Assessment and Coaching Skills
Lecture 1
Assessment is the first step in treatment. It not only checks diagnostic info but also is a dynamic
patient centred process providing biopsychosocial info.
Assessment = skilled information processing, using various instruments (e.g. clinical interviews),
which gives direction to decisions which concern the client (treatment, referral etc.). It identifies
strengths and weaknesses and can speed up the therapeutic process. Not labelling, but telling a
story.
5 basic assessment questions:
1) recognition: what are the problems?
2) explanation: why?
3) prediction/prognosis: how will the problems develop?
4) indication: which treatment?
5) evaluation: has it been resolved?
Phases of Clinical Assessment
1. EVALUATE REFERRAL QUESTION: what specific question needs to be answered by
assessment? What is the motive of referral and who are parties involved? What decision
needs to be made and who should be informed? If the referral question is not evaluated
there can be errors in test interpretation and results.
2. CLINICAL AND COLATTERAL INTERVIEWS: first contact with patient, forms clearer
hypothesis, you gain information on various aspects of patient's life
3. DEVELOP HYPOTHESIS: what factors are causing or reinforcing the problem? Must make
sense within specific psychological framework, e.g. social learning theory, cognitive
behavioural perspective etc.
4. SELECTING TESTS: tests should rule in or out the hypothesis, be aware of social and
demographic characteristics of client, make sure the test is appropriate for them
5. ADMINISTRATING AND SCORING TESTS: use appropriate norm groups
6. EVALUATION OF HYPOTHESIS: do we want to reject, modify or accept it
7. INTEGRATING DATA: making sense of data and integrating it to communicate it to client and
show how factors interact to the client (creating a dynamic understanding)
8. RECOMMENDATIONS: clear (evidence based), specific (to the individual) and reasonable, so
as to improve patient’s conditions
Ethical Practice of assessment: informed consent, clear explanation of assessment procedure,
confidentiality and when to break it, developing professional relationship. Also, awareness of stigma
attached to certain psychiatric diagnoses and awareness of diversity in demographics.
- patient centred assessment feedback = intervention, as it is not just informative but also reduces
distress
The Biopsychosocial Lens is important as there is always complex interplay of these 3 factors.
Treatment should not only address symptoms, as symptoms are triggered by life events/stressors
but based in biopsychosocial vulnerabilities. Main point = symptoms are enough for a diagnosis but
do not detail the development or backstory and have no predictive value.
,Basic instruments of assessment: clinical interview, behavioural observation, standardized screening
instruments
- obstacles to this include interviewer bias, differences in interaction, be aware of observation vs.
Interpretation
Behavioural observation -
Assessment is the first step of treatment - it is not only checking diagnostic criteria, it is dynamic and
patient-centred - it provides biopsychosocial info which should aid problem solving and decision
making
Tutorial
Therapeutic Alliance = mutual experience and expression of feelings, attitudes, thoughts and
behaviours between client and therapist during a therapeutic encounter.
Overlapping phases:
- establishing a mutuality (creating equal footing, consent and setting the stage)
- finding a fit in communication (congruent with emotional, speech and the cognitive level of client)
- activating the power of the client (from helplessness to being an active participant in treatment)
There is a dilemma of proximity and distance: maximum proximity whilst maintaining distance,
Distance = attitude of investigating, neutral stance, no judgement
Proximity = personal presence, empathy, safety
Interaction – can be issues with “no equivalent communication”, for example client expects you to
take authority or fix the problem instantly.
Good communication skills: affirmation, validation, normalization, reframing, self-disclosure,
fostering hope, empowering
Readings
a good psychological report:
- clarify thinking and crystalize interpretations
- all advantages and limitations involved with clinical judgement
- focus on the communication of interpretations, conclusions and recommendations
Phases in clinical assessment:
1) evaluating referral question = many practical limitations are due to inadequate clarification of the
problem. One can also not assume that initial requests for evaluation are adequately stated (can be
hidden agendas, complex interpersonal relationships).
2) data collection = many sources, e.g. school, medical and police records, observations etc. A
clients' history is often more important than test scores. Clinicians must have in depth knowledge
about what they are measuring for a good evaluation.
