1. Once the patient is seated, the session can be set in motion
1.1. Say nothing at all and wait for the patient to speak
1.2. Elaborate introductory remarks
1.3. Brief question to orient the patient and set the tone
2. Initial Principles Technique
2.1. Greet the patient in the waiting room with handshake, while introducing yourself and identifying the patient by name, unless there are other present in the waiting room
2.2. Start collecting impressions immediately, but do not over-value or over define these initial observations
2.3. Escort the patient to the consultation room and let him/her find the way to the chair used for the interview, directing him/her only if necessary
2.4. The interview should be conducted face to face
2.5. Need of note paper to record the patient's name and address, but do not do this until the end of the hour
2.5.1. Take as few notes as possible - preferably none- until after the session so the patient gets the full attention
2.5.2. The therapist must be able to maintain a fresh and full picture of recent sessions, particularly the last one or two
2.5.3. Keeping with medical and/or professional responsibilities, maintain some type of brief record to document the treatmeant of the patient
2.6. Having asked the patient about his/her problems, the therapist's next job is to listen to the patient
3. The Therapist's Goals in the first hour
3.1. Definition of the patient's emotional problems and establishment of a diagnosis
3.1.1. The therapist listens for the patient's symptoms, character structure, level of ego functioning, and current dynamics
3.2. Ascertainment of the background of these problems
3.2.1. The therapist learns about the patient's current life and its influence on his/her emotional problems, and determines how much the people and circumstances surrounding him/her will support or oppose treatment
3.2.2. Hear about the patient's early adjustment and childhood symptoms
3.2.3. Search for any major traumas in his/her childhood or adolescence
3.3. Determination of how the patient copes and assessment of his/her assets
3.3.1. Assess how the patient copes with his/her conflicts and anxieties and how well he/she is functioning overall
3.4. Determination of any acute problems
3.4.1. Do not fail to respond to emergencies and to search out fully any serious or dangerous symptoms
3.4.2. With suicidal or homicidal schizophrenic patients, it must be determined if there is danger to the patient or others
3.4.3. Acute anxiety and panic may require both medications and support thorough the therapeutic alliance
3.5. Clarification of the major resistances toward treatment
3.5.1. Alertness to indications of major resistances against therapy and interventions regarding them are among the most important goals
3.5.2. Detect early resistances to therapy as quickly as possible
3.5.2.1. Initial resistances form serious obstacles to treatment
3.5.2.2. Explore and analyze such resistances to enable the patient to deal with the interfering third person himself
3.5.3. It is preferable to convey the patient his/her responsibility for dealing with his/her parents or spouse, and to allow him/her to work it out with them
3.6. Assessment of the patient's capacity to work in therapy
3.6.1. Is made as the therapist listens to what the patient says and does not say throughout the session
3.7. Recommendations to the patient
3.7.1. The therapist should begin with a brief formulation to the patient, in the latter's own idiom, regarding the essentials of this difficulties
3.7.2. The therapist should indicate the type of treatment he feels will best help the patient with his problems
3.7.3. If psychotherapy is recommended, the therapist should state clearly that he/she feels he/she can be of help to the patient
3.7.4. The therapist should let the patient know that treatment is a long-term process which requires months and probably years
3.7.5. Where such obvious obstacles to treatment exist as major tendencies to act out or major opposition within patient or others, the therapist should address him/herself to them and anticipate the for the patient
3.7.6. The therapist should ask the patient if he/she has any questions and try to answer them honestly, directly, and briefly as possible
3.7.7. The therapist must deal with complicating factors such as medication, other therapists that the patients may be seeing, and other physicians who are treating the patient
3.7.8. Arrange a definite seconds appointment for further discussion; in this way the patient is more likely to continue with you
3.8. Establishment of the therapeutic alliance
3.8.1. Not all therapeutic relationships are alliances in the positive and constructive sense
3.8.1.1. Are not based on mature and realistic wishes for symptom relief through inner change and do not foster the patient's resolution of intrapsychic conflicts
3.8.2. The therapist must gently confront the patient with his/her unrealistic wishes regarding therapy and his fears of the therapist and treatment
3.8.3. The therapist establishes clear ground rules and defines the relationship verbally and nonverbally so that the proper therapeutic atmosphere prevails and everything is directed toward the exploration and resolution of the patient's neurosis
4. Assessment of Performed Attitudes and Transference Fantasies Toward the Therapist and Therapy
4.1. Patients come to their initial hour with conscious and unconscious fantasies, expectations, and feelings which are "preformed transferences"
4.2. Main sources of fantasies
4.2.1. The telephone conversations with the therapist
4.2.2. Patient's direct and indirect previous experiences with the caring figures of his/her life
5. Trial Interpretations
5.1. In the first sessions are actually not a means of a assessing treatability or psychological-mindedness
5.2. Interpretations of unconscious fantasies and conflicts are open to inevitable error and often generate antagonism in the initial hour
5.3. The risk in interpretations of this kind far outweigh their value
6. The Level of the Therapist's Activity
6.1. Let the patient determine the unfolding of the material and the extent of your activity; be flexible
6.2. Be active enough to obtain sufficient data
6.3. Keep in mind the tone that you are setting: professional, honest, helpful, thoughtful, and free-yet patient
6.3.1. Show concern, but do not become solicitous or verbally involved
6.4. Do not press the patient or challenge his/her defenses
6.4.1. Do not overly investigate an area to which the patient is especially sensitive