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What should a social worker do first when meeting a client with trichotillomania?

  1. Explore the feelings behind the behavior.

  2. Have the client wear a wig until she can stop the behavior.

  3. Reinforce that hair-pulling will likely lead to complete baldness.

  4. Teach the client thought stopping strategies.

The correct answer is: Explore the feelings behind the behavior.

The most appropriate first step for a social worker meeting a client with trichotillomania is to explore the feelings behind the behavior. Understanding the emotional and psychological context surrounding a client's urges to pull their hair is crucial for effective intervention. By engaging with the client about their feelings, the social worker can uncover underlying issues such as stress, anxiety, or trauma that may contribute to the behavior. This approach fosters a therapeutic alliance, allowing the client to feel heard and validated, which is essential in building trust. It also sets the stage for future interventions by providing insight into the motivations and triggers of the behavior. This foundational understanding is necessary before implementing specific strategies or interventions, as it ensures that any subsequent steps taken are tailored to the client's individual needs and context. The effectiveness of the therapeutic process is enhanced when the root causes are explored first, leading to more meaningful and lasting change.