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Monday, 18 September 2017

What should I ask in my intake session?

Structuring a therapy session - especially a first one - is a problem for many new therapists, and some not so new. We know we need to collect quite a bit of information, but there is often very little structure taught as to how to do this. Lots of good stuff about clean language, open questions etc, but not so much on what to actually ask.

Most people find the practicalities fairly easy - name, contact details, medical history, family and support system, job, interests, lifestyle etc. Then we come to asking about 'the problem'. But what to ask?

'What’s brought you here?' or 'What would you like the therapy to achieve for you?'
are a good start, but some clients find it easy to talk, and others are more reticent, finding it difficult to express how they’re feeling.

Having an overall structure to your questioning can be a really good approach for either - to encourage more reserved clients to open up or to keep chatty ones on track. I recommend remembering the word T.H.E.R.A.P.Y. to give you this. It's an acronym, of course, and each letter stands for a part of the information you should be gathering in your case history.

  • T is for 'Test the goals'. We often know what the client is here about in general terms before they arrive at the session. (I always ask when booking the appointment, to ensure it’s something I can help with.) In the session we need to get down to details. The three tests are -
    (a) is the goal positive? (i.e. what the client wants rather than what they want to avoid)
    (b) is the goal a SMART goal (i.e. specific, measurable, achievable, relevant and time-bound)
    (c) does the overall goal need to be chunked into smaller steps before working with it?
  • H is for 'History to Here and now' - this is likely to be the largest part of the intake discussion. It includes all the when, where, who, why, how questions about the presenting issue, from when it started to the present day.
  • E is for 'Establish what needs to change'. In other words, what changes does the client think they need to make to enable them to meet their goals? This isn’t just the obvious stuff like 'To be a non smoker I need to stop smoking', but also looks for resources they might need to acquire, like 'To be a non smoker I need new coping strategies for stress'.
  • R is for 'Re-imagine the future' - what do they think the world will be like when they have met their goals? How will they know when they are there? Many clients haven’t thought about this in detail but it’s good to get them to do so. What will they see, hear, do or feel that is different from now?
  • A is for 'Add-ons and Aggravations'.
    - Add-ons are what the client will do to support the work you’re dong together in sessions. It might be practicing techniques, listening to your audio, or keeping a diary.
    - Aggravations are whatever the client thinks might be a barrier to progress. This can include other people, like saboteurs who (accidentally or otherwise) tempt the newly smoke-free back to smoking, or practicalities like a shift pattern that interferes with establishing regular mealtimes.
  • P is for 'Planning'. I often tell my hypnotherapy students that a therapy plan is a bit like a birth plan and rarely gets to the end without some adaptations. Clients progress more quickly or slowly than expected, or meet unanticipated aggravations on the road. But it’s worth having a plan anyway because it provides structure, and you can monitor progress as you go.
  • Y is for 'Yomp ahead'. A bit obscure, I appreciate, but there are not that many words beginning with 'Y'! In any case, Yomp is Royal Marines slang for a march over challenging terrain carrying full kit, and I think it works really well as a metaphor for just getting on with the therapy. Once you have all the information you need, and a plan, you and your client to shoulder their 'baggage' and travel together at their 'own pace' across whatever terrain you find, until you reach your goal.
You may find, especially with clients who open up easily, that you don’t get this information in the order I've listed it. That's fine. Your communication with your client should be organic in nature, a naturally flowing conversation that moves around the topic in whatever way seems right at the time. But having a structure to fall back on will help you ensure you've got all the information you need by the end of it, and stop you drifting too far away from the point.

I’d suggest you try this with your clients, give it a go and see what you think. Let me know.

And if you would like to know more about T.H.E.R.A.P.Y., and get lots of other tips and information about providing effective therapy to your clients, you'll find just that in my book, 'Their Worlds, Your Words'.
  

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Author: is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
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