INTRODUCTION TO THE FIRST INTERVIEW BY MEANS OF THE

SPORT-CLINICAL INTAKE PROTOCOL (SCIP)

a. Obtain the client’s demographic information.

b. Confirm the method of payment:
c. Explain the procedure of the first interview:
1. The aim is to learn about you as a person and to obtain information on your
sporting career.
2. We will cover aspects directly related to your sport participation and your
interaction with different people influencing your participation, as well as important
life and sporting events.
3. Remember, you are a human being, not only a talented athlete. Therefore, a
multitude of factors in your daily life can have an impact on your sport
participation.
4. We will attempt to identify potential problem areas which may impact negatively on
your performance/ prevent you from performing optimally and consistently.
5. We will also try to identify areas of strength.
6. WE will try to identify the essence of the problem, in order for us to find the best
solution.
7. I am deliberately emphasising the word WE, because it requires our combined
efforts. You must give accurate, elaborated answers about your opinions,
experiences etc., in order for me to recommend a suitable mental skills training
program. The implementation of such a program will involve considerable
interaction, in order that you can make these skills your own.
d. Do you have any questions?
e. Please sit back... close your eyes (and keep it closed) and relax.
f. Self-directed relaxation script.
g. PRAYER.
h. SCIP.
i. Summarize the essence of the interview 5 minutes before the scheduled end of
the interview.
j. Indicate whether or not a follow-up session is required and book the appointment.
k. End the interview at the scheduled time.

17
 Division of Sport Science
Stellenbosch University
Tel: 021 808 4771
Fax: 021 808 4817
E-mail: HGrobbelaar@[Link]

Initials: ……. Surname:……………………………… Name………………….…………….

Date of birth: …………………………
Address: …………..………………………… Parents:……………………………………..
……………………………………… ……………………………………..
……………………………………… ……………………………………..
……………………………(………). ……………………………( ......... ).
Tel numbers: (…..) .................................. (h)
(…..) ................................. (w)
…..................................... (c)
Type of sport(s):……….……………………………………………………………………….
Level of participation: ....………………………………………………………………………
…………………………...………………………………………………………………………
Coach: ……………………………………………………….... Tel: …………………………
Referred by: ...………………………………………………………………………………….

Details of consultation:

Date: Consultation: Account:

………… ………………………………………………………..… ……………………..…
………… ……………………………………………………..…… ……………..…….…..
……..….. …………………………………………………..……… ………..……….……..
………... ………………………………………………..………… …..………….……..…
………… ……………………………………………..…………… ..………….………..…
………… …………………………………………………..……… …..…….……..………
………… ………………………………………………..………… ……...……..…………

18
 SELF-DIRECTED RELAXATION SCRIPT

Take a deep breath and slowly exhale. relax. Relax these muscles fully. Feel
Think “relax” (pause). Inhale deeply... exhale the tension flow away.
slowly... inhale deeply... exhale slowly. Now Inhale deeply... exhale slowly. Feel the
focus all your attention on your head. Feel relaxation in your lower back and
any tension in your forehead. Relax... stomach muscles. Relax... (pause).
(pause). Relax even deeper... and deeper... Inhale deeply... exhale slowly (pause).
and deeper. Relax even deeper... and deeper... and
Feel any tension in your jaw or other facial deeper.
muscles. Just relax the tension in these Now feel any tension in your upper
muscles. Feel the tension flow away. legs, both the front and back. Focus all
Inhale deeply... exhale slowly. Feel the your attention on these muscles and ask
relaxation in your facial muscles. Relax... them to relax. Relax these muscles fully.
(pause). Inhale deeply... exhale slowly Feel the tension flow away.
(pause). Relax even deeper... and deeper... Inhale deeply... exhale slowly. Feel the
and deeper. relaxation in your upper legs. Relax...
Now feel any tension in your arms, (pause). Inhale deeply... exhale slowly
forearms, and hands. Just relax the muscles (pause). Relax even deeper... and
in your arms. Relax... (pause). deeper... and deeper.
Feel any tension in your hands, fingers, or Remember to keep your facial muscles
arms, and just relax the tension in these relaxed. Keep your lower back and
muscles. See the tension flow out your body. stomach muscles relaxed. And keep your
Inhale deeply... exhale slowly. Feel the upper leg muscles relaxed. Keep all
relaxation in your arms and hands. Relax... these muscles relaxed. Inhale deeply...
(pause). Inhale deeply... exhale slowly exhale slowly. Feel the relaxation in all
(pause). Relax even deeper... and deeper... these muscles. Feel the relaxation even
and deeper. deeper... and deeper... and deeper.
Now focus your attention on your neck and Now feel any tension in your lower legs
upper back. Feel any tension in the muscles and your feet. Focus all your attention on
of your neck and upper back. Just relax the these muscles and ask them to relax.
tension in these muscles. Relax... (pause). Relax these muscles fully. Feel the
See the tension flow out of your body. tension flow away.
Inhale deeply... exhale slowly. Feel the Inhale deeply... exhale slowly. Feel
relaxation in these muscles. Relax... (pause). the relaxation in your upper legs. Relax...
Inhale deeply... exhale slowly. Feel the (pause). Inhale deeply... exhale slowly
relaxation in all these muscles. Feel the (pause). Relax even deeper... and
relaxation even deeper... and deeper... and deeper... and deeper.
deeper. Now relax your entire body. Relax it
Remember to keep your facial muscles completely. Feel all the tension flow
relaxed. Keep your arms and hand muscles away from your facial muscles... your
relaxed. And keep your neck and upper back arms and hands... your neck and upper
muscles relaxed. Keep all these muscles back... your lower back and stomach...
relaxed. Inhale deeply... exhale slowly. Feel your upper legs... and your lower legs and
the relaxation in all these muscles. Feel the feet.
relaxation even deeper... and deeper... and Inhale deeply... exhale slowly. Feel the
deeper. relaxation in all your body. Relax...
Now feel any tension in your lower back (pause). Inhale deeply... exhale slowly
and stomach muscles. Focus all your (pause). Relax even deeper... and
attention on these muscles and ask them to deeper... and deeper.

