NCJ Number
165946
Date Published
1995
Length
12 pages
Annotation
Prescription drug abuse represents an egregious example of the misapplication of the relationship between the client and the health care provider and complicates the clinical interview due to the client's hidden agenda.
Abstract
The case of a young man who approached a family physician and asked for Demerol for an alleged migraine headache exemplifies the issues involved in these difficult persons. The case demonstrates that in situations in which the clinician's index of suspicion indicates that the client has ulterior motives, the clinician must control the interview situation and make it clear that the physician will act only in accordance with regular practices. The next tasks of the interview include establishing rapport, facilitating a productive discussion, enhancing the client's self-esteem, gathering information, developing a therapeutic contract, providing information and instructions, and giving feedback and answering the client's questions. Useful techniques in the early phase of the interview include limit-setting, maintaining a neutral posture, and maintaining control. Establishing rapport and a therapeutic environment is difficult to achieve if the client's motivation is not honest. However, even a difficult client has some motivation for treatment and the interview can continue into information-gathering. This phase includes the history and the mental status examination. During the concluding phase of the interview, providing feedback and answering questions are important. Some positive statement concerning the physician's belief that the client will recover is part of the therapy and part of the interview process, even with difficult clients. These clients can be difficult and frustration, but interested clinicians should try to work with them. Tables