Aloha from Honolulu. This week Rita and I have been working from Honolulu, Hawaii as we attend and present at the annual convention of the American Counseling Association. Yesterday we presented on how counselors can integrate evidence-based relationships into the first interview. This is mostly based on John Norcross’s excellent work on evidence-based relationships. After the presentation one attendee asked if I could send him a copy of an intake interview outline. . . and so I’m posting a brief intake interview outline and an associated classroom activity below.
More on Highlights from Honolulu soon. But here’s an intake outline for now. This is from the Clinical Interviewing text, but you should keep in mind that the Clinical Interviewing text also includes a more extensive outline. See: http://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1118270045/ref=la_B0030LK6NM_1_1?s=books&ie=UTF8&qid=1396163487&sr=1-1
A Brief Intake Checklist
When necessary, the following topics may be covered quickly and efficiently within a time-limited model.
______ 1. Obtain presession or registration information from the client in a sensitive manner. Specifically, explain: “This background information will help us provide you with services more efficiently.”
______ 2. Inform clients of session time limits at the beginning of their session. This information can also be provided on the registration materials. All policy information, as well as informed consent forms, should be provided to clients prior to meeting with their therapist.
______ 3. Allow clients a brief time period (not more than 10 minutes) to introduce themselves and their problems to you. Begin asking specific diagnostic questions toward the 10-minute mark, if not before.
______ 4. Summarize clients’ major problem (and sometimes a secondary problem) back to them. Obtain agreement from them that they would like to work on their primary problem area.
______ 5. Help clients reframe their primary problem into a realistic long-term goal.
______ 6. Briefly identify how long clients have had their particular problem. Also, ask for a review of how they have tried to remediate their problem (e.g., what approaches have been used previously).
______ 7. Identify problem antecedents and consequences, but also ask clients about problem exceptions. For example: “Tell me about times when your problem isn’t occurring. What happens that helps you eliminate the problem at those times?”
______ 8. Tell clients that their personal history is important to you, but that there is obviously not time available to explore their past. Instead, ask them to tell you two or three critical events that they believe you should know about them. Also, ask them about (a) sexual abuse, (b) physical abuse, (c) traumatic experiences, (d) suicide attempts, (e) episodes of violent behavior or loss of personal control, (f) brain injuries or pertinent medical problems, and (g) current suicidal or homicidal impulses.
______ 9. If you will be conducting ongoing counseling, you may ask clients to write a brief (two- to three-page) autobiography.
______ 10. Emphasize goals and solutions rather than problems and causes.
______ 11. Give clients a homework assignment to be completed before they return for another session. This may include behavioral or cognitive self-monitoring or a solution-oriented exception assignment.
______ 12. After the initial session, write up a treatment plan that clients can sign at the beginning of the second session.
Prompting Clients to Stick With Essential Information
Using the limited-session intake-interviewing checklist provided in Table 7.2, work with a partner from class to streamline your intake interviewing skills. Therapists working in a managed care environment must stay focused and goal-directed throughout the intake interview. To maintain this crucial focus, it may be helpful to:
1. Inform your client in advance that you have only a limited amount of time and therefore must stick to essential issues or key factors.
2. If your client drifts into some less-essential area, gently redirect him or her by saying something such as:
“You know, I’d like to hear more about what your mother thinks about global warming (or whatever issue is being discussed), but because our time is limited, I’m going to ask you a different set of questions. Between this meeting and our next meeting, I want you to write me an autobiography—maybe a couple of pages about your personal history and experiences that have shaped your life. If you want, you can include some information about your mom in your autobiography and get it to me before our next session.”
Often, clients are willing to talk about particular issues at great length, but when asked to write about those issues, they’re much more succinct.
Overall, the key point is to politely prompt clients to only discuss essential and highly relevant information about themselves. Either before or after practicing this activity with your partner, see how many gentle prompts you can develop to facilitate managed care intake interviewing procedures.