Topic 5: Initial Assessment in Counseling {by 10/7}

Based on the text readings and lecture recording due this week consider the following two discussion points: (1) Share your understanding on why it is important to get an accurate understanding of the client’s problems early in therapy (i.e., intake/early sessions).  (2) Understandably, especially as a beginning therapist, the thought of assessing suicide can be anxiety provoking.  Share a few of your initial concerns when (not if) you are confronted with a suicidal client.  (Keep in mind, you will learn a lot more about responding to suicidal clients in future classes and on your practicum/internship.)

 

(3 – Prepare for Class [do not blog]) You will notice on my website (Class Lectures & Recordings) a short video “Assessment Review Introduction,” “Assessment Review Reflection Questions” template, and five assessments (under Class 7 – 10/14).  Please review these questions and the assessments before class.  You do not have to complete these assessments before class, but you can if you want.  In class, we will complete these assessments and discuss them based on the reflection questions.

 

Your original post should be posted by 10/7.  Post your two replies no later than 10/9.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

61 Comments (+add yours?)

  1. Victoria Cestodio
    Oct 04, 2021 @ 13:56:00

    It is very important to get an accurate understanding of the clients problems in therapy early on for many reasons. One of these reasons is that a lot of clients tend to come in for one problem, however we have learned that rarely there is one problem bringing them there. In class Dr. V used the example of someone coming to see him after he had a break up, however getting to know that right away led Dr. V to think this was just the straw that broke the camel’s back, and he was correct. Therefore, if we address the main problem you are coming to therapy for early on, we may be able to figure out other things contributing to the patient’s distress faster. This will then lead the counselor to gather more information on specific issues (frequency, duration of issues), etc. If the therapist does not get an accurate understanding of the clients problems this could actually result in a poor therapeutic relationship. This is because (especially as beginning therapists) we may underestimate our clients’ problems and their severity. If the therapist does this, it can make the client feel as though they are not fully understanding and if the client does not feel understood the therapeutic relationship is damaged.

    I definitely have a few concerns when thinking about assessing a suicidal client. One of my concerns is me not responding correctly (which I am sure I will learn more about), I am scared of saying something wrong and then having that client not feel understood (which is obviously the last thing you want to do as a therapist). One other concern I have is if I have a strong feeling someone is suicidal, how to bring that up to them. Should you ask your client directly or give them the Beck Hopelessness scale? Also, I have concerns that I might be uneasy letting them leave the session knowing they told me they are suicidal, and questioning when to make the call of not letting them leave. I am looking forward to the rest of this class and future classes to learn more about how to tackle this obstacle as a therapist.

    Reply

    • Vanessa Nichols
      Oct 05, 2021 @ 13:16:06

      Hi Victoria,
      I also talked about how important it is to understand the multidimensional nature of clients’ problems. I totally agree that it seems like often time problems are present in one specific way. Yet after discussion, the clinician was able to break down the general problem into multiple other problems. I think this breakdown is important, especially for the client, because it shows the client that you have some skills to offer, and although it’s the client’s life, you can maybe help the client achieve some additional insight.
      I related heavily to your concerns about dealing with a suicidal client, especially your remark about not responding correctly. I agree. I know that we are mandated reports and that we have to hospitalize people if they are a danger to themselves or others but how. Like how do you say that to the client, and what are the steps to actually doing that. It’s so anxiety-provoking because what if you do it wrong and the person does not receive the help they need. Or what if they leave and never come back due to the hospitalization. It is just such a touchy topic that until I get real experience with it, I feel like I’m always going to feel this way.
      Thank you!

      Reply

      • Kelsey McGinness
        Oct 09, 2021 @ 06:54:56

        Victoria, I like how you referenced Dr. V’s example about his client coming in for therapy after a break up. However that was more than likely just the tipping point. I feel a lot of the times when people go to therapy underneath their focal reason for being there, there are deeper points, events, tiggers, and reasons underneath that initial reason that later comes out and gets unpack. Therefore, I agree it’s important to dig deep during those initial sessions to learn more.

        Reply

    • Will Roche
      Oct 07, 2021 @ 12:49:51

      Victoria,

      You make a great point about how as beginning therapists, we may underestimate the severity of client’s emotions and problems they may have. That was also mentioned in another class this week, that inexperienced therapists may think they have solved their client’s problems if they show improvement. However, this usually is not the case, and I think as beginning therapists it’s important to understand that just because someone’s symptoms are improving, definitely does not mean that they are out of the woods in terms of their emotions. Therefore, it is imperative that we don’t allow ourselves to become comfortable or underestimate the severity of symptoms that our clients may have. In fact, it is probably best to be the opposite of that.

      Reply

  2. Mary Altomare
    Oct 04, 2021 @ 20:32:39

    The initial intake and the first few sessions are imperative for the counselor to establish and build a strong therapeutic relationship with their new client, and gather enough information to properly assess, create and implement an effective treatment plan. First and foremost, without establishing a strong therapeutic relationship, a clinician cannot provide effective or meaningful therapy to their client. Additionally, an effective initial intake is a combination of gathering information and building a therapeutic relationship. Therefore, it is imperative the clinician provide a safe space for clients to share their stories, express their thoughts and feelings, and learn about clients from their own point of view, in order gather information to understand the client’s needs. On the other hand, if the clinician does not conduct a successful initial intake or foster a strong therapeutic relationship within the first few sessions, there is high possibility that the client will not return back. Furthermore, if the clinician does fully understand the client’s needs and various factors that have been impacting their mental health, than therapy will not be meaningful or effective.

    The thought of assessing suicide as a new counselor does provoke some anxiety for me. One of the major concerns that I have for myself is underestimating the severity of my client report. Especially if it’s a new client and I am still working on establishing rapport and building a therapeutic relationship with them, I may not know them well enough if they are under reporting the severity of their thoughts, feeling and symptoms. Additionally, the biggest concern I have is allowing my client to leave the office knowing that they are suicidal. I believe that I will have a hard time reassuring myself that I did everything in that session to make sure they had the necessary support between each session. Furthermore, I would worry that the safety plan the client and I made together would not be utilized by the client if their thoughts and feelings intensifies one day. With that being said, I am sure that through experience and being in this program I will learn the best therapeutic techniques to hopefully provide my client with the support necessary if they are battling with suicidal thoughts.

    Reply

    • Victoria Cestodio
      Oct 05, 2021 @ 12:35:01

      Hi Mary,
      I mentioned the same thing within my response about having some anxiety about the client leaving when I know they are suicidal. I overthink a lot and I definitely think it will come out when that does happen. You also made me think of another concern I have and it is underestimating the severity of the clients suicide levels. I would never want to do this, and like you said it’s hard to get a good gauge at the beginning because you are still developing that relationship and rapport.

