Topics 5 & 6: Initial Assessment in Counseling & Using Assessment in Counseling {by 6/23}

Based on the text readings and lecture recordings due this week consider the following discussion points: (1) Share 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) Assessment has a broader role beyond just determining diagnosis.  What are some ways assessments can help therapists understand how presenting problems are affecting clients?   (4) What is the difference between formative assessment and summative assessment?  What are the benefits of formative assessment?

 

***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 multiple assessments (under Class 5 – 6/23).  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 begin completing these assessments and discuss them based on the reflection questions.

 

Your original post should be posted by 6/23.  Post your two replies no later than 6/25.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

35 Comments (+add yours?)

  1. Amanda Bara
    Jun 22, 2022 @ 20:17:48

    1. It is important to get an accurate understanding of the client’s problems early on in therapy in order to know what to focus on in treatment. If a counselor does not understand what a client is specifically struggling with there may be no substantial progress made in therapy. Intake and early sessions are crucial for getting an understanding in order to specifically target concerns. If there are no assessments taken during intake there is no direction for therapy to go in. A client might say that they are struggling with depression but when given intake assessments on anxiety and depression they may illicit more symptoms of anxiety. Although a client might have an idea of what they are struggling with, chances are they do not have a full understanding that would steer therapy in the right track. Intake assessments can also be important for monitoring treatment progress. When done accurately they provide a baseline of symptomology that with effective therapy should decrease over time. Getting an accurate understanding of the client’s problems also allows the client to feel that their needs are being addressed and will build rapport with the counselor. Intake sessions help counselors to get an overall view of their client as a person and the influential factors that may be affecting their problems.
    2. Being a beginning therapist comes with a lot of concerns and vulnerabilities. One of the greatest concerns is being confronted by a suicidal client. I know that in this stage of my education I still have a lot to learn I think it will always be difficult to have a suicidal client. When assessing suicide in a client one concern I have is offending the client when wanting to assess their suicidal thoughts/intentions. Specifically, I am concerned that a client will feel that I view them as psychotic or unstable. Another concern I have is communicating to a client about their assessment results in regards to suicidality. Sometimes there are severe implications and adjustments that need to be made in order to protect a client’s safety and I fear that they may refuse the protocols. This may in turn ruin the therapeutic relationship and make me question myself as a counselor.
    3. Assessment can help therapists understand how presenting problems are affecting clients in physical, psychological, behavioral and social ways. They allow us to see how an individual’s issues are affecting their daily functioning like hygiene, eating and completing daily tasks. Also, they can determine if there are physical symptoms that are attributing to the diagnosis or if there are other medical issues happening. Behaviorally we can see how an individual act if they are reckless, abusing substances or acting irrational and how it is affecting their mental health symptoms. Presenting problems can have social factors that are impacting an individual’s relationships which can be seen in assessments. Assessments over time allow us to compare an individual’s progress through therapy and how their presenting problems either diminish, stay the same or get worse. They are critical to not only giving diagnoses to clients but explaining in what ways they are being affected by their problems. Assessments allow us to mainly monitor how treatment is benefitting/not benefitting the client and evaluate the counseling overall.
    4. Formative assessment is a continuous evaluation performed to examine the process of something. Summative assessment is a cumulative evaluation performed at the end of something. It is also looked at as a final evaluation. The difference between formative assessment and summative assessment is the focus on what is being evaluated. In formative assessment the focus is on the process where in summative assessment the evaluation is on the product. Counselors may use a formative assessment to evaluate the client’s feelings of counseling as they go through sessions. They may also use a cumulative evaluation at the end of therapy to evaluate how the client felt about the entire thing. The benefits of formative assessment are that because it is an ongoing process changes can be made in order to create a more desirable outcome. For example, if an individual reports that their counselor is lacking some qualities they desire in session three there is still time in the course of therapy for the counselor to make changes in those aspects. Getting this feedback early can allow for more meaningful and effective treatment outcomes.

    Reply

    • Ashley Torres
      Jun 22, 2022 @ 23:29:14

      Hi Amanda, your feelings regarding a client with suicidal thoughts are very valid. As we begin to practice in real settings, everything will seem like a new experience. I can relate to your concerns because I also worry about offending a client while attempting to access their suicidal thoughts/feelings. We have learned that it is important to build a rapport and have empathy for our clients. Offending our clients is the last thing we want to do because it can break a relationship. I believe we will become confident as we complete our degree and practice different techniques to approach these situations.

      Reply

    • Luz Rodriguez
      Jun 25, 2022 @ 22:24:49

      Hi Amanda,
      I absolutely agree with you that if a counselor does not understand what a client is specifically struggling with not only is there no progress, but we also could be missing other areas that the client could be struggling in.
      I also think that it be difficult to talk to a client with suicide without triggering any type of action from the client that may make things worse it hard. When I worked in the hospital as a personal care assistant, we watched patient with suicide precautions we taught a little bit about how to approach but it a different ballgame coming into finding out and learning and asking the right questions to know if they are and how to deal with it.

      Reply

  2. Patricia Ortiz
    Jun 22, 2022 @ 21:32:37

    Based on the text readings and lecture recordings due this week consider the following discussion points:
    (1) Share why it is important to get an accurate understanding of the client’s problems early in therapy (i.e., intake/early sessions).

    It is important to get an accurate understanding of the client’s problems early in therapy because having the problem defined helps us organize and carry out a treatment plan and establish the goals of therapy. Establishing therapy goals is important because it represents therapeutic programming towards a precise orientation.
    The objectives should be achieved gradually and guarantee progress.
    Also, objectives allow people to move from a present state to the desired state. It is focusing on what they want to achieve and move towards there.
    Setting goals in psychotherapy is essential because people go to therapy because there is something they want to change, something they want to achieve, and we are the ones who have to accompany them to co-construct that goal and accompany them in drawing up that map to achieve it.
    Also, by understanding the client’s problems, we can be more empathetic with the client and build a strong therapeutic relationship, which is the base for every successful therapy.

    In conclusion, without successfully defining the client’s problem we cannot set therapy goals and without goals, we cannot develop an effective therapy session.

    (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.)