Taken from Martens (1987:123)

19
 SPORT-CLINICAL INTAKE PROTOCOL. [SCIP]
A. CURSORY DESCRIPTION OF THE PRESENTING PROBLEM

1. Describe the problem briefly.…..….……………………………………………………….

…………………………………..………………………………………………………….…
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
2. How often does it occur?..........…………………………………………………….……..
3. When did it begin?…………………………………………………………...……….........
4. How long has it lasted?………………………………………………………………….....
5. Where does it occur?………………………………………………………………….…....
6. What do you think is causing it? ..........…………………………………………….….....
……………………………………………………………………………………………...…
…..…………….……………………………………………………………………………...
....................................................................................................................................
....................................................................................................................................

B. DESCRIPTION OF ATHLETIC HISTORY

1. How did you get involved in your sport? ............………………………………………..

………….…..................................................................................................................
.....................................................................................................................................
2. How did you get to the level you are at now?…………………………………………....
………………………………………………………………………………………………...
………………………………………………………………………………………………...
3. What were some of the high points of your career? ......................................………..
……………………………………………………………………………………………..….
………………………………………………………………………………………………...
4. What were some of the low points of your career?.……………………………………..
……………………………………………………………………………………………..….
.……….……………………………………………………………………………………….
5. Who have been the most significant people in your sports participation? .................
……………………………………………………………………………………………..….
………………………………………………………………………………………………...
20
6. What role did these people play in your development? ..………………………………
……………………………………………………………………………………………..….
7. What were your goals when you began your sport?..…………...................................
……………………………………………………………………………………………..….
8. What are your present goals?........………………………………………………….……
……………………………………….……………………………………………………..…
….…………………………………….…………………………………………………….…

C. FAMILY AND SOCIAL SUPPORT

FAMILY

1. PARENTS: Married/ Divorced..........………………...... Ages: …………and………….

Quality of their relationship .…………….....……………………………………………........
Educational background………………………...………………………………………........
Current occupations.…………………………………………………………………………..
Your relationship with them ............................................................................................

2. SIBLINGS: Married/ Divorced……………..................... Ages:..……………................

2. Quality of their relationship .…………….....………………………..………………........
Educational background………………………...………………………………………........
Current occupations.…………………………………………………………………………..
Your relationship with them ............................................................................................

3. Your educational background...…..……………………………………………….……....

4. Previous psychiatric history of client and family (experience with and perceptions of
psychology) ……………………………..……………….................................................
5. Family involvement in sports participation:
a. Parents’ previous athletic experience.…………………………………………………....
………………………………….……….…………………………………………………….
b. Parents’ current participation in sport.......………………………………..……………...
…………………………………………………………...…………………….……………..
c. Parents’ involvement in your sports participation ...………………………………….....
…………………………………………………………….…………………………………..
d. Siblings participation in sports …...................…………………………………….…......
…………………………………………………….…………………………………………..
21
 SUPPORT SYSTEM

1. Number and quality of friendships within the sport .....………………………………....

…………………………………………………………….…………………………………..
2. Number and quality of friendships outside of sport.....…………………………….…....
…………………………………………………………….…………………………………..
3. What is your relationship with your coach?………………………………………...........
……………………………………………………….………………………………………..
4. What is your relationship with your teammates? …………………………………….....
……………………………………………………….………………………………………..
5. What are other sources of support you have?..……………………………………….…
……………………………………………………………………………………………...…
6. How satisfied are you with the support you receive from your family, friends,
coaches, teammates and others?...………………………………………………………
……………………………………………………………………………………......………
………………………………………………………………………………........................