      Reply

    • Vanessa Nichols
      Oct 05, 2021 @ 13:03:01

      Hi Mary,
      In my response, I made the same conclusion that understanding in the initial session is essential for establishing the therapeutic relationship. I think to show you understand in the beginning allows the client to have faith that you are listening to what they are saying and have the capabilities to help them. I think another thing is to make sure their problem is in your range of abilities, especially if you are a person that ends up working with more everyday problems.
      I relate very much to your concerns about working with a suicidal client. I am especially worried about letting a client leave that you know is suicidal but has promised that they will not kill or harm themselves. I wonder how you leave the office and not continue to worry about them until you see them again. Especially in the instant that you mentioned when you don’t really know the client that well. It’s like, how do you turn off the worry.
      Thank you.

      Reply

    • Lauren Pereira
      Oct 05, 2021 @ 15:55:30

      Mary,
      I like how you mentioned that a clinician will not be providing meaningful therapy without forming a good therapeutic relationship first. I completely agree because no one would want to completely open up to their therapist if they do not feel comfortable or cared for. The relationship is important in order to grow in therapy. The therapist also needs a better understanding and more background from the client in order to address the main cause for needing therapy. This all ties in to how the client trusts the therapist.

      I do agree that it is significant to understand the severity of the suicidal patient and that can bring on a lot of anxiety and worry. As a therapist, we want to make sure the client is cared for and we want to communicate all the right things to them. I also find it hard to not worry about the client after their session is over because you do not know how the client will respond once they are home. It is something I would like to learn more about in my graduate classes.

      Reply

    • Tom Mandozzi
      Oct 09, 2021 @ 01:55:31

      Hi Mary,

      I really resonated with what you said about being concerned with having a client leave your office knowing that they are suicidal. I found myself having this thought as well while considering the issue of suicide. I am looking forward to learning more and hopefully feeling more comfortable with this as we progress in this program, but I am curious as to what the best clinical practice is in the situation that you assess a client for suicide and the results suggest that there is some level of significant risk. What support can you provide them between sessions? Do you need immediate emergency services? Should you check in and be more available until next session, or direct them to other resources? I am sure this will be a case by case decision, and it will be informed by our ability to assess for risk, but it definitely seems daunting. Great post!

      Reply

    • Pilar
      Oct 09, 2021 @ 22:12:21

      Hello Mary,
      Establishing a strong therapeutic relationship is so important, and giving assessments is apart of that process by involving your client in every step of the process you build that relationship and learn more about your client at the same time. I also am concerned about receiving a suicidal client when I’m first starting out and am fearful because you have to be extra careful what you say and how you go about working with this client.

      Reply

  3. Vanessa Nichols
    Oct 05, 2021 @ 12:54:00

    There are multiple reasons why it is essential to understand the client’s problems early in therapy. One reason that the book mentions is that the initial session is critical to the effectiveness of the overall process. I imagined that if the client does not feel like you understand or can help them, the relationship is not off to a great start.
    The initial session also allows the clinician to understand the scope of the problem and if the client’s problems fit the range of the clinic, hospital, or counselor. An important aspect to remember about the presentation of issues is that they are usually presented by the client as a singular problem when they are generally multidimensional. In some cases, clients will come in saying that they have a specific problem, but once you begin talking, you realize what the real problem is. In the book, the girl came because she hates school. The girl didn’t hate school but fell out with her friend and felt she didn’t have anyone. It’s the clinician’s job to sort through what the client is saying and determine and prioritize the issues. The clinician’s ability to do this shows their capabilities and also shows the client that they understand. This understanding is fundamental in the building of the client-therapist relationship.
    I am anxious about being presented with suicidal clients. I am not so nervous that I want to avoid them altogether, but we are responsible for someone’s life. It’s our responsibility to see the warning sign. I am worried about what happens if you miss a warning sign or have a client presenting with suicidal ideation, but you didn’t think they would do anything, but they do. A huge concern for me is how do you leave without worrying about a client. For example, in the book, the clinician let the mom who was suicidal leave due to promises she made and because she has a son and didn’t buy the razor, but how do just accept that. How do you let them leave and not continue to worry about them?

    Reply

    • Lauren Pereira
      Oct 05, 2021 @ 15:49:13

      Vanessa,
      You make some great points! I agree that it is important to understand the client and their situations early on in order to get a more effective approach to therapy. The first few sessions are crucial for this reason because you need to be able to determine the major struggles but you also need to create a good bond with the client. The therapeutic relationship is very important in order for the client to trust you and for you, as the therapist, to be on the right track. If there is no positive movements in the beginning, it is likely not going to end with a positive outcome.

      I like how you mentioned you may be anxious when dealing with suicidal clients but you won’t be nervous enough to want to avoid the situation. This is a good mindset to have because I’m sure all therapists will run into these types of clients and scary situations. I feel as though it is normal to be nervous because of the big responsibility it is. You have your clients life in your hands so it must be hard not to worry about them after the session as well.

      Reply

      • Kelsey McGinness
        Oct 09, 2021 @ 06:57:33

        Lauren, I agree with you when you mentioned that you maybe nervous to engage in that conversation of suicide with your clients but those conversations get easier over time. I feel as though that first initial exposure conversation for any therapist for any hard topic can evoke some anxiety, however that is as you said natural. Great point!

        Reply

    • Bekah Riley
      Oct 05, 2021 @ 17:10:46

      Hi Vanessa.

      I really enjoyed reading your discussion post this week!

      I liked how you emphasized that the initial intake and early sessions have a significant effect on the overall outcome of therapy. This point stood out to me as well when I was reading the textbook. I also really liked how you explained that the client usually presents a singular problem, when often times the problem they have expressed is multidimensional. I think it is very important to keep this in mind as a counselor when trying to further understand the client’s problems and how to treat them.

      I have very similar concerns when presented with a suicidal client. I feel as though I will be so worried about the client after each session and constantly analyze what I said during the sessions.

      Reply

    • Mary Altomare
      Oct 06, 2021 @ 13:49:56

      Hi Vanessa,
      You made a great point in your initial paragraphs that if the client does not feel understood, or feel like the clinician can assist them through their problems than the clinician will not be able to provide meaningful therapy! It is the clinician’s job to make the client feel safe and comfortable enough to share their thoughts and feelings, and in listening and gathering information, the clinician is able to understand the complexity of the client’s problems. As you stated, the client may come in with one problem, but in actuality there may be more stressors that are impairing the clients daily functioning that they themselves are not even aware of!

      I have the same concern as you, I am so worried about a suicidal client leaving my office one day! I am also worried about missing a warning signs of a client being suicidal, especially a new client because they may be downplaying their actual thoughts and feelings.

      Reply

  4. Lauren Pereira
    Oct 05, 2021 @ 15:40:05

    It is significant to determine an accurate understanding of your clients problems early on in therapy for several reasons. These first few sessions are when the therapist and client begin building their therapeutic relationship. In order to do so, you must try to find the root of the client’s struggles in order to then dig deeper with them. This will not only lay out more clarity on why the client needs therapy, but it will also show the client that you care for them and you are putting their needs first. This is important early in therapy because your therapeutic relationship needs to form and that trust needs to build in order to know that there will be a positive outcome. Being able to determine the cause for needing therapy will then help find more factors for why the client may be feeling the way they do. Once trust is built and

    The thought of assessing a client who is suicidal is definitely scary to think about. My initial thought would be that if anything harmful ends up happening to my client, I would feel guilty for not being able to stop it. I feel as though these types of clients are much more delicate than others because you know they are having thoughts of killing themselves and it can be hard to determine what to say in order to flip that switch in their head. Another concern would be where do I start? What are the right things to say in order to try to help them get out of that dark place as quick as possible. This is a big responsibility because you technically have your client’s life in your hands during the session. I may feel anxious throughout the session and will definitely consider what I say before saying it to try to prevent any wrong terms. I might feel worried about the client after the session as well but I believe that this program will help guide me in the right direction when focusing in on suicidal clients.

