Assessments

….ahh, assessments the bane of existence to clinicians and client alike. They are tedious, time consuming where at best the questions feel irrelevant and repetitive and at worst invasive and uncomfortable. The only thing that’s worse than an assessment is having any answer raise the flag for another one.

   It seems there’s no shortages of assessments to examine when a new patient needs services. And why exactly do we need to do all these assessments?

   Because they help. They help discover mitigating factors, skills, obstacles, trauma,symptoms, substance use, maladaptive behavior, coping skills, stressor and supports among other things. All of which combine to help us make a diagnosis and create a treatment plan.

   Everyone thinks the biggest problem with an assessment is asking the uncomfortable questions or keeping the client from getting annoyed, frustrated, angry or shutting down. But, I think it’s the lying.

  Not every client lies, but most of them do…at some point at least. It’s not that they don’t trust you, or that they’re trying to be difficult, or that they don’t want help. There’s just so much guilt, shame and stigma attached to mental health, addiction and so many other aspects if life. Will the number of sexual partners, drinks on the weekend, or any other secrets kept be the thing that they’re judged for?

   I used to think assessments would be more truthful when it involved children, because there were multiple sources. Clearly gaps and inconsistencies would be sorted by having multiple narrators…alas no. Parents, grandparents fear judgement just as badly as an individual. Families harbor secrets ,trauma and dysfunction like anyone else.

  So we take what we learn and we make the best of it. We try to paint the clearest picture we can as we create a workable game plan to help this person heal, function, thrive and learn.

  15 year-old Female just released from inpatient 30 days with a history of running away and self harm. She has a family history of depression, substance use disorder and anxiety.

Client reports feelings of depression, anxiety, anger, sexualized behavior and trouble regulating her emotions. She reports vaping, marijuana use, occasional use of hallucinogenic, and using pain pills such as vicodin & codeine.

She lives with her Father, Grandmother & Grandfather, as her grandfather is currently in hospice care. Dad was awarded custody and there is no relationship with biological mother. There is a history of severe neglect and abuse with her mother, but client is unwilling to give further details.

Client has a history of skipping meals, binging, but no reports of purging. Reports enjoying soccer, reading and baking. No reported suicidal ideation, plans to commit suicide or previous attempts. No instances of violence or threats of violence to others.

While an initial diagnosis of depressive disorder single episode, unspecified anxiety ,unspecified trauma and adjustment disorder there is also a risk of future substance use disorders.

Which leads to the agenda of using DBT and TFCBT to treat and to create a treatment plan next session, during part 2 of the assessment.

……until next week