Using Assessment in Counseling PSY 504: Psychological Measurement

Treatment Planning Varies with client Assessment of the client’s level of functioning Statistical methods are much better predictors than clinician judgment Tests can lead to a better understanding of clients, which has a direct influence on the effectiveness of the treatment Gather quality information and evaluate it with a scientific approach

Treatment Planning More than just determining diagnosis To what degree are the problems affecting the client? What environmental or social factors are contributing to the client’s issues? What are the client’s strengths? Are there cultural issues that need to be considered? What is the prognosis?

Treatment Matching Beutler, Malik, Talebi, Fleming, and Moleiro’s (2004) suggest the following client characteristics to consider in treatment selection: Functional impairment – clients get worse if counselors underestimate level of impairment Subjective distress Problem complexity Readiness for change – includes identification of problems and motivation Reactant/resistance tendencies – more helpful to ask self, “what can I do to improve the therapeutic relationship and increase motivation?” Social support – quality, not quantity Coping style – clients tend to have patterns in how they respond to distress Attachment style – may be contributing to clients’ current issues; the counseling relationship is a strong predictor of positive outcome

Treatment Matching Rather than solely identifying client weaknesses, assessment procedures should also focus on identifying and enhancing human strengths and optimal functioning Positive Psychology – focuses on developing strengths and enhancements of well-being, while at the same time not ignoring weaknesses An important area to consider when assessing strengths is optimism – concerns hopeful expectation and a general expectancy that the future will be positive Dispositional optimism is associated with fewer depressive episodes, coping strategies that are more effective, and fewer physical symptoms than a pessimistic outlook

Case Conceptualization and Assessment A model for case conceptualization (Meir, 2003) Step 1: Identify the initial process and outcome elements Focus on the client’s problems and the processes that lead to the problematic behavior Step 2: Learn etiology of client problem The causes, precipitants, and maintaining influences of a client’s problems Step 3: Choose interventions for selected problems Should consider an empirically supported intervention Step 4: Consider the time frame of interventions and outcomes Step 5: Represent the conceptualization explicitly The more explicit, the easier to test, modify, and act on Step 6: Include at least one alternative explanation Step 7: Consider the model’s balance between parsimony and comprehensiveness

Monitoring Treatment Progress (Evaluation and Accountability) Two major types of evaluation: Formative – continuous or intermediate evaluation typically performed to examine the process Summative – more cumulative and focused on endpoint or final evaluation (i.e., product) [used for evaluation of accountability] Emergence of managed-care = demand for accountability information from clinicians Many managed-care organizations will not approve counseling services unless clinicians can show they are effective with clients

Monitoring Treatment Progress (Evaluation and Accountability) Assessing outcome should occur throughout treatment, not just at termination – i.e., formative – not a “one-time event” Counselors are increasingly required to evaluate their services and provide documentation of their effectiveness Better therapeutic outcomes result when clinicians receive feedback about clients’ progress during therapy And then shared with clients

Monitoring Treatment Progress (Evaluation and Accountability) Counselors should be adapting the methodologies and measures developed in counseling outcome research It is important to first determine what needs to be evaluated There needs to be a direct connection between the services provided and the outcome measures used Gather baseline information at the beginning Outcome Questionnaire (OQ-45.2) Symptom Checklist-90-Revised (SC-90-R) Brief Symptom Inventory (BSI)

Monitoring Treatment Progress (Evaluation and Accountability) Assessing outcome involves (Hill & Lambert, 2004): Clearly specify what is being measured Measure change from multiple perspectives (client, counselor, and outside observer) Use diverse types of assessments (e.g., rating scales, checklists) Use symptom-based and atheoretical measures Examine patterns of change as much as possible Scheme for Selecting Outcome Measures (Olges, Lambert, & Fields, 2002): Content (cognition, affect, behavior) Social level (interpersonal, intrapersonal, social role) Source (self, therapist, trained observer, relevant other) Technology (global, specific, observation, status) Time Orientation (trait, state)