I actually start noticing characteristics well before the first meeting if I am involved in the intake process. It can even start with that first phone call or email.
- how responsive the individual is. If they respond quickly, it suggests they may be very interested and committed to establishing care. In this territory also includes how ready the person is with their insurance information and completing new patient consents. The more quickly these are provided, the more indicative of a commitment to recovery and being an active participant which are very promising signs! This is important because they are indicative signs that this patient is likely to attend their first appointment. The first appointment is also the most likely to be canceled or ghosted.
- how the individual interacts with the staff member doing the intake process. I have seen individuals be polite and be clear communicators with effective interpersonal skills. Some are shy and overly apologetic. Others can be angry or even demanding. Even such a seemingly simple exchange can reveal a lot about where a person is at and where they are coming from. It can shed insights to contributors of life problems that person is coming to see you for. For example, does this person struggle with anger management? Whereas others struggle with being assertive and everything in between.
- body language reveals a lot about someone’s internal emotional state. Does the person maintain eye contact or are they avoidant? Does their body move fluidly or do they look stiff? Are they fidgeting? Someone who struggles with eye contact may have social anxiety or feel uncomfortable with the topic at hand (and depending on the topic, it can be revealing). I’ve met patients who are seasoned in undergoing therapy and they can talk and move freely. Someone who is relatively new or feeling embarrassed may look very stiff. Fidgeting can be an indication of anxiety. The mental status exam is important to use when formulating your clinical diagnosis/impression which shapes the treatment plan made together with the patient.
- What does the individual say and what does the individual NOT say? In other words, I like to try to uncover the real reason why a person is coming for care. Depending on the real reason, it helps me understand how helpful I may or may not be to that person and how we can plan our future visits. This has prognostic indications for likely how long you two will continue to meet with each other. Commonly I hear a very general reason like “depression” or “anxiety.” But the real question is: why NOW? Often people have had symptoms for a long time, but what was the straw that broke the camel’s back? Did someone’s depression get so bad that they had trouble even coming to work and are about to lose their job? Or perhaps they had a recent argument that was very stressful? The former person may call for a very different plan than the latter who may benefit from a treatment plan that also includes interpersonal skill building.