PLAGIARISM FREE "A" WORK SUMMARY TECHNIQUES

Chapter 9 "Why Assessment?

Assessment means gathering and organizing information about a client and the

client’s problems. Helpers collect information in a variety of ways, beginning with

the first contact as the helper studies the client’s behavior and listens to the story.

Formal assessment methods include testing and filling out questionnaires and

forms. Informal assessment encompasses all the other ways a helper learns about

a client, including observing and questioning. Formal assessment may occur at a

specific time in the helping relationship, but informal assessment is an ongoing

process because a client’s progress and the temperature of the therapeutic

relationship must be tested throughout. "

"Because each client’s situation is unique, it is impossible to predict how much

time to give to each stage of the helping process. Still, a rule of thumb is to spend

one session primarily in relationship building, with the only assessment activities

being the collection of basic demographics, observation of the client’s behavior,

and whatever else you can glean from the client’s story. The second and possibly a

third session are spent in a more in-depth assessment before moving on to a goal-

setting phase, which might include testing. Therefore, if a client is seen for 10

sessions, about 10% of the time may be devoted to assessment. Beginning a

relationship with a formal assessment can be a mistake because the initial

moments of any human encounter are so important (Gladwell, 2005). Imagine

how you would feel if you went for a doctor’s appointment and were asked only

to fill out forms, contribute blood samples, and answer questions but were not

allowed to talk about the reason for your visit.

When clients have been invited to tell their stories, they give much more

information during the formal assessment period that follows. They leave the first

session believing that they have made a start on solving problems, instead of

feeling dissected by tests and probing questions. Key data need to be collected at

the first interview, but there are several ways to handle this. For clients who can

read and write, asking them to come in early to fill out paperwork can be an

effective way of collecting information about their background and current

functioning.

Assessment Is a Critical Part of Helping

Sometimes you will hear that gathering a lot of historical information about a

client is not worthwhile. Certain theories emphasize the present and the future

rather than the past, and so they ignore history and personality data. It is true that

some helpers do spend an inordinate amount of time gathering background

information and administering tests. On the other hand, by failing to collect

critical data, you take the chance of making a serious mistake. You must know

your customer thoroughly (Gelso, Nutt Williams, & Fretz, 2014; Lukas, 1993).

Once I interviewed a 65-year-old man who had been a shoe salesman in

Cleveland. He had led an interesting life before retiring about 2 years before we

met. He reported no real difficulties, and, as he was very convincing, I couldn’t

understand why he had consulted me. As a courtesy, I talked separately to his 28-

year-old son, who had waited patiently outside. The son told me his father had

been a physician in Texas and 5 years ago developed a syndrome, which was

thought to be Alzheimer disease, a severe brain disorder with a deteriorating

course. When the client could not remember, he simply filled in gaps in his history

with very convincing fiction. That incident (and many others) taught me that it is

best to get as much information about a client as possible and information from a

variety of sources. If I had tested the client’s memory or talked to his son first, I

might have saved some time. More important, had I relied on the client as the

sole source of information, I might have sent him away without treatment.

Conducting superficial assessments, however, does not always lead to such

spectacular embarrassment. It is very common, though, for helpers to accept the

client’s story without a critical thought. Even the most astute helper can make

drastic mistakes. It is important to listen to what clients leave out and where they

minimize or deny. Also, it is easy to forget to ask specific questions, so using a

structured form for assessment is advised. Just because a client is well groomed

and comes from a prominent family does not mean that you should not ask about

drug abuse, intimate partner violence, or suicidal thoughts. Our prejudices and

worldview color our definition of pathology. Even the Diagnostic and Statistical

Manual of Mental Disorders (DSM) of the American Psychiatric Association, the

diagnostic bible, recognizes that misdiagnosis can occur when the helper is not

familiar with a client’s cultural background and interprets symptoms within his or

her own cultural context (Alarcón, 2009). The next section indicates how

assessment can provide the helper with critical information about the client that

charts the course of treatment.

Reasons to Spend Time in the Assessment Stage

Assessment Helps You Determine Whether the Client is a Good Candidate for the

Help You Can Provide

Counseling or psychotherapy from a trained professional is not the best treatment

for everyone. The client must have the capacity to form a relationship, motivated

to change, and able to attend sessions and understand what is going on (see

Truant, 1999). There may be better avenues of help for the client than “talk

therapy.” There are educational, online learning, occupational, chemotherapy, and

support group alternatives. When a client arrives for treatment, the first thought

should be: Is this the right place for this client? For example, in our university

clinic, counselors are only available one day each week. Thus, we need to assess

clients to make sure that they are stable enough to get along on their own

between sessions. We refer those who are not to a more intensive treatment

center.