    Reply

    • Bekah Riley
      Oct 05, 2021 @ 17:01:22

      Hi Lauren,

      I really loved your discussion post this week!

      As you mentioned, building a therapeutic relationship with the client is so important during early sessions. Without this relationship, therapy may not be as much of a comfortable space for the client. This could have an effect on the client’s progress and overall their outcome in therapy. In addition, I liked how you included that it is important to make sure the client feels understood and cared for in terms of putting their needs first. If the client feels that their needs are important to their counselor, that may encourage them to be motivated in making positive changes/improvements over the course of therapy!

      In terms of working with suicidal clients, I also think that I will be very anxious both during and after the session. Like you said, it feels like the client’s life is in your hands as a counselor and it is very hard not to worry about everything you say in each session and how the client is feeling after each session. I also believe this program will help guide all of us and prepare us for working with suicidal clients.

      Reply

    • Victoria Cestodio
      Oct 05, 2021 @ 21:50:29

      Hi Lauren,
      I think you touched on a great point, which is showing the client you care. As therapists we do have to show this to clients, and it also helps to build the relationship which is another important factor. When it comes to assessing suicide I definitely relate to feeling potentially guilty about a client self harming. In that situation I feel as though I might doubt myself as a therapist, which is worrisome. I think thinking about what you want to say before you say it is crucial in this kind of session! Like you mentioned, you don’t want to say the wrong thing, or have the client feel invalidated whatsoever.

      Reply

    • Mary Altomare
      Oct 06, 2021 @ 14:02:18

      Hi Lauren,
      I really liked your post this week. I liked how you explained that a clinician learning about the client’s problems will show that the clinician cares for them and their needs. I think that is a great way of looking at the initial intake! As you stated, gathering information in the first few sessions is crucial for the effectiveness of therapy. I completely agree with you that the thought of my client leaving the office and something bad happens to them, I would feel awful! You made a great point that I would try extra hard to find the right words in order to change their thought process. However, what is the right thing to say? What is the wrong thing to say? What is saying too much? What is considering saying too little? I feel as though all these questions would be looming in my head!

      Reply

    • Kelsey McGinness
      Oct 09, 2021 @ 06:59:47

      Lauren, I agree with you when you when you mention the responsibility of what if something happens. Being a therapist there are a lot of variables in your court and you always want to make sure your client is safe before and after therapy, and this is not always easy to have control over.

      Reply

  5. Bekah Riley
    Oct 05, 2021 @ 16:50:04

    Getting an accurate understanding of a client’s problems early in therapy is very important for many reasons. In reading the textbook and reviewing the lecture recordings, a point that stood out to me was that the clients’ experiences and expectations in the initial sessions with a counselor has a significant influence on the outcome of therapy. If the client has a negative outlook on therapy from the start, their motivation to change or improve may not be as strong. In addition, the client may feel a lack of hope for their future in therapy from a negative intake, having an effect on their progress. It is so important for the counselor to get an accurate understanding of the client’s problems as well as work to build a relationship with the client so that the client feels both comfortable and understood. This understanding and positive relationship can lead to a more positive outcome in terms of the client’s progress. Understanding the client’s problems from the intake in terms of possible treatment plans to consider will also be important in the client’s progress and outcome.

    As mentioned in the readings and lecture recordings, 70% of counselors have worked with clients who have attempted suicide. This statistic alone shows how important it is for a counselor to be prepared to work with a client who is suicidal. As a counselor, it is important to provide an effective treatment plan for the client based on their unique client factors that will lead to progress. However, knowing that a client is suicidal adds another element to the treatment process in the sense that it may feel as though the client’s life is in your hands as a counselor. One of my initial concerns when I am presented with a suicidal client is that I will not be able to get the client to see that there is hope. I really believe that if a client is able to be hopeful about their future and motivated to make positive changes then they can do it, but for a client that has considered or is considering taking their life, the steps to hope and motivation may be more challenging or a longer process. In addition, another one of my concerns is that I will be visibly more nervous and anxious to the client in knowing they are suicidal. My goal as a counselor is to be confident and show my client’s that I believe in them and their progress, ultimately leading to them knowing they can make positive changes.

    Reply

    • Madelyn Haas
      Oct 06, 2021 @ 20:34:41

      Hi Bekah,
      Your response was well written and a great read! I agree on all your points about the importance of the initial sessions. I especially appreciate how you mentioned how important it is in the first sessions to start building a good therapist-client relationship. First impressions are important even outside of counseling. In counseling, however, they can be even more important because it can influence whether a client wants to even continue therapy in the future. How you treat the client can affect their views on the efficacy and importance of therapy.

      As for your response about suicidal clients, I feel the same way. I know I will be nervous initially, and I am worried that the client will feel hurt, guilty, or embarrassed if they notice. That being said, I am sure every beginning counselor would be nervous with their first suicidal client(s). With practice, I am sure we will all become adept at helping suicidal clients. We just need to be, like you said, confident in our abilities and caring people.

      Reply

  6. jeremy
    Oct 06, 2021 @ 15:26:48

    A proper intake is vital to the therapeutic process. Most people form their opinions of others based on their own first impressions and starting off on the wrong foot can lead to ineffective therapy, because the client does not trust you, or believes you do not understand them. Getting a good read of the client’s problems helps you know what they may be struggling with both so you know what diagnosis to give, but also where to go in treatment first, if someone has anxiy and a smoking problem, seeing how the two interact and cause one another might indicate which needs to be treated first. Addionilay clients will give up if they feel frustrated with their progress, if you are several sessions in and have not yet made a serious breakthrough clients may remove themself physically leaving or becoming distant and hard to work with. Additionally early understanding of problems can help identify serious issues that will change the course of treatment, such as suicidality.
    I am very concerned with encountering my first suicidal client, while the theory may be simple, nothing is quite like the first experience, I know I will have a hard time masking horror when it happens, Not that i won’t be prepared, but I can already feel my heart rate will heighten and senses sharpen when i first encounter suicidality in a client. The simple change of, trying to improve your life to, trying to save it is a noticeable difference in severity. But I also know that after treating a client or two for suicidality, I will be more comfortable with similar situations, I will adapt, not necessary get used to suicidal clients. I will feel more confident with my ability when I reserved further training, but I ultimately do not see it outside of normal therapy, I will be scared my first few times but ultimately adjust to the stress of a suicidal client.

