New Patient Referral Questionnaire: Fill & Download for Free

Assuming you are running the practice or the front office for the practice, just put together a questionnaire to include with the intake paperwork for new patients.I wouldn’t get any more detailed than “doctor’s referral” — as in, not asking which doctor did the referring — unless you have an attorney’s OK on the questions. It’s probably a good idea to have that sort of once-over for the questionnaire once you’ve decided on the final questions anyway.You should also be aware, that if you change the questions, or add or remove them, going forward, you will skew the data collected vs. the older forms, and so it’s necessary that you put document numbers and document version numbers (or at least dates), so that if you track by computer, you don’t dump everything in the same database, or if you do, you can mine it out by which questionnaire was used.In other words, the information from one form and a different form will not be comparable, in aggregate, except in sections of questions which are identical between forms.Useful information doesn’t come from “big data”, if you throw disparate data into the same bucket.

What are some labels, stigmas, misconceptions, faulty generalizations or false dichotomies that medical profs, disordered people and/or the general population seem to get hung up on regarding survivors of abuse by a pw/ Cluster B PD?William Gorder, thanks for the A2A. I am honored sir!Among counseling professionals, I’m inclined to say they are on a long, slow learning curve toward providing the kinds of help abuse survivors need. Often enough, the patients themselves are difficult & complex. They may have disruptions in their family, living situation, finances, and possibly legal shit to resolve, and they’re overwhelmed. A therapist might focus on the types of help they normally provide, and maybe don’t consider that the patient also has a high-conflict divorce, or parental alienation, or both happening. Maybe the traumas began in childhood, but the awakening as a victim comes later, much later. The current approach seems to be to choose a therapist kind of blindly and see how it goes.I think a new schema of therapy for them might include a step like triage, to get a better idea of the number and degree of impacts, and directing patients to a variety of resources that they can afford. Considering things we’re all learning from the pandemic isolation, maybe a lot of this step could be done online, with questionnaires, chat sessions, etc. Patient meetings are already on Zoom, I just posted an article describing this from Dr Gary Greenberg in Sylvie’s space: Tony Olson's post in Wise & WonderfulThe whole thing could be integrated, such that many providers could share the referrals, and results of tests, etc from a single site with just a small staff of generalists who see the patient’s big picture from a treetop level. Since many providers are alone or in very small practices, it would benefit them and their patients by bringing those most likely to be good matches into their type of therapy.Disordered people are probably having a heyday, because victims now have a voice, so they’ve upped their game of playing victim. With more social awareness of the victim phenomena, calling one’s partner the disturbed one has become easier, and prima facie more credible than ever. In a recent question about who called whom a “narcissist”, I suggested the first person to do so is more likely the disturbed character.Victims of abuse are the most confused, especially early on in the scheme of things. Many seem obsessed with labeling or identifying their partner / abuser’s disorder, as if they were suddenly qualified to do so. Many seem to want a litmus test that “confirms” (or denies) a diagnosis of “narcissism”. Many seem to fill the space here and in support groups with stories of behavior, expecting a bunch of “virtual friends” to say yes, your partner / mother / boss is a “narcissist”. Then what? They want to fix the disturbed one? Get counseling with them? Save their marriage “for the children’s sake”? Or accept a financially devastating divorce just to get away, and hope for the best?I consider at least half the questions posed on Quora about interactions with disturbed people to be more like rants than actual questions. I usually pass on answering them, sometimes letting them season a day or two and skim the answers.The general public mostly doesn’t have a clue. As more of us survivors emerge into public discussions, we will gain credibility. For now, we haven’t as a society even reached Mt. Stupid. Dunning-Kruger effectPunch Line: There’s a light at the end of the tunnel, possibly in the works of Paul Levy about wetiko. “…that wholly personal story…is the patient’s secret, the rock against which he is shattered.” CG Jung

A couple of years ago I wrote an article about the experience of being an autistic psychotherapist.[1][2]An updated version can be found on Embrace ASD:An autistic therapist | Embrace ASDIt has now been three years since my diagnosis, and I have come to understand a lot more about what makes us great therapists, and how autism can play an important role in becoming a good therapist.Good & bad therapistsIn 2018, Dr. Scott Miller spoke about research that shows that certain psychotherapist characteristics are key to successful treatment.When I heard about the research, I was horrified to see that:20% of therapists are getting 80% of the (good) results; while42% of therapists are getting 20% of the results; and38% of therapists are doing consistent damage to their patients!Holy Cr*p! What is even more astounding is that 93% of therapists believe that they are in the top 20%. That is a concern, because it means a large part of therapists that do consistent damage actually think they are doing a great job, and think they are among the best!Unless you have trained with people like Dr. Scott Miller and Dr. Jon Fredrickson—who specialize in teaching feedback-informed treatment (FIT) and deliberate practice to achieve Clinical Excellence—a therapist really does not know where they fall in those statistics.I have trained with these practitioners whose goal is to teach therapists to achieve excellent results, and I am one