The First Helping Interview: Engaging the Client and Building Trust
Publication Year: 1996
Providing a practical handbook for practitioners in the helping professions, The First Helping Interview is a highly useful, easy-to-understand guide for both experienced and novice practitioners that reveals the steps involved in the crucial first meeting with a client. The authors approach the task of an initial interview by providing an overview of what the therapeutic process is and what to expect from clients, both those who seek help voluntarily and those who are required to get help. The book also covers the practical basics of therapy-counselor/client roles, physical settings, communication dynamics, assessment and diagnosis, record keeping, goals and contracts, and trust building. Separate chapters discuss special topics such as working with couples and families, the role of culture and ethnicity, when and how to ...
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: What Makes Therapy Happen?
- Establishing a Pattern
- Letting the Client Know You Know
- The Therapist as Teacher
- Chapter 2: Who are Our Clients?
- Voluntary Clients
- Involuntary Clients
- The Role of Anxiety in Acceptance of Therapy
- Clients and Trust
- What's Next?
- Chapter 3: Getting Started
- Setting the Appointment
- Your Own Anxiety
- Greeting the Client
- What Shall We Call Each other?
- Should the Client Be Comfortable?
- The Physical Arrangement
- Distractions Come in Many Shapes
- Starting the Interview
- The Home Visit
- Client Records
- Note Taking
- The Business of Therapy: Fees, Appointments and Telephone Calls
- Your First Meeting with the Client
- A Guide to Observing the Client
- Establishing Your Role
- And What of the Client?
- What's Coming Next?
- Chapter 4: Getting to Know the Client
- Listening, the Heart of Therapy
- Alerts, Red Alerts and Stop Signs
- What if You Miss Something—and it's Important?
- When the Client is More Than One
- Other Perspectives on Understanding the Client: Cognitive Processes
- How Much Structure—When and Why
- Linear and Circular Thinking
- Concrete and Abstract Thinkers
- Gathering Formal Information
- Getting Essential Information
- Reviewing Relevant Aspects of the Client's Present Environment
- The Use of History
- Putting it Together—Defining the Problem
- The Written Assessment or Diagnostic Statement
- The Client's Response to the Practitioner
- What Does the Client Bring to Therapy?
- Where Do We Go from Here?
- Chapter 5: Communication Dynamics of the Helping Interview
- The Sounds of Therapy
- A Quick Review of the Basic Therapeutic Responses
- Responses That Don't Work
- Other Responses That Help
- The Dynamics of Questions: Thou Shalt Not Ask the Wrong Questions
- Turn-Around Questions
- Dealing with Silence
- Other Difficult Moments or Games Clients Play in the First Interview
- Other Pitfalls of the First Interview
- The Dynamics of Intimacy
- Concluding the Interview
- Moving along …
- Chapter 6: On Rules, Goals and Contracts
- The Rules of the Game
- Whose Problem is it?
- How Much Structure?
- Understanding More about the Problem
- Specifying and Setting Goals
- Who Sets the Goals?
- Setting Priorities for Attention
- Specifying the Means of Change
- The Contract
- The Precontract
- Structuring the Therapeutic Contract
- The First Interview and the Contract—Implications for Success
- Where Do We Go Next?
- Chapter 7: Trust
- The Psychological Side of Trust
- Trust and Confidentiality
- How is Trust Built?
- Back to Trust—and How You Know You're Getting There
- And What Now?
- Chapter 8: Special Issues in Working with Couples and Families
- The Physical Setting
- The Family at Home
- Getting Started
- Redefining the Problem
- Keeping Confidences
- The Group Composition in the First Interview
- The Absent Family Member
- Homework Assignments
- Closing the Interview
- What's Next?
- Chapter 9: Working with Clients Who are Different
- Culture and Ethnicity: What Makes a Client Different?
- Gender Issues
- Oppressed Groups
- Know Thyself
- What the Practitioner Should Know
- How to Find Out What You Don't Know: The True Meaning of Acceptance
- One Last Point: On Being a Professional
- What's Ahead?
- Chapter 10: Serious Problems: When and How to Refer
- Making a Referral: When, How and Who
- The Referral File
- Physical Symptoms and Complaints
- Physical Abuse or Neglect of a Child or Adult
- Special Issues for Protective Service Workers
- Irrational Behavior and Threats of Violence
- What's Next?
