Case history as initiation of therapy

Taking a history from a patient should not be a matter only of obtaining facts to be written down in the case notes. It is an interaction between two people, and ought to be as meaningful for the person who answers the questions as for the questioner. The patient should be invited to use the occasion as a personal opportunity to review his or her past and present, and to make sense of what may previously have been a chaotic array of happenings. There is research evidence which demonstrates the potential power of the initial clinical encounter to change the drinker's attitudes, enhance commitment and clarify goals (Thom et al., 1992).

Assessment is therefore the beginning of therapy (Novey, 1968). The relationship between patient and therapist begins to be determined at this moment and, if the occasion is mishandled, the patient may not attend for a second appointment. A positive relationship has been shown between the perceived quality of the initial assessment and subsequent willingness to engage in treatment (Hyams et al., 1996).

This chapter seeks to cover practical issues related to the art and technique of history-taking. The earlier chapters have sought to lay out the general groundwork of understanding, and we now have to explore how that understanding is to be addressed to practical ends. The present chapter is cast in the form of a series of working guidelines.