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assessment_1.pptxAssessment
Change Process
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Client’s
Story
Getting the story
Assess & Evaluate
Setting Goals
Implement
Change
Reviewing the Change Process
As we get a client’s story we begin to assess and evaluate what’s going on in their life.
We then begin to review what needs to occur in order for change to happen.
Based on understanding what needs to occur for change to happen we develop goals of therapy.
What is Assessment?
Assessment is evaluating the client’s story and larger context in order to develop a plan for change
Story – Client’s perception about what is not going right in his/her life
Context – Other factors that influence that story like health factors, demographic background, major events, family-related concerns, etc.
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Why Do Assessment?
To help develop a plan for change (treatment plan) and set goals to work on the plan, which guides direction of counseling
To form a baseline for measuring progress, which helps us determine if progress is being made in the clinical work
To determine if a referral is needed, as a better provider might be more helpful in working with the particular client and their concerns
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Formal assessment
Activity 1A: What do you need to know?
Lars is a 45 year old man who calls your office and sets up a counseling appointment. When he shows up for his appointment he appears to be anxious and he looks exhausted. After some brief introductions you ask how you can be of help and he says “My life is a mess. My wife has filed for divorce, she wants to move to California to be near her family but that means I won’t get to see my kids. On top of all this, they just announced at work they are getting ready to do a bunch of layoffs and I think my job may be cut.”
What else do you need to know about Lars to develop a plan for change? How will you get this information?
Discuss in groups
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How do we get the information we need? Through the means of assessing
Methods of assessing:
Clinical interview
Written materials
Background materials
Psychological tests
Behavioral observation
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Elements of Assessment
Demographic information
Where they live, relational orientation and status, ethnic background, gender and sexual orientation, economic status, work background, educational background, etc.
Presenting problem
Problem-saturated story
What does the client indicate as the main problem(s)?
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Filling in the Presenting Problem/Story: Questions You Might Ask…
How long has this been a problem?
When does it bother you the most?
Are there times when the problem does not bother you?
What have you already tried to deal with the problem?
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Elements of Assessment
Demographic information
Presenting problem
Strengths and resources
Coping mechanisms
Social support
Cultural and spiritual beliefs
Motivation to change
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Elements of Assessment
Demographic information
Presenting problem
Strengths and resources
Background
Family history
Significant developmental events (normative events and non-normative)
Effects of race, culture, sexual orientation, age, class, immigration, and other influences
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Assessment for Family Background: Genogram
More Genogram Symbols (Belous et al., 2012)
Gender Identity -
Transgender: TG
Male-to-female transgender:
Female-to-male transgender:
Gender queer:
F2M
M2F
GQ
More Genogram Symbols (Belous et al., 2012)
Sexual Orientation/Attraction -
A: Asexual
B: Bisexual
L: Lesbian
G: Gay
P: Pansexual, Polisexual, or Omnisexual
Q: Queer
?: Questioning
Elements of Assessment
Biopsychosocial stressors
Stress that is
Physically related (biological)
Psychologically related (psychological)
Socially related (social and relational)
Stress from all these areas often overlap
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Elements of Assessment
Biopsychosocial stressors
Psychological functioning
Presence of symptoms reported by the client related to psychological problems
Observations of client’s behavior
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Elements of Assessment
Biopsychosocial stressors
Psychological functioning
Health and biological factors (assuming mental and physical health are related)
Chronic illness
Disability
Medications
Substance use/dependence
Wellness activities
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Elements of Assessment
Biopsychosocial stressors
Psychological functioning
Health and biological factors
Test results (see examples of tests provided)
Beck Depression Inventory (BDI)
Beck Anxiety Inventory (BAI)
Patient Health Questionnaire (PHQ)
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Communicating Assessment Findings
Discuss assessment findings with client
Seek feedback from client regarding findings
When sharing , be careful to note and validate the client’s strengths, normative developmental issues & challenges, & other areas for potential work
It can be helpful to have friends or family members present for discussion of assessment findings
Why do psychological testing?
May confirm conclusions gained via clinical interviewing alone, but can also reveal new information
Provides an alternate viewpoint to a clinical interview
Efficient because get a lot of information rapidly
Client comfort because may respond to test items more easily and honestly than to a person asking queries
Disadvantages
Social desirability
Cultural bias
May be seen as “pass-fail” by the client
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Elements of Assessment
Biopsychosocial stressors
Psychological functioning
Health and biological factors
Test results
Diagnosis
See next slide
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Diagnosis
What is a diagnosis?
A category an individual can be placed in based on their symptoms
Standardized in the DSM-V
To diagnosis…
Most symptoms need to occur daily
At least 5 symptoms need to be present
See next slide
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Example: Major Depressive Episode
Depressed mood most of the day
Diminished interest in or pleasure from activities
Significant weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or lack of energy
Feelings of worthlessness or inappropriate guilt
Inability to concentrate
Suicidal ideation
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Diagnosis
Diagnosis is useful for
Developing a plan for treatment
Insurance companies/reimbursement
Cautions
Can reduce people to a label and can start thinking about people as if they are their symptoms, called “Totalizing”
Cultural limitations
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Activity 2: To Share or Not to Share
Clients have right to ask for their diagnoses & a copy of contents of their clinical file
Debate about whether to share a DSM diagnosis with the client.
Share your opinion: How do you think sharing a client’s diagnosis with a client can be helpful? How might it be harmful?
Assessment Skills
Assessment Filling in the client’s story with other details
Review: Areas of Assessment
Demographic information
Presenting problem
Strengths and resources
Background
Biopsychosocial stressors
Psychological functioning
Health and biological factors
Test results
Diagnosis
Activity 1B: What do you need to know revisited?
Revisit this story and re-answer the questions based on what you now know about assessment:
Lars is a 45 year old man who calls your office and sets up a counseling appointment. When he shows up for his appointment he appears to be anxious and he looks exhausted. After some brief introductions you ask how you can be of help and he says “My life is a mess. My wife has filed for divorce, she wants to move to California to be near her family but that means I won’t get to see my kids. On top of all this, they just announced at work they are getting ready to do a bunch of layoffs and I think my job may be cut.”
What else do you need to know about Lars to develop a plan for change?
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Structured vs. semi-structured interviews
Predetermined set of questions
Interviewer sticks to the questions
Questions usually follow a particular order
Predetermined areas to ask about
Follow-up probes are possible
Interviewer may vary order as long as all areas are addressed
Assessment Interview
Filling in the presenting problem
Learning about strengths
Exploring background (family history, significant events, etc.)
Learning about stressors and health
Start with demo with me as therapist, student as client
Offer EC for student participation
Prime student – Student presenting with depressive symptoms; above are the things I’ll ask about
Begin with a preface, setting the context for the assessment
Group exercise
Number off
Working independently, each person identify 3-5 questions you could ask a client to learn more about this area
Brainstorm these as a class – let them know they will be interviewing one of the members of their group for four minutes on this area
As a group, identify a client. They will take turns playing this client in a role play
Interview in a round robin manner
Process afterwards
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