Tuesday, January 28, 2014

The role of assessments in therapy

I have a young idealistic counselor on my team. She is new to the field of clinical psychology but has been a counselor for some time now. For over a year now, she has been questioning the need of assessments and their use in our clinical practice. Assessments are expensive and also delays the start of therapy. This blog is an explanation for her ( and for our clients), in the importance of an assessment inspite of the added cost and supposed delay.
          The usual process followed in my clinic with any new client starts with a client interview to understand their issues. The counselor will typically make notes and summarize what she felt were the key issues, at the end of the session. She will also outline a plan of action for seeking resolution of these problems. An additional step of assessment is often recommended to get an objective sense of the problem areas. Here is why this step is important:

When the client talks to us about the issues he is facing, the self analysis of the personal situation is governed by his values, life experiences, personality, education, social and economic background etc. As a counselor, it is our job to fill in the gaps, look at this data with a comparitive population in mind and arrive at a clinical conclusion. Is the client history yielding any significantly different symptom than seen in other people in  similar situations and with similar personal history? If it is then, there is a chance of a clinical disorder/ mental health issue as opposed to just a difficulty in managing a certain life situation. An assessment makes that differenciation.
        With a lesser experienced counselor, who has not seen too many similar cases, the comparitive population data is minimal or non existant. This is where a test battery helps. Most test batteries are based on data available from hundreds of other clients with matching biographic details of age, sex, race, socio-cultural-economic status etc. No counselor can match this amount of detailed information irrespective of the number of years in this profession.

The second reason for this testing, is to find out the clinical diagnosis. Is the client suffering from a mental disorder? Most experienced counselors and psychologists will arrive at a conclusion within the first session. But, there is a small chance that the counselor's biases are at play in making that diagnosis. Good counselors are aware of their personal prejudices and will step away from it and look at the case objectively. If they fail to do so, they will refer the client to another professional (well, the ethical ones will). But, there is another kind of bias that creeps in, uninformed. It is caused by experience!!!! It leads to a case being stereotyped into a diagnostic category with complete brushing aside of small details that do not conform...often leading to a completely wrong diagnosis.
                                A standardised test will never have this bias. It will use the information, file it in neatly and integrate it objectively to give an indication of the right conclusion.

Well then, why not just do the test and get the counselor in, only after it is done. Sounds ideal, right? Not really. the assessment will indicate one or more inferences. The clinical observation of a counselor is very important. Every test has its limitations and does not use all the details of the client history. It is the counselors job to take the remaining data into account.
Psychological assessments are an important tool, one that complements the counselor's experience and gives unbiased data. A good counselor just needs to know its importance.

Friday, January 24, 2014


As I enter into 2014, I can’t help but reminisce about the year past. 2013 was an eventful year for me and Counseling India, the clinic I run in Bangalore. I moved to Seattle in May 2011 with just faith that the clinic will do alright. My fellow counselor was someone I trusted and depended on and she has delivered sincerely. We did well. The clients went home happy, we paid the bills and basked in the glory of a job well done.

But as I enter into the New Year, I am asking myself and my team if that would be enough. Will hard work and sincerity alone take us to newer heights and feed our minds and stomachs? Competition is up and newer, younger talent is abundant. It is imminently possible that just breaking even could start posing a challenge, something I have never experienced in my working life. The only way our clinic can grow is if we offer unique services. Exploring newer avenues of marketing can only help.

 For the last 13 years I have been uncomfortable and wary about marketing the clinic and myself. To me it was akin to selling a consumer product. The clinic and its services are much more than that. We offer solace, peace, direction.... not something that should be peddled as wares in the market. I have been scornful of fellow professionals in my field who do that. 
But my high and mighty thoughts and lofty ideals are tasting dust in the light of the modern sun. My leased clinic space is becoming pricier. Clients are getting snagged. Assessment kits and other instruments are getting more and more expensive with passing time. Good work alone is not going to help. We will have to aggressively market what we do. I have full faith in the services and assessments we offer, but organizing ourselves into an efficient team is the need of the hour. I am bracing myself for this non clinical work to increase the footfalls in the clinic. It’s not going to be easy. We are expanding our range of offerings to keep up with the newer expectations of the clients. We are brainstorming. We are stepping out of our comfort zones while walking the thin line between ethical professionalism and utilitarian issues

If I am honest to myself, hope is a precious commodity as I swim in new waters. The team is looking for motivation and direction and I have precious little apart from my clinical knowledge and experience to give them. But, I am learning new things about business, every day and discovering new insights.
As I walk down this path, there is only one thing that I am clear about -We will survive and we will thrive. Times are changing and so will we.

Sunday, January 19, 2014

The practice of psychology

I met up with two women last night over dinner. I have known one of them for some time and she brought along another friend. It was an interesting cultural mix. I am Indian born and raised in India and now residing in the US. One of the two women was Finnish, married to a Hungarian, lived in Copenhagen and moved to the US a few years ago. The third women, a new person to me, was Portugese, younger than both of us, unmarried, and a student in the US after having spent the last few years in Europe. As I said, an interesting cultural mix, guaranteed to lead to interesting conversations. What you wouldn't expect is the similarity of our conversation with the ones I have had with my Indian friends with the same kind of upbringing as I.

All throughout dinner, we spoke about the everyday struggle of being a working women with a family and house to take care of. We spoke about our relationships with our husbands, the issues plaguing our kids and the occasional, almost mandatory:) reference to our mother in laws. It sounded all too familiar to my discussions with my Indian girlfriends.

Its almost funny how similar we all are. Education, upbringing, family background, finacial status, cultural factors,........ its just a cloak. All of us have the same motivators, same triggers, similar goals, and the same reactions to the same incidents. Our life histories are by and large also similar.

And that is what my science is based on. Reseachers in my field continue to find the commonality in all of us and extrapolate that knowledge to help individual clients deal with their very personal issues. Yes, at its very root, it is an empirical science but the advances in research has allowed us to back these experience based inferences with cold hard facts and proofs.

We are counselors and psychologists by training and designaton but the real truth is that we are just keen observers of human behavior. That is what we really are.