Negotiating content areas for focus
• We hold responsibility for identifying opportunities where we can be helpful and eliciting person’s agenda
• Check, ‘Are we talking about the right stuff?’

Content areas for focus in the interview need to be explicitly negotiated. If as mental health professionals we see someone who has an experience, syndrome, etc, which could be helped by one of the evidence based treatments we have to offer and we don’t elicit it we have let them down. We know what we have to offer and it is our responsibility to elicit possible areas where this might be helpful. It is also our responsibility to use our clinical skills to bring forward the concerns of the person consulting us.

This needs to be revisited throughout the conversation. Gathering threads can be a good opportunity for this. For instance:

It can be helpful to this process if we make our agenda explicit, and time can be specifically negotiated. For instance:

“there are a number of issues which you have brought up. I also think it is also important to clarify whether antidepressant medication has a role here. Shall we spend 10 minutes on A, 12 minutes on B and 13 minutes on C?”

Sometimes these negotiations are not straight forward. For example, a person may identify an issue of importance but move to something different.

"This person doesn’t seem to know what they want. They are saying they want to talk about Y and yet they talk about X."

This can raise senses of confusion and frustration in the clinician. It is important to hold these responses, maintain an attitude of respectful commitment to bringing forward people’s knowledge and make the issue explicit and inquire about it.

“I notice we’re talking about X, you’re saying Y is important. How do you make sense of this? How do you place X? How do you see X as linked to Y? What do you make of this difference?”

In doing this exploration, there is a commitment to the view:

“There is something of worth here that I am not getting. What can I do differently to get a clearer understanding?”

It may be important to bring forward some detail as to how the person is making their choices. It may be that there are challenges in addressing certain areas and it is more helpful in engaging with addressing those challenges than avoiding the issue.