History Taking in Therapy: What’s Your Approach?April 1, 2008 • By Noah Rubinstein, LMFT, LMHC, GoodTherapy.org Founder and CEO
The GoodTherapy.org team received a question today from Brit, a visitor to the site, in response to the featured article, 50 Warning Signs of Questionable Therapy and 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 needs of the person in therapy.
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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 a person’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 the people I treated. But more often than not, the information I gathered was more helpful for my inner investigator than for the people I served. As the years went by, I began to realize that no matter how much I figured out, it did no good for the people I treated if they weren’t also figuring things out for themselves. You may 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 the person I’m sitting across from wants 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 that we trust the person to unfold on his or her own and that the person has what it takes to heal or to figure things out. Still, I’m sure there are situations and persons, perhaps those experiencing serious mental health conditions 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 people? 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!
© Copyright 2008 by Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved.
Permission to publish granted to GoodTherapy.org. The preceding article was solely written by the author named above. The view and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.
maddieApril 2nd, 2008 at 4:24 AM
I am not a licensed therapist but I would think it would be very negligent to ignore the history of as client and family history!
Stefanie Luna, LMFTApril 2nd, 2008 at 8:47 AM
Hi Brit. Hi Noah. Brit, thanks for raising this question. I agree this is a gray area within the counseling field. I have been both an agency therapist and a private practitioner and I have found over the years that every agency has it’s own process for conducting an initial intake. As Noah indicated, some are very involved and can take multiple sessions to gather the historical information and others have a “one-pager” that just takes down the basics.
In my private practice I adjust the intake process depending on the primary reason for seeking counseling. I often work with people going through infertility treatment so I want to get a fairly detailed family history and medical history. With some of my other clients I do a much more basic intake. And even at that I often find that key issues my intake doesn’t capture eventually surface within the course of our meetings, and perhaps in a more organic and therapeutic way.
So back to your question, Brit- I certainly wouldn’t form an opinion about the quality of the therapy based on this alone. I would be more interested in knowing if your friend feels a connection with the therapist. I would encourage your friend to share any information he/she thinks is important for the therapist to know so it can be incorporated into their work together.
JeanetteApril 3rd, 2008 at 3:00 AM
There are definitely two schools of thought on this one. I can see the rationale behind both approaches. On one hand you could see how the past can seriously affect a patient in an adverse way; however sometimes it is better to deal with what is going on in the past and help patients get beyond those issues in the past which seem to be holding them back from reaching their full potential.
runninfastApril 3rd, 2008 at 3:01 AM
Irresponsible is the only word that comes to mind when I imagine an involved therapy process without delving into the past. What happened in the past makes us who and what we are today. How could you not address that in therapy?
JillianApril 9th, 2008 at 2:20 PM
Why not just address the here and now and force the patient to take responsibility for the past, but to move on and deal with today’s issues?
Steve HApril 9th, 2008 at 2:22 PM
Because so much of what is going on in the here and now as you say is a direct result of our past. We cannot change the present without recognizing the things that happened to us in the past. Cleraly we have to learn from our past mistakes and those of others in order to not be destined to repeat them.
Daria KApril 10th, 2008 at 9:29 AM
That’s an interesting question, thank you for it. I am a narrative therapist, and we are taught to consider and question the taken-for-grante assumptions behind our ideas about “what should be done in therapy” and what is and is not an example of responsible behaviour. I do not believe that it is only personal and family history that is shaping the present. This idea is quite popular in the Western culture, but not in others; it is not an “universal truth”. It is the meaning the person makes of the events of the past (more or less consciously). And the hopes and aspirations, connected to what the person gives value to in life. When I meet with a person who consults me, I am interested in learning what are those values, and trace their history and possible future embodiment. I don’t think collecting the mere biographical facts is helpful; if it is done when the safe territory of identity is not created, such biographical interrogation might make the person feel as a “specimen” under a microscope, a “subject” in hands of very experienced expert researcher. Such an approach can recreate the power relationship that might have contributed to the appearance of the problem in the first place.
adminApril 10th, 2008 at 9:47 AM
Hi Daria, I very much appreciate you sharing the narrative approach to therapy and the potential pitfalls of history taking. I like the idea that it’s not the history taking that is the problem, it is how the history is taken that can be a problem. Thanks! Noah :)
CarolApril 14th, 2008 at 5:27 PM
As a patient, I’m very turned off at doing a detailed history at the first meeting. I don’t even know you and you want me to answer all these highly personal questions? What if I dont want to tell you about things just yet? I think things will come out when theyre ready to come out, and therapists can trust clients to bring things to light when they are ready to be dealt with. Thank you.
maddieApril 21st, 2008 at 3:55 AM
I disagree. My logic gets the best of me- how can you treat someone without knowing the issues which they have faced and dealt with, or maybe not dealt with in the past?
March 30th, 2009 at
It’s a great question and these are answers that show the gamut of belief and need of both clients and therapists.
I believe history is crucial but due to the level of crisis or stability in which clients begin the work it can unfold in different ways. Early on in my work it was my need and understanding that formally taking a history had to occupy the first couple of sessions or so, and I conducted my work that way. If someone comes in more curious than in urgent crisis mode, that is still my tendency.
However, if someone starts and they urgently need to talk about the present, I can let them know that I will also need to take a history but that I expect it will come together as we go on talking together. I then periodically ask questions about history as we go through what is troubling the person today. There is then a flow between gathering information about “there and then” and focusing on the process “here and now”, while starting to explore the meanings of the experiences to the person I’m working with.
winneyApril 27th, 2011 at 12:45 AM
Recent graduate of pschology, university of Nairobi.
Minimal history taking is absolute,for the Therapist to have an Idea of who the client is to get to a clearer picture of why help is being sort. The detailed history will unfold once the client and therapist have established a trustworthy rapport.
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