3) interpreting data = etiologic descriptions should focus on multiple interacting factors and support
recommendations for client. Use data to develop effective intervention plan, and pay attention to
incremental validity and limitations. Not labelling, but providing deeper understanding of patient.
Availability bias of interviewer = focusing on just one salient symptom
, Representativeness bias of interviewer = focusing only on characteristic symptoms of referral
question that mentions a specific diagnosis
Criticism of biopsychosocial model: can lead to use of whichever lens the clinician most favours,
allowing clinicians to justify their conclusions about the aetiology and treatment of
recommendations
Psychological disorders are result of complex interactions of an array of biological vulnerabilities and
dispositions, with many significant environmental and psychosocial events that can exert their
effects over time.
Biopsychosocial lens that is developmentally oriented can help formulate hypotheses about past and
present contributing factors.
Understanding many potential aetiologies of specific symptoms and behaviours, rather than
symptom sets and diagnoses, to understand what leads to and how to treat psychopathology
Aetiology = causation
Biological lens = many of the same psychological symptoms are present across many disorders
Psychological lens = e.g., someone with depression viewing past present and future in a more
negative light, or someone with somatization disorder hyper focusing on somatic dysfunction. Keep
in mind the patients' mental state.
Sociocultural lens = looking at the context of social life/pressures
Lecture 2
A first impression is when one forms a mental image of another, with accuracy varying depending on
the observer and target.
Interviewers tasks are defined by
- interviewer's personal goals
- contextual requirements
- goals and demands of the client
Interviewers can gain info on: why the client came, current symptoms, treatment options, central
problem-specific concepts of the client (beliefs and goals), general concepts of the client (beliefs and
goals), clients resources and competences
Building a therapeutic alliance - a stable emotional relationship - is important. Emotional closeness,
sympathy, and a fostering of trust and openness, and developing credibility and value-freedom of
assessor is important.
What can influence the client to come back? degree of suffering, expectancy of success, demands of
client, positive emotional experience
Positive markers of therapeutic alliance:
- purposive, targeted relationship
- work relationship
Lecture 1
Assessment is the first step in treatment. It not only checks diagnostic info but also is a dynamic
patient centred process providing biopsychosocial info.
Assessment = skilled information processing, using various instruments (e.g. clinical interviews),
which gives direction to decisions which concern the client (treatment, referral etc.). It identifies
strengths and weaknesses and can speed up the therapeutic process. Not labelling, but telling a
story.
5 basic assessment questions:
1) recognition: what are the problems?
2) explanation: why?
3) prediction/prognosis: how will the problems develop?
4) indication: which treatment?
5) evaluation: has it been resolved?
Phases of Clinical Assessment
1. EVALUATE REFERRAL QUESTION: what specific question needs to be answered by
assessment? What is the motive of referral and who are parties involved? What decision
needs to be made and who should be informed? If the referral question is not evaluated
there can be errors in test interpretation and results.
2. CLINICAL AND COLATTERAL INTERVIEWS: first contact with patient, forms clearer
hypothesis, you gain information on various aspects of patient's life
3. DEVELOP HYPOTHESIS: what factors are causing or reinforcing the problem? Must make
sense within specific psychological framework, e.g. social learning theory, cognitive
behavioural perspective etc.
4. SELECTING TESTS: tests should rule in or out the hypothesis, be aware of social and
demographic characteristics of client, make sure the test is appropriate for them
5. ADMINISTRATING AND SCORING TESTS: use appropriate norm groups
6. EVALUATION OF HYPOTHESIS: do we want to reject, modify or accept it
7. INTEGRATING DATA: making sense of data and integrating it to communicate it to client and
show how factors interact to the client (creating a dynamic understanding)
8. RECOMMENDATIONS: clear (evidence based), specific (to the individual) and reasonable, so
as to improve patient’s conditions
Ethical Practice of assessment: informed consent, clear explanation of assessment procedure,
confidentiality and when to break it, developing professional relationship. Also, awareness of stigma
attached to certain psychiatric diagnoses and awareness of diversity in demographics.
