Making the call for help is not a decision that is made lightly. It is a rare individual who is not anxious about picking up the phone and making that all-important call. Without a doubt, showing up for the first appointment may be equally anxiety provoking. However, if a client knows what to expect at the first session, this may help alleviate fear and anxiety.

During that initial call a question I’m often asked is, “What’s the cost of treatment?”  As a TAP provider, I can access monies allocated to the Office of Problem Gambling to support our treatment efforts. No one is ever turned away, and co-pays are based on one’s ability to pay, indebtedness, and need.  During the first appointment, I evaluate a client’s financial status and suggest an affordable co-pay.

The assessment or intake process normally takes 90 minutes. The goals of the assessment are for connection, disclosure, paperwork, and interpretation/planning. I encourage clients to come to their session at least 15 to 30 minutes beforehand to complete their paperwork so that they can spend the bulk of their first session sharing their gambling history and what they would like to accomplish in recovery.

In the connection stage of the first appointment, the goal is for the client to get to know the therapist and vice versa. During the disclosure phase, the focus is on the client telling his/her story. The information gathered is designed to formulate a plan of action.

During disclosure, I’m looking for what the client is seeking, his/her gambling history, and consequences.  This is the time during the assessment that I introduce the concept of gambling as a disease.

Paperwork consists of documents required by the state of Arizona’s Board of Behavioral Health, the Office of Problem Gambling, and HIPPAA as well as those documents required by the therapist. The issue of confidentiality is addressed.

The interpretation stage focuses on assessing what it is the client wants to achieve in therapy and prioritizes the client’s needs and assesses their support system. If there are medical concerns, I stress the need for an appointment with the primary care physician.

By the end of the session, we have an initial treatment plan, which will be our roadmap for next four to five weeks. The client receives an Informed Consent document to take home. We set a standing appointment. Standing appointments are very important for the client to begin the process of putting structure and accountability in his/her life.

Sometimes the client is accompanied to the first session by a friend or a loved one. Occasionally that individual is eager to share the impact of the addiction on their life or on the family system. When this occurs, I allow a small amount of disclosure and encourage that individual to seek his/her own appointment, or I refer them to Gam-Anon.

After this first appointment, clients are normally seen on a weekly basis. That’s when the real work begins, but it all starts with that phone call and first appointment.