As treating clinicians, we are interested in what makes a great initial interview with a client. We want the client to feel comfortable with us enough for her to share her most difficult memories and reveal aspects about herself that she is most ashamed of. We want the client to be honest and, as much as possible, not feel uncomfortable when she is honest.
If the client is a potential therapy client, we want her to feel confident enough in us to return for the next session. We need the client to feel that treatment is worthwhile and will ultimately help her. Thus, Carlat (2005) explains in his book, The Psychiatric Interview, the larger goal in mind during the diagnostic interview is treatment. If you do not keep this goal in mind during the first interview, your client may never return for the second visit and “your finely wrought DSM-IV-TR diagnosis will end up languishing in a chart in a file room.”
Studies have shown that up to 50% of clients drop out before the fourth session of treatment and many never return after their first appointment. There are many reasons for treatment dropout. Some clients do not return because they have formed poor alliances with their clinicians, some because they weren’t really interested in treatment in the first place, and others because the initial interview alone helped them enough to get them through their stressors. Thus, much more than diagnosis should occur during the first interview.
Alliance building, morale boosting, and treatment negotiating are all extremely important. You should establish a therapeutic alliance as you learn about your client. The very act of questioning is an alliance builder; people tend to like people who are warmly curious about them. As you ask questions, you formulate possible diagnoses, and thinking through the diagnoses leads naturally to the process of negotiating a treatment plan. These aspects are all important in the initial interview and can help to make the client feel more comfortable and return for further treatment.
Reference: Carlat, D.J. (2005). The psychiatric interview: A practical guide. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins.
Cindy A. Geil, M.A.
WKPIC Doctoral Intern