of the top 20% of therapists who get 80% of the results.So how does this relate to autism?Research-based practiceOne thing I think you need to have to be a good therapist is to have a passion for research, so you stay up to date with the latest scientific advances and understanding, so you can help your patients in the best way possible. And being autistic, I have a natural propensity to do research, to find out the truth, and to try to get a comprehensive understanding of things.But it’s not just about informing my clinical practice by research. My clinic is also informed by it, and rooms are set up accordingly.Research shows that soft lighting, a tidy room, and some personalization makes clients feel more comfortable. So I made sure my office looks soft, tidy, and homey. Here is my office:I sit in the chair next to the pink and purple painting. I also made sure there is cohesion in the colours in the room. As you can see, I include pastels, and limit the number of colours. I think it’s important to include colours to establish a positive atmosphere, but the colours can’t be too bold and diverse or it becomes distracting or even anxiety-inducing.My patients also have a choice to sit in 4 sitting places. Most people sit in the chair on the left side of the room, as pictured below:They can also pull out the chair in the photo below, or sit on the floor on a cushion, in which case I will join them on the floor.Research also shows that patients feel more submissive if you have your degrees behind you in your office. As such, my degrees are not behind me in my office, because I want my patients to feel like they are at my level.My degrees can be found in the waiting room instead, as you can see below.Qualities of effective therapistsNow let’s go through the 14 qualities of effective therapists based on research.1. Effective therapists have a sophisticated set of interpersonal skills, including:[3]Verbal fluencyInterpersonal perceptionAffective modulation and expressivenessWarmth and acceptanceEmpathyFocus on the otherBy the time we get to be therapists, we have undergone so much societal training and memorization of how to be in society."People with ASD traits seem to be able to analyze how people, in general, will react in a social situation, even if they have difficulties judging the mental states of individuals," said Anton Gollwitzer, a doctoral student in the Department of Psychology.[4]We have learned how to express the greater than normal empathy we feel.2. Clients of effective therapists feel understood, trust the therapist, and believe the therapist can help him or her. The therapist creates these conditions in the first moments of the interaction through verbal and importantly non-verbal behaviour. In the initial contacts, clients are very sensitive to cues of acceptance, understanding, and expertise. Although these conditions are necessary throughout therapy, they are most critical in the initial interaction to ensure engagement in the therapeutic process.[5]One amazing thing about many autistics is our non-judgmental nature. I realize that some of us do judge, but the majority of us are just curious. So I have often heard patients comment that they watched my face and body language for criticism, but all they saw was a curiosity expressed as a desire to understand them.3. Effective therapists are able to form a working alliance with a broad range of clients. The working alliance involves the therapeutic bond, but also importantly agreement about the task of goals of therapy. The working alliance is described as collaborative, purposeful work on the part of the client and the therapist. The effective therapist builds on the client’s initial trust and belief to form this alliance and the alliance becomes solidly established early in therapy. [6]A therapeutic working alliance is critical to therapy. I think many therapists do not understand the basics of what a working alliance is. The most critical thing about an alliance based on research is that the patient has expressed the internal emotional problem that they want to work on today. Patients get better when they clearly express what the problem is that they want to work on. Not the problem that their partner, mother, etc. think they have. It is also critical for therapists to NEVER assume what the problem is or project their own world view onto the patient. I always begin my sessions with, “What is the problem I can help you with today?”. When the client uses a defence, I reiterate the question, so that it allows them to enter a therapeutic alliance with me, so they can get the results that they came in for.4. Effective therapists provide an acceptable and adaptive explanation for the client’s distress. Anyone who presents to a socially sanctioned healer, such as a physician or a psychotherapist, wants an explanation for his or her symptoms or problems. There are several considerations involved in providing the explanation. First, the explanation must be consistent with the healing practice: in medicine, the explanation is biological whereas in psychotherapy the explanation is psychological. Second, the explanation must be acceptable and accepted by the client, a process that involves compatibility with clients’ attitudes, values, culture, and worldview. That is, treatments are adapted for patients. Third, the explanation must be adaptive—that is, the explanation provides a means by which the client can overcome his or her difficulties. This induces positive expectations that the client can master what is needed to resolve difficulties. Fourth, the ―scientific truth‖ of the explanation is unimportant relative to its acceptance by the client. The therapist is aware of the context of the patient (e.g., issues of culture, SES, race, ethnicity) in the development and presentation of the explanation. Acceptance of the explanation leads to purposeful collaborative work. [7]This means that it is critical for your therapist to be culturally trained. I took special training in counselling different cultures. Again, it is not up to the therapist to decide what problem the patient has, but instead, it is ALWAYS up to the patient to decide the problem they want to work on. Again people with autism tend to be rule followers as long as they