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Assessment skills are important because substance abuse counselors should be able to understand the basics of current diagnostic assessment tools and instruments. A competent LCDC should be capable of writing appropriate and professional descriptions of behaviors in regards to addictions. In order to gather relevant information about the client’s substance abuse history, counselors need to practice effective interviewing techniques; the interviews should include the client and other sources of information about the client, such as family members, friends, and coworkers.
A substance abuse counselor should be able to use these skills and explain to the client why and how the assessment takes place. In doing so, the client would have a better understanding of his/her own treatment process.
One of the most important things to remember about a client’s assessment is confidentiality. The assessment is the first opportunity for both the client and the counselor to interact with each other, therefore, confidentiality and professional work ethics should begin here.
Screening and assessment are two different tools. Screening is a process by which we can identify a potential problem with the client’s alcohol and other drug (AOD) use. This tool allows us to determine whether a client is eligible for a particular treatment program.
Assessment is a tool used to confirm the existence of a problem. This allows counselors to identify the nature of the problem and therefore suggest options for treatment. During the assessment process we can identify the client’s strengths and weaknesses, and his/her needs in order to develop an appropriate treatment plan.
Assessment instruments must be reliable and valid. Reliability means that consistent results are obtained under consistent conditions. Reliable assessment instrument provide consistent results when the assessment is repeated under consistent conditions.
Validity is the degree to which a test really measures what we want to measure, and not something else.
Nota bene: Reliability does not imply validity.
1. Goals in a first interview
a. Allow the client to tell you her/his story in her/his own words
b. Let the client know that you understand what she/he believes, even when it includes that she/he does not need to be there.
c. This is not the moment to express that you may disagree with client.
2. The first interview with the self-referred adult
a. The client feels the need to explore the possibility of getting therapy.
3. Prepare yourself in advance
a. Has the client been in the therapy before?
b. Review documentation
- Medical history
- Psychiatric evaluation
- Biopsychosocial assessment
- Previous clinician’s notes
c. Ask yourself
- What don’t I know that I need to know?
- Write down notes and questions you want to ask before calling the client to set up an appointment
- Add a healthy dose of skepticism to everything you find out
4. What to ask your supervisor before the first interview
a. Any questions you have after reading documents provided on the client
b. Whom to include in the interview
c. How long the session should last
d. How often should you see the client
e. How to introduce your self
f. When and how to record sessions
5. When calling the client, remember that
a. Your relationship with the client starts right there
b. How should you introduce yourself to the client
c. Be professional and concerned
d. Remember that this is NOT a therapy session
e. Maintain confidentiality from this moment on
- Find out if, and under what circumstances, you are required by law not to maintain confidentiality.
- Except in those circumstances (above), always get written consent from the client to share identifying information to other agencies
- Telephone calls: remember that even the fact that the individual is a client is confidential information.
- When necessary use fictious names and situations
6. The room set up is important
a. Keep it comfortable and simple
b. How would YOU feel coming here?
7. Before you start the interview
a. Select an assessment instrument, based on
- Your agency
- The age of the client
b. Explain the assessment process to the client
8. Ask your supervisor how you should gather information during the session
a. Taking notes?
b. Just listening?
e. Using a computer?
9. During the interview/session
a. Start where the client is
b. Your concern is the client’s feelings
c. Keep self-disclosure to the minimum
d. The focus is on the client, not on you
e. Practice active listening
f. Do not put words or feelings into your client’s mouth
g. Ask who, what, when, where, and how
h. Don’t ask WHY
- It assumes client knows the answer to his/her problem
- Client might feel attacked and therefore act defensive
- They might tell you more than they are ready to share
- If client tells you more than they meant to, they might never come back
10. Presenting problem
a. Why is the client here now?
- Basic data
11. At the end of the session
a. Leave enough time to ask your client if there are any questions
b. Ask client if she/he would like to come back
c. Give the client a card with information about her/his next appointment
d. Walk your client to the door
e. Be aware of the door-knob syndrome
- Client waits to tell you something very important until there is not time left to discuss it
- You can end the session by saying “That sounds like something we should talk about. Let’s begin with that next week.”