    Reply

    • Madelyn Haas
      Oct 06, 2021 @ 20:24:23

      Hi Jeremy,

      I enjoyed reading your response. Your analysis about the importance of initial sessions is extremely fitting. I think your example about anxiety and smoking elucidates the importance of initial sessions. It is extremely important to find out all of the client’s problems and prioritize which is most serious. Like if a client is suicidal and also has a drinking problem, it would be horrible if a counselor tried to prioritize the drinking problem.

      Also, I feel similarly about working with a suicidal client. I know myself well enough to know that I will be extremely anxious when the time comes for me to have my first suicidal client. That being said, I also know that I am an adaptive person. I’ve gotten over my anxiety many times in the past, so I am sure I will be able to get through this as well. I appreciate that your response had a positive ending, so I am making sure mine does as well this time! We’ve all got this (or will in the future).

      Reply

    • Pilar
      Oct 09, 2021 @ 22:19:02

      Hello Jeremy, I like that you mentioned not being judgmental of the client, and being observant and patient of them in the process because they are learning and processing themselves as well. I said the same thing about having a suicidal patient the first one will be telling, No one can truly prepare ahead you just have to go through it, I agree I may have an initial reaction of shock too.

      Reply

  7. Madelyn Haas
    Oct 06, 2021 @ 20:11:09

    There are a lot of reasons why it is important to get an accurate understanding of a client’s problems early in therapy. If a client does not feel understood early on, they are more likely to discontinue therapy with you and may even distrust therapy as a concept in the future. Also, research has found that the outcome of therapy can be traced back to initial sessions, meaning that if the client perceives the early sessions as bad/unhelpful, the therapy will be perceived as bad/unhelpful overall. It is also important to get accurate information because that will influence your treatment plan for the client. If you underestimate the client’s problem, you will invalidate them and will not be able to help them change. Finally, one extremely important reason for understanding the client’s problems is the potential risk of suicide. If you underestimate how bad the client is doing, it could result in an unnecessary death.
    As mentioned in the previous paragraph, underestimating suicidality can be extremely dangerous for the client. When I eventually start meeting with clients, the thing I am most nervous about is a client dying by suicide. Although a counselor does not cause a client to die by suicide, I am sure they often feel extreme guilt about not being able to prevent it. I am extremely worried about this, especially because according to the textbook about 1/4 of counselors have a client die by suicide. I am especially worried about making judgement calls about involuntary commitment. If I overestimate the risk, it could lead to broken therapeutic-client relations, a huge hospital bill, and other negative social, mental health, and financial outcomes for the client. Worse, if I underestimate the risk, it could end with the client dying. This is something I considered before deciding to go into graduate school, so I am obviously willing to learn and work with suicidal clients, but I am extremely nervous right now about the prospect of it.

    Reply

    • Kristin Blair
      Oct 07, 2021 @ 08:51:56

      Hi Madelyn,

      Great post! I agree with you in terms of overestimating and underestimating the risk. All of the things you mentioned were right along the lines of my thinking as well. However, while reading your post I thought, what if by overestimating the risk, the client feels “labeled” as suicidal and it makes them feel even more depressed?! Just one more thought to be nervous about haha.

      Reply

    • Tom Mandozzi
      Oct 09, 2021 @ 01:41:36

      Hi Madelyn,

      I like that you touched on the potential challenges that come with overestimating the suicide risk of a client. My initial thought is to only consider underestimating this risk and the potential of missing signs of suicidal tendencies and the impact of this potential death, but it is also a great point to evaluate the potential consequences of overestimating risk as well. I completely relate to what you said about contemplating the inevitable issue of working with suicidal clients before pursuing graduate school in this field, but I am glad we will continue to learn the best clinical practice in addressing this issue. I am sure this topic is daunting for all new counseling students and confidence with managing these concerns comes with time, supervision and practice. Great post!

      Reply

    • Teresia
      Oct 09, 2021 @ 17:33:40

      Hi Madelyn,

      Great post, I enjoyed reading it. I also wrote something similar about the client not wanting to continue therapy if they feel like their therapists don’t understand them. This is why it’s very important to understand the full scope of what the client is seeking treatment for. I also have the same worries about underestimating the risks and the client then dying. Although I also understand that this is a part of the profession and with more education and experience, I believe we’ll get better at handling the situation, but I’m sure we’ll still have those concerns in the back of our heads.

      Reply

    • Teresia
      Oct 09, 2021 @ 18:11:55

      Hi Madelyn,

      Great post, I enjoyed reading it. I also wrote something similar about the client not wanting to continue therapy if they feel like their therapists don’t understand them. This is why it’s very important to understand the full scope of what the client is seeking treatment for. I also have the same worries about underestimating the risks and the client then dying. Although I also understand that this is a part of the profession and with more education and experience, I believe we’ll get better at handling the situation, but I’m sure we’ll still have those concerns in the back of our heads.

      Reply

  8. Kelsey McGinness
    Oct 07, 2021 @ 08:23:30

    It is important to get an accurate understanding of the client’s problems early in therapy through an intake and during early sessions so that you are able to get a clear picture of what is motivating him/her/them to seek therapy, how long such thoughts/actions have been occurring, learn any past history of therapy and why it did not did not work out (it’s like dating, not every therapist will work for every client), and then continue to unpack those details in early sessions. It creates a solid foundation for clients and therapist to start to build on for their progress. You can’t help someone move forward if you do not know their past and where they are at in the moment they come to you. For me, for example, when I began with my current therapist, we spoke over the phone and she asked me a variety of intake questions before our first session, then in our first session she brought up those responses and I told my story. While telling my story she would ask deeper questions to unpack more to better understand me, my past, my triggers in order to help get me here one year later.

    As a beginning therapist it can be anxiety provoking to assess a client who is suicidal or experiencing suicidal ideation. The reason I think I would become anxious about it is because everyone’s triggers are different when it comes to their suicidality. Being transparent, what were my triggers may not be someone else’s, in fact they may be completely opposite to what I know through personal experience and through personal loss through suicide. As an overthinker, I feel I would worry that I will assess for it and then ultimately push towards that route the more it is spoken about and unpacked because by speaking about it more, it may make those thoughts more prevalent in their mind. I know there is a proper approach to speaking with someone who is presently suicidal, and knowing how to help talk them off that ledge is a balancing act.

    Reply

    • Emily Barefield
      Oct 07, 2021 @ 09:59:15

      Kelsey,

      You brought up a lot of important things to think about as a therapist in early sessions. I appreciate the analogy to dating that you used. Recognizing that I will not be a perfect fit for every client helps take off some of the pressure and frustration that may occur when a relationship does not work out. I also appreciate you sharing your experience with intake and early sessions as a client.

      I also appreciate that you bringing up that everyone’s triggers are different; it highlights the importance of not viewing only one particular type of client as suicidal, but looking for the potential in every client during intake. I can also relate to overthinking! Because assessing suicide has such important implications, it is hard not to overthink and want reassurance that you made the right decisions.

      I really appreciate you sharing your personal experiences, great post!

