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Whether you are in private practice or work for a larger organization, there is always time pressure. Most of us book an hour or so to see a new client, and in that time we try to get as complete a picture as we can of what's been happening in this person's life. Inevitably we manage only to sketch out a brief outline, and try to discern whether we have anything useful to offer the person.
In our training we might often see a person three or four times to complete an assessment, and even then it would seem that we'd barely scratched the surface. A human life is immensely complex and we can't really get the whole picture in a few hours.
Some of our training seemed designed to instil the kind of distorted thinking in us that, in clients, we try to help them exorcize. One odd idea is that we will learn enough from a client during assessment that we can create a complete treatment plan for them, start to finish, then put ourselves on a kind of therapeutic autopilot as we work through the plan.
In fact, this never happens. We will always learn more as the sessions progress. Our understanding of the issues will deepen and suggest new avenues for the work. Clients will develop more trust in us and divulge information that they did not feel comfortable sharing up front.
As well, there are disadvantages to spending three sessions in assessment. If we are billing clients, we will cost them a lot before we ever offer them anything in return. If they have extended health insurance, we may go through most of their paid sessions before treatment begins. And after three sessions, we have set an unhelpful norm for seeing us: the therapist's office is a place you go and answer endless questions, without really getting to work on the process of change.
At best, a treatment plan is a rough outline of the first few steps of therapy, with some idea of where the ultimate destination might be. It's open to revision as we go along.
Even though our intake is necessarily incomplete, we still want to use it to get as complete a picture as we can. But we will never have time to ask all the questions we might like. So we can ask at least some of them on paper, and invite the clients to answer them when we are not billing them for our time.
The Intake Package
Psychometric questionnaires are an obvious source of information that many of us use. There are hundreds of these, and most are specific to the problem at hand. For depression you'd use one, for PTSD another.
Behavioural monitoring is another option. We can ask clients to take home a diary sheet of one sort or another, and keep track of their symptoms, their activities, their panic attacks, or whatever would be useful.
An intake questionnaire is also useful. In the course of assessment we usually want to (or have to) get certain kinds of information: the client's birth date, marital status, person to contact in case of medical emergency, medications being taken, treatment history, and so on.
Most of these questions don't need a lot of explanation by the clinician, and there is little point in spending valuable assessment minutes asking them and writing down the client's answers. We want to make the most of their time with us. So most clinicians use an intake form for clients to fill in before their first appointment.
To help with this, Private Practice Made Simple provides a sample intake form that clinicians can use as a model to develop their own. There's a pdf version you can print out and use as a general guide, and an MSWord version that you can actually edit with the details you want to include in your own form. Here they are:
(The link for the Word version opens our list of available forms. Just scroll down until you see the Client Demographic Form and look for the Word copy.)
As always, of course, I can take no responsibility if you later discover that this template doesn't include crucial information that you need, or if your clients find it difficult or objectionable to fill out. What I can say is that our clients seem very accustomed to filling out intake forms whenever they see a new provider of almost any health-related service, and no one seems to balk at the prospect of completing it.
Toward the end of the form it asks two questions that I believe are very important to good therapeutic outcome.
"In your own words, what is the nature of the concern you wish to address in therapy?"
Life is complicated. In the course of assessment we will inevitably become aware of many issues that a person might work on to their benefit. But why are they actually there? What is the main thing they really want our help with?
"Therapy can be a powerful force for change. In order for it to be most effective it helps to have a clear and specific goal. You may find it difficult to express your hopes for therapy in the form of a goal, but please at least make an initial effort. ... Feel free to list more than one goal if you wish."
What is the finish line for therapy, at least at the start? What would be a sign that the client got what they came for? Many people have difficulty with this. They come because they are experiencing distress, not because they have a grand vision of the future. But if we don't know where they want to go, we will likely set off in the wrong direction. Let's invite them to begin thinking about the outcomes they would like. We will inevitably return to this issue in the assessment interview, and repeatedly as therapy progresses. Let's signal the importance of the matter early.
Next Friday: Time to calculate what you actually need to earn in order for your practice to work for you. The form we'll discuss is a long and detailed one, and frankly not all that much fun to work on. But as I stress in the Private Practice Made Simple workshops, it's perhaps the best hour or two you'll spend in practice planning.
A BONUS: Does your practice will involve diagnosing clinical depression? Maybe my online course "Diagnosing Depression Using DSM-5" can help. Click here to access this $25 course for 80% off, or just $5.
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Want more information on operating a private psychotherapy practice?
Check out my book Private Practice Made Simple. It contains information on starting a practice, creating a space, designing a website, getting referrals, managing finances, avoiding burnout, and much more.