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Post by alison on Mar 2, 2016 11:09:38 GMT
I found the diagnostic interview difficult. Whilst this was a false situation (interviewing my husband!), I could see that I’d find it difficult to develop and maintain rapport using this interview format with a client. Also I wasn’t able to complete the interview within 30 minutes (despite missing out a number of questions). I felt uncomfortable with the sheer volume of questions and their ‘interrogative’ nature. However, I appreciate the intended purpose of the Diagnostic Interview.
For my work, it is useful to be aware of the content and purpose of the Diagnostic Interview. But, I don’t envisage using this interview framework with clients. That said, there are some questions that could potentially be useful, if for example I had concerns about psychosis or dissociation.
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Clare
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Post by Clare on Mar 5, 2016 13:47:14 GMT
I found this quite challenging, however my clients fill out a questionnaire which includes many of the questions that are asked in the 5-12 minutes, this form is filled out in the first 10 minutes of the session. This gives me an opportunity to see an overall picture of the client.
I agree with Alison, the particular question concerning Psychosis and dissociations very interesting. 13-17 minutes is far too short I found my ‘client’ (friend) wanted to explore some of the questions more.
My client commented that it was more of a tick box exercise and felt uncomfortable the number of questions and not being able to discuss her issues further which she found frustrating but understood the purpose of the assessment.
I will add some of the questions to my questionnaire, but I will not be using this particular style in my practice. Currently, the assessment interview does not fit my approach to therapy. However, I will ensure that I have a copy of the interview at my clinic; there may be an opportunity in the future that this assessment would be appropriate and needed by a client.
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tutor
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Post by tutor on Mar 6, 2016 6:25:24 GMT
Hi Alison and Clarem
This exposure to the diagnostic interview was for experiential reasons. The medical model is probably diametrically opposed to your style. The client is probably coming to see you in order to have an approach that is different to the medical model.
Please beware of questionnaires that ask lots of medical tick box questions - these may break rapport with the client. You need a coverall question that gets them to tell you of significant past or present medical or psychiatric issues.
Tutor
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Post by Chris on Mar 6, 2016 14:14:29 GMT
For me, this exercise shows both the necessity of a detailed diagnosis and the drag effect it can have upon therapy and establishing the client-therapist relationship. It highlights (for me) the need to establish a slick paperwork / recording mechanism, with the bulk of the job being done before therapy begins - a nice signature on a crisp, clear document which efficiently covers the arse of both client and therapist, whilst providing crucial technical information.
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Post by alison on Mar 8, 2016 13:10:01 GMT
I agree (tutor comments) that in the majority of cases clients are coming for a different approach to the medical model. I have never used lengthy questionnaires in my practice, but I do use a contract and medical history form (which is very short and only asks 3 things: contact details of GP, medication, past/current illnesses. The way I use this contract and form has changed over time. When I first set up in practice, I sent the contract/form out to clients (by email) before our first meeting. I no longer do this. I have learnt that rapport begins to develop before we even meet. I don't want my client's first experience of me to be being confronted with medical (and personal) questions. I found it was setting us off on the 'wrong foot', creating a 'therapist as expert' framework, which is not the way that I work.
Also, it was not uncommon for clients (further into the therapy process) to 'suddenly' share details of an illness or physical complaint, that they had not detailed on the pre-therapy form.
The way I work now is to ensure that the key questions on my medical form are woven into conversation during the first session. This way I am aware of issues related to safety and contraindications to hypnosis etc.
I am also beginning to ascertain whether or not I am the right therapist for this client, whether I want to commit to working with this client, whether the client wants to work with me.
The way I 'frame' the contract/medical form, is then dependent on what information I am getting verbally/non-verbally.
If I feel sure (or as sure as I can be) that it's appropriate for us to work together - then I would give the paperwork at the end of the session and ask them to return it next session (or email in advance of next session). This is what happens in the vast majority of cases. Although with some clients, it feels better to fill in the forms together.
However, it is not unusual for me to delay giving any paperwork until session 2 or 3.
If I'm not sure about working with the client or have concerns/doubts supervision is an important component. In supervision, we may agree a particular emphasis for questions/exploration in the following session. There have been times when my supervisor has given me a list of questions, or a depression score process, for example. So the questions are bespoke to client needs rather than 'off the peg' 'one size fits all'. And of course 'therapist need' in terms of 'what is important for me to know'
I have found this approach far more effective because the questions happen within a context of good rapport - and are relevant to the therapeutic process/needs of the individual.
And in terms of 'arse covering' - on reflection, in my early days when I was breezily giving out the contract and medical form in advance of therapy, I think I was actually more vulnerable. I find clients are (understandably) more open and honest when trust is established. The contract is based on a mutual, and informed, agreement. And I don't always 'agree' to proceed with a client. It isn't always in their best interests that I do so, and supervision really helps me explore and be aware of this.
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Clare
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Post by Clare on Mar 9, 2016 13:56:27 GMT
Thank Alison for some interesting points made. I too give my clients a medical form & contract, I stress to my clients to be brief in answers because like you I can fill in any gaps after my initial consultation. Supervision is essential for me to keep me on my toes and continually adapt the consultation for every new client.
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