      Reply

    • Tressa Novack
      Oct 07, 2021 @ 16:18:25

      Hi Kelsey, I agree with what you had to say about the beginning sessions of therapy. It is important to get a clear picture of the client. I mentioned how we need to look at the client as a whole person, not just their presenting problems. I also mentioned how it is necessary so that we can try to figure out the best way to help our clients. I like what you had to say about suicide and your honesty in saying that you would worry about pushing the client towards that route the more you talk about it. That is similar to a fear I have of making my client feel even worse when talking with them, especially when they are suicidal.
      Tressa

      Reply

  9. Kristin Blair
    Oct 07, 2021 @ 08:44:25

    Getting an accurate understanding of a client’s problems is a valuable tool to ensure more success and longevity of treatment with the client. This is especially important since the average number of sessions a client has with a provider is 1-3 sessions. Of course, many clients will stay longer than that, however, there is also a percentage of those who decide therapy is not for them for a multitude of reasons. Therefore, this is your moment! The first few sessions should be for assessing the true reasons for seeking therapy and their severity, as well as building a rapport. Doing these two things simultaneously is preferable. Knowing the level of severity of the client’s current situation can help the therapist navigate how to continue to interact with the client and tailor the interview to the best needs of that individual. You want the client to feel comfortable with you as a person, as well as a therapist. Personally, I just think people give and receive information better if they can connect with the therapist (or anyone really) on a “personal level,” or identify with them in some way. By gathering the correct information and accurately assessing the client’s needs, helps the client feel understood and validated which will strengthen rapport as well. If the therapist seems confident, personable, and professional throughout the initial interview, this should help precipitate the best outcome.

    The idea of being presented with a client who expresses suicidality is of course stressful. I think one of my initial concerns would be to have to confront a client that I believe to be withholding that feeling or desire. One would like to think that if someone is seeking therapy they would be at a place where they feel open enough to discuss and disclose all their feelings, but that will not always be the case. Someone may feel comfortable sharing some things but others not so much? What would make that even more challenging, is when I do confront the client about my concerns, my probing then shuts the client down and they discontinue therapy sessions. As a therapist, I would be left with questioning myself as a professional (did I ask the right questions? Were they truly not feeling suicidal, and I offended them? Etc…). Additionally, I would be obviously worried that they really were suicidal and now they are without therapy and hopefully not hurting themselves etc…

    Reply

    • Emily Barefield
      Oct 07, 2021 @ 09:51:10

      Hi Kristin,

      You did a great job of emphasizing how important building rapport in the early sessions is to the success of therapy. Bringing up that the average of number of sessions attended is 1-3 really highlighted this point. I also appreciate that you noted it is important for the client to feel comfortable with you both as a therapist and as a person. A client being comfortable with you as a therapist might be related to how they view your professional competence, while the client being comfortable with you as a person might be related to your interpersonal and rapport-building skills. Being a therapist and a person are obviously intertwined, but I like that you highlighted the importance of both aspects.

      I did not really think about having to confront a suicidal client who says they are not suicidal, but I would also struggle with that, especially because suicide assessment should be done early on in therapy, often before relationship has been established. I would also be concerned about confronting them in a way that does not push them away. Great post!

      Reply

    • Will Roche
      Oct 07, 2021 @ 12:46:15

      Kristin,

      You make a good point with your concerns of confronting a client when they may be suicidal. When I was writing my response, I wasn’t taking into consideration that they may be feeling this way, but verbally withholding that information from their therapist. That definitely will not be an easy conversation to have if they are withholding that very serious information from the person they are supposed to confide in. That type of responsibility that a therapist has is something that will be difficult to get used to and use properly.

      Reply

  10. Emily Barefield
    Oct 07, 2021 @ 09:36:55

    Getting an accurate understanding of the client’s problem during the intake and early sessions is so important because it influences if the client chooses to continue therapy and predicts therapy outcomes. The intake and early sessions are essential for building the relationship with the client and establishing rapport. If the client views you as incompetent or as dismissive of their problems, they are unlikely to continue therapy with you. But if they feel understood and are convinced you can help them, they are more likely to continue with treatment. It is important not to underestimate a client’s struggles. They will likely feel dismissed and the treatment they receive will not adequately address their struggles. Research shows that the quality of the therapeutic relationships during the early sessions, not the later sessions, predicts long-term positive results of therapy. Therefore, it is so important to build a relationship and establish rapport with the client early on. It is very difficult to make progress with the client if they do not trust you and do not feel comfortable with you. While establishing a relationship with the client is crucial to the success of treatment, it is also important to gain a good understanding of what they are struggling with (this also does improve the relationship. Gathering information and building a therapeutic relationship must be intertwined.

    I am generally a very emotional and empathetic person, so I know that having a suicidal client will be challenging for me to navigate emotionally, especially initially. While it is important to show empathy and be invested in clients, I know that I will need supervision and guidance on how to balance those emotions with maintaining my own mental health. I anticipate struggling with balancing being at least partially responsible for the life of a suicidal client, feeling guilty if a client does commit suicide, and recognizing there is a limit to what I can do.

    Reply

    • Monika Dhamale
      Oct 07, 2021 @ 14:31:18

      Hi Emily,

      You made some really good points here. I totally agree with you if the clients don’t feel understood or dismissive they are unlikely to continue working with you. Also building a positive therapeutic relationship early on will put the client at ease and enable them to talk freely, leading to positive outcomes. I can be emotional at times too, so I totally understand how it feels to deal with suicidal clients but then I think we can’t actually make decisions or do things on behalf of our clients. All we can do is make sure we are assessing the problems and doing the best we can and stay strong.

      Reply

    • Tressa Novack
      Oct 07, 2021 @ 16:13:45

      Hi Emily, you make a lot of really great points. It is really important to establish rapport, because the first sessions will determine whether or not the client continues with therapy. This is something that I failed to mention in post. I did mention that the first sessions are important so that we can gather background information and see our client as a whole person. I feel like this relates to your point about not underestimating the clients and not dismissing their problems. I agree with your thoughts on working with suicidal clients. It can certainly take a toll on our mental health and that is something we need to be aware of.
      Tressa

      Reply

  11. Will Roche
    Oct 07, 2021 @ 12:41:22

    There are a multitude of reasons why initial intake and early sessions are so crucial in being able to understand the client’s problems. First are foremost, I believe that you need to garner a therapeutic relationship with this client in order to want them to keep returning to therapy. If you are unable to create this relationship with a client, they may seek treatment elsewhere or more likely than not, stop going for therapy altogether. This would be a significant problem as it would be likely that their symptoms would worsen rather than be treated appropriately. Additionally, the textbook states that a client’s issues are almost always multidimensional and typically occur in a social context. If a client comes in and says they are in therapy because of one singular social event, it typically is just the catalyst as to why they should be in therapy in the first place. Because of this, it is imperative that the therapist is able to identify the underlying causes of the client’s motivation for being in therapy. Overall, I think that these are two very important factors in understanding a client’s motivation for coming to therapy and how necessary it is to establish a relationship and understanding of them as quickly as possible.

