Where to Start and What to Ask Quotes

“Once the client is seated, if she starts talking, let her. And pay very close attention. Often, the first things the client tells you are the most significant. If”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“IF A CLIENT HAS A PHYSICAL
SYMPTOM How long has she had it? How often does it occur? How much does it interfere with her daily life? Has she seen a doctor?”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“REMEMBER When writing up your mental status exam, whenever possible, document your observations with the client’s own words.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“observations about every client, but to remind yourself that, first of all, a good clinician is a good observer. Behind that statement lies a premise that nothing is irrelevant in understanding a client, especially at the beginning. With each successive meeting you will alter or enhance your understanding of the importance of some aspect of your first observations, but for now your radar should be scanning all the time, picking up the most obvious and the most subtle visual cues.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“ESSENTIAL AREAS TO ADDRESS IN THE
MENTAL STATUS EXAM APPEARANCE: How does he look and behave? SPEECH: How does he speak? EMOTIONS: What is his predominant mood? What is his predominant affect? (Mood = How does the client feel most of the time? Affect = How does the client appear to be feeling while he is with you?) THOUGHT PROCESS AND CONTENT: (Process = How does the client think? Content = What does he think about?) SENSORY PERCEPTIONS: Are there any indications of illusions or hallucinations? MENTAL CAPACITIES: Is he oriented × 3? What is your estimate of his intelligence? Can he remember and concentrate? How are his judgment and insight? ATTITUDE TOWARD THE INTERVIEWER: How does the client behave toward you?”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“The biopsychosocial assessment is based mostly on facts about the client’s life and a description of the problem which the client has provided you during a series of interviews. The mental status exam is essentially your observations. It is used in different ways in different clinical settings, but those differences have more to do with the time at which one formulates one’s findings than they do with content.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“two
LOOKING, LISTENING,
AND FEELING:
THE MENTAL STATUS EXAM”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“that you never let a client leave your office if you have any sense that she may do herself, or someone else, harm.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“You are now ready to end the session and usher your new client out. You rise and walk to the door; then, as your client is about to leave, she says, “Well, I guess next week I’ll have to tell you about the time my father tried to kill himself.” This is known as the “door-knob syndrome”: that is, the client waits to tell you some piece of information that is terribly important or frightening or embarrassing until there is no time to discuss it further. The general rule is to say something like, “That sounds like something we should discuss further. Let’s begin with that next week,” and not to allow the session to be prolonged. This”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“So, you and your new client have agreed to meet again next week. Perhaps, depending on how your agency works, you have told her that you will meet for 45 minutes once each week. Or perhaps you have agreed that you will discuss with the treatment team what approach would be most useful and that you will report those findings to her at the next session. It is often helpful to give the client a card noting the date and time of your next meeting. (You may not want to do this for all clients. It’s a judgment you’ll have to make at the time.) However, it is best to do this without asking the client if she needs it, since you may embarrass her. As”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“CONFIDENTIALITY 1. Find out if, and under what circumstances, you are required by law not to maintain confidentiality.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“The client may also raise the question of confidentiality: Who will know about what is discussed between the two of you? This issue will be discussed in a number of different contexts later in the book, but it is important for now to realize that there are some exceptions in practice to the notion that client confidentiality will be upheld at all costs. For instance, information is usually shared in agencies where there is a team approach to treatment decisions. Also, in most settings where students train, there are seminars or other learning situations in which group discussions of cases occur. More importantly, in instances involving certain risks of danger to the client or others, there are exceptions in the law to your right to keep information confidential. You should discuss these issues with your supervisor in advance. You need to find out what exceptions prevail and get some basic guidelines so that you will be prepared and comfortable in talking with your clients about how things work in your agency. Usually, after noting the exceptions, you should be able to reassure the client that no information about her will leave the agency without her written consent.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“If the client does want to come back you need to arrange a time to meet again; in addition, if your agency requires it, you need her to sign some kind of permission to provide services. You may also need to discuss how fees are paid, insurance coverage, and other documents that may need to be filled out.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“So, what information do you want to gather during this first interview? Foremost is her description of why she is here now as opposed to six months ago or six years ago (this is known in clinical parlance as the “presenting problem”). You want the basic data if you don’t have them: name, age, marital status, occupation; with whom she lives and where; any previous experiences of therapy; and perhaps some preliminary information about her family of origin. You also want to get some sense of her support system: Does she have friends? Do her relatives live nearby? Does she have a good working relationship with colleagues at her job? Many of these answers will emerge spontaneously. If they don’t, ask for them. Toward the end of the session, you want to leave yourself enough time to ask the client if she has any questions. In addition, you want to ask whether she would like to come back again and talk further. You might help her make that decision by pointing out what you are seeing, e.g., that she seems to be struggling with her feelings about her father’s death or that it is sometimes difficult to know the right thing to do when you are having trouble with your child. The goal here is to try and arrive at a mutual definition, in language that seems right to the client, of what the presenting problem is. Under the best circumstances the client will say something like, “That’s exactly the way I would have said it.” If you do not reach a mutual definition, however, that is not a reason to despair, since you are new at this. It is perfectly alright to suggest that the client return again so you can further explore and clarify what it is she would like your help with. If”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“The sum total of all this, then, is that you want to ask only about facts and information the client can provide without having to probe her feelings or motivations. After all, if she were clear about her feelings, she probably wouldn’t be coming for help with a problem in the first place. Furthermore, asking “why” can lead you into making premature judgments about the client’s problem, since you will be fighting the desire for explanations and conclusions.