- Chapter 11: Legal and Ethical Issues in the First Helping Interview
- Professional Ethics
- Whose Values are Better?
- The Ethics of Confidentiality
- The Worker-Client Contract Revisited
- The Ethics of Means and Ends
- The Problem of Rules
- Some Closing Thoughts on Ethics and the Misuse of Power
- Chapter 12: Afterthoughts
- On Self-Disclosure
- Who Helps the Helper?
- On Protecting Yourself
- On Rules, Suggestions and Contradictions
- On Becoming a Professional
- After the First Interview
- A Conclusion of Thoughts
- Once More with Feeling
Sage Human Services Guides[Page ii]
A series of books edited by ARMAND LAUFFER and CHARLES D. GARVIN. and other organizations.
- GRANTSMANSHIPby Armand Lauffer (second edition)
- CREATING GROUPSby Harvey J. Bertcher and Frank F. Maple (second edition)
- GROUP PARTICIPATIONby Harvey J. Bertcher(second edition)
- BE ASSERTIVEby Sandra Stone Sundel and Martin Sundel
- NEEDS ASSESSMENTby Keith A Neuber with William T. Atkins, James A. Jacobson, and Nicholas A. Reuterman
- DEVELOPING CASEWORK SKILLSby James A. Pippin
- EFFECTIVE MEETINGSby John E Tropman (second edition)
- CHANGING ORGANIZATIONS AND COMMUNITY PROGRAMSby Jack Rothman, John L. Erlich, and Joseph G. Teresa
- HELPING WOMEN COPE WITH GRIEFby Phyllis R. Silverman
- EVALUATING YOUR AGENCY'S PROGRAMSby Michael J Austin, Gary Cox, Naomi Gottlieb, J. David Hawkins, Jean M. Kruzich, and Ronald Rauch
- ASSESSMENT TOOLSby Armand Lauffer
- UNDERSTANDING PROGRAM EVALUATIONby Leonard Rutman and George Mowbray
- FAMILY ASSESSMENTby Adele M. Holman
- SUPERVISIONby Eileen Gambrill and Theodore J. Stein
- STRESS MANAGEMENT FOR HUMAN SERVICESby Richard E. Farmer, Lynn Hunt Monohan, and Reinhold W. Hekeler
- FAMILY CAREGIVERS AND DEPENDENT ELDERLYby Dlanne Springer and Timothy H. Brubaker
- DESIGNING AND IMPLEMENTING PROCEDURES FOR HEALTH AND HUMAN SERVICESby Morris Schaefer
- GROUP THERAPY WITH ALCOHOLICSby Baruch Levine and Virginia Gallogly
- DYNAMIC INTERVIEWINGby Frank F. Maple
- CAREERS, COLLEAGUES, AND CONFLICTSby Armand Lauffer
- TREATING ANXIETY DISORDERSby Bruce A. Thyer
- TREATING ALCOHOLISMby Norman K. Denzin
- WORKING UNDER THE SAFETY NETby Steve Burghardt and Michael Fabricant
- MANAGING HUMAN SERVICES PERSONNELby Peter J. Pecora and Michael J. Austin
- IMPLEMENTING CHANGE IN SERVICE PROGRAMSby Morris Schaefer
- PLANNING FOR RESEARCHby Raymond M. Berger and Michael A. Patchner
- IMPLEMENTING THE RESEARCH PLANby Raymond M. Berger and Michael A. Patchner
- MANAGING CONFLICTby Herb Bisno
- STRATEGIES FOR HELPING VICTIMS OF ELDER MISTREATMENTby Risa S. Breckman and Ronald D. Adelman
- COMPUTERIZING YOUR AGENCY'S INFORMATION SYSTEMby Denise E. Bronson, Donald C. Pelz, and Eileen Trzcinski
- HOW PERSONAL GROWTH AND TASK GROUPS WORKby Robert K. Conyne
- COMMUNICATION BASICS FOR HUMAN SERVICE PROFESSIONALSby Elam Nunnally and Caryl Moy
- COMMUNICATION DISORDERS IN AGINGedited by Raymond H. Hull and Kathleen M. Griffin
- THE PRACTICE OF CASE MANAGEMENTby David P. Moxley
- MEASUREMENT IN DIRECT PRACTICEby Betty J. Biythe and Tony Tripodi
- BUILDING COALITIONS IN THE HUMAN SERVICESby Milan J. Dluhy with the assistance of Sanford L. Kravitz
- PSYCHIATRIC MEDICATIONSby Kenneth J. Bender
- PRACTICE WISDOMby Donald F. Krill
- PROPOSAL WRITINGby Soraya M. Coley and Cynthia A. Scheinberg
- QUALITY ASSURANCE FOR LONG-TERM CARE PROVIDERSby William Ammentorp, Kenneth D. Gossett, and Nancy Euchner Poe
- GROUP COUNSELING WITH JUVENILE DELINQUENTSby Matthew L. Ferrara
- ADVANCED CASE MANAGEMENT: NEW STRATEGIES FOR THE NINETIESby Norma Radol Raiff and Barbara Shore
- TOTAL QUALITY MANAGEMENT IN HUMAN SERVICE ORGANIZATIONSby Lawrence L. Martin
- CONDUCTING NEEDS ASSESSMENTSby Fernando l. Soriano
- ORAL HISTORY IN SOCIAL WORKby Ruth R. Martin
- THE FIRST HELPING INTERVIEW: Engaging the Client and Building Trustby Sara F. Fine and Paul H. Glasser
- MEASURING THE PERFORMANCE OF HUMAN SERVICE PROGRAMSby Lawrence L. Martin and Peter M. Kettner
Copyright © 1996 Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or otherwise, including photocopying, recording, or by any information storage and retrieval systgem, without permission in writing from the publisher.
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Library of Congress Cataloging-in-Publication Data
