by Noah Rubinstein, LMFT
Executive Director GoodTherapy.org
The GoodTherapy.org Team received a question today from Brit, a visitor to GT, in response to the featured article, “50 Warning Signs of Questionable Therapy & Counseling.”
Brit writes, “Should a good therapist in the beginning stages of the therapy request a historical summary of the client in order to provide good counseling? I have a friend in counseling and the therapist did not ask for historical family information. This friend comes from an alcoholic family…..Should we be concerned?”
My guess is that there are many answers to this question. With so many different philosophical orientations, different approaches, and models of therapy, not to mention different generations of therapists all trained differently to some degree, the range of responses might be quite varied indeed. Some therapists spend hours gathering historical data and completing initial evaluations, others work in the here-and-now, preferring to dive into the work on the first meeting, and others are somewhere in the middle. And of course, a lot of what a therapist begins with depends on the presenting problems and the client’s needs.
I was initially trained as a family therapist, and in my early years of practice I would spend many hours gathering information in an attempt to get a clear picture of what was contributing to the client’s issues. I approached my intake assessments the way an investigator might, searching for some thread that might tie things together into a neat little package. Sometimes my efforts helped and things became clearer for me. Sometimes my insights actually benefited my clients. But more often than not the information I gathered was more helpful for my inner investigator than for my clients. As the years went by I began to realize that no matter how much I figured out, it did no good for my clients if they weren’t also figuring things out for themselves. I know, you think this would be obvious to a young therapist, but it was one of my many blind spots. So, nowadays I spend much less time gathering information in the beginning than I used to. I tend to begin where my clients want to begin.
If the presenting problem requires asking more questions or asking about family history, then I might take the time to ask. But most people, when allowed to lead, will take you right were they need to go –to the heart of the problem–, and will disclose the most important information as they go there. By letting a person unfold naturally we are communicating to them that we trust them to unfold on their own and that they have what it takes to heal or to figure things out themselves. With this said, I’m sure there are situations and persons, perhaps those experiencing serious mental illness or substance abuse, who are not ready to unfold on their own and who need more direction, guidance, and history taking.
But this is my bend; what’s your approach to starting with new clients? Do you take a history? How much do you rely on historical data? If you do take extensive histories, what are the benefits as you see them? If you don’t, why not? And what are the benefits, in your view, of not leaning too much on history taking? Thanks for taking the time to chime in! Noah :)
©Copyright 2008 by Noah Rubinstein, LMFT, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Noah and/or see his GoodTherapy.org Profile