D. HEALTH STATUS

1. How is your health presently?......................……………………………..………………

………………………………………………….……………………………..………………
….................................................................................................................................
2. Injuries:
a. What injuries have you had in the past and when?...………………………………...…
………………………………………………………………………………………………...
……………………………………………………………………………………………...…
b. Do you have any injuries at present? …………………………………………………....
………………………………………………………………………………………………...
……………………………………………….………………………………………………..
c. If present, how do these injuries affect your training & competitive performances?
………………………………………………………………………………………………...
……………………………………………….………………………………………………..
3. Sleep:
a. How are you sleeping lately?..........……………………………………………………….
b. Are you tired often? ………………………………………………………………………...

22
c. Has your sleeping changed recently?…………………………………………………….
d. Do you have difficulties getting to sleep? ...................................................................
e. Prior to falling asleep, what thoughts are going through your mind? .........................
....................................................................................................................................
f. Are you waking up during the night?..…………………………………………………….
g. If so, what thoughts are going through your mind? ..……………………………………
………………………………………………………………………………………………...
h. Have you been having any dreams lately? .........……………………………………….
i. What was in your dreams?..……………………………………………………………….
……………………………………………………………………………………………..….
………………………………………………………………………………………………...
j. If sleep difficulties are present, how do they affect your training and competitive
performances? .....………………………………………………………………………….

4. Eating:
a. Describe your eating habits..……………………………………………………………...
....................................................................................................................................
b. Have you had any recent changes in your body weight? ..........................................
c. How has your appetite been?……………………………………………………………...
d. Have your eating habits changed?………………………………………………………..
e. Has your eating influenced your training and competitive performances?.................
....................................................................................................................................

5. Alcohol and drug use:

a. Do you drink alcohol?…………………………………………………………………........
b. How much and how often?.…………..………………….………………………………...
c. Do you take drugs of any kind?………………………..……………………………….....
d. What kind and how often?.............……………………………………………..………....
Allowed or banned?…………………………………………………………………….......
e. If alcohol and/or drug use are present, how have they influenced your training and
competitive performances? ........………..………………………………………….…….
………………………………………………..……………………………………………….
6. When was your most recent physical examination?……………………………..…......
a. Were there any physical problems?..……………………………………………….…….
…………………………………………….…………………………………………………..
23
 E. IMPORTANT LIFE EVENTS

1. What do you recall as the most important events in your athletic career, e.g.,
events that influenced you a great deal?....................................................................
.....…...………………………………………………………………………………………..
.……..…..….…………………………………………………………………………………
2. What do you recall as the most important events in your general life?..……..............
………………………………………………………………………………………………...
....................................................................................................................................
...…..…………………………………………………………………………………..……...
3. Has anything important happened to you recently in your athletic life? .......…….......
………………………………………………………………………………………………...
………………………………………………………………………………………….…..…
…...……………………………………………………………………………………..….....
4. Has anything important happened to you recently in your general life?………..….....
………………………………………………………………………………………………...
.…..……………………………………………………………………………………………
…..………….………………………………………………………………………………....

F. CHANGES PRIOR TO THE ONSET OF THE PRESENTING PROBLEM

ATHLETIC
1. Physical:
a. Quality and quantity of training..................……………………………………………….
……………………………………………….………………………………………………..
....................................................................................................................................
b. Technique……………………………………………………………………………………
…………...……………………………………………………………………………………
....................................................................................................................................
c. Physical conditioning .…………………………………………………………..………….
……………………………………………………………………………………..………….
…...…………………………………………………………………………………......…….
d. Health..……………..........…………………………………………………………….…....
Injury………........…………………………………………………………………………...
Illness..…….………………………………………………………………………………...
Fatigue.........………………………………………………………………………………..
24
2. Mental:
a. Self-confidence..…………………………………………………………………………….
………………….……………………………………………………………………………..
………………….……………………………………………………………………………..
b. Anxiety………………………………………………………………………………………..
………………………………………………………………………………………………...
………………………………………………………………………………………………...
c. Concentration...……………………………………………………………………………...
…………………,……………………………………………………………………………..
..……………………………………………………………………………………………….
d. Motivation…………………………………………………………………………………....
………….……………………………………………………………………………………..
………….……………………………………………………………………………………..
e. Pre-competitive mental preparation ..............……………………………………...…….
………………………………………………….………………………………………..……
….................................................................................................................................
.....................................................................................................................................
f. Pre-competitive and competitive thoughts and feelings .…………………………..…..
……………………………………………………………………………………………...…
….................................................................................................................................
.....................................................................................................................................