Assessment Gives Crucial Information to Plan Useful and Realistic Goals

The main purpose of assessment is to gather information that will be useful in

planning the goals that will guide the helper and the client. Assessment must have

both breadth and depth. As far as breadth is concerned, the helper must throw

the net broadly enough to make sure nothing crucial escapes. That is why many

treatment facilities use a standardized assessment or psychosocial intake form

that requires details about the client’s medical, psychological, and social history as

well as current functioning. Depth refers to getting detailed information on

specific issues such as suicide, the existence of mental disorders, and the

“presenting problem” or specific issue that acted as a catalyst for the client’s

decision to seek help.

Assessment Helps Clients Discover Other Factors Related to the Problem

A woman came to a community clinic asking for help in dealing with problems at

work. She recognized that her job was stressful, but she found that she was

unusually irritable with her co-workers and wanted to work on that problem. After

some reflection and homework by the client, we discovered that her angry

outbursts all happened between 1:00 p.m. and 2:00 p.m. on days when she had

not eaten lunch. The client knew that she became grumpy when she was hungry,

but she had never connected this with her behavior on the job. A physician helped

the client to deal with a problem of low blood sugar, and her extreme irritability

diminished, which in turn helped in her relationships and her work. We might

easily have treated the problem as anger without ruling out physical causes. In

another case, we found that a client’s anxiety was at least partially due to drinking

eight cups of coffee per day.

Assessment Helps us Understand the Psychological Impact of the Client’s

Environment

For example, is the client living with family, in a shelter, or alone? Does the client

suffer isolation from not speaking the dominant language or belonging to a

religious minority? If the client is a child, what is happening at school every day

that might be affecting the problem? Is the child bullied, rejected by classmates,

or encouraged by a teacher?

Assessment Helps us Recognize the Uniqueness of Individuals

We all have the tendency to generalize and stereotype. Unless we ask clients

about family and cultural background issues, we may make assumptions about

them through our personal cultural lens. The behavior of people from different

cultural groups may be judged as being more pathological than of those who

share our own background. A systematic assessment helps us be less manipulated

by these strong social influences and more objective because we are recording the

answers to standard questions rather than merely relying on our own impressions.

Assessment can also be useful in helping clients recognize their own unique

personality, values, strengths, and interests (Armstrong & Rounds, 2010; Gallagher

& Lopez, 2019).

Assessment Uncovers the Potential for Violence

Assessment can identify individuals who are at risk for violence toward self or

others, especially by collecting a thorough history. Although it is not possible to

always accurately predict violent behavior, a history of self-inflicted injury or harm

to others can cue us to examine the client’s situation more thoroughly and take

precautions (see Granello & Granello, 2007; Juhnke, Granello, & Granello, 2011).

(See also Table 9.1.) School counselors are recognizing the need to identify

potential for violent behavior in the aftermath of school shootings and in the wake

of renewed interest in bullying (Bernes & Bardick, 2007; Felix, Sharkey, Green, &

Tanigawa, 2011)."

"Assessment Helps Clients Become Aware of Important Problems

Frequently, painful issues are pushed out of awareness or remain unrecognized

until brought to the surface through assessment (Granello, 2010). A common

example of this is substance use. When clients are asked to list and discuss the

problems that alcohol has caused, the results can be surprising. Many alcohol

treatment centers take thorough histories and use motivational interviewing as a

beginning step in breaking down the alcoholic’s denial system (Miller & Rose,

2009).

Assessment Helps the Helper Choose Which Techniques to Use

When you think about learning helping techniques, chances are that you have not

considered assessment as a critical part of that process. Yet how do you know

which techniques to use? The answer is derived from two sources of knowledge:

information about your client and information about the client’s problems. If you

know that your client is very religious, for example, you will be able to select

techniques that the client will embrace. If you know when and where your client

has panic attacks, you will be better able to identify an effective plan. We have to

think about what methods to use with which clients for what particular problem

(Paul, 1967). The next section covers the basic techniques of assessment that are

appropriate to use at all stages of treatment to gain knowledge about clients."