    I understand that assessing suicide can be anxiety-provoking because I, as a counselor, want to be helpful and always have the right answers for my clients. With this population, we should always be extremely careful with how to handle every session and situation. If I am confronted with a suicidal client I would always proceed with caution and being warm and empathetic, for example, using words like “Would it help you to talk to me about how you feel?” and always being honest, for instance, “I can’t even imagine what it’s like to feel the way you feel now, but if you help me maybe I can understand you better”. I believe these words make a suicidal person feel like a normal person and human.

    Also, if I feel anxiety, I would remain calm, and transmit tranquility, empathy, concern, and understanding for their situation, because non-verbal communication is very important in a therapy session.
    I would be afraid of asking them directly about suicide but I think that asking the patient directly makes them feel relieved, understood, and supported. For instance, imagine that you have been thinking about suicide for a long time and that you cannot talk about it with anyone because it is considered a taboo and uncomfortable subject. What weight would you carry on you, right? On many occasions, talking about it with a psychologist can be therapeutic in itself.

    (3) Assessment has a broader role beyond just determining diagnosis. What are some ways assessments can help therapists understand how presenting problems are affecting clients?

    Psychological assessments are used to evaluate one or more than one of the different areas that are part of the individual like examining the qualities, traits, psychic characteristics, and skills (“know-how”).
    Also, with psychological assessments, we can get to know the functioning of people and, in this way, discover their emotions or internal conflicts.
    In addition, with psychological assessments, we can evaluate the capacities, aptitudes, personalities, and interests that a person has.
    Since psychological assessments help the therapist to understand different aspects of the individual they can analyze and measure how a certain variable affects one client differently than other clients. Those variables can be biological (physiological and neurological), cognitive (intellectual capacities and aptitudes) for example, mental processes that allow us to know and function in the world (attention, memory, language), personality traits and patterns, like ways of being, acting, or behaving habitually and environmental variables.

    For instance, if a client has an anxiety disorder, by knowing different aspects of them like biological, cognitive, and personality traits, then we might predict that they could also have a predisposition for developing another anxiety disorder, for example, Obsessive-Compulsive Disorder (OCD) and, we know that OCD can be caused for a combination of biopsychosocial factors.

    Another example is when a therapist has a client that recently lost his job and goes to therapy to learn how to deal with it, the therapist by assessing the client might determine some aspects of his personality, and if he is a person with high sensitivity, negative emotionality, and low conscientiousness, is more likely to experience negative thoughts and therefore, develop a major depressive disorder. So, the therapist knowing this could start a therapeutic plan to avoid the development of such disorder. Also, that client might be struggling more with the problem of losing a job, than another client that has less sensibility, positive emotionality, and high conscientiousness.

    (4) What is the difference between formative assessment and summative assessment? What are the benefits of formative assessment?

    A formative assessment occurs at each and every stage. Its main objective is to guide the person to achieve their medium and long-term goals. It is a continuous evaluation process based on the search and interpretation of evidence about the achievement of a goal.

    Summative assessments are administered to collect information about objectives Due to its nature, this type of performance evaluation should be done at the end of a cycle.

    The objectives of the two evaluations are different. For formative assessment, the goal is to improve something in the individual. For summative assessment, the goal is to assess the individual performance.

    There are some benefits of Formative Assessment:
    It is carried out throughout the assessment process. It mainly intends to detect what are the weak points rather than determine what are the results obtained, it is a continuous, dynamic, and multidimensional process, that allows comments, which serve to identify problems and correct errors in time.
    It allows each individual to express the mastery of motor skills, cognitive strategies, and attitudes, detecting the deficiencies, and achievements that they present.

    This type of evaluation is flexible, stimulates self-confidence and motivation, and it is an opportunity for the individual to evaluate their performance.

    Reply

    • Ashley Torres
      Jun 22, 2022 @ 23:41:39

      Hi Patricia, I really enjoy reading your response and viewing the questions from your point of view. What struck out to me is your thoughts on possible experiences with a client with suicidal thoughts. I primarily focused on what could go wrong during a session, but you brought positivity into light. For example, you explained how asking a person about suicide can be beneficial to the client. They might feel understood, relieved, and supported because someone notices they are struggling and that can be a turning point. I really appreciate how you brought up that it could be therapeutic to the client because I felt less concerned after reading it. Overall, your response made me realize that this interaction does not have to be negative, and it can make a difference in someone’s life.

      Reply

    • Sarah Kendrick
      Jun 25, 2022 @ 16:10:35

      Hi Patricia. I liked your emphasis on the importance of goal setting. Individuals do indeed often want to change something i they are seeking therapy and “just making the change” can be overwhelming. Having a treatment plan involving the main goal, objectives, and interventions really seems to clarify the steps for the individual and make the process of change less intimidating. I also like your explanation of what else psychological assessments measure, including more positive traits of the individual outside of their diagnoses.

      Reply

  3. Rachel Marsh
    Jun 22, 2022 @ 22:18:37

    1- Gaining insight into client problems early in therapy is imperative to know what approaches to use, decide what assessments to use, and to help establish therapeutic rapport. If a counselor were to start providing therapy without understanding the client’s presenting problems, this would likely prevent the selection of treatments that are relevant to the client. Likewise, understanding the client’s presenting problems early can help narrow down what assessments a counselor may want to prioritize. For example, if a client comes to a counselor with concerns of post-traumatic stress disorder, it would not likely be beneficial to administer an assessment for a personality disorder unless other signs of the disorder were seen in the initial session. Finally, gaining insight into client’s problems early in therapy is integral to promoting therapeutic rapport. Taking the extra step to understand client problems early in therapy can cultivate an empathic, trusting client-therapist relationship by giving the client a chance to explain their experiences and their problems and feel more understood.

    2-As a counseling student, I have several fears surrounding suicide in clients. Firstly, my biggest fear is that I would falsely assess a client as not being at risk for suicide when they truly are. This has happened to people in my life where the signs were missed, which ultimately ended in them taking their own lives. As a future counselor, this is something I fear the most.
    Secondly, I am concerned that I wouldn’t
    be able to effectively address suicide in a client when the time comes. In this case, I am worried that I would not be able to refer them to the correct resources or take the correct actions.

