Quotes from Susan Lukas

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

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.

The next question is: How will you remember what the client tells you? There are many schools of thought:

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.

REMEMBER Ask who, what, when, where and how. Don't ask why.

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.

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?

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.

CONFIDENTIALITY 1. Find out if, and under what circumstances, you are required by law not to maintain confidentiality.

that you never let a client leave your office if you have any sense that she may do herself, or someone else, harm.

two LOOKING, LISTENING, AND FEELING: THE MENTAL STATUS EXAM

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.

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.

REMEMBER When writing up your mental status exam, whenever possible, document your observations with the client's own words.

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one HOW TO CONDUCT THE FIRST INTERVIEW WITH AN ADULT