3. Competitive:
a. Competitive level, e.g., regional, national………………………………………...……...
…………………………………………………………………………………………..…….
b. Stage of competitive season....…………………………………………………………....
………………………………………………………………………………………………...
c. Current performance level, e.g., winning record, competitive statistics ...…………....
………………………………………………………………………………………………...

4. Equipment
a. New equipment ................………………………………………………………………....
………………………………………………………………………………………………...
b. Deterioration of old equipment ...................................................................................
....................................................................................................................................
25
 SOCIAL/ ENVIRONMENTAL

1. Changes in relationships: family, friends, school, work? ............................................

……………………………………………………………………………………………...…
….……………………………………………………………………………………….….…
2. Teammates or coaches? .........................………………………………………..….…..
………………………………………………………………………………………….….….
….................................................................................................................................
3. New relationships?………………………………………………………………..………...
………………………………………………………………………………………………...
……………………………………………………………………………………….………..
4. Training and competitive sites? ......................................................…………………..
…………………………………………………………………………………………….…..
.……………………………………………………………………………………………….

CHANGES IN COGNITION-AFFECT-BEHAVIOR

1. Changes in cognition: negative, obsessional? ...........................................................

...................................................................................................................................
2. Changes in affect: sadness, anger, joy? ....................................................................
...................................................................................................................................
3. Changes in behaviour: routines, habits? ....................................................................
...................................................................................................................................

G. DETAILS OF PRESENTING PROBLEM

1. Indicate typical situation: what was going on at the time, competitive setting/
scenario? .…………………………………………………………………………………...
………………………………………………………………………………………………...
………………………………………………………………………………………………...
………………………………………………………………………………………………...

PERSONAL INFLUENCES

1. Describe your thoughts ..…………………………………………………………..……....

............…………………………………………………………………………………….…
….……........................................................................................................................

26
b. Describe your feelings...……………………………………………………………...…….
....................................................................................................................................
…………………………………………………………………………………………..…….
c. Describe your behaviour……………………………………………………………………
…………..………………………………………………………………………………...….
…….…….…………………………………………………………………………………....

SOCIAL INFLUENCES

1. What other people were around you?.……………………………………………..……..

………………………………………………………………………………………….……..
2. What were they doing?…......................................………………………………..…….
………………………………………………………………………………………………...

CONSEQUENCES

1. What happened after the problem occurred?………………………….………….……..

…………………………………………………………………………….……………..……
2. How did significant others react? ...............………………………….…………………..
…………………………………………………..……………………….……………………
3. What kind of thoughts and feelings did you have?……………….…………………......
…………………………………………………………...………………….………………..
……………………………………………………………………………….………………..
4. Your attributions of the problem? ...........………………………….……………………..
……………………………………………….………………………….……………………
…………………………………………………………………………….……………….…

GREATER EXPLORATION

1. Has this happened in the past: when and why?..…………………….……………..…..

2. When does it occur: practice, particular competitions?……………….………………...
3. Is there a consistent pattern of occurrence? ....………...……………….……………....
……………………………………………………………..………………….………………
………………………………………………………………………………….……………..
4. What sorts of things are going on when the problem is worst ?...……….……….……
………………………………………………………………………..………….……………
………………………………………………………………………………….……………..
27
5. What sorts of things are going on when the problem gets better? ........….……….....
…………………………………………………………………………………….…………..
…………………………………………………………………………………….…………..
…………………………………………………………………………………….…………..
6. What do you think is causing it? ........……………………………………….…………...
…………………………………………………………………………………….…………..
…………………………………………………………………………………….…………..
…………………………………………………………………………………….…………..
…..……………………………………………………………………………….……………
7. What do you think you can do to get over it? .....…………………………….………….
……………………………………………………………………………………………..….
………………..……………………………………..……………………………...………...
………………………………………………………………………………………………...
8. What do you want to accomplish by being here? ..………………...…………………...
……………………………………………………………………………..………………….
………………………………………………………………………………………………...
………………………………………………………………………………………………...
………………………………………………………………………………………………...

H. SUMMARY:
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
…………………………………………………………………………………….....................

I. PROPOSED PLAN OF ACTION:

..………………………………………………………………………………………………….
.…...……………………………………………………………………………………………...
..........…..……..…………………………………………………………………………………
…….………..…...….……………………………………………………………………………
……....……………..….…………………………………………………………………………
…….………………..…………………………………………………………………………....
28