    3- Aside from diagnostic purposes, assessment can be beneficial to help understand how a client’s presenting problems are affecting their quality of life and general well-being (Whiston, 2016). Two clients with the same diagnosis may not perceive their diagnosis the same way in how it impacts their quality of life. For example, two clients may have a diagnosis of social anxiety disorder. One client living with social anxiety may still be able to go to work and engage with others despite their social anxiety but may have a hard time going into crowded places
    while another client living with social anxiety may refuse to leave their house, avoid all interaction due to fear of judgement, and be unemployed due to their anxiety. Seeing how a diagnosis impacts a client’s life in this way is highly beneficial to choosing the right treatments and tailoring therapy goals to the client. Going back to the social anxiety example, it wouldn’t be beneficial for the first client to have a goal of finding a job after therapy given that their anxiety . This would likely be a more beneficial goal for the second client. A more suitable goal for the first client may be going into a crowded store. Seeing how a diagnosis plays a role in the client’s life in this way can help refine intervention to meet the needs of a client. With just a diagnosis, a counselor cannot effectively tailor treatment to them given individual differences that may present in a diagnosis. Two clients with the same diagnosis will have differing impacts on their life. Overall, assessment is beneficial in determining these.

    4-Formative evaluations are interviews administered during therapy with the aim to assess the counseling process (Whiston, 2016). On the other hand, summative evaluations are typically conducted just prior to therapy termination with the aim to ascertain the overall effectiveness of services (Whiston, 2016). Formative evaluations may carry more benefit than summative evaluations in that they are conducted in the middle sessions of therapy, providing an opportunity for the counselor to adapt therapy to best fit the client’s needs considering the results of an evaluation. Summative evaluations are beneficial, but only focus on the outcome of therapy and not necessarily the process. But understanding how the therapy process itself is either benefitting or inhibiting the client in progressing toward their goals can help increase the chances that the client will achieve those goals.
    References

    Whiston, S.C. (2016). Principles and applications of assessment in counseling (5th Ed). Brooks/Cole.

    Reply

    • Sam Keller
      Jun 23, 2022 @ 13:49:52

      Hi Rachel!

      I really liked in question 3 how you talked about the extent of impact a disorder is having on a client’s quality of life. We can do assessments to identify the ‘what’ but it is then important to assess ‘how much?’ and the practical ways a disorder is impacting a client’s life. It can let us also choose appropriate interventions and goals. I really liked the example about not choosing employment as an immediate goal for social anxiety. The more intense a client’s impairment is the more that steps towards their goal might need to be broken down into smaller subgoals so as not to go too fast. A note on anxieties about assessing suicidal clients. Thank you for sharing your fears! I think if I found myself in the situation of losing a client to suicide that it would be very difficult not to blame myself to some extent. However, something my old boss explained to me helped me with this idea. She said that it is important to remember that while we are here to help, we cannot live the lives of our patients for them. They will ultimately make their own choices and they may not always be good ones. We are going to do our very best to keep everyone safe but we are not omnipotent and cannot know everything about what a client is thinking/feeling. There is a difference between having wishes that you could have picked up on subtle signs that something was going to happen and taking on total responsibility for another person’s actions. I don’t know if this way of thinking is right or wrong but it did help me think about it in a different way.

      Reply

  4. NikkiAnn Ryan
    Jun 22, 2022 @ 22:36:06

    When assessing a client’s problems, counselors should try to gather a comprehensive understanding of the problems by exploring the frequency, the degree to which it affects daily functioning, past methods used to attempt to manage the problem, and other relevant information. It is essential for counselors to have a clear understanding of the presenting problem early in therapy in order to develop a thorough case formulation. This will guide the development of therapeutic goals and treatment plans, so it is important to understand the problem accurately and fully, otherwise, the goals may not be meaningful, and the treatment interventions may not be effective. Additionally, counselors may underestimate the severity of the problem if they do not have an accurate understanding of the issue which contributes to poor outcomes for the client and the therapeutic relationship. It is also important to try to get an understanding of the problem early in therapy because many clients do not return after the intake or one follow-up session. Therefore, it is crucial to understand the issue and pique the client’s interest and motivation in working on the problem early on, so they continue sessions.

    As a beginning counselor, I have concerns about working with suicidal clients. One concern I have is about asking the “right” questions to gather more information from a client expressing suicidal ideation. I worry that by not asking certain questions I might miss out on valuable information that I could use to help my client. Another concern I have is that clients may start discussing suicidal ideation but then regret sharing that information and not disclosing any more information, especially if it is early in the therapeutic relationship. In this situation, I would worry about balancing respecting their desire to not share but also continuing to ask questions to ensure they are safe and not planning to end their life. Additionally, one of my biggest worries is about being the one to “make the call” about whether my client is in a good enough space to go home after a session without attempting or committing suicide. I worry that they may say that they do not have a suicide plan or that they will be safe, but then end their life if their thoughts and situation worsen after the session.

    Psychological assessment should extend beyond simply diagnosing clients to be integrated into the counseling process. Assessments can aid the development of case conceptualizations, treatment goals, and interventions. The information gathered from assessment measures can be used to determine how to structure and enhance the therapeutic relationship. This is significant because the therapeutic relationship is an essential part of the counseling process and outcomes. Assessments can also be used to identify client strengths. This provides another avenue of exploration for clients and counselors rather than solely focusing on limitations. In addition to treatment planning, assessment can be used to monitor treatment progress. Evaluating the effectiveness of treatment interventions allows counselors to adjust interventions along the way and communicate the progression of treatment to clients throughout the counseling process rather than waiting until the end of counseling. Lastly, assessment can be used for evaluating counseling and maintaining accountability. Evaluating and documenting counseling and gathering accountability information is essential for some programs to demonstrate that clients have benefited from services and sometimes to obtain funding. Ultimately, effective counseling should incorporate assessment into the entirety of the counseling process.

    Formative and summative assessments are used to evaluate the counseling services process. Formative evaluation is continuous or intermediate whereas summative evaluation is a cumulative assessment of services that is typically conducted at the end of the service. The focus of summative evaluation is on the outcome, or the product, and formative evaluation focuses on the process. Formative evaluation is beneficial because rather than waiting until the end of the service, counselors can monitor the effectiveness of the counseling throughout the process. They can modify the treatment interventions and check in with the client about the therapeutic progress throughout the service to improve the overall outcome for the client.