    Personally, I believe that when I encounter a suicidal client it will instantly add more pressure to the situation for me. I’d be concerned that the magnitude of the situation may throw me off of what I typically may do for clients. I would realize that the situation is more dire than other client’s needs, and so it would just put much more pressure on the situation than maybe other clients’ problems. This definitely will be an anxiety provoking experience and I wouldn’t want that to inhibit the skills that I will have in the future. I am hoping that in the future of this program I will learn how to quell these concerns I may have and learn how to deal with this type of situation adequately.

    Reply

  12. Monika Dhamale
    Oct 07, 2021 @ 14:09:52

    In the initial sessions, clients might not have a clearly defined problem or an issue for which they are seeking therapy. So if the counselor is not aware of what exactly is the client looking for, there is always a risk that the client drops out of therapy or gets into serious trouble, for example in the case of a suicidal client. How a therapist takes these considerations into account may influence the process, the outcome of therapy, and the nature of the therapeutic relationship. Research indicates there is a connection between attending to a client’s presenting concern and an effective outcome. Understanding client’s problems early in therapy will not only give us better outcome for the client but also make sure the client doesn’t stop the therapy if they feel they are not getting what they are looking for. A counselor not understanding the severity of a client’s problems is at the risk of having a negative outcome. Also, the earlier the client’s problems are identified the more time counselor gets to explore and plan the intervention strategies.

    One of the main concerns I have in dealing with suicidal clients is making sure the client follows through and sticks to the therapy sessions. Individuals who have suicidal behavior may have a diagnosable psychiatric disorder, it can often be years before their disorder is accurately assessed and effective treatment is implemented. Many clients may have considerable frustration and discouragement related to the lack of simple or clear answers to their difficulties. As a result, many suicidal clients withdraw from treatment after the resolution of the immediate crisis. I might also feel anxious dealing with suicidal clients but I want to make sure this doesn’t impede my ability to deal effectively with clients’ issues. Another concern is not able to identify a client with suicidal ideation, especially if the client is not giving clear signs. I am also worried about dealing with impulsive clients who may not have an actual suicide plan ready but may still commit suicide if their situation deteriorates.

    Reply

    • Moises Chauca
      Oct 09, 2021 @ 11:55:41

      Hello Monika,
      I enjoyed reading your post! I liked your points about initial sessions. You pointed out an awesome aspect about the initial sessions. The therapist should be able to identify the client problems early, so they have more time to explore and plan more interventions. To be honest, I did not think of the aspect about initial sessions. Thank you! Lastly, your point on suicidal clients relates to my concern too. I would worry about the client life outside of therapy sessions and hope that they are following the plan. I am extremely worried of not being able to identity suicidal ideation also, I think that is the first step of working with a suicidal client, and failing to do that causes me anxiety. Great job!

      Reply

  13. Tom Mandozzi
    Oct 07, 2021 @ 14:17:24

    Based on the readings and lecture recording, there is a critical importance in establishing the therapeutic relationship and gathering information during the initial intake process in order to set the stage for a welcoming environment that promotes change. One thing that stood out to me particularly is what Dr. Volungis mentioned regarding our role as therapists and wanting to motivate people to make changes. It is important that the client have the motivation and readiness for change but establishing an appropriate and efficient environment and gathering important information may support that process. It is important to gather background information, cultural influences, medical history, social developmental history, and further details about the client in to create a clearer picture of clinically significant factors in treatment. I think this is important because it also shows the therapists ability to look at several different factors and engage in culturally competent and individual-based therapy instead of feeling like treatment is a one-size-fits-all approach.

    It is very important to gather frequency, intensity and duration of presenting problems to determine how much impairment to daily functioning is taking place. Gathering details about significant life events can assist the therapeutic process and help establish and inform treatment planning, goals, objectives and interventions. I think these aspects are important because it makes the client feel that therapist is interested in hearing about what information feels important to them and may feel validated in the problems they are experiencing. This stage of gathering information can also help assess readiness and motivation for change and whether the client feels the problem can be changed. Clients who perceive their counselors as trustworthy have better counseling outcomes and this begins during the intake process. This might support the client in sharing their problems in the presence of an attentive and non-judgmental environment in which they feel heard and understood.

    Naturally, the thought of supporting a suicidal client seems both daunting and anxiety provoking. The statistic that 71% of counselors have worked with individuals who had attempted suicide in itself was particularly shocking to me. My first thoughts are that there is a lot of pressure as the clinician working with a client that has suicidal risk because you would want to make sure you are assessing for risk appropriately and making sure you are aware of any signs of suicidal risk. The lecture mentioned factors for assessing suicide potential including substance use, hopelessness and previous attempts. It is comforting to know that we will be continuing to learn about the topic of suicide in the context of counseling so that we as counselors can be appropriately prepared to manage the issue of suicide.

    Reply

  14. Pilar
    Oct 07, 2021 @ 15:54:15

    It is important to have an accurate understanding of the clients problems early on because it’s is important for example if you do have a client thinking about suicide or who have created a suicide plan you know that you need to address this problem immediately because it is time sensitive. You need to know how severe their issue is. When clients take these assessments they may not even think about how they were feeling or have words for it. They might answer the questions in the assessment and learn something about themselves, they might fill out the Drug Abuse Screening Test or the Short Michigan alcohol assessment test and not even realize they have a problem. Sometimes it’s about asking the questions in the first place. In addition it is helpful to know how long a client has had the issue because it’s possible they have met with other therapists before you and have been struggling with keeping up with treatment. You need to know any past methods of treatment they may have undergone so you don’t waste time on something that’s not going to work. Knowing even just a little of your clients background can be super helpful as well, like for example are they working? Do they have a spouse, how old are they, because these are factors that could influence them. It is also helpful to know where the client stands, how motivated they are to change and do the work because this will give you a gauge of how to approach future sessions with them.

    In reference to being confronted with a suicidal client, To be honest I am not entirely sure how comfortable I am dealing with a suicidal client, I’m not really sure how anyone can truly prepare for that. You are trained but when it actually happens it will still take me aback. If I have a client that tells me they are considering suicide I will definetly work with them to try to get them to consider other options and to get to the bottom of why they may feel this way. I do know however knowing me, If I work with them and do all I can and they still do it, I would feel bad that they were suffering so much, that it got to that point. I won’t blame myself but I will feel empathy for them and for their loved ones, but I would probably think back to the session with the client and think about what more I could have said. I just hope that clients feel comfortable enough to let me know they feel suicidal, because some people may not admit it for fear of report. I have had a conversation with someone who was having suicidal thoughts but it wasn’t just me present for the conversation. So a concern I do have is dealing with that situation one on one and not knowing what to say initially, especially if I get a client like that early on in my career.

    Reply

    • Sandra Karic
      Oct 09, 2021 @ 20:50:56

      Hi Pilar,
      I really liked that you talked about how you should know about a client’s previous experiences with therapy, what worked, and what didn’t work. I also agree with you, some clients, I think especially in cases of substance abuse, may not be fully aware of the problem, or if they even have a problem. I worry about not knowing what to say to clients too. I think with suicidal clients it’s kind of hard to imagine the scale of how much they’re suffering. And I absolutely agree with you that some things training just can’t fully prepare you for.

