Usually scary and intimidating for beginners

• How do I proceed?
• Where do I begin?
• What do I do after I begin?
• What should I accomplish?

I. Four goals of the first interview:

        A. Establish rapport:
                1. Relationship skills explained 45% of the variance in outcomes of a sample of family therapy cases.
                2. Significant differences between the quality of relationships of experienced and inexperienced therapists

        B. Build confidence in the therapeutic process

        C. Gather relevant information (what is relevant depends on variety of factors)
                1. Type of agency (e.g., hospital, counseling center, out-patient clinic)
                2. Institutional requirements (e.g., DSM-IV diagnosis)
                3. Whether you are planning to continue to work with client
                4. Who the client is (child, adult, couple)
                5. What the presenting problems is (e.g., depression suggests a suicide assessment)

        D. Negotiate a therapy contract
 

II. Phases of the first interview:

        A. The telephone call (may be done by receptionist)
                1. Gather basic information, including name, address, and phone number
                2. Ask for a brief description of the problem (e.g., what would you like to see me about?)
                3. Optional: Identify other members of the household and other people involved
                4. Contract for the first interview, including
                        a. Date and time
                        b. Place (give directions)
                        c. Fee for initial session
                        d. Who will attend (individual, mother & child, couple, family).

        B. Prior to the interview. Goal: to prepare for the interim
                1. Develop tentative hypotheses to be tested during interview
                2. Develop strategy for 1^st interview, including specific questions
                ** Question: What to wear? **

        C. The greeting (5 minutes). Goal: Welcome client(s) and introduce them to therapist
                Introduce yourself to the contact person and greet others if present, including children. Greetings should be
                age-appropriate ** Question: Is it better to shake hands? **

1. Optional: Invite people to sit where they wish (use information diagnostically)
2. Orient the client(s) to the room. Point out any recording equipment, observation mirrors, and, if appropriate, where children's toys are located. Remind about length of meeting
3. If you are audio or video taping, obtain oral permission from all adults (obtain signatures at end of session).
 
D.  The social phase. Goal. Establish a nonthreatening setting for client, get to know him/her better, help them become more comfortable

1. Briefly engage in some informal (and uncontroversial) conversation. Weather and parking are good for adults.
2. Introduce the agenda (e.g., let me start by getting some information about you)
3. Start with basic demographic information (e.g., name, job, length of marriage). If working with more than one person, talk to each person individually, including children. Try to find something interesting about everyone.
4. Note client's language and nonverbal behavior. Attempt to match and use this style in future sessions

1. Generally good to begin with an open-ended question. Let client tell his/her story (e.g., Why did you decide to make an appointment with me? What is it you're hoping I can help you with?).
2. Help clients be more specific, if necessary
a. How is this a problem for you
b. When did this problem begin? How long has this been going on?
c. Can you give me an example of the last time this happened?
d. What prompted you to come in now?
e. Help the client clarify his/her thoughts (e.g., reflect back)
      3. Explore the involvement of others
                    a.  From whom does this person receive support
                    b.  What has client been advised to do? How did this go?
                    c.  Obtain information about previous therapy, if any
      4. Ask about recent changes (moves, illness, job change, new family members)
      5. Ask about other things that you think are relevant
          (e.g., abuse, substance use, medical Hx, eating and sleeping behaviors)
      6. Process
                    a. Try to be empathic and noncritical. Treat people with dignity
                    b. Affirm the importance of each person's contribution
                    c. Don't offer advice or interpretations, even if asked
                    d. Block interruptions from others, if persistent
                    e. Go slowly
** Question: Is it a good idea to self-disclose?**