Tuesday, November 10, 2015

The First Interview

     Let's talk a little about the start of the interview and the client working relationship. How does a good therapeutic relationship start? First impressions being what they are, I think that it is important to come up with a way to greet clients that is relatively standardized, because this will allow the clinician to be comfortable in that setting, hopefully transferring that state of ease onto the client. It might be important to note that different clinicians are going to proceed through the first session differently. Also, where a clinician practices might make the decision for the clinician, as to how that first session operates. Let us start with the greeting.
     The very first contact with the client can be a crucial make or break point. I think that an appropriate greeting involves a warm smile, a healthy handshake, and an introduction involving identity. While I am not partial to the smile, I think that it does calm the client and gives them a positive first image to be remembered later on. The handshake very much depends on the client: some clients are touch-averse. Frequently the clinician can gain this information from the assessment, which can happen over the phone or from a previous appointment. The introduction should probably  entail name and any degree-related formality (Dr. and such). I'm not sure that there should be too much talking about self at this point because there could be a walk back to the office or a "settling in" period that separates the greeting from the formal introduction.
     There is much more to do in the first interview, obviously, than the greeting. The next step would be the "setting in" period. After that is the introduction phase, which is a complicated phase, full of sub-phases that I hope to talk about shortly. After the introduction, depending on the reason for therapy and the setting, first-session questions should be asked in order to gain a baseline understanding of the client. I hope to go over some of these questions here. I also wish to explain the end of the first interview and what should be discussed then. This includes possible avenues of therapy going forward, talks about the frequency of care, the length of each session, the length of treatment in general, etc. I realize now that I forgot to talk about discussion points in the introduction. The introduction is the time to talk about payment/insurance, clinician degrees/certifications/licenses, specialties, and any relevant experience of the clinician. Client concerns with therapy can be dealt with here or could be discussed in the baseline questions. I think that there are more questions in that section that I have forgotten, so I will hope to explain them further later.
     The greeting having been covered already, what does one do during the "settling in" phase? Normally some small talk may occur here. This is a good time for the therapist to introduce the space, asking whether the configuration is good for the client and, if not, how the pattern of chairs, desks, and tables might be more agreeable. This is also the time to get any water or tea that the client or clinician would want. This stage is very much the "hemming and hawing" between stage. After the settling in in comes the formal personal and professional introductions.
     I think it is important to note that the introduction is not only a space for the clinician to "awe" the client with his or her credentials, but also to ask some important questions about the client. Introductions, as such, should be mutually presented. This time is the chance for the clinician to inform the client about the clinician's work experience, including some history on where and how long the therapist has worked. This may bring up some points of similarity between the two parties, possibly strengthening their bond from the beginning. It is also the clinician's job to expound on the proficiencies and deficits of the clinician's practice. What do I and what don't I do well? This talk might include the therapist's orientation to clinical work and their expectations of the client (and themselves). As previously mentioned, insurance information and payment should also be discussed early on (rather than later on in the session. I would like to mention that session rules should also be discussed. Perhaps these are the same as client/therapist expectations or perhaps not. Obviously any special degrees, certifications, and licenses should be quickly introduced for the edification of the client.
     Between introductions and baseline questions, there might be a good opportunity to ask clients about their previous counseling experiences, including quantity and quality of treatment. This is important because the clinician can know what worked and did not work with the client. He or she can also know what not to do or how not to act - possibly just as important as the prior point.
     There are other questions that must also be asked in the first interview, including more assessment-based questions, these include:

  1. Full name/nicknames
  2. Address, phone number
  3. Employment/job/occupation + feelings about it
  4. Family growing up + feelings about them
  5. Family now + feelings about them
  6. Religious background (what type/denomination)
  7. Psychiatric symptoms
  8. SI/HI
  9. Why are you here? 


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