      Reply

  15. Tressa Novack
    Oct 07, 2021 @ 16:02:01

    It is important to get an accurate understanding of a client’s problems early in therapy so that we can assess how severe the client’s problems are, if they are in any immediate danger, and so we can begin to develop a treatment plan for the client. The early sessions of therapy are important so that we can gain an understanding of our client as a whole person. Background information such as family dynamics, where a client works or goes to school, and social relationships are all pieces of information that could help counselors better understand clients and their problems. It is necessary to look at the whole picture when assessing our clients so that we can come up with the best form of treatment.
    One of my initial concerns of being confronted with a suicidal client is that I feel like I will be walking on eggshells around them because I will be worried that something I will say will make them feel even worse. I am also concerned that I will feel that there is too much pressure when working with a suicidal client and that my anxiety will make me ineffective. Lastly, I feel like I will just be on such high alert that my client will commit suicide that I won’t be able to get anything done.

    Reply

    • Teresia
      Oct 09, 2021 @ 18:10:46

      Hi Tressa,

      Great post! Understanding is important to create an effective treatment plan. I think it’s also important because it helps build a therapeutic relationship with the clients if they feel like you understand why they are seeking help. I am also concerned that something I say will make the situation worse. Although I think with more learning and experience we’ll be more equipped to treat suicidal clients.

      Reply

  16. Alexis Grey
    Oct 07, 2021 @ 16:12:28

    Initial sessions are extremely important. Our text even points out that the quality of experience in the first few sessions are more essential to positive outcome in therapy than are the clients’ expectations prior to coming in to therapy. I thought this was really surprising honestly, I might have expected that client expectations effected outcome at least equally as much.

    That being said clearly the first few sessions and getting an accurate understanding of the client’s problems is extremely important, especially if that client has low amounts of insights into their own problems. If someone in the therapeutic relationship (therapist or client) can’t uncover the true nature of the problem, then neither will uncover a solution either. It is important to listen and to pick up on the issues the client is dealing with and to help them identify them more clearly if there is a lack of insight or a vagueness to their statements. Understanding is the first step, without understanding therapy will become ineffective. Its also important in the first sessions to create a good and trusting relationship, and to give the client the feeling you are listening and working with them so that their first sessions ARE positive experiences, this will affect and set the tone for the rest of the therapeutic process.

    My biggest concern in working with suicidal clients is that in the first sessions, I am able to not judge them or make them feel like them talking about suicide makes me anxious or scared (even if it does). For a person in that mindset, the last thing they want is to be looked at like having those thoughts is so bizarre and so dangerous and so wrong, they should feel like therapy is a place they can be honest about the pain they are in. The last thing I would want is for them to feel judged or negative in any way after our session and decide not to return the next week. That is my biggest concern. I have never had a conversation with a suicidal person whom I do not know well already, and so my other concern is being a little unsure what to say not having a deep understanding of the client – at least at first. Suicide is such a sensitive topic and has to be approached the right way, if its only my first second- or third-time meeting someone I am anxious about not knowing what to say to them in that moment. I know especially at first the pressure not to say the wrong thing will feel heavy, and so I have tried to imagine how to prepare for that.

    Reply

    • Moises Chauca
      Oct 09, 2021 @ 11:33:50

      Hello Alexis,
      You made some great points on your post. I agree with your points about initial sessions. The quality of the first sessions are crucial as it predicts the therapy outcome. This surprised me too! The client expectation influence the outcome, but not as much as the therapeutic relationship. Your point about insight on the client problems is crucial because some clients will be able to express their emotions and thoughts better than others. The therapist should be able to identify the client insight level and facilitate them to understanding them problems. Lastly, I agree with the points you made about suicide clients. It is important to be self-aware about your reactions, behaviors, and responses when working with suicidal clients. This causes me great anxiety also because I do not want to say or do the wrong thing that can potentially affect the relationship and therapy.

      Reply

  17. Sandra Karic
    Oct 07, 2021 @ 18:04:05

    I think getting an accurate understanding of your client’s problems early in therapy is important for a number of reasons. Primarily, having an accurate understanding of your client’s problems early on is associated with better treatment outcomes. It’s also a safety issue, particularly when working with suicidal clients. Obviously, underestimating the severity of a client’s problems can be incredibly dangerous. I also think that having an accurate understanding of what’s going on can help a client feel understood and validated, which is vital to establishing a therapeutic relationship. Conversely, not having an accurate understanding of the client’s problems could lead the client to feel frustrated, misunderstood, and pessimistic about treatment. They might give up on you as a therapist, or even therapy in general. Finally, coming up with a treatment plan for a client sounds very difficult, if not impossible, if you don’t have an accurate understanding of what the problems are.
    I think one of my biggest anxieties related to working with suicidal clients is having to hospitalize someone. I’m sure there are plenty of cases where people are hospitalized, return to baseline, and feel thankful for the experience. But I worry about someone having a horrible hospital experience and then feeling responsible for it. Though I guess someone can recover from a bad hospital experience, they can’t recover from death. Like others, I wonder what I would tell a client before hospitalizing them, and find myself failing to come up with responses. I also worry about the possibility of clients hiding the fact that they’re suicidal, either because they’re worried about hospitalization or because they don’t want to be talked out of it.

    Reply

  18. Olgena
    Oct 07, 2021 @ 22:06:30

    First, I think that one of the most important skills that a clinician should have or work with is emotional intelligence. It is important to understand a client most needed elements early in therapy because that is how a clinician could develop effective treatment plans that would help the client. Furthermore, by trying to identify these elements earlier, could help the clinician to find other variables or overlapping causes leading to certain issues. In addition, understanding these problems earlier, would help the clinician to examine potential risk that could be dangerous or life threating to an individual. Moreover, being fully prepared to explain to the client any possible prediction and being well informed of their previous background or medical reports plays a crucial role.
    Assessing a suicidal client as a beginning therapist, to me would be really challenging considering the lack of experience and practice where I would be the one who is playing an important role in this person life, and he/she is looking up to me. However, I think that as a clinician you must prepare yourself mentally on how to approach a client when you are exposed to many difficult cases. As a beginning therapist, I think that I (everyone) must be honest to myself and ask or direct the person to a more experienced and proficient expert where I could also assist and train myself more about the case. Overall, a client safety comes first, and overcome any clinician professional ego. The above statement I made, does not mean to me that I would never be ready or assist a client with suicidal thoughts in the future, but I cannot deny that the responsibility as a human being and a professional is truly HUGE

    Reply

    • Jeremy
      Oct 09, 2021 @ 17:09:37

      You made a really good point about the use of emotional intelligence in therapy. I liked how you linked to the beginning sessions of therapy. Emotional intelligence is very useful when you can use it intuitively to determine the moods states of others, Understanding the inflection a client uses when discussing certain life issues can greatly impact what we probe for more details for and how certain life stressors can affect their emotions.
      I liked what you said about our duty as not just clincialns but humans. we can still act on this dity with being scared or nervous. Honesty is a key part of the therapeutic relationship, the genuine concern that you feel for your client can very well be exactly what is needed, Understanding that our concerns and fear is not disticnt separate from our duty as a clinician and human can be a great tool in our arsenal

