin an initial assessment, but cannot finish because the patient becomes upset)....

SWer: Please have a seat.

Client: (Not making eye contact) Thank you.

SWer: What brings you here today?

Client: I have not been feeling well these past few weeks. When I tested positive, I went into severe depression. Now, I feel like my body is breaking down. I have diarrhea, can't sleep well at night, nauseous.

SWer: How are you feeling right now?

Client: A little better. I thought you were just going to ask me to fill out a survey or something. This is different than what I am used to.

SWer: Well, we do care about our patients and make every effort to make them feel as comfortable as possible. Would you be ok with me asking you some personal questions?

Client: OK. Go ahead.

SWer:How were you infected? Was it through drugs or through sex/sexual contact?

Client: Sex

SWer: Sex with men or women? Or both?

Client: Men

SWer: When were you diagnosed with HIV?

Client: 2006. November 2006. I remember that night. It was snowing hard outside. I kept looking out the window in his room thinking “how did I end up here in his bed?”

SWer: Did the person who infected you tell you about his HIV status beforehand?

Client: No. That is the unfair part. He should have told me and given me the chance to decide whether to use a condom or not! (Client becomes tearful). It has destroyed me!

SWer: What happened to you and him after you tested positive for HIV?

Client: He left me. He said I cheated on him because he was “clean.” But he is the only person I have ever had sex with. He told me that he did not deserve to be put at risk. He said I was a “whore” and that I was going to die fast. Now, I am all alone.

SWer: I am so sorry to hear that. Is there anything you could have done at that time for yourself?

Client: I should have put a condom on him. He kept telling me “Trust me. Trust me baby. I’m clean.” Now look at me. I’m sick. I am still in shock.

SWer: You have the right to feel that way and to be angry. It sounds like he was not honest with you from the beginning. But, I am glad you came to our clinic today. I am going to help you learn about our clinic and the services we can offer you. As a social worker, I can help you get in contact with support in the local community including referrals to support groups and individual therapy that can provide you a safe space to explore what living with this illness may mean to you. This can also give you an opportunity to meet people who may share similar experiences with you. Does this sound like something that may be helpful to you?

Client: Yeah. I am just scared. And lonely...

SWer: Please understand that the doctor and I are here to support you as best we can. At this clinic, we have a team-centered approach where we will always make every effort to schedule you to see both the doctor and social worker during the same visit. It will also allow us, as your providers, to communicate easily regarding your care and provide you with the best service possible. Feeling scared of the unknown and lonely are two sane responses to this traumatic life-altering journey you have been experiencing. Does this sound like something you may find useful at this time?

Client: Yes. You seem to care. I appreciate it.