One of my favorite parts of the therapeutic process has always been that first meeting with my clients. I love building rapport, talking about what therapy looks like and getting to know people. Because of that, I sought out extra opportunities to do client intake assessments and learned some things along the way.
People rarely start therapy when everything is going well in their life. They usually come in feeling overwhelmed, frustrated or confused about why things in their lives are going so poorly. For this reason, it's sometimes difficult for people to articulate exactly what it is that brought them into therapy in the first place. They just know they’re ready for a change. When they’re unable to communicate clearly it’s easy for both the client and the therapist to get frustrated.
However, it doesn’t need to take weeks of sessions to narrow down specific things so that both you and your clients have a clear picture of what’s going on. Here are some tips on how to get out of the ambiguity:
- Use a calendar. People often use terms such as “a long time ago” or “a few years ago.” This isn’t necessarily to be ambiguous on purpose. Sometimes, people just don’t remember the details! However, you can help to jog their memory by bringing out a calendar and giving them a visual reminder. This often gives people the foundation to flesh out a story more clearly.
- Break up the day. Ever ask a couple or a parent to define how often something happens and they answer “all the time” or “all day”? That’s likely not an accurate description (although it gives you an idea of the level of overwhelm or frustration). In these circumstances I help people to break up the day by saying “Okay, well think about from the time he wakes up until he goes to school. How often does it happen then? What about during school? Then, from the time he gets back from school until he goes to bed?” This questioning serves multiple functions. It helps the client (or significant other) to paint a more realistic picture of what’s going on and gives them a baseline for which to evaluate progress later on. It also teaches them to avoid using all-or-nothing language and create goals for treatment.
- Reword the question. Sometimes we limit the information we receive because of the way we asked the question. If I ask “Do you have a criminal record?” I may get a very different response than if I asked, “Have you ever been arrested?” This one I know from personal experience! Another question I stopped asking was, “Who is in your family?” I replaced that with “Who lives at home?” to get a more in depth answer and then followed it up with “Who is in your family that doesn’t live at home?”
- Use the magic phrase- “What does that look like?” You might have five people come to you in one day all saying they are “nervous” or “depressed.” But that is such a subjective experience it doesn’t tell me anything! I would follow up with “What does it look like when you’re depressed?” That gets people to contemplate their actions and gives you as the therapist a much better idea of your client’s intensity and skills.
- Ask for more detail. Never settle for the phrase “normal” or “fine.” Just like #4, that doesn’t give you any information! We all certainly have a different idea of “normal” so asking follow-up questions will help see what the client’s view of “normal” is. I tend to be quite honest about this, often saying something like, “Normal can mean different things to different people. Tell me more about that” or “Tell me what normal means to you.”
- Draw a picture. I was once talking with a client and he was having difficulty conveying to me the details of a particular topic. Out of frustration he said, “It would be easier if I could draw it out for you.” What insight he had! I gave him a pencil and paper and we ended up having such a fruitful discussion. As he began to draw an outline, he starting giving me details about which I may not have even asked. If clients are having difficulty talking, try another method of communication. This works especially well with children and teens.
While there are lots of interviewing techniques and therapeutic interventions, I find these to be especially helpful in aligning with clients to make sure we're on the same page. Rather than find the questions annoying, most people are very receptive to getting more detailed. They appreciate that I'm taking the time to really get to know them and get a clear picture of why they came to see me.
If you feel like you might need more help with client assessments, check out my online program, Meaningful Documentation, where we spend an entire week focusing on how to have better intake assessments and even set up your own personal intake documents.
If you liked these tips, please share this article with a colleague. Let’s all collaborate and help one another be better clinicians. Happy writing!