Formal assessments in counselling and therapy

Formal assessments used in emotive-cognitive counselling and psychotherapy

By Dr Jim Byrne; Updated on 12th September 2022

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The power of exploratory and diagnostic assessments to heal emotional wounds, and/or to help with meaning-making and the problem solving process.

Assessment in counselling, healing effectsIn the early years of my counselling practice, I was reluctant to get involved in providing formal assessments for clients, using questionnaires.  (I preferred to conduct informal assessment, through conversation, over time). I occasionally dabbled with a questionnaire or two, when I felt stalled with a client, but I could see their limitations. In particular, I disliked formal assessment because I believed that psychiatric assessments tend to place individuals in “mental health boxes” out of which it is difficult to escape. In other words, I was aware of the potential for psychiatric assessments to have a harmful effect on individual clients. (And the history of assessment in the social sciences, from Galton onwards, left a lot to be desired, in terms of honesty and human values).

During the early years of my counselling practice, I had a relatively simple model of human disturbance – at the core of which was Dr Albert Ellis’s simple (and simplistic!) ABC model, which asserts that people are upset by their beliefs – PERIOD! Or Full Stop!  (I did occasionally use the 100 item questionnaire from REBT, until I met a very disturbed client who could immediately see how to answer the questions so that he got a score of 100% Rational; so then his wife had to be the problem.  When I reflected upon this experience, I realized that a young teenager could figure out which answers they “had to give” in order to appear to be wholly rational! End of experiment!)

Dr Jim in Thirsk001Over time, I also realized that the REBT model is a partial, limited, and client-blaming philosophy of therapy.

I also discovered that some individuals were emotionally distressed because of what was going on in their guts – as in the case of  a person who is depressed because of the overgrowth of Candida Albicans in their large intestine (even in the absence of any psychological trigger!).

And then I discovered that some individuals were engaged in relationship conflict, because of their lack of sleep; or feeling overloaded with work.

And, in the biggest blow, I discovered that not all clients “lead with their thinking” – which is one of the central assertions of rational therapy.  Some lead with their feelings. Some lead with their behaviour. (Joines and Steward, 2002).

So then I had to open my mind to the possibility that there might be ways of doing formal assessments which would give me the optimum amount of information about my client’s lives, so that I could quickly and easily help them to focus on the areas of maximum leverage in their lives.

And, so, that is what I now do.  Before I meet with any client, I want to know about some of their fundamental personality states and traits; some of their basic lifestyle habits; and, very often, something about their early childhood, including their attachment style, and whether or not they experienced childhood developmental traumas.

Publication CoverAnd then, very recently, I read an article which summarizes some research which demonstrates that almost half of a group of grief counselling clients were helped sufficiently by the initial formal assessment process alone, and did not need to go on to have any grief counselling. The process of going through the formal assessment helped them to think/feel through their situations, and to create a helpful narrative about their life, which allowed them to move on. (See Wilson, James and Gabriel, 2016: Making sense of loss and grief: the value of in-depth assessments

https://www.tandfonline.com/doi/full/10.1080/02682621.2016.1218127)

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Postscript: But I do not just do formal assessments in my opening sessions. I also have a face to face (or Skype) meeting, after completion of the relevant questionnaires; then a follow-up “session review report”, and then 5 to 7 follow-up psycho-educational documents (known as ‘bibliotherapy’), to help the client learn the knowledge and skills that will help them to resolve the problem(s) which we had discussed.

And in the first session after the formal assessments, I am largely engaged in “informal assessment”, which involves trying to make sense of the results of the formal assessments, in the context of the life history – or relevant life story – of the client.  And this often modifies some aspects of the formal assessment.  For example, recently I worked with a young woman whose formal assessment revealed certain aspects of her personality functioning, but concealed some other aspects, which only came to light during the informal conversational assessment phase. As a result of integrating the formal and informal assessment, we now have a much better understanding of her personality traits and states.

At other times, the formal and informal assessments are later modified by features of the client’s psychological functioning which only emerge during the act of working through a particular therapeutic process.

So flexibility and creativity are as important as formal assessment data!

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