      Reply

  19. Teresia Maina
    Oct 07, 2021 @ 22:31:47

    Getting an accurate understanding of the client’s problem early in therapy is very important for many reasons.Most individuals already come with a preconceived idea of what they think therapy will be like, so it is very important to build a good therapeutic relationship in the beginning. During intake if they do not establish a good relationship the client might come to the conclusion that the therapist is not an expert in their field. This will make the client more reluctant to receive treatment or be open about the struggles they are facing.One that I found most important was that clients might be seeking treatment for one thing but there might be other underlying issues that contribute to the problem they were coming in for. It is crucial to get a good read on the client problem to give a correct diagnosis. Figuring out the underlying issue will make treatment more effectful.
    I can definitely say that I am anxious about my first time assessing suicide in a client. One thing that scares me is how to start the conversion about their suicidal thoughts because I don’t want anything I say to make the situation worse. Another concern I have is that I might underestimate the client’s symptoms and miss the signs that they are suffering more than they are showing. If anything did end up happening, my initial thought would be to partly blame myself thinking that there were steps I could have taken if I recognized the signs. My biggest concern is that if a client is suicidal and I let them leave I have no clue what is going to happen between them leaving and our next session. Although I know with time, experience, and more education/training I will be more equipped to handle the situation .

    Reply

    • Olgena
      Oct 09, 2021 @ 23:11:10

      Hello Teresia,
      I really like how you described the importance how a healthy rapport with a client is crucial. Based on what you said I also think that making a client feel secure that they are in ” good hands” and that the person that they are about to trust and share their struggles is professional and an expert on the field. Moreover, this fact helps to get a better understanding of the issues on the first intakes that would help creating a beneficial treatment plan. Last, I support every point you made for the second part of the discussion. I think that beside the fear and anxiety having a huge responsibility for your client life, it is important to show full confidence and hope to your client. Moreover, being in your first steps as a therapist , I think that second opinions by experts in the field would truly be helpful to bust the best techniques that would serve the client.

      Reply

  20. Moises Chauca
    Oct 07, 2021 @ 23:50:24

    It is essential to understand and have an accurate view of the client’s problems in the early session because the initial sessions are good predictors of the therapy outcome. During early sessions, the counselor and therapist start building a relationship that is strengthened by the counselor skills to quickly understand and conceptualize the client issues. Many clients share vague information about their problems, and sometimes one problem is influenced by many factors rather than one factor. A counselor should be able to identify these factors and apply them to the assessment and treatment. In addition, the initial intake interview process is crucial. Counselors begin to use interview facilitating skills to establish rapport, build a therapeutic relationship and gather demographic and clinical background information.
    As an upcoming counselor, I feel anxious working with suicidal clients, but not avoid them. I would feel responsible for the person’s life. One of my concerns of having therapy with a suicidal client that shows minimal suicide risk and that these risks increase immensely. Another of my concerns is that the plan we created wouldn’t be enough for the client’s suicidal symptoms, and they go with their plan. I would feel guilty that maybe I could have done more to prevent it. Lastly, I know for my first client, my heart will be beating faster, and I will be anxious that I could make a mistake. However, I know that I will learn to manage these emotions during my internship and future courses.

    Reply

    • Jeremy
      Oct 08, 2021 @ 17:45:07

      Hey Moises,

      It’s a really good point you made, chances are if a client and a counselor do not connect in an early session, they likely will not make serious headway during the session. I agree a good therapist really needs to listen to what clients say and what the summary points towards, what they spent time on, what they may need further probing into. since these issues are often multifaceted, It is hard for an individual to keep everything straight.

      I totally understand what your saying, the stress of a client’s symptoms getting worse while in my care feels incredibly stressful.

      Reply

    • Sandra Karic
      Oct 09, 2021 @ 20:40:50

      Hi Moises,
      I agree that a lot of clients are probably fairly vague when originally sharing their problems. I like that you talked about how counselors should use their skills in the interview process to establish rapport and a therapeutic relationship. I think it’s important to add a human element to the assessment/information gathering process. I also think it would be really hard not to feel guilty if a client committed suicide, or at least wonder what more you could have done. But I really liked how your blog post ended on a positive note.

      Reply

    • Olgena
      Oct 09, 2021 @ 23:24:08

      Hello Moises,

      Great post where you explain the importance of understanding a client problems early in therapy because that would be a great way to build best treatment, predict other overlapping variables that could affect them, and choose the right assessments. Moreover, I could not agree more where you said that beside the anxiety and insecurity a new clinician might feel with a suicidal client is important not to avoid him/her but work toward the best methods in order to do what is best for the client. I also think that one of the hardest skills that a clinician must apply is hiding some of his/her own personal feelings to provide his client security and strong maximal support. Thank you!

      Reply

  21. Pilar
    Oct 09, 2021 @ 22:10:24

    Hello Mary,
    Establishing a strong therapeutic relationship is so important, and giving assessments is apart of that process by involving your client in every step of the process you build that relationship and learn more about your client at the same time. I also am concerned about receiving a suicidal client when I’m first starting out and am fearful because you have to be extra careful what you say and how you go about working with this client.

    Reply

  22. Pilar Betts
    Oct 21, 2021 @ 18:47:24

    Assessment is more than just about coming to a conclusion about a diagnosis. When you decide on a treatment you need to know how much the problem is affecting the client, is it impairing their function, what are the environmental, cultural and social factors that may be influencing their problem. When assessing the client it is important to also assess non-diagnostic qualities such as the complexity of their problem, what their coping skills are, what their attachment style is and what their social support system looks like. Without these key elements of assessment you may underestimate the clients problem and therefore choose a treatment plan that won’t be effective for that particular client. By assessing something like coping skills in a client you will be able to gauge how the client will react to a treatment or to the news of a diagnosis. This is important to know because if a patient’s coping mechanism is self harm or drug abuse you might go about treatment very differently then if their coping mechanism was denying reality or internalizing the problem. Assessment of the severity of the problem is very important because you don’t want to underestimate severity, especially in a suicidal client because that would be dangerous.

    Formative assessment evaluation is continuous and used to examine the process.Formative assessment focuses on how the treatment is working rather than did it work. On the other hand,
    Summative assessment evaluation focuses more on the result of the treatment, the end result.Formative assessment evaluation is beneficial because it holds the treatment accountable to provide the best care for the client. By focusing on the progress being made rather than the outcome, formative evaluation is in the clients best interest, ensuring they are progressively getting better rather than just being better when they started. The best example I can’t think of to explain this is placebo studies. The treatment drug tends to do well simply because people believe it is helping them, yet that doesn’t actually mean that they are progressively getting better because after the study what happens? Formative evaluation doesn’t just focus on a result, it focuses on the effectiveness of the actual treatment overtime.

    Reply

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Adam M. Volungis, PhD, LMHC

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