4 The Praeger Handbook of Mental Health and the Aging Community
Presenting Problem
Insurance practices often require early diagnosis in order to begin pay-
ment cycle, and as a result, there is often a sense of pressure to get a correct
early assessment, based on the client’s input and your personal observa-
tions. The presenting problem may be the issue that is pressing for the cli-
ent or it may be the most comfortable issue the client is able or willing to
discuss with you as your relationship begins. The nature of the presenting
issue will color the time you spend together (short or long term), the inter-
ventions you choose, and the resources and additional services you might
suggest for your clients and their families. A thorough intake may include
a mental status exam, or a series of questions asked and answered com-
bined with your own clinical observations. Additionally you are ethically
bound in your initial contact with the client to advise regarding informed
consent, your professional mandates, and your compliance with HIPAA
(Health Insurance Portability and Accountability Act) regulations. It is im-
portant for the therapist to remember that while assessment is imperative
in the first session or two, ongoing assessment is required to address client
safety, abuse, exploitation, and mental health. Some things to consider in
this initial assessment period are as follows:
• How would you diagnose this family issue?
• Are there any professional limitations you should consider before taking on this
case (scope of practice, bias [age-ism or other], and any countertransference)?
• Are there cultural considerations in this family that you should be aware of?
• How would you test your theories and support your work with this family
(supervisors, consultation, Internet, books)?
Unit of Treatment
Unit of treatment is the term used to help you define who might be
included in therapy. Individual therapy refers to working one-on-one with
an individual client. When working with caregivers, this unit can provide a
place of respite, and replenishment for the ongoing challenges of care provi-
sion for a family member or loved one. Family therapy regards the family
itself as the unit of treatment. It is important to remember that elder care
can create stressors and conflicts within the family system and among family
members and support team. The unit of treatment can help you determine
your role in client support: Are you amplifying the voice of your clients or
helping them understand the concerns of other family members? Are you