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“REMEMBER Ask who, what, when, where and how. Don’t ask why.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“Remember, she has a right-and you have an obligation-to protect her from a sense of premature intrusion into her private feelings, particularly since you have not assessed what effect such revelations will have on her functioning.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“In addition, you will be exploring the unique terrain of this person’s life. You should feel free to ask questions about her experience. For instance, “Mary is your sister-in-law?” or “Did you move a lot?” or “It sounds like things changed a lot after your mother died.” And most importantly, it is okay to say, “I don’t understand.” Remember, the client will appreciate your interest in her, and asking her to help clarify who or what or when or how is a way of demonstrating your interest. The question to avoid, however, is “Why?” For instance, “Why did your father do that?” or “Why did you feel that way?” or “Why can’t you tell your brother that?” These questions call for an understanding of motivation and for a response that suggests insight about the client’s own behavior or the behavior of others. They are also implicitly asking the client to articulate feelings. She may do that spontaneously, but it is best not to ask for feelings yet. There are a number of reasons for this. First,”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“And while she is talking, the most important tasks you have are to listen and not put words (or feelings) into the client’s mouth. What that means is that the client may describe to you a situation that would make you feel angry, or frightened, or helpless. However, that’s not necessarily what the client feels or can accept that she feels. Therefore, you need to respond with language that is as emotionally neutral as possible. Stay away from loaded words like “furious” or “incompetent” or “I would have felt…” Also, avoid clinical jargon like “depressed” or “anxious” or “guilty.” Let the client tell you what she is experiencing by simply listening or saying something like, “That sounds like it was very difficult for you,” or, “I can see this is very painful for you.” Let the client define what difficult means or what it is that is painful for her.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“In the meantime, unless you feel, or have been told, that there is a compelling reason to do so, the less you reveal about yourself the better. This can often be accomplished by explaining that the purpose of your meeting together is to help the client understand the difficulties she is struggling with. If this seems withholding, remember that the focus of concern should remain on the client’s needs and how best to meet them. One way to impart this feeling is to help the client start talking about what brought her here. This can be a straightforward question. Or, if you know something about the client’s situation from the intake information, you might want to guide her by saying something like, “I know your husband died two months ago. Can you tell me more about that?” Remember, the purpose of the interview, no matter how much you know, is to get the client to tell you her own story in her own words.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“If she doesn’t start talking, you might want to introduce yourself again, this time adding to the introduction the fact that you are an intern (or extern, or student, or whatever phrase your school or agency prefers). If you know you will be staying in the agency for only a limited time, ask your supervisor or your school what the policy is concerning when to inform your client of that fact. Some feel it is best to let the client know at the beginning that you are a student and will be leaving the agency on a given date. Others feel it is better to proceed as if you were just another member of the staff and to wait until the client is engaged to tell her about your departure. You will have to find a position on this issue that is comfortable for you, but it is best to clarify it before you start interviewing clients. Some clients may pursue this issue. They may want to know more about your credentials, or they may tell you they were “expecting to see a doctor.” You may need to explain something about how the agency works and who comprises the staff. Or this may lead to a discussion of the client’s previous experience with therapy. It is generally best, however, not to get into an extended discussion about who you are.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“Now you are ready to greet the client. This moment is important. Although it may vary slightly depending on how many people are involved and the circumstances under which you are seeing the client, there are a few basic principles intended to transmit courtesy, interest, and a clear message that this is a professional rather than a social relationship. If at all possible, you should always go out and meet the client rather than having her sent to your office by a receptionist. Opinions vary on whether you should introduce yourself more or less formally, e.g., “I’m Ms. Lukas” versus “I’m Susan Lukas” versus “I’m Susan.” They also vary on the issue of whether or not to shake hands with clients. Depending on her clinical outlook and the circumstances under which a client is coming for therapy, your supervisor may feel that any physical contact might transmit a misleading or potentially threatening notion about therapy. Therefore, all these questions should be discussed before the first interview. Having greeted the client, and while leading the way to your office, you should remember that the interview has already started. Listen very carefully to what the client is saying and make a mental note of your overall first impression. When you have ushered her in, pay attention to how the client reacts to your office. What does she say? Where and how does she choose to sit? (If possible, you should arrange seating so the client can sit facing you at a distance that permits her to speak in a normal voice, but is far enough away so that she does not feel you could reach out and touch her. If the client comes from a culture in which reaching out and touching another person’s arm is a sign of friendship or interest, then she can move the chair closer to you if she chooses to.) Does she wait for you to suggest that she sit down? Does she sit on the edge of the chair? Does she seem disorganized? Try to help the client to feel more comfortable. Show her where she can hang her coat if she wants to. Suggest that she might feel more comfortable in another seat. But remember: If the client chooses not to do any of these things, do not urge her to. The goal is to “start where the client is,” rather than expecting her to do it your way. You are concerned with her feeling of what is comfortable, not yours.