Engagement and Alliance Building Begins with Assessment
When patients contact me to make an initial appointment, I tell them about my beginning process. Specifically, I explain that for me to get as clear a sense as possible about what led them to pursue a therapeutic relationship – whether psychotherapy or psychoanalysis – we will engage in the following:
- An initial 90-minute intake appointment, where we discuss immediate concerns, problems, and reasons for seeking professional consultation at this time, where I obtain historical and other relevant background information;
- A session where patients complete several scientifically developed, objective, reliable, and valid measures to assess problems in living as well as interpersonal strengths, needs, and vulnerabilities, which give us textured information about one’s beliefs, experiences, thoughts, and feelings;
- A 90-minute feedback appointment, where we review the findings together, with the broad objective of better understanding what brought you to my office. Together we devise goals for a therapeutic plan and determine the frequency of sessions going forward.
Please know that while I do not believe the subjective experiences (one’s inner state) of a person can be completely described by responses on psychological assessment tools, my experience, both as a clinician and researcher, has taught me the value of gathering this kind of information.
In addition to the qualitative information obtained in our initial 90-minute appointment, objective data obtained from these normed, standardized, and empirically supported instruments help us:
- Assess (measure) and conceptualize the nature and extent of your life difficulties in ways we both can use in our work together. Based on these findings, I am able to consult the research literature and formulate additional hypotheses in my effort to better understand the origins of your current difficulties. Particularly important, these data enable us to better collaborate and formulate an effective treatment plan together;
- Identify “pathways and channels” to facilitate personal growth and change in relationships. Scores on these measures are often helpful to patients because they provide an emotional vocabulary putting words to feelings, thoughts, attitudes, and characteristic patterns of behavior that are frequently difficult to express clearly upon initial intake;
- Clarify the strengths you bring to our therapeutic project;
- Discover problems that either you might not have been able to articulate or we had not thought initially to explore;
- Articulate answers to the following two critical questions at the outset:
- What do you want to get out of our therapeutic relationship?
- How will you know when you have gotten what you want from our relationship?
- Monitor progress toward reaching the goals we mutually set for our relationship.
In my experience, this gentle, respectful, and systematic assessment approach balances subjective information gathering (via our one-to-one discussions) with predictions from objective assessment about what approach is likely to work best to reach our therapeutic goals. This process accelerates our ability to answer what I call The Prime Directive:
Why does it make sense that I am having these set of problems with these people in those situations right now in my life, and what can I do to be more effective and satisfied in these relationships?