    Reply

    • Rylee Ferguson
      Jun 25, 2022 @ 12:26:43

      Hi NikkiAnn. I enjoyed reading your response and liked your perspective on fears with working with suicidal clients. I think you are right about the need to balance people’s boundaries with asking questions about their thinking. It makes sense that even though we might ultimately decide we need to ask prying questions in order to ensure their safety, the therapeutic relationship might be negatively impacted. I also liked your definitions for summative and formative assessments. It makes me think that even if summative assessments are concerned with the end product, formative assessments are superior because the best way to ensure the end product is successful is to check in along the way while there is still time to make adjustments.

      Reply

    • Rachel Marsh
      Jun 25, 2022 @ 19:58:30

      Hello NikiAnn,

      I enjoyed reading your response to question 3. Specifically, I appreciate how you discussed the importance of assessment to promote accountability.
      You bring up a great point when you mention that promoting accountability can ensure that clients benefit from the services they receive. Mental health workers should do everything they can to ensure that their clients are meeting their goals and are happy with the services they are being provided with. Moreover, with such a growing emphasis on documentation in healthcare, it is imperative for providers to justify the services they are providing. Assessment is a great way to achieve this.

      Additionally, I appreciate how you mentioned the importance of using assessment to focus on strengths and not limitations alone. Assessing strengths is beneficial not only to help increase the client’s confidence, but once identified can be use to empower the client in areas of their life that would benefit from growth. Overall, I loved reading your post! You brought up some great points!

      Reply

    • Luz Rodriguez
      Jun 25, 2022 @ 22:38:12

      Hi NikkiAnn
      I agree with we must look at frequency and finding out what the amount that is beyond the normal for the client being able to show them that it is a problem. I do agree with the find out earlier in the session in order help formulate an assessment that will help them to improve. I think a lot of clients what the counselors to be honest but also will to help them and be able to notice it from the beginning helps to build the repour that is needed.
      I think it hard to ask the “right question” because of so many factors so that as counselors we don’t make client uncomfortable with telling us. I agree that it must be twice as hard to even disgust the intent of doing the action but if there something that can be talk about of found out that can change the perspective of thinking it would help.

      Reply

  5. Ashley Torres
    Jun 22, 2022 @ 23:15:47

    The intake/early sessions of therapy lay a foundation for the client’s treatment plan. It is important to accurately understand the clients concerns early in therapy to distribute the appropriate assessments. The therapist should gather background information, past experiences, present feelings, their problems intensity, and their degrees. In the intake session the goal is to explore and define the individual’s problems. If a therapist does not fully comprehend their clients struggles, it could be detrimental for the client. A therapist also needs to learn the severity of the client’s problems to build a rapport and have empathy. Once they have gained an accurate interpretation the therapist can start collaborating with their client to complete assessments, set goals, and begin the corresponding treatment plan. There are lots of different disorders and emotions that overlap with symptoms. If a therapist assumes or is not precise in the individual’s diagnoses or struggles, the client will have a difficult time improving because they are not being challenged appropriately. The client is attending therapy because they want to change but that change can only be successful if the therapist builds a rapport and understands the clients struggles.

    As a beginning therapist, serious situations like accessing suicide will be concerning in my future. My first concern is bringing up the topic of suicide because I do not know if my client will have a negative reaction to it. I will need to inform them that I will be distributing a suicidal assessment to identify their risk of suicide. That can be nerve racking because I don’t want them to assume that I am calling them suicidal. Another concern I have is encountering a client with a high risk of suicide. I want the client to trust me and keep our session confidential but if they are in a dangerous place, I will need to act accordingly. I have also learned that hospitals are great at keeping patients alive but lack in the treatment aspect. Therefore, I will need to be very confident if the client is high risk because I don’t want them to feel betrayed which will discourage them from future therapy.

    Assessments are essential tools used in therapy. Not only do they determine diagnosis but help therapists understand how presenting problems are affecting clients. Assessment can help illustrate the severity of the client’s problem and that will be considered while developing the client’s goals and interventions. When assessments are interpreted to the client, they are more likely to feel engaged and self-aware. It is crucial for a client to develop their self-awareness and explore their problems to see improvements. Assessments can also be used as motivation and reassurance for clients. For example, a client can be given an assessment on anxiety in their early sessions. As the client progresses, the therapist can distribute the same assessment and compare their progress. Not only will the client be informed of their new strengths/weaknesses, but they will be reassured that change is happening. In another case, a client may not progress, and the assessment will indicate to the therapist to approach the interventions differently.

    Formative assessment is the continuous or intermediate evaluation performed to examine the process of the counseling service. For example, a counselor will continuously monitor the progress the client is making during the intervention. In contrast, summative assessment is a cumulative evaluation of the counseling service. Here a counselor is focusing on accountability and determining if the services were successful. Formative assessments are very beneficial because a therapist and their client are being informed during the treatment if their plan is working. If the assessment shows the client is improving, then they are taking appropriate measures to improve. If assessments are not showing improvement, then this is the time to make changes and evaluate what is not working. This technique is beneficial to the client because their intervention plan can be altered but in a summative assessment, it would be too late to make changes.

    Reply

    • Sam Keller
      Jun 23, 2022 @ 13:38:36

      Hi Ashley!

      I really liked your comprehensive summary of why information at intake is important. The past affects the future, which is why when doing intake it is important to look at their background and past behavior. This could also identify areas that are especially sensitive to that client, such as the past death of a loved one. There is real danger when therapists make assumptions instead of asking questions. The process itself could also be good for building rapport because it gives you something very clear to talk about in initial sessions. When talking about being afraid of calling clients suicidal, that is a very understandable fear! Thank you for sharing your thoughts. While it seems like a question that most people would respond to with anger (and some do) clients can instead respond to questions in a very matter of fact way. Because suicidal ideation can be very shameful and scary, some clients will actually feel a sense of relief when someone asks them directly. It can give them an ‘out’ to ask for help. If they respond with anger it is helpful to keep in mind that the client could have a) raised in a way where they equate weakness to being ‘bad’, b) are reflecting their own fear/self-loathing/shame/self-anger back at the therapist, or c) some other reaction based in their own emotions. Reminding them (and yourself) that you are asking because you care about their wellbeing and safety is a good way to look at it. A situation where you might need to send someone to the hospital to keep them safe can seem very daunting.