make sense to us, and so we are taught as therapists to be culturally sensitive, and it is likely that we will look a tthe research and do training to such extend5. The effective therapist provides a treatment plan that is consistent with the explanation provided to the client. Once the client accepts the explanation, the treatment plan will make sense and client compliance will be increased. The treatment plan must involve healthy actions—the effective therapist facilitates the client to do something that is in their best interest. Different treatment approaches involve different actions, but the commonality is that all such actions are psychologically healthy.One of the things that autistics are really good at is following rules and procedures. So…following a treatment plan that is consistent with what we explained to the patient is consistent with our very nature.6. The effective therapist is influential, persuasive, and convincing. The therapist presents the explanation and the treatment plan in a way that convinces the client that the explanation is correct and that compliance with the treatment will benefit the patient. This process leads to client hopefulness, increased expectancy for mastery, and the enactment of healthy actions. These characteristics are essential for forming a strong working alliance.A good therapist has evidence of the efficacy (what the evidence shows) of treatment. They are able to offer the client a plan that is evidence-based with statistics of the likelihood of the treatment plan working and being suitable to the person. One of the things that I spend a lot of time doing is looking at research, as well as training with the top people in the field in treatments that show high efficacy.7. The effective therapist continually monitors client progress in an authentic way. This monitoring may involve the use of instruments or scales or by checking in with the patient regularly. Authenticity refers to communication to the client that the therapist truly wants to know how the client is doing. Administration of scales, for instance, without a discussion with the client, is insufficient; effective therapists will integrate progress evidence into treatment. Therapists are particularly attentive to evidence that their clients are deteriorating.Autistics excel at pattern finding, and patient feedback is no exception. I have always given patients questionnaires or asked them directly how they have been since our last session and checked in with specific challenges that they are having. Without that, I would have no idea whether the way I been interacting with them and the tools I have offered have improved their set of symptoms.8. The effective therapist is flexible and will adjust therapy if resistance to the treatment is apparent or the client is not making adequate progress. Although the effective therapist is persuasive, clients may not accept the explanation and/or treatment or may not be making adequate progress given the nature of the problem. The therapist is aware of verbal and nonverbal cues that the client is resistant to the explanation or the treatment, and uses the evidence gleaned from assessing therapeutic progress with outcome instruments. The effective therapist takes in new information, test hypotheses about the client, and is willing to be ―wrong.‖ Adjustments might involve subtle differences in the manner in which the treatment is presented, the use of a different theoretical approach, referral to another therapist, or use of adjunctive services (medication, acupuncture, etc.).Research shows that if patients do not show improvement within the first 7 sessions, they are unlikely to improve with that therapist. Why the therapist, rather than the treatment. Well, it turns out, much like Alice in Wonderland’s ‘Everyone Wins’, the efficacy of different therapies is about equivalent. What makes the difference is the therapist.9. The effective therapist does not avoid difficult material in therapy and uses such difficulties therapeutically. It is not unusual that the client will avoid material that is difficult. The effective therapist can infer when such avoidance is taking place and does not collude to avoid the material; rather the therapist will facilitate a discussion of the difficult material and in therapy will address core client problems. Such discussions are typically emotional and thus effective therapists are comfortable with interactions with strong affect. When the difficult material involves the relationship between the therapist and the client, the effective therapist addresses the interpersonal process in a therapeutic way (i.e., what is called by some the ―tear and repair‖ of the alliance).Research showed that non-autistics process thing from one level only, however, for autistics, we can process problems from two different levels (or vantage points). As an autistic, I can process things on these two different levels. It allows me to ‘dive’ into the emotional space of a patient in order to feel what they are feeling, and then come back to the surface to see things cognitively (which means I can choose the best evidence-based treatment for the client and process what they are feeling from cognitive empathy.10. The effective therapist communicates hope and optimism. This communication is relatively easy for motivated clients who are making adequate therapeutic progress. However, those with severe and/or chronic problems typically experience relapses, lack of consistent progress, or other difficulties. The effective therapists acknowledge these issues but continue to communicate the hope that the client will achieve realistic goals in the long run. This communication is not Pollyannaish optimism, but rather a firm belief that together the therapist and client will work successfully. This hopefulness is about the client (i.e., the client can achieve the goals) and of the therapist him or herself (i.e., ―I can work successfully with this client.