Chapter 11: Initial Interviews and the Psychological Study, pages 230-245 

A social worker must keep the psychological study and the diagnostic understanding separate, in order to avoid skewing the facts to fit the theory.

• Psychological study = observation and orderly arrangement of the facts about a client and his or her situation
• Diagnostic understanding – the thinking of the social worker about the facts: the inferences drawn from them

Preparing Before the Initial Interview:

• Cognitive preparation = the thoughts the social worker has about the clients and their situations
• Affective/empathetic preparation = the social worker’s efforts to put him/herself in the other’s shoes
• Anticipatory hunches and empathic feelings of the social worker are tentative and are immediately modified on the basis of information and attitudes presented by the clients when they are actually seen in that first initial interview

Initial Decisions:

• In a first interview, two of the many questions to be answered are:
  • Is this the right place for the client to be helped?
    • If the conclusion is no, a referral to someone else, who could help the client, would be expected. In referral, the social worker does not stop with giving information about another resource but, if the client consents, contacts the other agency, sometimes arranging an appointment, but in any case preparing the way for an easy reception. In any case, this all requires the client’s consent.
  • For how long shall we decide to work together?
    • Sometime during that first interview, usually toward the end, a preliminary estimate is made of how long the work will take.
    • The suggestion of an initial time span can be especially helpful with many reluctant clients or with others who fear that they will be snagged into an interminable treatment process.
• Some initial interviews take place with involuntary clients. It is essential to help those clients express their negative or mixed feelings about the interview at the beginning. Once that is done, a social worker may go on with dealing with the problem that brought the client there. It is essential, though, that the social worker shows warm interest, as well as understanding of the feelings of reluctance.
• Clarifying time arrangements and arriving at agreement about these as well as about appointment times and, where appropriate, fees, are part of what is sometimes called the contract.

Locating the Problem:

• The problem can be concrete or psychological or both…
• One can never be sure of whether there are additional ramifications to the presenting problem without asking the client whether there are other troubles or exploring factors that may be contributing to the difficulties that may also require consideration. So in psychological casework we explore outwardly from the problem to areas that one theoretically expects will be related to it.
• When the actual problems seem broader than or different from the presenting one, this needs to be commented on in a way that will bring possible complication to the client’s attention. This must be done at the appropriate time, however.

Precipitating Factors:

• Ascertaining the event or events that finally brought about the request for assistance and those that seem to have precipitated the emergence of the problem is important.
• Facts about issues that may have triggered problems are often key to the diagnostic understanding of the dynamics of the dilemma.
• By asking questions the social worker can pinpoint and bring to their attention possible contributing factors to the problem at hand.

Differences between Worker and Client:

• Social workers need to be alert to attitudes of personal reticence, distrust because of differences, marked dissimilarities in experience and values between client and worker, or difficulties in casting the worker in a therapeutic role.
• The social worker also has the responsibility to make every effort to bridge the gap by becoming as familiar as possible with some of the generalizations about people at various stages of life or about a client’s cultural traditions and patters, class identifications, and so on.
• The social worker must always approach clients – those of similar or dissimilar backgrounds – with a great deal of humility, and remember that the most important information about clients comes from clients themselves.
• Social workers must ask questions courteously, with tremendous respect, interest, and willingness to learn.

Who Is to Be Seen?

• Applicant alone vs. applicant with other people, such as family members
• It is important to let clients know that when one person makes changes in therapy, these changes can affect the quality of a relationship with someone who is closely involved but not participating; therefore, it may be wiser and fairer to include that person in the treatment or at least offer him or her the option of being involved.
• The social study of many problems often can be greatly facilitated by multiple-person or family interviews; one has the opportunity to observe the interactions among family members, as well as learn directly from as many people as possible their views of the situation.

Observation and Deduction:

• The social worker is closely observing the ways in which the client handles this first interview and the way in which he or she relates to the social worker.
• An important question to ask the client is what they have already tried to alleviate the troubles: what has worked, what has failed.

Gains in the First Interview:

• Turn the client’s mind toward issues that he or she may later want to think about more fully
• Ideally, he or she will leave the first interview feeling some relief from pressure, some hope that here is someone who is competent to help, and, at best, some readiness to take the first steps toward understanding and alleviating the problem.

The Exploratory Period and the Fact-Gathering Process:

• Each interview adds its increment as new aspects of the person and the person-situation gestalt emerge. The worker is dealing with a living, changing process. Feelings change, new events constantly occur, people reveal themselves more fully as trust grows.
• The social worker must understand that every problem falls into a certain system: the parent-child system, the husband-wife system, the family system, the health, school, or work system.
• Knowledge of factors that often contribute to different kinds of dilemmas immediately suggests the various systems that may be pertinent.
• Each time of difficulty that emerges during the early interviews suggest avenues that may need to be explored.
• The fact-gathering process receives its impetus and direction from two sources:
  • The client’s desire to tell about the difficulties
  • The worker’s desire to understand what they are, how they came about, and what motivation, capacities, and opportunities exist for dealing with them
• There needs to be a balance between the client’s free association, spontaneous flow of words, and the direction of the social worker.
• Before asking, a social worker must question his or her own motives for making the inquiries, especially regarding highly intimate or painful matters. It is important that the reasons for asking about such matters be made clear to the client.
• The best way to secure a clear picture of interaction is not simply to ask direct questions, but to have things described in detail, in a process of ventilation.
• An important aspect of these explorations is their revelation of how the client tries to cope with whatever difficulty he is experiencing, knowledge that is especially useful in throwing light on ego functioning, dysfunctional interaction patterns, etc.

Physical and Emotional Illness:

• The psychosocial worker is alert not only to what the client says, but also to other signs that might point to the possibility of illness, such as appearance, poor appetite, tiredness, sleep problems, as well as mild symptoms, such as pain, swelling, rashes, indigestion, and dizziness.
• It is also important to inquire about drug use. Familiarity with physical changes and behavioral indicators associated with substance addiction is essential.

Early History:

• The social worker should learn the client’s thoughts about when the present difficulty began. Sometimes, however, the client does not see early history, such as childhood or adolescent memories, as pertinent to the problem, unless the social worker somehow makes the connection.
• One needs to be alert to the sequence of events, especially important happenings that preceded or coincided with periods of symptomatology or poor functioning.

Additional Sources of Information:

• Conjoint sessions are often more effective than individual meetings because not only does it allow the worker to gather the facts, but it also allows the family members to direct their attention to their interactional patters while they are in the process.
• A visit to the client’s home. This should only happen, though, when the client is clearly willing for the social worker to come.
• It is sometimes useful to consult, with the client’s knowledge and consent – on a very selective basis – other people who may be in a position to add to the worker’s understanding of the client, such as a doctor, a teacher, a clergyman, employer, or friend.
• Reports of medical or psychiatric diagnosis or treatment, of psychological tests, and of previous treatment may be pertinent to the social study.

The study should start with what the client sees as the problem and its antecedents, as well as what he or she has tried to do about it and has thought about how it can be resoled. If appropriate, the study can then move on to look for present and sometimes past factors that may be contributing to the current dilemma.  

The best way to obtain an accurate picture is to enable clients to have sufficient confidence in the worker so that they can speak fully and frankly.