Chapter 7 Assessment, Formulation, and Goal Setting

Chapter 7 Assessment, Formulation, and Goal Setting

Chapter Outline

Chapter 7 Assessment, Formulation, and Goal Setting

I. Assessment

A. Levels of Assessment

1. Process of the assessment

a. Why am I doing the assessment?

b. Who is the client?

c. What do I want to know?

d. How should I gather the information?

e. Where should the assessment take place?

f. When will I have enough information to plan?

2. Content of the assessment

a. Who are the important people in the client’s life?

b. What are the presenting problems, strengths and resources?

c. Where do the successes and problems occur and where will intervention be most effective?

d. Why is the client coming now and interested in continuing?

e. When did the problems begin and when in the client’s life am I entering the story?

f. How can I, the client, and others help?

B. Formal Clinical Assessment

1. Diagnosis, treatment planning or research

2. Individuals, families, organizations

3. Intrapersonal

4. Interpersonal

5. Sociopolitical barriers and assets

6. Spiritual resources

7. Impact of larger social forces—poverty, racism, oppression

Box 7.1 Assessment Outline

C. Methods of Assessment

1. Interviews

2. Observations

3. Testing

4. Review of life records

Box 7.2 Release of Information

D. Techniques of Assessment

1. Exploration and elaboration: questioning, prompting, probing, reflecting, summarizing, underlining, refocusing, and initiating new topics

2. Sustaining techniques

3. Encouraging the client to assess the clinician

E. All Interviewing Requires Assessment

1. Understanding before responding

2. Assessment becomes second nature

F. Principles of Assessment

1. Assessment should be reliable

2. Assessment should be valid

3. An objective and an outcome of initial conversation as well as an ongoing process guiding clinical interchange.

4. Includes evaluation of the clinician, the relationship, the appropriate services, the surround, and the interface between all

5. Culturally responsive

Figure 7.1 Culturagram

6. The more methods and strategies used to assess, the more balanced the understanding

Figure 7.2 Strength-based Genogam

Exercise 7.1 Your Strength-based Genogram

7. Multiple perspectives add new dimensions

8. What is observed is altered by the presence of the observer

9. Clinicians can be drawn or "inducted" into systems they are assessing

10. Where assessment carried out influences the kind of data gathered

11. Seeing the client at only one particular moment in time

12. The assessor is also being assessed by the client

13. Research informs clinical assessment

14. Real understanding involves more than data gathering

II. Conceptualization or Formulation of Assessment Findings

1. The sum of investigations and hypotheses

2. What facts imply about past and present functioning, potentials, issues, and dynamics

3. Condenses and attributes meaning to rich data

4. May include formal DSM diagnoses

5. Addresses client motivation for change

6. May include prognostic statements and implications for planning

7. Multidisciplinary team

A. Levels of Inference

1. Low levels stay close to the data

2. Moderate levels often base hunches on correlations between one behavior and another

3. The greater the speculation, the higher the level of inference

4. Level often related to clinician’s theoretical orientation

Exercise 7.2 Moving from Data to Inference

B. Formal DSM Diagnosis

1. Categorization of symptoms into discrete diagnostic categories

2. Multiaxial system

Box 7.3 DSM-IV-TR Criteria for Major Depressive Episode

Box. 7.4 5 Axes of DSM-IV-TR

3. Danger of reducing people to symptoms

4. Cultural biases

5. Cultural formulation

C. Moving Beyond Formal Diagnosis

1. Strengths and coping mechanisms

D. Reformulation and Reconceptualization

1. Ongoing process

2. Clients may disclose more over time—requiring reformulation

III. Assessment Summaries or Psychological Reports

A. Formulation

1. Often required for managed care and insurance

2. Avoid speculation

3. Clearly written, no jargon

CLIP 7.1 ASSESSMENT AND FORMULATION

B. Communicating Assessment Findings

1. Sharing information gathered

2. Helps if significant others present and communication is directed to whole group

3. Strengths and assets

4. Developmental issues and challenges

5. Areas for further work

6. Cultural awareness and judgment required

IV. Goal Setting

A. Desired Outcomes

1. Short-term and long-term goals

2. What clients do well and want to sustain and enhance

3. Issues to be addressed, problems to be resolved, resources and skills needed

B. Specific and concrete

Exercise 7.3 Turning Abstract Goals into Concrete Goals

C. Partializing and Prioritizing

1. Breaking goals down into objectives

Exercise 7.4 Partializing

2. Prioritizing

a. from simple to difficult

b. staging the work

c. outside factors may affect

d. different stakeholders may have different goals

Exercise 7.5 Prioritizing

CLIP 7.2 DEVELOPING GOALS

V. Conclusion