Week 1 - Intake Assessment A Flashcards
Intake Assessment A
Ackerman (2001)
What are the factors the author describes as potentially impeding good treatment outcomes?
Therapist personal factors:
being rigid, uncertain, critical, distant, tense & distracted
Therapist Techniques:
- overstructuring,
- inappropriate self disclosure,
- unyielding use of transference interpretations
- inappropriate use of silence.
These personal factors and techniques also have a similar (negative) influence on therapist ability to recognise and control ruptures.
What is the Therapeutic Alliance?
- key factor in an effective therapeutic relationship
- defined by bordin (79) as a collaboration between the client and the therapist based on the development of an attachment bond as well as a shared commitment to the goals and tasks of counselling.
The working alliance is viewed as a collaborative effort targeting which 3 processes?
1) client and therapist agreement on GOALS of treatment,
2) client and therapist agreement on how to achieve the goals (TASK agreement), and
3) the development of a personal BOND
Why do we assess therapeutic alliance?
So we can have a metric to compare future performance against, i.e. the therapist can see whether the alliance is improving or not and what specific parts of the alliance may need work
The importance of the therapeutic alliance?
Individuals seeking treatment are often feeling unsafe, it is of utmost importance that they feel they are in a safe place and that the therapist genuinely feels concerned for them. A client will not make any progress in terms of interventions they are asked to work on if they do not trust the therapist (or feel safe, like the therapist is on their side, etc)
Judith Beck’s Perspective on Therapeutic Alliance
- be a nice human being in the room with the client.
- treat your client the way that you would like to be treated if you were a client
- accept that clients are supposed to be difficult, that’s why they are clients
- help clients feel safe with you
Judith Beck’s Perspective on Therapeutic Alliance
- be a nice human being in the room with the client.
- treat your client the way that you would like to be treated if you were a client
- accept that clients are supposed to be difficult, that’s why they are clients
- help clients feel safe with you
Judith Beck’s perspective on depressed clients
- frequently see themselves as failures
- may be concerned that they will fail in therapy too
- often see themselves and their lives as out of control
- may think that nothing (including therapy) and no one (including you) can help.
Working Alliance Inventory
Horvath and greenberg (1986)
36 items – therapist, client, observer forms
Each WAI subscale has 12 items and is scored on a 7-point Likert-type scale ranging from 1 (never) to 7 (always)
Subscale scores can range from 12 to 84 and can be summed to obtain a total score. Thus, total scores can range from 36 to 252. Higher scores reflect more positive ratings of WA.
WAI SUBSCALES
Goals – the extent to which there is agreement on the “goals (outcomes) that are the target of the intervention”
Tasks - the extent to which there is agreement on the “in- counseling behaviors and cognitions that form the substance of the counseling process”
Bond - the extent to which a client and therapist possess “mutual trust, acceptance, and confidence”
MICROSKILLS
Attending behaviour Paraphrasing Questions Reflection & exploration Summarising
Attending behaviour
eye-contact,
body language,
interactive and observant,
minimal encouragers,
vocal qualities,
verbal tracking
Paraphrasing
Accurately reflecting ‘Ze Essence’ of what the client has said in your own words – briefly! – Avoid parroting
Two types or combination of both:
Reflections of content – e.g. issues – apparent and undercurrent, meanings, events and consequences, etc.
Reflections and exploration of feelings – observed - picking up verbal and non-verbal messages, explicit & implicit
Summarising
similar to paraphrasing
but brings together more information shared over a longer time
more integrated
Purpose?
- -Can focus the interview
- -Can facilitate deeper exploration
- -Assists in goal identification and prioritising
- -At the end of interview for closing
Use of Questions
Can be open & closed depending on purpose
Examples for open questions
–Can you please describe that feeling?
Examples for appropriate closed questions
–What do you do for work?
collaboration
Respecting the client – working with rather than delivering
What does collaboration look like? E. g.
- -client suggests own goals,
- -working together on tasks,
- -providing space for client to share their story in their own fashion (e.g. Cindy)
Intake Interviews: Contextual Issues
May occur on entry to a service/facility/or on referral to you
Ensure they know where interview will take place (e.g., directions, maps)
Consider setting for:
- Privacy & comfort for client
- Safety issues
- Scheduling issues
Goals of Intake (in general)
To establish rapport and build therapeutic alliance with client
To get an understanding of the presenting problem(s)
To get an understanding of relevant history
To assist with diagnostic decision making
To elicit hope & establish plan for further assessment & treatment
Intake Interview: Structure
(Shea’s phases)
(shea, 1988)
Introduction Opening Body Closing Termination
intake interview: Introduction
Make explicit:
- Who you are (i.e, name, discipline, role)
The purpose of the interview
With whom the information you gather is shared
Confidentiality
Recording of the session (if relevant)
Note-taking
Introducing yourself and what you do
Your role
If applicable, your orientation
What you will do
What the client needs to know
- Length of interview
- Confidentiality
Confidentiality Example
All information provided to me during the therapy session is confidential except under special circumstances:
I form the opinion that you or someone else is at risk of harm
You disclose that you have committed a criminal act with major social consequences
In case of legal proceedings, if my files are subpoenaed
In any instance, I will make every effort to let you know that I need to break confidentiality
Intake Interview: Body
Presenting problems: Identifying, evaluating (e.g., frequency, duration, intensity), and exploring client problems Background information -History of presenting problem -Psychiatric history -Developmental history -Personal history (e.g., relational/social) -Educational/occupational history -Medical/health history
Identifying goals
Presenting problems
What is happening NOW that they are having trouble with?
Work out the general areas first
Then drill down to get more information
Triggers / context, onset, frequency, duration and intensity of each symptom:
What is the symptom?
When does it occur? (triggers / context)
When did this start happening? (onset)
How often does it occur? (frequency)
How long does it occur for? (duration)
How bad is it when it occurs? (intensity)
histories
History of presenting problem Psychiatric history Developmental history Personal history – relationships Educational / occupational history Medical / health history
Goal setting
Why is it important to set goals?
- Gives direction
- Scientist-practitioner approach
Goals should be specific and measurable
- Goals should be collaboratively decided
- -Why?
Closing involves
Reassuring and supporting
Summarising critical themes and issues
Instilling hope
Empowering
Clarifying where to next
Timely session endings
Watch for client’s termination behaviour and/or statements
Consider your own response to ending the session
