This week we are looking at Assessment in counselling, and how it informs the counselling work. In counselling, assessment is the process used to determine if counselling is appropriate and needed, which type of counselling would be the most suitable for a client’s needs, and to take an initial measurement of the severity of the client’s issues.
Assessments are important because without some kind of formal information gathering at the start of the process, the entire therapeutic relationship could be started on the wrong foot. That’s not to say that it couldn’t get back on track of course. There are some pieces of data that need to be collected for administrative reasons, such as the clients name, date of birth and contact details, but the real purpose of an assessment is to find out things like the level of a client’s distress, what kind of support network they have in place, how long the problem has been going on for, how well the client is functioning in everyday life, as well as determining if there is any risk of self-harm, harm to others, or suicide. It can also be beneficial to determine whether the client has had any previous therapy or psychological interventions, and if they are currently taking any medication. Baseline readings of a client’s wellbeing taken at the assessment stage can be used as a benchmark for the future, to see how the therapy is progressing.
Assessments can be done as an initial session, before the counselling really starts, in both agencies and private practise. In some agencies a more experienced counsellor or supervisor may carry out this assessment and decide whether to pass the client on to a trainee or a specialised member of staff, depending on the severity and/or complexity of the client’s presenting problems. In other agencies a volunteer or trainee counsellor may carry out the assessment. In private practise the first session is often used as the assessment, and helps the counsellor determine whether they can help, and also for the client to see if they think they might gel. An assessment can also be carried out by email in the form of a questionnaire. Cognitive Behavioural Therapy often uses such charts and scales to determine the severity of a client’s issues and how they may be feeling, which is very measurable and is one of the reasons why it is popular with the NHS at the moment.
In some ways assessment is similar to diagnosis, but they also have their differences. Diagnosis of mental health disorders are commonly used by those in the medical field such as GPs or psychiatrists, so if a client is diagnosed with depression, anxiety or stress, the relevant course of treatment can be followed, be it therapy or medication. Counsellors typically refrain from such labels and work within the client’s own language for their problems, this helps them conceptualise it in their own minds rather than being influenced by how they think they should feel or act. For example if they were labelled as suffering from depression but didn’t necessarily present all symptoms of the problem, they could act out in a way to fill that particular gap. Clients could also have a negative reaction to being labelled with a certain disorder, thinking that it’s above them, or that “I’m just a normal person, I can’t be clinically diagnosed as a manic depressive”.
On the other hand, an advantage of a client having a label, or being diagnosed with a particular mental health problem could help them if they wished to do some research on it off their own back, or it may give them a vocabulary to better deal with the problem. One of the best ways in which a counsellor helps others is with their knowledge of all the tools available, and how they let the clients themselves use those tools, and become masters of them without them even realising. Once the therapeutic relationship has been established, a counsellor can provide a client with technique or treatment method explained in a language they understand, without the client getting bogged down in reams of counselling theory.
Another important part of assessments and their continuing relevance throughout the therapeutic relationship is referrals. A referral is when a counsellor refers a client to another service that is more suitable for the client’s needs. This could be for a number of reasons, such as a lack of experience with particular problems on the counsellor’s part, or if the client needs specific help with something like their finances or housing. There are many different counselling agencies that specialise in certain areas, as well as other types of support such as women’s refuges, employment agencies, doctor’s surgeries and the Citizens Advice Bureau.
Sometimes it can be hard to make referrals. If a client comes to a counsellor because they feel constantly rejected, referring them to another counsellor may not do them any good – it may well trigger more feelings of rejection. Transitioning to a new counsellor also raises confidentiality issues. Just how much of what a client has told the original counsellor should be passed on to the new one? How much would that influence the new counsellor’s frame of reference?
