Chap 5: The Evaluation Session Flashcards
Objectives of Evaluation session
- collect positive and negative information for diagnosis, conceptualisation and treatment plan
- Determine appropriateness of therapist and therapy
- Adjective treatment
- Alliance, educating about CBT and setting up an action plan
Limit the evaluation session duration by
- completing questionnaires self report forms
- getting past psychiatric and medical reports
- arranging for a meeting with family member at the end of the evaluation session if needed
Structure of the Evaluation session
- greet the client,
- collaboratively decide participation of a family member or friend
- set the agenda and convey session expectations
- conduct the psychosocial assessment
- set broad goals,
- relate your tentative diagnosis, treatment plan and educate the client about CBT,
- collaboratively set an Action Plan,
- set expectations for treatment, and
- summarize the session and elicit feedback.
Starting the Evaluation session
- Get informed consent signed i.e costs, risks and benefits of treatment, limits of confidentiality, cost, mandatory reporting, records privacy
- Review records
- Set Agenda:
Not therapy so no active work on issues multiple questions to make a diagnosis, some relevant some not…to rule in and out problems
Expect interruption, bother?
Tell client what to expect
- Set Agenda: start of every session… ….to focus and best utilize time
Today’s agenda why you are here, your symptoms, functioning, history - What’s going right with your life, best period of your life, anything else?
- Tentative diagnosis….talk more next week after review,
- Focus of Treatment
- Tell you about CBT
- Broad goals and how you would like your life to be different
- Questions and concerns
Anything else you would like to cover?
Conducting the assessment
- Get detailed history and assess various areas
- Elicit description of a typical day: helps understand clients daily experience, facilitates in Goal setting, pinpoints positive activities that can be encouraged and activities that are avoided.
- During their description note
Mood variation, social interaction, functioning at home work free time, free time spend, activities that bring pleasure/accomplishment and connection, self care activities, activities that are avoided
- What time wakeup and bed?, First thing out of bed, lunch? Anything else, nap?, Dinner? , Get in bed?, Sleep right away? , Sleep through?
Difference from weekends?
Responding to hopelessness, skepticism about symptoms and getting better or committing to treatment….
Tell that such automatic thoughts will be targeted for treatment….
It’s Good you told me that…how does this thought make you feel? Will target such thoughts in sessions… what makes you think it might not work ? you are not alone we will work together I can’t guarantee 100% but what you have told me makes me think it will work. Can I tell you some of these? are you willing to give it a try? do you want to come back next week?
- Too much detail:
‘For the next few questions, I just need you to answer yes, no or I am not sure ‘
Or
‘Sorry to interrupt but I need to know…’
Responding to Too much detail:
‘For the next few questions, I just need you to answer yes, no or I am not sure ‘
Or
‘Sorry to interrupt but I need to know…’
Clients concern about previous treatment not working
Positively reinforce them (“It’s good you told me that”
Ask whether they felt they
had a good relationship with their previous therapists
whether, at every session, their therapists
• set agendas,
• figured out with them what they could do to have a better
week,
• made sure the most important points of the session were
recorded for them to review daily at home,
• taught them how to evaluate and respond to their thinking
themselves,
• successfully motivated them to change their behavior, and
• asked for feedback to make sure therapy was on the right
track.
I’m glad to hear that your previous therapists didn’t do
all these things. It sounds as if our treatment here will be differ-ent. If it were exactly the same as your past experiences, I’d be less
hopeful.”
If the previous therapist did all that, spend more time finding out precisely what occurred especially
whether the therapist provided treatment individualized for the cli-ent and his/her specific disorder(s), based on the latest research
and practice guidelines. In any case, you can encourage the client
to give your treatment a try for four or five sessions and indicate
that you and the client can then review how well treatment is work-ing.
Seeking additional information
Is there anything else that’s important for me to know?” and
“Is there anything you’re reluctant to tell me? You don’t have to tell me
what it is. I just need to know whether there’s more to tell, maybe some
time in the future.”
Involving a trusted person
Make sure there is nothing the client wants
you to refrain from saying. Elicit the client’s agreement for you to
inquire what the family member/friend thinks is most
important for you to know;
• ask about the client’s positive qualities, strengths, and
helpful coping strategies;
• review your initial diagnostic impressions; and
• present your tentative treatment plan and elicit feedback.
If the client doesn’t want you to talk about all these topics or wants you
to address something else, make a collaborative decision to do so, or
provide a rationale for why you don’t think it’s a good idea.
Sharing Diagnostic impression
If unsure, tell the client you need time to review the collected information from history, forms and prior reports.
If sure,
Suggest diagnosis tentatively and offer hope that you can help e.g. your experience with prior similar clients, success of CBT as a treatment, qualities that make the other person a good client, good prognostic factors.
Set Goals, Share Treatment plan, elicit what client thinks about it
Set goals based on what client told
Remind client that you will do it step by step so it’s not overwhelming
At every session,
Find out what’s important for the client to work on (set a goal) and work towards it
Figure out obstacles that may get in the way
Problem solve around it.
Tell that 50 percent therapy will be around problem solving, teaching skills to change thinking and how you behave.
Earlier you said you keep celebrating, so we are going to learn to evaluate the thoughts… what evidence is there that your thought is true, what evidence that it isn’t? Any other way to look at the situation.
Teach skills to change anxious/depressed thinking to be more realistic
Come up with activities to try that can improve your life.
So the general treatment plan would be:
Set goals
Work toward them one by one
Learn skills
Setting the Action plan
Create an easy action plan during the evaluation session so the client knows they have to carry work in between sessions.
Make short targets/ activities that you will do throughout the week in between sessions. This is called the action plan for the week.
Place it where you can easily see and read it everyday….(reminder of what you have to do)
Walk, give credit for anything you do even reading action plan…
Remember it’s harder to do anything when you are depressed, so always give credit
Establish expectations for treatment
Set how frequently you would meet.
How long would treatment last.
E.g. 15 to 20 sessions
Depends on long standing issues… could take longer
If you decide on termination, I can refer you to another therapist
Summarize the session
Ask any questions?
How are you feeling about what we discussed today
See you next week for the first session
