Assessment Session As Preparation For Therapy

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

In this article, I will discuss the structure of the assessment session; I will explain how the therapist helps to form the client's request and his expectations from the therapy.

For therapy to be successful, it is necessary to establish a therapeutic relationship, evaluate the client's problems, and develop a preliminary conceptualization. Finding out detailed information about the client's past and present helps to draw up an individual plan to achieve the goals of therapy.

I usually ask clients to fill out standard questionnaires in advance so that they can read the information they need before starting therapy and make the assessment session more productive. This preparatory work helps to shorten the duration of the assessment session.

The assessment session has a sequential structure, each stage of which I will describe in detail.

Stage 1. Beginning of the assessment session

After greeting and getting to know the client, I explain how the session will be held and what is needed to identify pressing issues, which we will pay attention to in the next sessions.

Therapist: “Today we will conduct an assessment session with you, where you will tell me everything I need to know about your experiences. I will ask you questions to identify the main problems that we will be working on in therapy. Sometimes I will interrupt you to clarify some points. If it bothers you, please tell me.

Then I will share my impression of your case: we will discuss the plan and goals of therapy, and you can ask me any questions."

Stage 2. Diagnostics

In order to draw up an effective therapy plan for a client - to formulate goals, organize the therapy process and plan sessions - it is necessary to obtain detailed information about the client's present and past life. So I find out the following:

• age and marital status, with whom he lives;
• complaints and problems;
• what events in life influenced the formation of the problem;
• how the client dealt with the problems;
• a history of psychiatric or psychosocial treatment and the client's opinion of its effectiveness;
• medical history, hospitalizations, suicide attempts;
• the use of psychoactive drugs;
• psychiatric family history;
• childhood, adolescence and other necessary information.
• age and marital status, with whom he lives;
• complaints and problems;
• what events in life influenced the formation of the problem;
• how the client dealt with the problems;
• a history of psychiatric or psychosocial treatment and the client's opinion of its effectiveness;
• medical history, hospitalizations, suicide attempts;
• the use of psychoactive drugs;
• psychiatric family history;
• childhood, adolescence and other necessary information.

Also, if necessary, I would like to ask you to describe in detail how he spends his typical day, from the moment he woke up in the morning until he went to bed in the evening. I ask how the client spends his typical day off. I pay attention to how often his mood changes, how he interacts with other people, what his everyday experiences are, and what he avoids in his actions.

During the evaluation phase, I observe if there are signs of the client's uncertainty about whether the treatment will help them. For example, it can manifest itself in a hopeless tone of speech. Then I use the spoken automatic thoughts of the client to delicately lead them to understanding. cognitive model, which will become the target of therapeutic intervention.

There are times when clients hide their feelings. They fear that they will not like the therapist or their way of thinking will be judged. If the client is not sure that he can be helped, I positively reinforce the fact that he expressed his concerns - it is important that the client actively participates in the therapy process and speaks openly about his experiences. This will strengthen the client's confidence in success and strengthen the therapeutic alliance.

It is important to structure the words of the client to get the right information. Therefore, I immediately set the right direction for the dialogue.

Client: "I think my problems are too difficult …"

Therapist: “So, you assume that your problems cannot be solved. How do you feel about this thought? Are there feelings of sadness and hopelessness?"

Client: "Closer to hopelessness."

Therapist: “We will discuss such depressive thoughts from the next meeting. We will analyze how true such a thought is. And today tell me, could my words or actions make you doubt that therapy will help you?"

Client: "I'm just not sure it will work."

Therapist: “It's good that you said this. I cannot predict in advance, but from your story I have not heard anything that would make me doubt the success of therapy."

In addition, I clarify why the client may think that therapy will not help him. Based on the answers, one can understand what led to this belief and how to build a future work strategy.

If clients have had a negative experience with therapy, I ask about the course of the therapeutic interaction with the previous therapist. For example, did the therapist do the following at each meeting:

• voiced the agenda of the session;
• made recommendations to make the next week better;
• created coping cards;
• taught how to assess the validity of thoughts and behavior change;
• received feedback and made sure of the correct course of therapy.
• voiced the agenda of the session;
• made recommendations to make the next week better;
• created coping cards;
• taught how to assess the validity of thoughts and behavior change;
• received feedback and made sure of the correct course of therapy.

Many of my clients have not had this experience before. So I say, "My approach will be different from what you've tried."

At the end of the assessment, I will find out, “Is there something important that you are not yet ready to tell me? Now you can not talk about it if you want - we will talk about it later."

This detailed collection of information helps to better plan the entire therapy and set goals for the first therapy session.

Step 3. Setting goals and explaining the therapy plan

I tell the client about the goals of the therapy and how it will go. I explain what actions will be needed to improve his well-being and find out the client's opinion on the plan I proposed.

Therapist: “Today, we will outline the goals of therapy in a generalized way:“ Reduce symptoms of depression; improve social contacts”. We will set more specific goals at the next meetings. Before starting the session, I will find out what problems you want to solve. For example, you say that finding a new job is difficult for you. This problem relates to the goal of improving behavioral skills. We will find solutions that will help you make feasible plans for yourself and focus on important actions.

In addition, we will identify dysfunctional thoughts that are negatively affecting your life and work to replace them with more realistic ones. Together, we will find optimal solutions to problems that you test in between meetings.

In therapy, you will learn new skills that you can use to improve your life. You will learn to solve problems on your own by reasoning and acting to effectively achieve your goals. You will see by your own example how therapy has a positive effect on people - through gradual steps to change thinking and behavior every day."

Stage 4. Schedule agreement

The frequency of therapy appointments once a week is optimal for most clients. The exception is clients with severe depression and anxiety - they will need additional support. Towards the end of therapy, the intervals between appointments increase so that the client can learn to apply the therapy skills learned on his own.

Therapist: “Most likely, the therapy will take 10 to 15 sessions. If we find more complex problems that you want to solve, it will take more time.

Our meetings will take place once a week until your condition improves. Then between sessions there will be a gap of one to two weeks, and possibly three. After completing therapy, I recommend meeting for supportive sessions every few months. We will determine this together in the future."

Conclusion

The information obtained during the assessment session is used to create the most effective therapy plan for a particular client. In addition, a preliminary description of the goals and plan of therapy is reassuring to the patient and helps him to become more actively involved in the work immediately after the assessment session.

Although the treatment regimens may have common points, there are always important differences that depend on the specific case. That is why it is so important to pay attention to each step, carefully and consistently conducting the assessment.

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