- patient centred assessment feedback = intervention, as it is not just informative but also reduces
distress
The Biopsychosocial Lens is important as there is always complex interplay of these 3 factors.
Treatment should not only address symptoms, as symptoms are triggered by life events/stressors
but based in biopsychosocial vulnerabilities. Main point = symptoms are enough for a diagnosis but
do not detail the development or backstory and have no predictive value.
,Basic instruments of assessment: clinical interview, behavioural observation, standardized screening
instruments
- obstacles to this include interviewer bias, differences in interaction, be aware of observation vs.
Interpretation
Behavioural observation -
Assessment is the first step of treatment - it is not only checking diagnostic criteria, it is dynamic and
patient-centred - it provides biopsychosocial info which should aid problem solving and decision
making
Tutorial
Therapeutic Alliance = mutual experience and expression of feelings, attitudes, thoughts and
behaviours between client and therapist during a therapeutic encounter.
Overlapping phases:
- establishing a mutuality (creating equal footing, consent and setting the stage)
- finding a fit in communication (congruent with emotional, speech and the cognitive level of client)
- activating the power of the client (from helplessness to being an active participant in treatment)
There is a dilemma of proximity and distance: maximum proximity whilst maintaining distance,
Distance = attitude of investigating, neutral stance, no judgement
Proximity = personal presence, empathy, safety
Interaction – can be issues with “no equivalent communication”, for example client expects you to
take authority or fix the problem instantly.
Good communication skills: affirmation, validation, normalization, reframing, self-disclosure,
fostering hope, empowering
Readings
a good psychological report:
- clarify thinking and crystalize interpretations
- all advantages and limitations involved with clinical judgement
- focus on the communication of interpretations, conclusions and recommendations
Phases in clinical assessment:
1) evaluating referral question = many practical limitations are due to inadequate clarification of the
problem. One can also not assume that initial requests for evaluation are adequately stated (can be
hidden agendas, complex interpersonal relationships).
2) data collection = many sources, e.g. school, medical and police records, observations etc. A
clients' history is often more important than test scores. Clinicians must have in depth knowledge
about what they are measuring for a good evaluation.
3) interpreting data = etiologic descriptions should focus on multiple interacting factors and support
recommendations for client. Use data to develop effective intervention plan, and pay attention to
incremental validity and limitations. Not labelling, but providing deeper understanding of patient.
Availability bias of interviewer = focusing on just one salient symptom
, Representativeness bias of interviewer = focusing only on characteristic symptoms of referral
question that mentions a specific diagnosis
Criticism of biopsychosocial model: can lead to use of whichever lens the clinician most favours,
allowing clinicians to justify their conclusions about the aetiology and treatment of
recommendations
Psychological disorders are result of complex interactions of an array of biological vulnerabilities and
dispositions, with many significant environmental and psychosocial events that can exert their
effects over time.
Biopsychosocial lens that is developmentally oriented can help formulate hypotheses about past and
present contributing factors.
Understanding many potential aetiologies of specific symptoms and behaviours, rather than
symptom sets and diagnoses, to understand what leads to and how to treat psychopathology
Aetiology = causation
Biological lens = many of the same psychological symptoms are present across many disorders
Psychological lens = e.g., someone with depression viewing past present and future in a more
negative light, or someone with somatization disorder hyper focusing on somatic dysfunction. Keep
in mind the patients' mental state.
Sociocultural lens = looking at the context of social life/pressures
Lecture 2
A first impression is when one forms a mental image of another, with accuracy varying depending on
the observer and target.
Interviewers tasks are defined by
- interviewer's personal goals
- contextual requirements
- goals and demands of the client
Interviewers can gain info on: why the client came, current symptoms, treatment options, central
problem-specific concepts of the client (beliefs and goals), general concepts of the client (beliefs and
goals), clients resources and competences
Building a therapeutic alliance - a stable emotional relationship - is important. Emotional closeness,
sympathy, and a fostering of trust and openness, and developing credibility and value-freedom of
assessor is important.
What can influence the client to come back? degree of suffering, expectancy of success, demands of
client, positive emotional experience
Positive markers of therapeutic alliance:
- purposive, targeted relationship
- work relationship