      Reply

  6. Rylee Ferguson
    Jun 23, 2022 @ 08:56:59

    (1) It is important to get an accurate understanding of the client’s problems early in therapy, say during the intake session, so the problems can inform various aspects of therapy. Depending on the problems that are identified, different treatment approaches might be better. Some counselors might realize that the concerns of the client are not within their area of expertise. In this situation it would be wise to suggest other colleagues that might be a better fit to address those issues. The problems might also be of immediate concern and so should be identified early on. If the client is suicidal for instance, you would want to get that information as soon as possible so that you can create safety plans and ensure they are not an immediate danger to themselves. Overall, you want to find these things out early on so you can format your approach to best fit the situation and avoid wasting time on the topics that aren’t really important.

    (2) I volunteered at a crisis hotline as a call taker and so I have some experience working with individuals with suicidal thoughts. I am familiar with asking if someone is suicidal and doing risk assessments. However, my interactions were limited to the one phone call in most instances. My role was very in the moment whereas counseling will be a continuing relationship. I am concerned about how to effectively monitor suicidal client’s symptoms over the course of our sessions and how to provide them with the helpful treatment. My fear would be not doing enough to ensure the client’s safety before leaving my office.

    (3) The idea is that in order to best work with a client you want a holistic understanding of them. Therefore assessment can tap into several areas beyond diagnosis to gather other informative details about the client. For instance, assessments can identify how well the client is functioning in their day to day activities involving work, school, and relationships. If the functioning is impaired it may clue in the therapist that some problem of the client’s is debilitating. Therefore this problem may be one that should be addressed earlier in the course of sessions. Family information, regarding structure and relationships could be useful as well. The environment the client goes home to likely has a big influence on their wellbeing as does if they feel like they have a strong social support from friends or family. This information can let a therapist know who the client trusts moving forward and what relationships they may or may not want to work on.

    (4) Formative assessment involves evaluation throughout the timeline of therapy whereas summative assessment takes place at the end of working with a client as a final evaluation. Formative assessment allows therapists to get an idea of how their client is doing while they still have time left to work with them. Therefore they can see if it’s working and make changes so the client actually benefits from the sessions. Formative assessment might also inform the specific areas that need improvement before sessions are terminated. For example, perhaps through sessions the client’s suicidal thoughts have remited but they are having more anxiety as they engage in social situations. It would be helpful to target this in therapy as well rather than learn this at the very end when the client is leaving.

    Reply

    • Amanda Bara
      Jun 23, 2022 @ 10:42:52

      Hi Rylee! I enjoyed reading your discussion as I felt you made some interesting points. Specifically, how addressing problems in intake may make the counselor refer the client to another therapist. I think as counselors we want to be able to help everyone no matter their problems however we have to think of the best interest of the client and how they can get the most out of therapy. I think that is so awesome that you worked at a crisis hotline as it gives you experience working with suicidal individuals in their most vulnerable times. I think your concerns are valid for wondering if you are doing enough to ensure a clients safety however I think that when we are in the moment we will be overly careful. Great discussion post!

      Reply

    • Kiara Mark
      Jun 23, 2022 @ 21:22:19

      Hi Rylee, I liked your response about why it is important to get an accurate understanding of the client’s problems early in therapy. I never thought of the experience of having to refer a client to someone else because after the intake assessment the disorder is not within the counselor’s speciality. I wonder if this happens often or if a client’s opinion on what the disorder is similar to what they actually have. Additionally, do primary care physicians usually refer the client to a mental health counselor or does the client find a counselor who is covered under their insurance and takes things from there?

      Reply

  7. Luz Rodriguez
    Jun 23, 2022 @ 10:02:37

    1. In the initial meeting with the client, you start to build the relationship as well as trust with the client for the client to start being able to express their truthful concerns to you without any hold back to information that may be help you in assessing the client. In the early sessions you can create a relationship and trustfulness sense to client that their being heard and being taken seriously. By doing this you start to build a sense to the client that you’re helping them and want to help them and care about how their feeling increasing their chances of improvement in their sessions. It starts to build the repro you need to have with the client for future sessions. As well as you have a feedback system where they can understand you interpretation of there issues as well as their feedback to you or where you need to look at more information there no holding back of issues or feeling that the client mite does not express right away.
    2. Some concerns could be will they keep attempting ? or could there be a trigger they don’t see that is leading them to the intentions of the suicide. Ask what if I don’t ask right or enough questions that can lead me in more of a certain path in assessing the client making sure if they do or don’t have the ideations of completing the suicide attempt. Will I be able to pick up on the cues that will alert me to pick up on a person’s suicidal attempt. How to handle it after in explaining to the client that they are experiencing this without possibly putting them into a larger panic or discomfort.
    3. Sometimes as mental health counselors we can better understand and show the client that certain behaviors and social experiences can bring up psychological dilemmas that can bring problems or issues to the client themselves causing a distress in their activities. As well as their physical presentation through these episodes so that they have a better understanding of their mental health. Some of these experiences can be caused by medical problems being able to make a interpretation if it more medical and addressing the issue if it isn’t and it is more medical being able to send them to right area so that they can the right help to improve other symptoms that are the main cause. Then you would be able to provide them with the information and access what is working for them and not working so that they may be able to improve the course of treatments and improve.
    4. When a Formative assessment is done on a client. The client is not engaging to the fullest in the participation of the assessment. The assessment then holds minimal to no value when it has been taken due to the lack of engagement of the client. Is more of a faster way to get feedback for the counselors in knowing how well the client understands the problems or concerns.
    When a Summative assessment has been done on a client. The client is more of being evaluated the learning aspect of the client form the beginning of a time session. It more of an assessment of them at there worst, the encouragement of memory and how they remember, instead of client understanding the matter that they are expressing.
    The importance of Formative Assessment is more on the actual process of the assessment and what need to be worked on with the client. This can determine if the client wants to change or is engaged with the interventions about changing the behaviors that they are addressing.

