Sensitively Uncovering the Client’s Work History – Pitfalls and Solutions (excerpted from the Psychiatric Clinics of North America)

Mar 07, 2017

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Sensitively Uncovering the Client’s Work History – Pitfalls and Solutions (excerpted from the Psychiatric Clinics of North America)

TISA Description of the Problem: As we begin this new year, we have a very special series of “Tips of the Month.” In 2007 our TISA website was honored by having an article published in the Psychiatric Clinics of North America based upon our Interviewing Tip of the Month feature. The article was entitled, “My Favorite Tips from the Interviewing Tip of the Month Archive at the Training Institute for Suicide Assessment and Clinical Interviewing.” (Shea, SC: Psychiatric Clinics of North America, June 2007). These tips all appeared on this website and will now be re-printed with some additional comments – as they appeared in the Psychiatric Clinics of North America – during the next eight months. Congratulations to all of the contributors whose tips were chosen as the very best.

Let us begin with our first tip from the article: Many aspects of taking a social history, and even seemingly innocuous questions about demographics, can sometimes pose significant hurdles to engagement. A tricky engagement situation can arise when we are asking our clients about their employment. The following set of valuable tips was provided by Mike Cheng, M.D.

Tip: After the introduction, many clinicians will proceed to ask about identifying and demographic data, prior to starting the chief complaint or taking the history of the presenting problem. Often such inquiries start with questions about living situation and marital status. One area of difficulty is asking about occupation.

For example, for women, I have been taught to avoid asking, “Do you work?” for such a question may imply that a woman, who does not have a “paid” job, is not working. By implying that domestic chores and/or child rearing is not work, the clinician may be inadvertently denigrating the client on a subtle level.

On the other hand, asking “Do you have a job?” or “Are you working?” may tend to alienate any client who is not currently employed outside of the home. Due to this, I have seen some interviewers tactfully ask, “Do you have a job or are you between jobs?” Alternatively, I find the following question to be the most tactful: “Are you working at the moment?” The addition of the words “at the moment” helps the client to “save face.”

In the last analysis, because of all of these complexities, I have found the easiest single question to ask is the following, “How do you support yourself?” This phrasing allows for a variety of responses from the client such as: “I’m on disability.” or “I work as a teacher.” or “My spouse brings in the money for us.” From the start, this simple question can provide surprisingly good insights into the employment situation of the client and even how the client feels about his or her current situation

TISA Follow-up: The above interviewing techniques provide a variety of thoughtful ways for helping clients to feel comfortable when sharing job status. Another nice question is to ask, “Do you work outside of the home or in the home?”

Tip provided by:

Michael Cheng, M.D.

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