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“You need to get some basic data and you need to get it accurately. One option is to inform the client that recording information accurately is the purpose of your note-taking and ask her if she feels comfortable with your doing that. Most clients will say “yes”; however, if one doesn’t you will simply be confronted with the need to cultivate an essential habit: that is, making some notes after every interview. The word some is emphasized because you will not always have time to write down everything. If you make it a practice to note five or six key phrases or observations, you will probably be able to reconstruct much of what happened.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“The next question is: How will you remember what the client tells you? There are many schools of thought:”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“So, now you’ve arranged the first interview. What next? If you are fortunate enough to have your own office, take a look around and ask yourself how you would feel coming there. If your client is likely to bring a child, is there anything for the child to play with so you can talk to the parent? If the client is in a wheelchair, can she get through the door or do you need to meet in some other office? If the client has trouble speaking English, would it be reassuring to have someone there to translate, or would it be insulting? And lastly, do you have pictures of your current partner or your children on your desk or other personal memorabilia around? If so, it’s probably a good idea to ask your supervisor’s opinion about whether or not to put them away, since they have to do with who you are and not with who the client is, and you have no idea what meaning the client will attribute to them or how she will see you once she has seen them.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“If you are supposed to telephone the client, remember that your relationship starts when she answers the phone. Be professional and concerned but remember that the purpose of the call is not to do therapy over the telephone but to arrange a mutually convenient time when you can meet face-to-face. The client may be anxious; however, do not assume that you know what that anxiety is about. Also remember that asking for help is not an easy thing to do.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“Then, if you have voluminous records to read, start by asking yourself what’s missing. If there are no medical records, why not? (You will find more on the importance of medical information in Chapter Three.) If that person was seen at another agency, were the records requested and have they arrived? If the person is taking medication, what kind, how much, and who’s giving it to her? Start taking notes about the basic facts: age, ethnicity, who’s in the family, presenting problem, I.Q. scores, diagnosis, etc. Begin to build a profile on that person in your mind, ask questions, do your homework-and then add a healthy dose of skepticism to everything you’ve found out. Why? Because your job is to find out who that person really is, and the information in a file is only as useful and accurate as the competence and insight of the people reporting it.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“Helping a client with all those things is part of your job. But before you can begin-in fact, before that person walks through the door-you must prepare yourself. In many agencies part of your preparation will be reading some documentation on the client. That may be nothing more than a two-line summary of the problem the client has reported and a telephone number you can call to set up an appointment. On the other hand, if the case is being transferred to you, it may mean a huge file that includes a medical history, a psychiatric evaluation, a mental status exam, a biopsychosocial assessment by a previous clinician (or clinicians), that clinician’s progress notes, a report of psychological testing, a diagnostic code, and many other types of information. Whether it is one page or fifty, though, your response ought to be the same: What don’t I know that I need to know? Start making some written notes for yourself, beginning with those questions that you need to have answered before you call the client back to arrange an appointment. For instance, you may want further clarification of her current problem, if possible, so you can be sure she is coming to the right place. You may want to find out if anyone told her there is a fee charged. Or, if the case appears to involve more than one person, you may want to inquire about who should be included in the first interview. You should raise those questions with your supervisor or with the person who had the initial phone contact.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“your goals in a first interview are always the same: First, to allow the client to tell you her own story in her own words. You may have voluminous documents that you have read before your first interview; however, it is still crucial that you hear-or elicit-the client’s understanding of why she is there and what she thinks the problem is. This does not in any way imply that you necessarily accept, or even agree with, the client’s interpretation or definition. It simply means that you want to hear it from her. Second, to let the client know that you understand what she believes, even if it is her belief that she does not need to be there. This involves listening carefully to what the client is telling you and acknowledging it by something as simple as saying, “Are you saying that you are having difficulty in your relationship with your husband?” Or, “Maybe you’re saying that you would really rather not be here.” The client’s realization that you are an interested listener and that you are making an effort to understand her is the essential first step in engaging any client in treatment. If you disagree with the client’s perception of the problem, this is not the time to say so. Depending on the nature of the treatment (e.g., family therapy), you may restate the family’s perception of the problem using a different framework, but that will be taken up in the chapter on the first family interview. For now, just remember that the overriding purpose of any first interview is to listen and to let the client know that you are trying to understand.”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook

“one
HOW TO CONDUCT THE FIRST
INTERVIEW WITH AN ADULT”
― Susan Lukas, Where to Start and What to Ask: An Assessment Handbook