Coming to work in mental health care in the Netherlands (2)? The Intake Session

No matter how many years of experience you have in the field of mental health, (re-) starting your career in a new country is always challenging. PsyGlobal wants to guide you in this challenging process, to make sure your landing will be as soft as possible.

We interviewed Dutch professionals Wendy Weijts, clinical psychologist and psychotherapist, connected to WorldPsychologists, and teacher at RINO Amsterdam and Myra Haakman, psychologist, psychological lead at PsyGlobal, and co-founder of WorldPsychologist, about the Dutch vision on mental health care. In the first article, we talked about structure and a professional relationship. In this article, we talk about the intake session. An article about the diagnosis, treatment plans and evaluation will follow.

Everything starts with a good intake

In Mental Health Organisations (curative clinical care – GGZ)*, the first session with a new client lasts 60 minutes. This intake is often done by you as the basic psychologist, and your supervisor might join in the last 15 minutes to get a feeling with the client as well. In these 45 or 60 minutes, the most important role of a therapist is to ask questions. Some psychologists have their own ‘intake format’ that lists important questions. This is up to you. It can however be helpful to work with standardized questionnaires, to make sure you don’t miss anything.

Steal with pride

We asked Myra and Wendy to share some of the questions from their intake format. Feel free to pick the ones that resonate. They might come in helpful.

First, it’s important to clarify the client’s issues. Always keep the DSM-5 in the back of your mind when clarifying these: 

• How come you are here today? What makes you come to seek help specifically today, instead of two months from now, or two years ago? 
• Can you describe your challenges / issues?
• How did these issues become problems now?
• How do you deal with your challenges / issues? What do you do to cope with them?
• If you were your own therapist, what would you advise yourself to do?
• How would somebody else explain your issues? (Your mum, partner, friends)

It’s also important to get to know the client:

• Can you tell me something about yourself? What do you do in your day-to-day life? How is your family situation? Do you have friends with whom you can talk about your problems?
• Who knows you are here today?
• Who supports you?
• When you are not feeling well, how can I see that?
• Is it difficult for you to ask for help?
• Do you drink alcohol, use drugs, or take medication?
• Do you notice physical problems that are or might be related to your mental problems (somatic)?

Learn about their past:

• Have you been diagnosed before? Are there any mental problems in your family?
• Have you had treatment before? What worked and what did not?
• Did you ever take medication before? Did that help?
• What have you done yourself to cope? What worked?
• Have you ever attempted suicide (before)?

And finally, it’s important to understand your client’s goals:

• If this treatment is done, what has changed?
• If you wake up tomorrow and a miracle has happened, what has changed? What do you do that’s different from what you do today? How would you notice that something has changed? 
• Is there a parallel goal you want to accomplish besides solving your mental issues? For example: find a job, a new house, get married, change the relationship with friends / family.
• What is your goal for this treatment? (There might be more than one issue, but it is not said that the client wants to work on every issue.)

Setting goals is probably the most important, but also most difficult. If you set goals with your client, make sure to make them SMART. They must be realistic. If you don’t think they are, be honest about it. That also helps in growing trust.

 Some Mental Health Organisations use their own standard questionnaires for intake sessions, also to measure effectiveness of the treatment. You will use the same questionnaire at the start and at the end of the treatment. An example of such a questionnaire is the ROM, the Routine Outcome Monitoring. The ROM used to be mandatory for insurance. This is no longer the case, but it can still be useful.

Insurance Matters

Working in curative clinical care (GGZ)* in the Netherlands means you have to deal with your client’s insurance and other stakeholders. That means that certain steps in the process are mandatory to take. Let’s put those chronologically:

1. A client comes to you with a referral from their family doctor. After the intake session, you have to send a letter back to the family doctor to report about the client. The content of the letter should always be discussed with the client, before you send it. 
2. After you set a diagnosis, you have to share this with the insurance company. This is done through the HoNOS+. This is a questionnaire from the ZPM (Zorgprestatiemodel – Care Performance Model) and it stands for ‘Health of the nation outcome scale’. The only thing that you share with the insurance is the so-called ‘Zorgzwaarte’, the intensity of the care. Everything else is private information. 
3. Together with your client and your supervisor, you finalize the treatment plan.
4. It’s also important to keep in mind that your client has to be seen by your supervisor (the ‘regiebehandelaar’), at least once within the first four sessions, and after that at least once a year. This is also due to insurance matters.

After the intake session, you’ll most likely be asked to set a diagnosis, together with your supervisor. We’ll dive into this process in the next article. 

* if you work in a municipality or preventive care, the ‘rules’ in this article often don’t apply. However, it could be very useful to keep them in mind in your work, as they might help you to structure your sessions.

Do you want to read more about working in a merely Dutch culture? We have written another article about stereotypes in the workplace. You can find it here.