INTAKE INTERVIEW AND REPORT WRITING CHAPTER 7 Uzm. Psk. Özlem Ataoğlu

What Is Intake Interview? Basically, they are interviews for evaluation before counseling, psychotherapy or medical treatment It is a starting point for people who seek for professional mental help You need to have the answers of the followings at the end of your interview: Does the patient has troubles due to mental, emotional or behavioural problems? If yes, do these problems need to be treated? How should you provide the treatment? Who should give the treatment and where it should be given?

They are NOT for intervention The content of the intake interview depends on the interviewer, institution, and the reasons of the interview We take the first data from our observations, referral form and registration information

Goals of Intake Interview Reasons for referral, questioning therapy goals, defining and evaluating them Collecting information about the styles of interpersonal relationships, skills, and personal history Evaluating up – to – date circumstances and functionality Sharing related information with other related mental health professionals

How to collect information? After your question “Sizi bugün buraya getiren sebep nedir?”, try to understand the reasons of consultation around 15 mins During this, to develop therapeutic bond use non – directive listening behaviours, positive attending behaviours When you have an impression about the basic problems, use directive questioning

The patients mostly do not consult with pure symptoms so in order to differentiate and to make differential diagnosis, you generally need to know the basics of DSM – V The problems are related to the therapy goals so while summarizing, try to emphasize the goals and change Also, you will make the patient create more realistic therapy goals

Patients generally complain about people around them, express their concerns about their lives and their symptoms are ambiguous You have to understand the problem areas and goals in the first quarter of the interview in order to move directive questioning to define the emotional, behavioural and mental problems We try to make the patient think about the other problem areas and frame the problems, choose them and determine the goals

You need to help the patient define the problems and concerns This is about guided discovery – as a therapist you have to discuss, clarify, summarize and frame these problems After all of these are done, you need to move the area that is the most problematic for the patient Even if you know which problem area causes other dysfunctions, you start with the problem that the patient indicates

Focusing on the patient’s indication shows your respect, that you listen to him/her, empathy, facilitates to gain trust, and breaks any possible resistance Only by this way, you can do motivational interviewing and direct your patient to the area you would like to study on WARNING: If the patient does not define his/her concerns as problems – YOU SHOULD NOT EITHER

You should have a list of questions that you practice regularly while framing the problem area Try not to plan your questions in a definite order Sometimes when you let the patient talk, you will collect more important information than your plans Do not forget that you should have a flexible plan

How to conceptualize problem areas? You can have the basics from Lazarus’ BASIC ID model Behaviour Affect Sensation Imagery Cognition Interpersonal Relationships Drugs

The most important model is A(ntecedents), B(ehaviour), C(onsequences) Cognitive – behavioural therapists emphasize the reasons of the problems and their outcomes The most important model is A(ntecedents), B(ehaviour), C(onsequences) What did you experience before this problem appear? Which behaviours cause these problems? Which events, beliefs, experiences are followed by after this problem? **You should combine Lazarus’ model with ABC model for the best outcomes

Obtaining history In the first intake interview, you have to gain information from 3 sources: personal history, relationship with others, mental status examination After you understand the main reasons for consultation, you need to ask “Why now?” By this way you are able to understand why the patient is ready now, whether someone directed him/her or s/he is ready to talk

After you have obtained the answer, you are ready to move to history of the patient You can either collect all of the information about childhood/past events or try to collect childhood information about the problem areas Try to start with non – directive techniques to collect psychosocial history After you have the general view, you can move to more directive questioning Even your patient wants more directive questions, you should let your patient think for a couple of minutes

The patient may show resistance and feel uncomfortable about talking their past or say they cannot remember anything Talking about past events can be too risky, you can find some traumatic events At this point, what you should do is to listen too carefully, show affective commitment and use reflection of feeling + feeling validation

If the patient is too enthusiastic about talking about events with emotional baggage, try to use this to find out the coping strategies It is beneficial both for you and your patient You need to encourage your patient’s strengths after talking about these problematic areas Move your patient from past events to today – facilitates to move away from disturbing experiences If your patient still experiences those emotions, it means that s/he still has those traumas on the surface or thinks that nothing has changed

When you move to more directive questioning, you start to collect more concrete information about the past events The stories your patient chooses to tell is a sign of today’s problems Your patients are expected to tell both positive and negative childhood events – if s/he tells only negative events, it is a sign of depressive disorder; if s/he never tells negative past events, it is a sign of repression (defense mechanism) If your patient talks about negative memories even if you ask, do not force your patient to talk about positive memories

Ask for adjectives to define people around your patient Then, ask to define events that match with those adjectives While collecting psychosocial history you need to ask for First memories Parent and sibling memories School and friend relationships Job experience Other (romantic relationships, sexual experiences, medical history, psychiatric history, etc.)