    Reply

    • Amanda Bara
      Jun 23, 2022 @ 10:37:15

      Hi Luz! I like how you pointed out how important it is to build that relationship with the client in the first couple of sessions. It does help the client feel comfortable and supported when given assessments which they may be weary about. Your concerns about being confronted with a client that is suicidal are similar to mine. I think as counselors we want to do everything we can to help a client in this position and missing any important information could be detrimental not only to the client but to us. Great discussion responses!

      Reply

      • luz Rodriguez
        Jun 25, 2022 @ 22:44:42

        Hi Amanda,
        It just like when we start talking to people, we talk to people to get a feel of their personality see if we can be friends and we build a relationship of friendship I think is another way of thinking about it. We build the trust with our friends over time not after the first day. Yes I agree it can be detrimental to client if we it.

        Reply

    • Rachel Marsh
      Jun 25, 2022 @ 20:07:07

      Hello Luz,

      In your answer to the first question, I like how you brought up the importance of using an initial session to make the client feel heard and validated. The initial session for therapy sets the stage for subsequent sessions, thus it is crucial to ensure that you gain as much information from the client. Going beyond that, it sets the stage for building therapeutic alliance. One of the best ways to optimize therapeutic alliance is through empathy. In the initial session and beyond, attentively listening to the client and making them feel validated is a great way to achieve this. In the initial session, if a client doesn’t feel heard or validated, they are significantly less likely to participate in future sessions or engage in treatment.

      Additionally, I like how you brought up the idea of having a feedback system to build rapport. Not only is it important for clients to feel reassured, but also feel understood. Communication is monumental in this area. Having feedback involved as you mentioned to ensure that the therapist understands what the client is attempting to communicate and clarifying are effective ways to achieve this. Overall, great post!

      Reply

      • Luz Rodriguez
        Jun 25, 2022 @ 22:52:00

        Hi Rachel,
        I think a lot of clients think that there coming to us to tell us their issues or problems and we just don’t truly want them to get better. Client going in probably feel like there no compassion or understanding because some of stigmas that they may have heard. Which is hard for counselors to change but if we could show it with in first session, I think client is more likely to stay and be more appt to keep coming they feel understood. Yes, by having the feedback I feel like you let the client know that your listening you care and want to help . I feel like it gives them the assurance that you care and listening to them.

        Reply

  8. Tuyen Phung
    Jun 23, 2022 @ 11:44:35

    Getting an accurate understanding of a client’s problems early in therapy is important in several ways. First, just like a patient with a physical disease so that they can be treated, a counselor needs to know specific problems early in therapy to go appropriate direction for treatment. Second, an early understanding of the client’s problems can help to prevent serious conditions regarding life issues, such as abuse or suicide. Third, early understanding of problems in the client can help counselors establish a therapeutic relationship in which the client can receive empathy or compassion from the counselors.

    There are many crucial concerns when confronting a suicidal client. The most interesting information in the text that I found in the reading this week is the idea of disclosing suicidal thoughts. There are myths in which people think that talking more about suicide can cause clients to think more about suicide. It should be seen the fact that people ignore or deny the thought when they have it. This can cause serious consequences. When working with people with suicidal thoughts, it is practitioners’ legal requirement to report the case, not to investigate it. Many cases of preventable deaths occur because of practitioners’ hesitance of reporting the case when they are subjectively unsure about the suicidal intention. Finally, discovering potential instruments or tools that clients tend to use for suicide is very important to prevent it.

    Assessments are necessary not only for diagnosis but also for understanding the way therapists present problems that are affecting clients. Looking at specific consequences of clients’ behaviors in the results can help therapists understand how the problems affect their functioning. Therapists can understand the severity of problems in clients’ lives through their self-reports with formal and informal devices such as checklists and rating scales. In addition, understanding more about clients through assessment can aid therapists to evaluate the severity of their problems in their lives by showing both their strengths and weaknesses. Finally, assessments can support therapists in building relationships with clients before going deeper in treatment.

    In counseling, evaluation is important for its progress. Formative evaluation refers to intermediate or continuous evaluation in the process. In contrast, summative evaluation refers to the cumulative evaluation. The two types of evaluation differ in their focuses: formative evaluation focuses on the process while summative evaluation focuses more on the overall results. In counseling, formative evaluation is beneficial in checking how the treatment is going with clients, leading to appropriate adjustment and promotion.

    Reply

    • Patricia Ortiz
      Jun 24, 2022 @ 15:50:41

      Hi Tuyen!
      I like how you described that understanding more about clients through assessment can aid therapists in evaluating the severity of their problems in their lives by showing both their strengths and weaknesses. I agree with you because counselors should communicate the clients’ weaknesses and their strengths too. That way the client is motivated to get better and to work harder. Also, by knowing the clients’ strengths and weaknesses, the counselor can have a better understanding of the client and develop a good treatment plan.

      Reply

    • NikkiAnn Ryan
      Jun 25, 2022 @ 09:21:43

      Hi Tuyen! I like your discussion about the myth that talking about suicide makes clients think more about suicide. I attended training about suicide when I started working as a residential counselor, and we discussed this myth and the myth that asking a client about it will “give them the idea” to commit suicide. During this training, we also practiced asking about suicide because as you said, some practitioners may experience hesitation. I also like that you noted that getting an understanding of a client’s problems early in therapy can help prevent suicide because you can use assessments and make necessary plans to try to prevent it.