- You NEVER let a client leave your office if you have a sense that she/he might hurt her/himself or others.
Reference: Where to Start and What to Ask – Susan Lukas
1. View of Human Nature
a. REBT assumes that the individual has the capacity to be completely rational, irrational, sensible or crazy, which Ellis believed is biologically inherent .
b. Ellis was most concerned with irrational thinking especially that which creates upsetting or irrational thoughts.
c. Most common irrational beliefs that clients find disturbing (Ellis, 1984, p.266)
i. It is absolutely essential to be loved or approved of by every significant person on one’s life.
ii. To be worthwhile, a person must be competent , adequate, and achieving in everything attempted.
iii. Some people are wicked, bad, and villainous and therefore should be blamed or punished.
iv. It is terrible and a catastrophe whenever events do not occur as one hopes.
v. Unhappiness is the result of outside events, and therefore a person has no control over such despair.
vi. Something potentially dangerous or harmful should be cause to great concern and should always be kept in mind.
vii. Running away from difficulties and responsibilities is easier than facing them.
viii. A person must depend on others and must have someone stronger on whom to rely.
ix. The past determines one’s present behavior and thus cannot be changed.
x. A person should be upset by the problems and difficulties of others.
xi. There is always a right answer to every problem, and a failure to find this answer is a catastrophe.
d. Individuals are easily disturbed because of gullibility and suggestibility
e. Ellis was a proponent of the individual thinking of their behavior as separate from their personhood, i.e. “I did a bad thing” rather than “I am a bad person.”
f. Ellis believed that each individual has the ability to control their thoughts, feelings and their actions. In order to gain this control, a person must first understand what they are telling themselves (self-talk) about the event or situation .
g. Cognitions about events or situations can be of four types: positive, negative, neutral, or mixed. These cognitions result in similar thoughts with positive leading to positive thoughts, negative leading to negative thoughts, etc.
2. Role of the Counselor
a. Counselors are direct and active in their teaching and correcting the client’s cognitions.
b. A good REBT counselor must be bright, knowledgeable, empathetic, persistent, scientific, interested in helping
others and use REBT in their personal lives (Ellis, 1980).
c. The counselor does not rely heavily on the DSM-IV categories.
a. The primary goal is to help people live rational and productive lives.
b. REBT helps people see that it is their thoughts and beliefs about events that creates difficulties, not the events or situations themselves
c. REBT helps the client to understand that wishes and wants are not entitlements to be demanded. Thinking that involves the words must, should, ought, have to, and need are demands, not an expression of wants or desires.
d. REBT helps clients stop catastrophizing when wants and desires are not met
e. REBT stresses the appropriateness of the emotional response to the situation or event. An situation or event need not elicit more of a response than is appropriate
f. REBT assists people in changing self-defeating behaviors or cognitions
g. REBT espouses acceptance and tolerance of self and of others in order to achieve life goals
a. The first few sessions are devoted to learning the ABC principle:
i. Activating event
ii. Belief or thought process
iii. Emotional Consequences
b. Cognitive disputation is aimed at asking the client questions challenging the logic of the client’s response.
c. Imaginal disputation has the client use imagery to examine a situation where the become upset. The technique is used in one of two ways:
i.The client imagines the situation, examines the self-talk, and then changes the self-talk leading to a more moderate response.
ii.The client imagines a situation in which they respond differently than is habitual, and are asked to examine the self-talk in this
d. The Emotional Control Card is an actual card intended for the client to carry in their wallet which has a list of inappropriate or self-destructive feelings countered with appropriate nondefeating feelings. In a difficult situation, the client has this reference card on their person to help them intervene in their own self-talk. (source: http://www.liverehab.com/rational-emotive-behavioral-therapy)
e. Behavioral disputation involves having the client behave in a way that is opposite to the way they would like to respond to the event or situation.
f. Confrontation occurs when the counselor challenges an illogical or irrational belief that the client is expressing.
g. Encouragement involves explicitly urging the client to use REBT rather than to continue self-defeating responses.