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.
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.
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