The first interview: establishing an effective helping relationship / authors, Sara F. Fine and Paul H. Glasser
p. cm. — (Sage human services guides; v. 70)
Includes bibliographical references and index.
ISBN 0-8039-7140-0 (acid-free paper). — ISBN 0-8039-7141-9 (pbk.: acid-free paper)
1. Counselor and client. 2. Interviewing. 3. Counselors—Training of. I. Glasser, Paul H. II. Title. III. Series.
This book is printed on acid-free paper.
97 98 99 10 9 8 7 6 5 4 3 2
Sage Production Editor: Michèle Lingre
We dedicate this book to the people who inspired us to write it, to those among us who help other people deal with crisis, overcome impossible problems, or enhance the quality of their lives. When we began to think about our audience for this book, we thought first about social workers and psychologists, those who work in agency settings and those in private practice. As time went on, we realized that there are so many other professionals and volunteers who are “unsung heroes,” who help others through personal caring, sometimes with advice and information, and often by just listening. We dedicate this book to them:
AIDS Counselors—who deal with lingering death in the spirit of hope and acceptance
Child Care Workers—who provide emotional sustenance to their charges
Clergy—who are often the first—and the last—resort for people in trouble
College Student Services Personnel—who often help young people away from home for the first time to grow up
Cops—who are always around when you need one
Counselors for the Homeless—who provide a sense of hope when none seems possible
Crisis and Debriefing Teams—who are there for support when disaster hits a community
Drug and Alcohol Counselors—who help their clients find substitute gratifications for their addictions[Page xii]
Emergency Room Workers—who help others deal with life and death every day of their working lives
Employee Assistance Counselors—who give a human face to an often impersonal world of business
Employment Counselors—who help people with one of the most important aspects of their lives
Firefighters—who are often the first to be there when tragedy strikes
Foster Care and Adoption Workers—who seek a place for abandoned children to find love and security
Funeral Directors—who may provide the only grief counseling available
Geriatric Workers—who help clients who are often frail in body and spirit
Group Workers—who make it possible for individuals in the group to help each other
Hairdressers, Cab Drivers, and Bartenders—who sometimes help by offering advice and information as well as by just listening
Health Care Workers—who help people fight pain and fear
Hot Line Counselors—who know the right thing to say in a crisis
Hospice Workers—for whom “success” is death with comfort and dignity
Librarians—who often are able to direct people to the help they need
Mental Hospital Attendants—who are often the most important link between patients and other human beings
Nurses—who provide care for the spirit as well as comfort for the physical pain of their patients
Pharmacists—who frequently are the first to hear about emotional as well as physical problems
Physicians—who must distinguish between the psychological and physical symptoms their patients bring to them and find ways to treat both
Private Practitioners in Various Disciplines—whose office walls have heard cries of desperation and anguish to which they must respond
Probation and Parole Officers—who so often work with people who are alienated and isolated from society
Protective Services Workers—who help the most helpless in our communities
Psychiatric Nurses—who bring a special sensitivity to those we call disturbed[Page xiii]
Psychologists and Social Workers in Mental Health Agencies—who daily deal with human despair
Public Assistance Workers—who help people survive with dignity
Residence House Counselors—who are on call whenever they are needed
School Counselors—who deal with the complex relationship between emotional well-being and the ability to learn and grow
Self-Help Group Members—who help themselves by helping others
Settlement House Workers—who deal with the most depressed and disenfranchised in our society
Social Workers—who apply their skill and training to victims of social injustice
Street Gang Workers—who learn to confront and de-escalate violence while they themselves are in danger