      Reply

  9. Sam Keller
    Jun 23, 2022 @ 13:26:08

    1) It is important to get an accurate assessment of an individual’s issues on intake partially because we want to have comprehensive data. We cannot judge what issues a person might have on initial impressions alone. A very high functioning individual could have a substance use disorder or depression that might not be immediately apparent. Other issues such as self-injury could be hidden from view as well. Additionally a person will sometimes come to intake at the lowest point in their disorder where they have finally admitted to themselves that they need help. They could view therapy as their last resort. Such individuals are potentially at a higher risk for suicide. Therefore it is important that we get as much information as possible, even if we need to ask very blunt intake questions in order to do so.
    2) I have actually dealt with aspects of this before in my work as a residential counselor. It is important to recognize that these people are still just people. It can be helpful for some to view suicidal ideation as a high level medical crisis like a heart attack. You are to stay calm, not leave the person alone, and go through the assessment steps to determine if additional steps need to be taken to keep this person safe. Most (but not all) times a suicidal client is only an imminent danger to themselves. Don’t be afraid of them but be afraid for them. Try your best to be connected with them and be non-judgmental. Being blunt in a gentle way is sometimes necessary as not every person is going to want to volunteer details. It can be very stressful at the moment but just take deep breaths and do what you need to do to make sure this person is safe. It is better to assume the worst than to not and have something happen.
    3) Assessments can also help you gain information about other factors of the individual such as their willingness to speak about difficult issues, their willingness to engage with mental health professionals, and how they cope with their illness. One person might be extremely distressed while you do an evaluation while another might be outwardly calm but inwardly in crisis. Assessments can also be a springboard that you can use to talk about difficult topics. A person might be insistent that things aren’t so bad but could score so highly on an objective depression scale. That gives you data. Is this better for this person within the context of their disorder (aka is it usually worse for them)? Are they used to insisting to everybody that they are fine even when they aren’t? Are they resistant to speaking about difficult issues once you go over the results of the assessment or are they very straightforward about it?
    4) A formative assessment is one that is repeatedly given over the course of treatment to see how something is progressing. A summative assessment is given at the end of treatment to view cumulative results. The first measures progression while the second measures final results. Formative assessment can be very useful during therapy to see if therapy overall is yielding an improvement in symptoms or if a specific intervention is causing improvements/declines. If you have been using a thought record with the client for 4 sessions and the client’s formative assessment scores are improving then you know the intervention is being effective. It also lets you know when an intervention is having no impact or is causing symptoms to worsen.

    Reply

    • Kiara Mark
      Jun 24, 2022 @ 10:06:07

      Hi Sam, I liked your response about the additional use of assessments. Assessment can be used as a tool to get to know the client’s way of addressing or not addressing problems. For example, a client can be completely honest on an assessment that provides results of a possible disorder but when the time comes to talk about what is wrong the client denies a problem. A counselor can now use the results of the assessment to hint at the presence of a problem. If the client responds this way during a session then this denial is probably happening at home too. I never thought about using an assessment to help gauge how a client is at home without asking them.

      Reply

    • Rylee Ferguson
      Jun 25, 2022 @ 12:32:51

      Hi Sam, I wanted to highlight two points in your discussion post that I really enjoyed. Firstly I like the concept that assessments can bring to light existing coping mechanisms a client has at their disposal. This way the therapist is not accidently recommending strategies the client already knows and is not working well enough for them. Instead they can take what they already know and build off that baseline to better meet the needs of the client. Another point I liked was about how assessments can be springboards for talking about difficult topics. I think as a new therapist it may be intimidating to bring up hard topics seemingly out of nowhere. The use of assessments and the questions involved can act as helpful segues into topics that would be otherwise difficult to express. Thanks for bringing these thoughts to my attention!

      Reply

  10. Kiara Mark
    Jun 23, 2022 @ 13:29:41

    During early sessions it is important for counselors to get an accurate understanding of the client’s problems in order to give them the best treatment plan. A counselor can talk with the client and subjectively determine what could be wrong but their view of the severity and level of impairment might differ from how the client experiences it. An assessment is an objective measure that can be used to gather background information, cultural and religious standings, and the severity of emotions and impairment. The assessment can help the counselor to rule out disorders and then narrow down on which disorder is present through conversation and possibly more assessments to determine the best treatment plan. Additionally, sometimes a client may come in ‘knowing’ what they are struggling with but when they do the intake assessment they have a different disorder. If a counselor was to go just off of what they client says the treatment plan that was created may not be the best fit for the client.

    I have two main concerns with having a suicidal client. I am worried about whether or not I would be able to help them and what to do if they commit suicide. If I am unable to help them, what do I do? For example, the client has suicidal ideation and I have tried various treatment plans and inquired for ideas from other counselors about some of their treatment plans but, nothing seems to have helped what do I do then? Am I supposed to refer them to someone else and what if they refuse to be referred even though both the client and I have acknowledged that my treatment plans are not working? Additionally, if I have a client who commits suicide, are there specific actions I am supposed to do? For example, am I supposed to go to the funeral and write a letter to the family saying my condolences with an apology for not being able to help them or nothing at all?

    There is more to assessment than determining diagnosis. Assessments can help therapists to understand how presenting problems are affecting the client’s everyday living. Symptoms of mental disorders are exhibited differently on each person. For example, two people can have depression but for one person they do not experience depressive mood while the other person does which affects their social relationships and motivation to do everyday activities. Assessments can also be used to see the client’s strengths along with their weaknesses. This is extremely important for younger clients. Some parents get too focused on the limitations of the child and the diagnose. They forget the child has strengths in other areas. Additionally, assessments allow the counselor to view client’s progress in the treatment plan. If there has been no improvement since the client started the therapy plan then the counselor knows to make improvement or adjustments to the plan for more effective treatment.

    Formative assessment is a continuous or intermediate evaluation usually to examine the counseling service progress. Formative assessments look at the process of the services. This is extremely important for counselors so they can analyze their work and determine if there are improvements to be made not only for treatment but also in the counselor overall. Additionally, this assessment can help lead to a more positive summative assessment. If the counselor provides formative assessments throughout the client’s treatment they can increase their chances of having a treatment that works best for the client because they are making improvements as each assessment results are received. Summative assessment is a cumulative evaluation of counseling services that are usually given at the end of counseling services. Summative assessments give an overall summary of the effectiveness of the counseling services. These assessments are more focused on the end product of the services. Managed care agencies and third-party payers give reimbursements to clinicians who show their counseling is effective. It is integral that counselors analyze the effectiveness of the treatment as time goes on.

