Initial Assessment in Counseling

Chapter 6

Demographic Information

Client Background Information

Health and Medical History

Client’s Presenting Concern(s)

Other Relevant Information

Information Gathered in Initial Interview

1. Explore each significant problem from multiple perspectives

2. Gather specific information on each major problem

3. Assess each problem’s intensity4. Assess the degree to which the client

believes each problem is changeable5. Identify methods the client has

previously used to solve the problem

Defining the Client’s Problem

Prochaska et al.’s Transtheoretical Model:

1. Precontemplation2. Contemplation3. Preparation4. Action5. Maintenance

Assessing the Change Process

Consider credibility: Does counselor appear trustworthy, expert, attractive?

Open-ended vs. closed-ended questions

Commonly used techniques: Paraphrasing, clarifying, reflecting, interpreting, summarizing

Verbal and nonverbal behaviors

Interviewing Skills and Techniques

Establish rapport and familiarity Adjust questions to child’s developmental level Ask questions in a warm professional manner Explain reason for asking questions Define limits of confidentiality Structure interview to be developmentally

appropriate (use physical props, games, toys, etc.)

Use variety of question types; avoid abstraction Do not stop child’s disruptive behavior too

quickly; observe

Interviewing Children

Structured: established set of questions asked in same manner and sequence to each client

Unstructured: counselor has idea of possible items but conducts interview in a unique manner depending on the client’s needs

Semi-structured: combination of structured and unstructured; certain questions are always asked, but there is room for exploration and additional questions

Types of Interviews

Checklists Standardized Informal

Rating scales Standardized Informal

Other Strategies Used in Initial Assessment

Suicide is 10th leading cause of death in the U.S. (NIMH, 2010)

71% of counselors have worked with individuals who had attempted suicide; 28% of those practitioners had a client who had committed suicide (Rogers et al., 2001)

Risk factors vs. warning signs

Assessment of Suicide Potential

Assessment of Suicide Potential: Warning Signs & Risk Factors

Warning Signs

Imminent or pressing danger; individual should be evaluated for possible intervention

Tier 1 Tier 2 (Rudd et al., 2006)

Risk Factors

General picture indicates long-term risk for suicide attempt

Risk factors often associated with demographic characteristics Gender Age Race/ethnicity

Adolescent suicide - 3rd leading cause of death among 15-24 year olds

Assessment of Suicide Potential

Other factors: Drug/alcohol use Depression – hopelessness/helplessness Previous attempts Recent loss, divorce, or separation Personality factors History of psychiatric disorder Personality disorder “Protective” factors

Assessment of Suicide Potential

Suicide Potential Instruments:

Suicide Probability Scale (Cull & Gill, 1992)

Beck Scale for Suicide Ideation (Beck & Steer, 1991)

Beck Hopelessness Scale (Beck & Steer, 1993)

Suicidal Ideation Questionnaire (Reynolds, 1988)

Adult Suicidal Ideation Questionnaire (Reynolds, 1991)

Assessment of Suicide Potential

Assess level of depression with every client (Morrison, 2007)

Know the symptoms – cognitive, affective, behavioral/ physical

Assess severity and type of depression

Some formal instruments: Beck Depression Inventory-II (Beck, Steer, & Brown 1996)

Children’s Depression Inventory-2003 Update (Kovacs, 2003)

Children’s Depression Rating Scale-Revised (Poznanski & Mokros, 1996)

Hamilton Depression Inventory (Reynolds & Kobak, 1995)

Assessment of Depression

In most mental health settings, 29% - 50% of individuals seeking services will also have substance use disorder (Adesso et al., 2004)

Assessing substance use is needed throughout counseling process if counselor detects possibility of problem

Explore alcohol use and drugs taken (prescription, over-the-counter, street drugs) Substances used & amount taken Social & interpersonal aspects Internal & external triggers

Assessment of Substance Abuse

Motivational Interviewing 4 general principles: express empathy, develop

discrepancy, roll with resistance, support self-efficacy

Substance Abuse Subtle Screening Inventory 3 (SASSI-3)

SASSI-A2 for adolescents

Assessment of Substance Abuse: Methods & Instruments

CAGE interviewing technique (Mayfield, McLeod, & Hall 1974)

1.Have you ever felt you need to cut down on your drinking?

2.Have people annoyed you by criticizing your drinking?

3.Have you ever felt bad or guilty about drinking?

4.Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

“acid test” method

Assessment of Substance Abuse: Methods & Instruments

Used to describe client’s level of functioning and self-presentation

Generally conducted during initial session/intake interview

Usually organized around: (Trzepacz & Baker, 1993)

Appearance, attitude, and activity Mood and affect Speech and language Thought process, thought content, and perception Cognition Insight and judgment

Mental Status Examination(Polanski & Hinkle, 2000)