‖). As a corollary, effective therapists mobilize client strengths and resources to facilitate the client’s ability to solve his or her own problems. Moreover, the effective therapist creates client attributions that it is the client, through his or her work, who is responsible for therapeutic progress, creating a sense of mastery.I have been asked a number of times, why I have been able to remain as a trauma therapist day in and day out over twenty-five years without quitting, or having a breakdown. I always say the same thing—my patients get better, so I feel like I can help—I myself feel optimistic, as I have seen patient after patient recover and thrive.11. Effective therapists are aware of the client’s characteristics and context. Characteristics of the client refer to the culture, race, ethnicity, spirituality, sexual orientation, age, physical health, motivation for change, and so forth. The context involves available resources (e.g., SES status), family and support networks, vocational status, cultural milieu, and concurrent services (e.g., psychiatric, case management, etc.). The therapist works to coordinate the care of the client with other psychological, psychiatric, physical, or social services. Furthermore, the effective therapist is aware of how his or her own background, 5 personalities, and status interact with those of the patient, in terms of the client's reaction to the therapist, the therapist's reaction to the client, and to their interaction.12. The effective therapist is aware of his or her own psychological process and does not inject his or her own material into the therapy process unless such actions are deliberate and therapeutic. The effective therapist reflects on his or her own reaction to the client (i.e., countertransference) to determine if these reactions are reasonable given the patient presentation or are based on therapist issues.One of the recommendations for therapists is that they attend regular counselling. Due to my autism, I have always followed that rule. I attend therapy pretty much weekly, with a break in the summer. I have found too many patients can tell what is going on in the therapist’s life based on the information that they give the patient. For example, one patient that was trying to remove herself from an abusive marriage with a pedophile was told by her therapist that there were reasons that her husband behaved that way—found out that her therapist was beating his own wife. I have always followed the proverb: ‘Healer, heal thyself’. As Jon Kabot-Zinn says: ‘It is critical that we as therapists do this work because who else will? But is is also critical that we do not become caricatures of the very people we try to help.13. The effective therapist is aware of the best research evidence related to the particular client, in terms of treatment, problems, social context, and so forth. Of particular importance is understanding the biological, social, and psychological bases of the disorder or problem experienced by the patient.I chose to do my Masters (in Science—Applied Psychology) in England because I felt they were ahead in their psychology research. The method that we were taught is called Case Formulation. Case Formulation requires three things: 1. The patient as the expert in themselves, 2. The therapist as an expert on the research and clinical experience, and 3. Evidence-based research. So EBR is always the choice I utilize in my work with patients. I feel there is enough research on a variety of therapies for me to use, that I do not need to use my patients like lab rats.14. The effective therapist seeks to continually improve. The development of skill in an area involves intensive practice with model-based feedback. Feedback on the progress of clients is critical to improvement but the feedback is most useful if imbedded in a coherent model of therapy so that the therapist can make specific changes and determine the outcomes produced by such changes. Evidence that a client is not making satisfactory progress is useful but the knowledge that the client is not making satisfactory progress and that there is insufficient agreement about the goals of therapy provides information that the therapist can use in this particular case. Moreover, the therapist can use such information across clients to detect general patterns. The essential point here is that the effective therapist, by definition, is the therapist who achieves expected or more than expected progress with his or her clients, generally, and who is continually improving.I research daily. I take courses all the time. I read books. I look at patterns. This is something about autistics. We love to learn about our favourite topic. We love learning about our favourite topic more than hanging out with people socializing.Autistic therapistsThere is also research specifically on why autistic people make good therapists.In 2019 an article was published entitled, Those with autism make good social psychologists. The article is based on research from 2019 by Anton Gollwitzer et al., which shows that:[8]Autism traits predict slightly higher social psychological skill (based on ∼6,500 participants in 104 countries).Autism traits were found to correlate with social cognitive skill.Heightened systemizing is what leads to this greater social psychological skill (based on 400 participants).What heightened systemizing (also called hyper-systemizing) refers to is that autistic people are great at analyzing systems and relationships and finding patterns, as research from 2009 by Simon Baron-Cohen shows.[9] And this ability to analyze systems will be trained on whatever our special interest is. For me, that special interest is human psychology.I do a lot of research, I watch patterns in behaviors, and I can often predict what people will do before they even decided to do something. This awareness of people, combined with empathetic concern and compassion, I think is what makes autistic therapists good at what they do.Footnotes[1] What Is It Like to Be a Therapist With a Disorder? — Quora[2] What Is It Like To Be A Therapist With Autism?[3] https://www.apa.org/education/ce/effective-therapists.pdf[4] Those with autism make good social psychologists[5] https://www.apa.org/education/ce/effective-therapists.pdf[6] https://www.apa.org/education/ce/effective-therapists.pdf[7] https://www.apa.org/education/ce/effective-therapists.pdf[8] Autism spectrum traits predict higher social psychological skill[9] Talent in autism: hyper-systemizing, hyper-attention to detail and sensory hypersensitivity