    Reply

    • Patricia Ortiz
      Jun 24, 2022 @ 16:16:26

      Hi Kiara, I feel the same way as you when you described your concern about If you were unable to help a client that has suicidal ideation, and after trying various treatment plans and inquiring for ideas from other counselors about some of their treatment plans, nothing helped. I feel like this is my main fear because I would like to be able to help my clients and make them feel better, also, I would not know how to proceed with the family because in some way they put all their hope in us.

      Reply

    • Tuyen Phung
      Jun 25, 2022 @ 17:07:19

      Hi Kiara,
      You showed very interesting reasons for the importance of getting an accurate understanding of a client’s problems. I also think that when clients come for therapy, they do not even know their own problems. Therapists are the ones they put trust to help them. However, if a therapist does not have an accurate result of an assessment, the trust can be eliminated and the treatment does not match the client’s own issues, leading to no effective treatment. Importantly, I think that some assessments are not as objective as they should be, including observation and self-report. Therefore, it is crucial to be aware of assessments in finding accurate results for clients. Also, I think that an accurate understanding of clients’ problems can lead to the priority of treatment for clients because many clients come for therapy with various issues and comorbidity.

      Reply

  11. Jonas Horan
    Jun 23, 2022 @ 19:14:33

    1) Intake and early sessions are critical because they establish the therapeutic relationship and inform the direction of treatment. Getting accurate information as early as possible will reduce the chance of a misstep in treatment choices, especially ones due to underestimating the severity of a client’s issues. It is also important to be able to tackle the client’s problems and explore directions for growth early in the process. Doing this instills more confidence in the client, who may be more likely to remain committed to therapy. Additionally, for practical reasons, forming at least a workable diagnosis by the end of the first session is necessary in order to charge insurance. While this may seem utilitarian, it does reflect practical concerns that will help therapy move forward.
    2) I think that what concerns me about working with potentially suicidal individuals is that things may go wrong even if I do everything right. Obviously there are things that you can do in order to reduce the risk, but it is scary knowing that even good practices aren’t a guarantee. I suppose this is simply one of the more serious instances of the general problem becoming too entangled with your work as a councilor. Being able to let go of your client’s problems after you’ve done everything you can is generally a good skill to have, but dealing with suicidality is an extreme.
    3) Often in therapy the presenting problem reveals other more complex issues that a client may not be able to put into words. Assessment reveals more information about a client and brings up aspects of their experience that may not initially be apparent. The diagnosis itself may not indicate the practical direction to take with a client, since their case represents an individual presentation of the condition. Just like interviews, assessments are a way to dig deeper and explore the exact nature of problems such as the relationship between a client’s feelings of depression and their feelings of hopelessness, for example.
    4) Formative assessment is ongoing assessment that informs us about an ongoing process such as therapy. Summative assessment implies that the assessment is taken at an endpoint, such as at the end of a sequence of therapy. Formative assessment may be more useful, for the obvious reason that it informs us about things that we can change as we continue the process.

    Reply

    • NikkiAnn Ryan
      Jun 25, 2022 @ 09:23:06

      Hi Jonas! You brought up some great points about the importance of obtaining accurate information during the intake and early sessions including for treatment and diagnosis purposes. I had not previously realized that many programs and services require a diagnosis for the client by the end of the first session. As you said, in order to be able to charge insurance, it is necessary to diagnose quickly and therefore critical to have a good understanding of the presenting problems. Also, I think it is important that you also highlighted the importance of instilling confidence in the client early on so that they return after the intake, as many clients may not.

      Reply

  12. Sarah Kendrick
    Jun 24, 2022 @ 15:56:29

    It is important to get an accurate understanding of the client’s problems early in therapy so that the helper can further accurately treat the client. If the helper has an accurate understanding of the specific and significant problems of the client, the problems can be prioritized and then treated. This is important for early in therapy so that the time has not been “wasted” on lesser prioritized problems. Helpers need to further be aware of bias as how they interpret the clients’ information and problems may not be accurate (which is the importance of utilizing appropriate measures or interviews).

    Regarding assessing suicide, I have had some experience in assessing individuals in the moment in a group living environment. While these mid-crisis assessments were effective and led to more discussion than action, my program did have the unfortunate experience of a new intake who was assessed by a clinician for suicidality and showed no concern, then passed away less than twelve hours later. The detectives continuously asked about if there were any signs but as far as us residential counselors were made aware, this individual was reportedly hopeful and excited about their future at our program and that while they had an extensive history, in the moment of the assessment they did not present as being at risk. Therefore, I unfortunately have this experience that leads to my biggest concern that an individual will not be truthful about the intensity of their symptoms/problems.

    Assessments can help therapists understand how presenting problems are affecting clients by generally providing different information about the client. Assessments can inform therapists about their clients’ level of functioning and social support. If a client’s daily functioning is impaired (for example if they are frequently calling out at work due to their symptoms), this may tell the therapist just how intensely the client is being affected by their problems. Further, if a client has a lack of social support, whether the client’s problems are affected by the lack of social support or if they have a lack of support affected by their problems (meaning perhaps they have pushed away their social supports), this may be something the therapist will want to work with the client on improving as it is important to have social support. People are affected by and present their problems differently. Therefore, it is important to assess for other information outside of diagnoses to truly understand how clients are affected by their presenting problems.

    Formative assessment/evaluation refers to continuous/intermediate evaluation that is typically performed to examine the counseling services process whereas summative assessment/evaluation refers to the cumulative evaluation of services and is typically given towards the end of services, providing an overall indication of the effectiveness of services. The benefits of formative assessments are that in continuously assessing, one is better able to evaluate the process in the moment/present instead of finding out towards or at the end of treatment. One can observe change as it is happening or if there are minimal/no changes, can adjust treatment.

    Reply

    • Tuyen Phung
      Jun 25, 2022 @ 16:46:47

      Hi Sarah,
      Thank you for sharing your experience with suicide cases in your past program. When I learned about the topic in assessment, I also think of closure of suicidal intention in individuals because of distrust in helping professionals. Therefore, a therapeutic relationship in the initial session is essential. I also like your idea of distinguishment between formative assessment and summative assessment as evaluation of the counseling process and services. I think each has its essential role, but formative assessment can occur before we can have a summative evaluation.

      Reply

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Adam M. Volungis, PhD, LMHC

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