Evaluating interpersonal relationship styles Our behavioural patterns depend on people and situations mostly How do we decide our behaviours should be? It depends on our roles within the relationships – sometimes we are more dominant, sometimes we choose to be directed, sometimes we are more close to some people, sometimes we show distance What we should do is to collect information about these relationship patterns – past relationships, today’s relationships, your relationship

It is not possible to end up with a general formula of the patient’s relationship patterns with only intake interview Instead, you should create a temporary hypothesis about these patterns In order to collect these information, you should be careful about your own emotions, as well Your emotional and personal reactions to the patient can be because of countertransference In the first intake interview, our goal is to collect information and create hypothesis

Evaluating functionality After you have evaluated past relationships, you need to move to today’s functionality This is a message that we move from past to today By this way we give a message that “we want to focus on your strengths and outer factors” What we typically ask is “Bana rutin bir günününüzü anlatabilir misiniz?” If your patient is still experiencing past events’ emotions, use feeling validation and give hope for change While ending your interview it is important to give hope and realistic information about the emotions  this will make them feel more comfortable and are approved by the therapist

Evaluating therapy goals and tracking change Patients want some change in their lives so we need to ask their expectations Generally what we ask is “Bu seanstan/terapi sürecinden beklentileriniz nelerdir?” Try to generate as concrete goals as possible so that both you and the patient can track the change Even if you understand the goals from the problem areas defined at the beginning, generate them again for a positive motivation Defining goals lead us to termination

Intake Interview Report One of the most important and hardest part is reporting You have to define these followings: Your target group Structure and content Writing open and core information Confidentiality of the report Sharing with the patient

Defining target group Ask this question “For whom do I write this report?”  for yourself, supervisor, patient, colleague, insurance company? If your patient will read this report, then you do not talk about psychopathology and use more simple language If you write it for your colleague, supervisor, then you may want to use more terminology and indicate your analytical thinking WARNING: Even if we do not offer our patient to read the report, s/he will always has a right to read it – so you should always be careful about what you have written

Defining structure and content Your structure and content depend on your profession It is beneficial for you to write a detailed report for yourself because in your treatment progress you will need to refer these information However, depending on the area the report will be used, it can be too long so sometimes it’s structure and content are needed to be changed

What can be included to the report? Demographical information Reasons of consultation – brief (If available, who directed the patient and in what context) Behaviour observation and MSE Detailed reasons for consultation, if available history of the disorder/problems Previous treatments, family background Medical history Developmental history Social and family history Functionality areas Diagnostic impression Case formulation and treatment plan

Writing open and core information Your first attempt will not probably be good enough so try a couple of times It is probably a better idea to write the report right after the interview Write what comes up to your mind as a draft, then you can fix it Having an outline will facilitate the writing process Ask for what is expected from your report Follow sample reports Practice! ** After you have written, check the report  did you write it as the way they have expected? Is it detailed? Does all of the information relevant? Is it OK if your patient wants to read the report?

Confidentiality of the report You should be careful about the confidentiality of your reports You should not leave them on your desk or open on your PC Try to keep a hard copy and an electronic copy on your PC in case of you lose them If you keep an electronic copy, it can be a good idea to use a nickname in case of hackers

Sharing report with the patient Legally, all of your patients have the right to have an access to your reports This means that you should be very careful about what you have written  sharing information can cause some troubles You should indicate that you will keep records and they have the right to have an access Warn them that you have used terminology If the patient demands to read the report, you can say that you would like to review to eliminate the possibility to have a misunderstanding Arrange a new appointment and have a look together If s/he is not your patient anymore, you can choose to send it to the patient; give it to another health professional; or refuse