Structure—set the form and organization of the meeting(s) for you and the client:

Inform and clarify rules and expectations

confidentiality
exceptions to confidentiality
supervision
notes and records

Begin education in the role of client

Carry out initial decision making (and set model for how decisions are made in therapy)

What actions are to be taken?
Do you and the client continue meeting or not?

Close the first session

Set the form of ending a session
Leave taking ritual

Process—how you respond (verbally, vocally, nonverbally) to the client during the session; the “how” of the interview:

Attending to the client

Welcoming

Your posture
Making eye contact
Nonverbal acknowledgement: nodding, gestures

(what about touching?)
(what about note taking?)
(what about taping?)

Talking with the client

Open ended versus closed questions

Basic interview skills:

Restatement
Paraphrase
Reflection of feelings
Demonstrating empathy
Summarizing

(what about clarification?)
(what about confronting?)

Engaging the client: interest, concern, respect, warmth, empathy

Content—the information you begin to gather about the client, the presenting concern, the client’s “life, the universe, and everything”; the “what” of the interview:

Basic information (name, age, birth date, address, contact information, (emergency numbers, releases) (parents’ names, school, grade, teacher)

Initial exploration of the problem(s)

What is the difficulty?

Elaboration: what, how often, how long, how bad, what
has been done, how has this worked?

What else is causing difficulties?

Exploration of situation

When, where, with who does the problem occur?

Exploration of person/life

Characteristics, traits, coping responses, etc.
Overall structure of life beyond problem
Social history

Risk areas

first tier (may trigger breach of confidentiality,
mandate actions/highly problematic or dangerous)

depression/suicide
aggression/homicide
abuse (child, elder, spousal/partner)

second tier (serious issues which may destabilize client’s
life or threaten safety)

eating disorder
self-injurious behavior
alcohol/drug abuse
sexual behavior
delinquent/criminal behavior
gambling
academic failure
psychosis
running away

third tier (serious areas/competencies affecting client)

symptoms
family relationships
emotional regulation
executive functions
developmental status
health

Development of your initial plan:

Do you meet again?

Actions to be taken:

by client
by therapist

Initiation/set structure/inform of ground rules, (.1 hour)

adults: “Hello, I’m . . . ., have a seat, let me give you an give you a general view of how we might proceed and see how that sounds to you, alright?”

youth: “Hello, I’m . . . ., would it be alright for you and I to talk together for a little while?”

“Any questions?”

Summarization/feedback

Client directed portion of interview, (.1-.2 hour)

adults: “So, how can I be of help?”, “What brings you in today?”

youth: “What’s going on?”, “Why did your parents being you to
see me?”

Obtain a statement of the presenting concerns in client’s own
words.

Summarization/feedback

Therapist directed portion of interview, (.2 hour)

adult: “I’ll need to know a lot more about this problem, but right now I’d like to take a few minutes to fill in some other information, would that be alright?”

youth: “It’s been a tough week for you. Before we decide what to do about that, I’d like to find out a little more about you, OK?”

Use prompts and probes to gather information

Summarization/feedback

Return to presenting complaints for decision making: (.2-.3 hour)

adults: “OK, thank you for letting me get a picture of things. I think it’s time we made some decisions about our next step.”

youth: “OK, Here’s what I think we might do to help this. . . . How does that sound?”

Propose an initial therapeutic plan (for treatment, for further
assessment, for case management, etc.):

proposal
contract
rules (confidentiality, release of information, expectations)

Summarization/feedback

Conclusion of session (<.1 hour)

“I’ll see you here next week at noon.”

Crisis—client status

Client is distraught
Client is chemically compromised

Emergency—therapist status

Client is dangerous to self or others
Client is in eminent risk
A medical emergency appears to be manifesting
Client is noncompliant/noncooperative
Client is disruptive
Client leaves session