The initial interview

Question 1

Goals of the initial interview

Answer 1

• discuss confidentiality and establish informed consent
• begin building rapport and the therapeutic relationship
• communicate empathy and warmth
• demonstrate non-judgmental positive regard
• foster collaboration/partnership
• gather information to develop a case conceptualization and treatment plan.

Question 2

Things to consider before initial contact

Answer 2

• Who is your client? (Individual, couple, group, family)
• What is the goal?
  
  • Counseling/therapy (treatment planning)
  • Diagnostic evaluation (court evaluation, personal injury, neuropsychological)
  • Triage or risk assessment

Question 3

Ways to establish rapport and structure

Answer 3

• eye contact
• open ended questions
• discussion
• common terms
• client-directed with therapist redirection
• non-verbal interest (lean forward, open body language, eye contact)

Question 4

Things to avoid in initial interview

Answer 4

• staring
• yes/no questions
• interrogation
• technical/showing off
• forcing topics or allowing rambling
• blank slate (not reacting)

Question 5

Stages of an initial meeting

Answer 5

• establish rapport and structure
• gather data and identify assets
• goal setting

Question 6

Introductory comments include

Answer 6

• Introduction (name, role)
• Structure, e.g. plan for meeting (what will be done, how long, logistics)
• Informed consent and confidentiality

Question 7

Informed consent and why it’s important

Answer 7

A document describing what the client is agreeing to and their rights as a client. Important so client can an informed decision and to demonstrate respect for client autonomy. Should be obtained verbally and in writing. An informed consent document should describe the process of therapy, policies around payment, missed appts, insurance, contact, etc, and confidentiality (including limits to confidentiality).

Question 8

Limits of confidentiality

Answer 8

• supervisor
• self-harm: making a call that this person is a danger to themselves.
• other-harm (specific person- in SC the person has to be named, and you have to inform them.)
• vulnerable population (children, elderly, disabled)
• legal requirement (court-order, judge subpoena)

Question 9

What types of behavioral observations might you make early on?

Answer 9

Pay attention to

* dress/appearance
* cleanliness/personal hygiene
* affect and body language * interaction with others
* social skills
* interaction patterns

Question 10

What else are you hoping to understand about the client in the initial interview?

Answer 10

• Goal: obtain detailed view of client, not just find diagnosis
  
  • obtain a sense of the “problems”
    
    • may be more than one
    • may be a diagnosis or related to a diagnosis
    • may NOT fit a diagnosis
  • beliefs/world views/ perspectives
  • assets (hobbies, fun activities, strengths)

Question 11

How to begin an assessment

Answer 11

• Okay, let’s begin. Tell me about yourself and the difficulties you are having/what brought you in today.
• What prompted you to come in?
• What would you like to be different?

Question 12

Things to ask about in the initial interview

Answer 12

• Symptoms: what makes things worse/what makes things better?
• Social support/stressors: family, friends, coworkers
• ABC’s (antecedent-behavior/beliefs-consequences)
• Assets/strengths: hobbies and activities
• sexuality
• cultural identity and importance
• case management needs
• Who
  
  • who involved?
  • who are supports?
• What
  
  • What happens?
  • What are the thoughts/feelings/behaviors?
  • What makes it worse?
  • What makes it better?
• Where?
  
  • How does your environment help/hurt?
  • Where does this happen?
• When
  
  • How long does it last?
  • How often?

Question 13

When to direct or redirect

Answer 13

• client providing all historical info without “here and now”
• clarification of vague answers/statements
• too much focus on others and not enough on self
• clearly tangential information
• detail is excessive for initial session

Question 14

If unsure about client’s readiness to change

Answer 14

• Readiness Ruler (1-10); motivational interviewing technqiue
• How important is it to you to make this change?
• How ready do you feel to make this change?

Question 15

How to end a session

Answer 15

• Summarize important information you heard
• validate their experience
• anticipate potential desire for avoidance
• express hope for future session
• plan for next steps

Question 16

Goalsetting at end of a session

Answer 16

• Goals should be elicited from client, not assigned by therapist
• Less clearly defined goals are ok at this point
• Can work on establishing clear and concrete goals collaboratively later