Assessment in Counseling
Chapter Five: Assessing Client Problems
Purpose of the Chapter
Examines the general process of assessing clients' presenting problems.
Involves:
Information Collection: Relevant to defining the problem.
Conceptualization: Analyzing this information into a coherent understanding of the client.
Client Resources: Considering resources available to the client.
Clinical Assessment in Counseling
Occurs at two stages:
Intake Interview: Before assignment to a counselor.
Counselor's Sessions: Throughout sessions with the assigned counselor.
May include both paper and pencil assessment instruments and interviews during the intake process.
Approaches to Clinical Assessment
Drummond and Jones (February 2010) identify two methods:
Psychodiagnostic Method: Focused on evaluating client problems and contextual conditions; aims to determine:
Type of counseling needed.
Intervention types used.
Likely progress during counseling.
Psychometric Method: Often refers to specific tests or instruments.
Assessment is defined here in a broader sense: the gathering and analyzing of information from the client for appropriate counseling goals.
Considerations for Clinical Assessment
Defining a problem is complex; perception of problems can vary widely among individuals.
Key questions for counselors include:
How to separate their worldview from the client's.
What information is significant in understanding the client’s issues.
How to navigate between crisis counseling and other forms of counseling.
These guiding questions inform the clinical assessment process and affect both counselor and client.
Challenges in Assessment
Assessment can be difficult, especially for novice counselors.
Common Errors in Assessment:
Conceptual Foreclosure: Jumping to conclusions about the client’s issues without full understanding.
Following Plot: Focusing on the client's storyline rather than the underlying process or context of their issues.
Clients’ Motivations for Seeking Counseling
Clients generally reach out for help due to:
Daily functioning concerns.
Feelings of discouragement or despair.
Vulnerability is prevalent among clients and counselors alike, leading to challenges in assessment discipline.
Purposes of Assessment
Provides systematic means to solicit and organize relevant client information.
Helps identify significant cultural and individual conditions that relate to the client’s presenting problems.
Enables counselors to understand the client's perspective and report factual circumstances.
Reactive Assessment: Can instigate changes in the client’s perceptions or behaviors.
Dimensions of Assessment
Assessment encompasses various activities undertaken for understanding client concerns.
Begins typically during intake but continues throughout counseling as counselors seek ongoing understanding.
Formal Intake Interviews
Definition: A structured process to collect comprehensive background relevant to the client's problems.
Not used in every counseling context; for example, school counseling may depend on accumulated knowledge over formal intakes.
Intake should generally last one hour to ninety minutes; must be managed effectively by the counselor to maintain focus.
Key aspects of intake:
Gather basic background information (family, history, presenting issues).
Must ensure clients understand the intake's nature and purpose.
Intake Forms
Vary significantly based on agency’s mission.
Comprehensive services collect numerous details, including:
Medical history.
Mental health history.
Substance use.
Family and legal histories.
Colleges might utilize targeted checklists for specific issues.
Writing Results of the Intake Interview
Utilize descriptive, non-diagnostic language where appropriate.
Avoid inference; assessments must be defensible and unbiased.
Importance of accurate information re-emphasized, especially in crisis situations.
Identifying Data Required:
Client's contact information, background information, family status, and current living situation.
Presenting Problems: Primary and Secondary
Document problems as reported by the client, including:
How issues affect daily life.
Manifestations: Thoughts, feelings, observable behaviors.
Context of events related to problems (when and how do problems arise?).
Client's Life Setting
Assess daily routines, activities, and cultural background influencing the client.
Important to understand the socio-cultural context of the client's life.
Family and Personal History
Collect detailed information about:
Age, occupation, relationships of family members (parents, siblings).
Any history of mental illness, substance abuse, or family dynamics.
In-depth personal history includes:
Medical, educational, vocational, military, sexual, and relationship histories.
Description of Client During Interview
Observations about physical presentation and demeanor, including:
Communication style, emotional state, engagement level.
Summary and Recommendations
Draw connections between stated problems and accumulated information.
Evaluate the suitability of counseling approaches and therapists' fit based on the information gathered.
Problem Definition
Clinical assessment extends beyond intake; involves ongoing definition and exploration of problems through subsequent sessions:
Uncover deeper issues that may be overlooked initially.
Goals of problem definition include:
Explore intensities and manifestations of problems.
Identify contributing thoughts, feelings, behaviors, and patterns that maintain the problem.
Client Coping Skills, Strengths, Resources
Determine how clients cope with issues, documenting:
Successful coping strategies and resources available in their environment.
Contextual Realities of Problems
Recognize that issues may originate outside the individual, influenced by societal systems or contextual conditions.
Important to consider how circumstances affect problems, particularly in systemic contexts.
Clinical Assessment with Children
Unique challenges due to cognitive development:
Gather information primarily via parents or guardians.
Establishing rapport is crucial for successful assessment.
Consideration of child-focused techniques (e.g., play therapy).
Issues Related to Child Clinical Assessment
Assess the child's pertinent background, trauma history, environmental contributions, and the suitability of parental support systems.
Clinical Assessment with Couples and Families
Emphasizes a systemic approach focusing on interactions, rather than individual characteristics.
Use of family genograms to delineate family dynamics and relationships.
Using Assessment Information
Develop treatment strategies based on insights from assessment:
Identify patterns influencing counseling processes and determine effective interventions.
Skills Associated with Assessment
Skills necessary for effective assessment include:
Verbal and nonverbal attending.
Paraphrasing content.
Using open and closed questions strategically.
Effects of Assessment on Clients
Positive and negative client responses to assessment can arise. Each client’s reaction is unique:
Positive responses may include feelings of relief, understanding, and hopefulness.
Negative responses may include anxiety, defensiveness, vulnerability, and feeling evaluated.
Balance between questions and other response skills is key to maintain rapport.
Case Illustration of the Intake Interview: Angela
Identifying Data: 45-year-old female, teacher, two teenage children, divorced six years prior.
Range of Problems: Mood control issues, feelings of failure relating to parenting and work.
Current Life Setting: Routine activities, few relationships, some struggles with social engagement.
Family History: Close family ties, minimal mental health history in immediate family.
Personal History: Medical conditions, previous counseling experiences, dealing with depression since divorce.
Counselor Observations: Moods affecting energy levels, expressing a mixture of hope and despair.
Integration and Recommendations
Continue problem definition based on the gathered information to inform treatment planning.
Utilize assessment to apply interventions focused on cognitive and interpersonal modalities.