‘‘How should I do it’’? Clinical dilemmas therapists struggle with during the mental health intake

Abstract

In order to achieve the competing demands of the intake, therapists must make rapid decisions on how to use the limited time allocated for the mental health intake. No research to date has systematically examined how therapists perceive and manage these demands. Here, we investigated the clinical dilemmas therapists described facing during the intake session. We conducted in-depth interviews with therapists immediately following their intake session with 117 clients presenting for a new episode of care in community and hospital-based mental health clinics in Israel. We analyzed the interviews using thematic analysis. Overall inter-rater reliability among three raters who coded the narratives was high (kappa=0.72). The main themes that emerged from the data were: (1) systematic collection of diagnostic information versus uninterrupted flow of speech; (2) collection of sufficient diagnostic information versus attendance to client's emotional state; (3) structural limitations of intake versus client's flow of speech; (4) therapists' versus clients' goals for the intake; (5) focus on psychiatric assessment versus use of rapport-promoting techniques during intake; (6) prior data documented in the client's medical chart versus diagnostic information collected during the intake. Our findings stress the need for providing therapists with strategies to deal with time trade-offs to best use the restricted time allocated to them during the intake to complete a thorough diagnostic assessment while allowing their clients tell their personal unique story.