whether the therapist will meet regularly with the
child, with the parents, or with both. The first
order of business, then, is for someone to explain
generally what the clinic is all about and the kind of
help that can be given. This important step can
have a significant bearing on the client’s attitude
and willingness to cooperate. Whether this initial
contact is made by a therapist, a social worker, a
psychological technician, or someone else, it is
important that the contact be handled with skill and
sensitivity.
Once the client’s reasons for coming have been
discussed, the next step in the general sequence can
be explained. It may be useful at this point to dis-
cuss several specific issues. Who are the professional
staff, and what are their qualifications? What about
the matter of fees? Are the contacts confidential,
and if not, exactly who will have access to informa-
tion? If there are medical complications, how will
these problems be integrated with therapy contacts?
Does it seem reasonable to proceed with the client,
or does a referral to another agency or professional
seem more appropriate? These and other questions
must be dealt with up front.
Assessment
Once it has been mutually agreed that the client can
likely profit from continued contact with the clinic,
one or more appointments can be arranged for an
assessment of the client’s problems. As we have
already seen in preceding chapters, a variety of
assessment procedures may be followed depending
on the exact nature of the client’s problem, the
orientation of the professional staff, and other fac-
tors. Often, there is an intake interview, which may
consist largely of compiling a case history. Other
information may be gathered by administering var-
ious psychological tests. Sometimes arrangements
are made to interview a spouse, teacher, family
members, or friends. In some instances, too, it
may be considered desirable to have the client sys-
tematically record self-observations of behavior,
thoughts, or feelings in different situations.
For some clients, consultations with other pro-
fessionals may be desirable. A neurological workup
may be necessary, or a medical examination may be
scheduled to rule out non-psychological factors.
For some clients whose problems are related to eco-
nomics or unemployment, additional consultation
with social workers or job counselors may be
appropriate.
After all the information has been compiled and
analyzed, a preliminary integration is attempted.
What is desirable here is not a simple diagnostic
label but a comprehensive construction of the client’s
problems in light of all the psychological, environ-
mental, and medical data available. This initial
conceptualization of the client will provide guide-
lines for the specific therapeutic interventions to
be undertaken. As therapy proceeds, changes in the
conceptualization of the client will likely occur, and
therapeutic goals and techniques may change some-
what as a result. Assessment is an ongoing process
that does not cease with the second or third inter-
view. In fact, many now advocate weekly patient
assessments during treatment in order to alert thera-
piststolackofprogressorevendeteriorationin
functioning (e.g., Lambert, 2007)The Goals of Treatment
As soon as the assessment data are integrated, the
therapist and client can begin to discuss more sys-
tematically the nature of the problems and what can
be done about them. Some therapists describe this
phase as a period of negotiation over the goals of
treatment. Others suggest that client and therapist
enter into a“contract”in which the therapist agrees
to alleviate a specified set of the client’s problems
and to do it in the most effective way possible.
Naturally, no one can absolutely promise a perfect
cure or resolution of all problems. Clients in turn
will state their desires and intentions. In effect, their
contract usually covers such matters as the goals of
therapy, length of therapy, frequency of meetings,
cost, general format of therapy, and the client’s
responsibilities.
When a child’s behavior is the focus of treat-
ment, these discussions may include the child in a
variety of ways. Importantly, many children may
not understand what therapy is, why they are330 CHAPTER 11