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.

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