What is the evaluation session? - Chapter 5

This chapter will discuss the evaluation session with the use of subquestions.

The first meeting with a client is the evaluation session. Effective cognitive behavioral therapy requires the therapist to evaluate clients thoroughly, so that the therapist can accurately formulate the case, conceptualize the individual client, and plan treatment. Assessment is not limited to the first meeting, because with each session the client will enclose new information. Even if another clinician has performed the evaluation, the current therapist will at least need to collect additional information before starting with the therapy. Before the first session takes place, the therapist needs to collect as much information as possible about the client. In the first session it can be discussed if it could be helpful if the client would bring a close friend or family member to one of the sessions. This could provide the therapist with more information and insight into the client’s life. It is important that the therapist lets the client know what to expect from the appointment. This is called: setting the agenda.

What are the goals of an assessment session?

A checklist of sorts can be applied when it comes to the assessment session:

• The therapist can create a case conceptualization of the client.

• The therapist should consider if he/she is the right therapist for the client. For example: Does the therapist have enough time for the client?

• The therapist should consider whether additional services or treatment (such as medication) may be indicated.

• The therapist should initiate a therapeutic alliance with the client.

• The therapist educates the client about CBT.

• The therapist identifies goals and an easy Action Plan.

For the therapist it is desirable to collect as much information as possible before the evaluation session.

How would a therapist structure an assessment session?

Once again, a checklist could be applied to the session that would look roughly like this:

• Greet the client.

• Collaboratively decide whether a family member should attend.

• Set the agenda.

• Conduct the assessment.

• Set initial broad goals.

• Link the tentative diagnosis to the broad treatment plan and educate the client about CBT.

• Make an Action Plan together.

• Set expectations.

• Summarize and elicit feedback from the client.

In the assessment phase the therapist will ask about many areas of the client’s current and past experience. Another important part of the evaluation is asking clients how they spend their time. Are there variations in their mood? How do they interact with other people? How are they functioning at school/work? Are they actively avoiding situations? These are questions that can be answered if a client describes his/her typical day. A therapist needs to be alert for indications that the client is unsure about committing to the treatment.

In the final part of the assessment, it is useful to ask clients whether there is anything else important to know. At the end the therapist needs to explain that he will need to review notes and form an eventual diagnosis. It depends on the client whether it is a good idea to tell them their diagnosis, or if it is better to just summarize the problems and symptoms the client is experiencing without labeling it in the form of a diagnosis.

Setting goals and relating to a treatment plan at the end of the session can provide clients with hope. The therapist also sets the expectations for treatment, including: how long clients should expect the treatment to take.

Creating an easy Action Plan with clients at the evaluation gets them accustomed to the idea that it is important to carry on the work of the session throughout the week. The therapists should make sure he/she keeps a copy of the Action Plans.

The clients should have reasonable expectations for the treatment.Having the right expectationts can help reduce the possibility of termination and lead to better outcomes of the treatment. Give clients a general sense of how long they should expect treatment to take.

After the first session the therapist writes a cognitive conceptualization and comes up with a treatment plan. The therapist should check his/her findings with other health professionals to collect more information about the client.