Teachers—who so often provide more than “book learnin’ “
Teachers of Social Work, Counseling and Clinical Work—who watch with pride as students grow into helping professionals
Trainers—who are responsible for teaching others to be helping professionals
Travelers Aid Workers—who help those who are lost and confused and far from home
Visiting Nurses—who are sometimes the only link between the patient, his family and the medical community
Volunteers in Shelters for Battered Women—who put their own safety at risk to be available to those in critical need
Volunteers for Victims of Violent Crime—who help and counsel, often preventing psychic scarring[Page xiv]
Introduction: On Writing about the First Helping Interview[Page xv]
Those of us who practice in the helping professions came out of our training programs with a wealth and breadth of preparation behind us. We had read extensively in the theories of our disciplines, role-played a variety of clients and therapists, and discussed simulated problems and situations; we had interned and been supervised, we had written countless numbers of papers and classroom tests, and some of us had validated our competence through a professional licensing examination. Sometimes we felt overloaded and overwhelmed; at other times, we felt that we finally had a grasp of what we needed to know. But we all left our training years behind with the absolute knowledge that our real training was just about to begin, that our most important professional development would be the result of our “on-the-job training.” We also knew that we could use all the help we could get as we started out on our own.
It was from this awareness that we began to think about this book on the first helping interview. We decided to write a book that would be practical and useful, easy to read in an evening or two, and simple to use as a reference, should a question or concern surface as one enters into practice with a new client. Most of what we have included in this book may not be new to the more experienced practitioner, and like us, you probably learned much of it from your own experience. New practitioners will probably find that although much of this material was presented to you in your readings or in the classroom, some of it may be new to you. Our intention was to write a handbook, an easily reviewed summary of the important issues that the helper faces in that first meeting with a new client.
[Page xvi]The title of this book, The First Helping Interview: Engaging the Client and Building Trust, implies multiple meanings and intentionally so. Does it mean that the book is meant for the experienced therapist who is about to meet a new client for the first time? The answer is yes. Is it for the new worker about to meet the first client and engage in helping for the first time? The answer is yes. Is it for students taking a course or starting an internship? The answer is yes. Is it a book for people who find themselves in a counseling role without the benefit of formal training? Again, the answer is yes. Is it for child welfare and public assistance workers, probation and parole workers? Absolutely. We believe that experienced practitioners as well as novices need to look specifically at the issues surrounding the first interview, that these are unique and uniquely important issues, and that they need to be specified and underscored.
We have focused our attention in this book on the communication dynamics and principles of helping that are particularly relevant to beginning a therapeutic relationship, whether the helper is a psychologist, social worker, school counselor, psychiatric nurse, marriage and family counselor, or other kind of mental health or social agency worker. We have addressed the practical aspects of beginning this kind of work and discussed some of the specifics of assessment, diagnosis, and strategies that are necessary ingredients for establishing a professional relationship in the first interview. This book is not an exhaustive exploration of all aspects of counseling theory and practice but rather a selective overview of concepts that are the keystones of the therapeutic relationship. These concepts, often presented in the context of a one-to-one session, are then developed as they apply to counseling couples and families.
