Initial Assessment in Counseling Chapter 6

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

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

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

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

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

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

Other Strategies Used in Initial Assessment Checklists Standardized Informal Rating scales

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

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

Assessment of Suicide Potential 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 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)

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

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

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

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