Overview

The intake hour is almost up, the client across from you has just disclosed a trauma history their referring provider missed, and the disposition decision is yours to make. Apply a generic adult interview structure to a trauma survivor, an acutely suicidal client, an immigrant family with cultural framings you did not ask about, or an older adult presenting with cognitive concerns - and the formulation you build will determine the quality of every clinical decision that follows. This book retrains the clinical interview itself, so what you elicit at the first encounter reflects what is actually happening rather than what the referral framed. - Therapeutic alliance under pressure - apply Bordin's tripartite framework and the Safran-Muran rupture-repair model when the client tests the relationship in the first session - Diagnostic precision across DSM-5-TR - recognize hypomania, complex PTSD, first-episode psychosis, borderline features within a trauma framework, and pseudodementia before they harden into the wrong chart label - The CASE Approach to suicide risk - elicit ideation, plan, intent, and behavior across four time regions using the validity techniques that surface what clients conceal - The Tarasoff duty in real time - know when the duty triggers, what discharges it, and the documentation that protects clients and clinicians both - Cultural humility that holds up under pressure - apply the Cultural Formulation Interview and the culturagram with immigrant, refugee, and cross-cultural clients without imposed assumption - Genograms and ecomaps that reshape formulation - three-generation McGoldrick-Gerson conventions integrated with Hartman ecomaps and trauma overlays - Capacity, civil commitment, and advance directives - apply the four-component framework to specific decisions and document the reasoning the proceedings require - Crisis interviewing and Project BETA de-escalation - manage the agitated, dissociating, or actively suicidal client without losing the alliance For clinical social workers, mental health counselors, psychiatric nurse practitioners, residents, fellows, and graduate students who conduct the assessments that determine what care comes next. Add it to your shelf, and to the next intake you walk into.

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