Although it was our intention that this book be relevant to all practitioners in the helping professions, some sections are particularly directed to child welfare and public assistance workers, as well as probation and parole workers. In those sections we address the context for service, that is, the agency, organization, or institution that has referred the client to a practitioner for some form of counseling. We discuss the particular problems in working with the involuntary client, the one who has been ordered to see us and for whom the consequences of refusal are severe. We address specific issues that reflect the needs and demands of practitioners in those agencies and give specific examples and guidelines, particularly in Chapters 3, 8, and 9. Workers in these areas often have difficult clients whom they see in less than comfortable environments. We hope that this book will be valuable to them.
[Page xvii]Although the focus of this book is on the therapeutic first interview, not all practitioners call themselves therapists. We have therefore varied the designations we use and sometimes refer to the therapist as the practitioner or the professional or the helper or the counselor. We have purposely avoided using psychologist or social worker because much of what we write is applicable to both professions. However, in those sections that primarily address issues concerning clients who are seen through a social agency, we sometimes refer to the practitioner as the worker, a term that is generally associated with this kind of practice.
At the same time, we have tried to avoid terminology that has specific meaning to one or another of the mental health disciplines. Instead, we tried to use a more general language with meanings that cross the lines of disciplines. In the same spirit, we have tried to present principles about the first interview that transcend the theoretical biases and goal orientations of the various mental health professions and of the individual practitioners within those professions. We found that this was not as easy as we had thought.
For example, we avoid the term intake interview because of its implications for an action-oriented outcome for the helping relationship. Yet we do not avoid discussion of the need for problem solving and action as a goal of therapy. We hope that regardless of our terminology or biases, the reader will bring a personal orientation to the reading of this book, just as we, the authors, brought our own orientations to our writing. We believe that this is as it should be, that the action orientation of social work and the personal growth orientation of psychology and counseling are inclinations, not absolutes. They are counterpoints to each other and each enhances and adds dimension to the other. We hope that the commonly accepted principles underlying all interpersonal practice will come through and that you will accommodate them to your own discipline, purpose, style, and professional orientation. We believe that the different perspectives complement each other and that together they provide an understanding of the significant ingredients that make change happen and help people resolve the dilemmas and distresses of their lives.
This book is an amalgam of the perspectives of its two authors, social work and psychology. It focuses on the basic principles of therapy and the counseling relationship that are common to all of the helping professions. The material we present is based on accepted theory and reflects what we have learned about practice from current research. The reader may be aware of differences in the perspectives of the two disciplines represented [Page xviii]by the authors: Whereas social work focuses predominantly on the action goals and behavioral outcomes of the helping relationship, psychology emphasizes the dynamics and process of therapeutic interaction and the personal growth and development of the client.A Note about the Use of Pronouns
In order to avoid the implication of sexism as well as the awkward “he or she” followed by the clumsy “her or his” and the irritating tendency to mix singular and plural pronouns in the same sentence, we have varied the use of gender in each chapter for both therapist and client.About the Format
It was difficult to decide in what order or under which chapter headings to arrange our topics. We were, after all, not describing the rules of a game. We were trying to capture a process, an essence. Even if this were a book on baseball, stating the rules and outlining procedures describing them is very different from the process and subtleties of playing the game. The process can't be as carefully defined. Events and procedures intermingle with each other and interact on one another. One can't always tell where one ends and another begins.
So we made the decision to trust our own experience and to deal with issues as they came up in our thinking and writing. We assumed that if something seemed important or appropriate to write about at a particular time, it would be important to the reader at that time as well. You will find that we often bring up an issue in one place because it feels right to discuss it there, and then we bring it up again later to review, refine, and reflect on it in greater depth. Like the professionals we are, we also believe that if something comes up again and again, it is because the issue is important and deserves to be revisited.
The helping interview is a unique occurrence. It can have a profound impact on the lives of people who experience it. We hope we have done it justice.
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About the Authors[Page 187]
Dr. Sara Fine is a Psychologist who teaches counseling theory and practice, group dynamics, and organizational behavior to graduate students at the University of Pittsburgh. She also maintains a private practice, consults with organizations, and gives seminars and training workshops in communications, counseling, and related areas all over the United States and in countries from the Middle East to the Far East.
Dr. Paul Glasser is a Distinguished Professor at the School of Social Work, Rutgers University. He is seasoned in the field of social work, an experienced practitioner as well as a senior faculty member in social work education. He was the dean of two schools of social work for over 15 years. His specialty is working with groups and families.