1. Initial Assessment in Counseling
Chapter 6

2. Information Gathered in Initial Interview
Demographic Information
Client Background Information
Health and Medical History
Client’s Presenting Concern(s)
Other Relevant Information

3. Defining the Client’s Problem
Explore each significant problem from multiple perspectives
Gather specific information on each major problem
Assess each problem’s intensity
Assess the degree to which the client believes each problem is changeable
Identify methods the client has previously used to solve the problem

4. Assessing the Change Process
Prochaska et al.’s Transtheoretical Model:
Precontemplation
Contemplation
Preparation
Action
Maintenance

5. Interviewing Skills and Techniques
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

6. Interviewing Children
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

7. Types of Interviews
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

8. Other Strategies Used in Initial Assessment
Checklists
Standardized
Informal
Rating scales

9. Assessment of Suicide Potential
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

10. Assessment of Suicide Potential: Warning Signs & Risk Factors
Imminent or pressing danger; individual should be evaluated for possible intervention
Tier 1
Tier 2 (Rudd et al., 2006)
General picture indicates long-term risk for suicide attempt

11. Assessment of Suicide Potential
Risk factors often associated with demographic characteristics
Gender
Age
Race/ethnicity
Adolescent suicide - 3rd leading cause of death among year olds

12. 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

13. 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)

14. Assessment of Depression
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)

15. Assessment of Substance Abuse
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

16. Assessment of Substance Abuse: Methods & Instruments
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

17. Assessment of Substance Abuse: Methods & Instruments
CAGE interviewing technique (Mayfield, McLeod, & Hall 1974)
Have you ever felt you need to cut down on your drinking?
Have people annoyed you by criticizing your drinking?
Have you ever felt bad or guilty about drinking?
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

18. Mental Status Examination (Polanski & Hinkle, 2000)
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