Two decades ago, in January 1993, Susan Lukas released Where to Start and What to Ask: An Assessment Handbook, aimed at guiding mental health practitioners toward better psychological assessments and intake interviews.
Though the author died in 2008, her publisher, W. W. Norton & Company, has released a new edition this year, this time with a companion CD. The book is written mostly for those practitioners either in training or early in practice, and it remains quite relevant.
Lukas writes clearly and concisely, offering quick yet interesting insights. She helps readers understand why assessment is important, then provides skills to improve one’s interviewing skills. There are two goals for the first interview with adult self-referred clients, Lukas writes: allowing the client to tell their story in their own words, and letting the client know that you understand their point of view. She reminds clinicians to meet the client where they are instead of going by their own pre-set agenda for the session.
In assessing a new client’s mental state, Lukas writes, one should observe appearance, speech, emotions, thought processes, perceptions, capacities, and attitudes. However, observing mental state is not enough: One must also assess a client’s medical history — something Lukas says clinicians tend to overlook. The book provides templates for write-ups of both the mental state and medical history aspects of the assessment.
Lukas also provides guidance on assessments in situations beyond that of the adult self-referred client. She discusses the distinction between systemic family therapy and simply seeing families, as well as special considerations for interviewing children.
In a separate chapter, she helps therapists navigate clinical interviewing with couples, reminding us to never assume that a couple wants to stay together just because they are seeking therapy. A significant portion of the book is also dedicated to the assessment of safety issues such as self-harm, substance abuse, and child neglect.
Perhaps one of the most useful aspects of Lukas’s work is that she makes it a point to address the ways assessments must differ depending on the client. This, paired with her templates and tips for write-ups, makes her book a useful reference for any mental health practitioner.
Where to Start and What to Ask: An Assessment Handbook
W. W. Norton & Company, May, 2012
Paperback, 208 pages