BMFT 602: Internship I February 2, 2010

Today’s Agenda Setting up the client file (8:10-8:20) Informal & formal assessment (8:20-9:05) Break (9:05-9:20) Ethical & legal issues (9:20-10:50)

Setting up the Client File Yellow folders - 2nd cabinet from right in Intern Room Date in left-hand corner Client code in right-hand corner - your therapist code plus 01, 02, Label - client’s last name, type of therapy (I, C, F), your last name

Setting up the Client File Three tabs on inside right Sessions - casenotes & progress records (most recent on top) Testing - assessment profiles & other testing Intake - Phone Intake Sheet, signed Client Services & Consent Agreement, Client Info Questionnaire & Assessment Packet, Fee Sheet, other materials such as Releases of Information Inside left Bottom - Opening & Closing Checklist Top - Client Contact Sheet

Assessment Definitions Group of procedures used at outset of therapy to design an initial treatment plan The process of getting to know enough about a family to make informed treatment decisions The sequence of actions taken by the therapist designed to yield information about how the family operates & the functions of the presenting problem in the family

General Assessment Plan Conduct initial assessment Presenting problems Attempted solutions Crisis & stressful life events Rule out substance abuse Rule out biological problems Rule out potential issues of harm Suicide Family violence & abuse Sexual abuse Duty to warn issues

General Psychosocial Assessment Affect, behavior, cognitions Meaning system Spirituality Couple & family system Social systems outside the family Families in larger social context

Significance of Spiritual Assessment Cultural competency Family strengths Client autonomy Accreditation requirements

Definitions Spirituality - an individual’s existential relationship with God (or Ultimate Transcendence) Religion - expression of the spiritual relationship in particular beliefs, forms, & practices that have been developed in community with other individuals who share similar phenomenological understandings of transcendent reality

Spiritual Assessment Options Initial brief spiritual assessment Identifies the effect of clients’ spirituality on service provision & client care Determines whether more comprehensive spiritual assessment is required Spiritual history Narrative framework Anthropological framework - affect, behavior, cognition, communion, conscience, intuition Spiritual lifemap Spiritual genogram Spiritual ecomap Spiritual ecogram

Assessment Decision Tree Hodge (2005) Brief Assessment Brief assessment sufficient or is a comprehensive assessment warranted? Sufficient AssessmentComplete Warranted Are generational/historical factors important? Yes Are generational factors the primary focus or are current relationships also of interest? Generational Spiritual Genogram Generational & Present Spiritual Ecogram No Are current relationships the primary focus or is life history also relevant? Current Relationships Spiritual Ecomap Life History Diagrammatic Spiritual Lifemap Verbal Spiritual History

Other Topics of Assessment Couples - relationship history & sexual functioning Family dynamics Family roles Family emotional expression Family individuation Family power distribution Family communication Family subsystems Readiness for therapy Family rules, myths, & rituals Disengagement Parentification Stress Work-related factors PTSD

Advantages of Formal Assessment Tools Help to objectify & organize treatment effort while establishing atmosphere of purposeful direction to replace family chaos Provide family members an opportunity to systematically understand what others’ concerns are Opportunity to self-disclose through paper & pencil rather than their usual method, which has failed

MFI Assessment Protocol

Instruments Used Adults OQ 45.2 RDAS Beck Depression Inventory Solution Building Inventory Questions re: violence in intimate relationships Premarital clients - PREPARE Adolescents - open-ended questions about relationships with parents/peers

Other Instruments Available in MFI MMPI-2, MMPI-A - need to seek assessment supervision 16PF - need to seek assessment supervision MSI-R Conners FACES

Other Topics of Assessment Couples – relationship history & sexual functioning Family dynamics ▫Family roles ▫Family emotional expression ▫Family individuation ▫Family power distribution ▫Family communication ▫Family subsystems Readiness for therapy Family rules Family myths Family rituals Disengagement Parentification Stress Work-related factors PTSD

Advantages of Formal Assessment Tools Help to objectify & organize treatment effort while establishing an atmosphere of purposeful direction to replace family chaos Provide family members an opportunity to systematically understand what other members’ concerns are Individuals are provided with the opportunity to self-disclose through paper & pencil rather than their usual method, which has failed

MFI Assessment Protocol Other assessments available for use ▫MMPI ▫Connors ▫MAST Supervision – must formally discuss 16PF & MMPI results with supervisor

Break

Ethical & Legal Issues

Suicide Misperceptions ▫Discussing thoughts of suicide will cause an attempt ▫Discounting the seriousness of suicide threats ▫Believing that a therapist cannot intervene effectively Demographics (National Institutes of Mental Health) ▫3 rd leading cause of death for young people ▫4 times as many males as females ages ▫More than 6 times as many males as females ages ▫Per 100,000:  1.3 Children ages  8.2 Adolescents ages  12.5 Young adults ages ▫Highest rates among American Indian and Alaska Natives, Non-Hispanic Whites ▫Lowest rates among Hispanics, Non-Hispanic Black, Asian and Pacific Islanders

Suicide Factors to assess ▫Detail or specificity in the plan ▫Lethality and reversibility ▫Intentionality ▫Proximity ▫What is preventing the person from committing suicide? ▫Family members – Do they prevent or increase the possibility of suicide?

Suicide Characteristics of families w/ suicide potential ▫Inability to accept necessary changes ▫Role & interpersonal conflicts ▫Disturbed family structure ▫One-sided intrafamilial relationships ▫Affective difficulties ▫Communication disturbances ▫Intolerance for crisis

Suicide If a child or teenager is threatening suicide… ▫Develop a safety plan with the parent/guardian that includes…  Contacts for crisis situation  Agreement to remove weapons/harmful substances from the home  Daily parental assessment of suicidal ideation

Suicide MFI Policy ▫No Harm Agreement ▫Contact with resource persons – may get a release to talk with those people ▫Assess the need for psychiatric care or hospitalization ▫Call your supervisor asap after the session ▫Extreme situations – call 911 ▫Assess suicidal ideation every session with your client until the threat is no longer present – best way is to use scaling question ▫Take copious notes

Other Ethical/Legal Issues Sexual attraction to clients Feeling bored/stuck with clients Running into clients outside of therapy Whether or not to accept phone calls at home Touching clients Reporting sexual or physical abuse

General Rule Talk to your supervisor or a trusted colleague as soon as possible!!