After making empathic contact, I conduct a mental status examination in order to arrive at as comprehensive an evaluation as possible in the initial hour. I assess motivation, capacity for insight, flexibility, frustration tolerance along with an understanding of the presenting problem and symptom constellation. I attempt to see how affects are handled, thoughts are presented, what mood is prevalent and how well or poorly I am related to. Resistances are initially bypassed while attempting to ease the person into the therapeutic encounter.

I arrive at a psychotherapeutic diagnosis and develop a preliminary formulation of the goals of continued work. This formulation includes an understanding of what a person is seeking in his life and what seems to be blocking his or her progress and achievement. An informal ‘contract’ is negotiated which serves as a blueprint for the therapeutic work ahead. There is early interpretation of the transference, where appropriate.

The above is done in an attempt to determine whether interventive efforts should be directed at nurturing, maintaining, enhancing, or modifying inner capacities; mobilizing, improving, or changing environmental conditions; or improving the fit between inner capacities and external circumstances.

Richard B. Joelson, DSW
110 East 87th Street
Suite 1E
New York, NY 10128
info@richardbjoelsondsw.com