Assessment & Treatment
A comprehensive mental health assessment consists of a brief interview with the parents/caregivers, as well as reviewing the social history information that they provided. This assessment is combined with a face-to-face interview with the young person. During the interview, the client and clinician assess which symptoms and behaviors are most life impairing. Through a series of interview questions, the clinician effectively rules out a plethora of different mental health concerns that could be contributing to the client’s need to see a counsellor. Once the assessment is complete, the clinician, client, and their parents/caregivers develop a treatment plan that strives to get the young person happy and healthy and the clinician out of their life. In situations involving older youth and young adults, parents/caregivers may not be involved in the assessment process, although each situation is unique.
A good clinical assessment is an ongoing process. Although an initial comprehensive assessment is conducted during the first session, good clinical practice always involves the process of ongoing reassessment in order to ensure that the client is being provided with the most effective treatment plan possible. Both the assessment and treatment plan should be evidence-based, which means they are informed by empirical research that proves their effectiveness.
Example of Assessment & Treatment
Take the case of someone who may have depression. The methods used to treat depression caused by substance abuse would be different from those used to treat depression caused by grief and loss. A comprehensive mental health assessment not only helps identify the underlying factors that may be causing difficulty for the client, it also helps the client and clinician categorize which symptoms and behaviors are of most concern and how all of them impact and are related to each other. The assessment is the ‘figuring out’ and ‘planning’ stage of counselling. A good treatment plan for any client is one that is transparent and explores all possibilities without making assumptions about the underlying cause of one’s mental health concerns.
Research shows that it’s the rapport between the therapist and client that determines the effectiveness of counselling. Without good rapport, counselling will be less effective, regardless of the clinical modality used. Therefore, it is often better to focus on relationship building, as well as an effective and ongoing assessment, than it is to focus on staying within the confines of a particular clinical modality. In my opinion, becoming overly focused on the use of a particular clinical modality doesn't allow for flexibility. Human beings are dynamic and ever-changing. As a result, they will likely benefit most from a counselling approach that is equally dynamic and ever-changing. When a counsellor becomes overly focused on using a particular clinical modality, they may lose sight of alternative approaches that could yield more positive results. The goal should never be to have the client fit into the counsellors preferred therapeutic approach, but rather have the counsellor offer a therapeutic approach that fits the clients needs.
The Difference in Clinical Modalities
The bulk of my training is in cognitive behavioral therapy, dialectical behavioral therapy, and applied behavioral analysis. That said, my clinical practice doesn’t operate exclusively within the framework of these clinical modalities, as there is similar overlap among many clinical modalities in that they share common approaches and strategies. For example, cognitive behavioral therapy can look very similar to other clinical modalities, such as narrative therapy.
The effectiveness as a counsellor has a lot to do with how a particular clinical modality is provided to the client, not the modality itself. For example, throughout my career, I have conducted countless sessions with kids on a beach; batting rocks into the ocean with a stick while using diagrams and drawings in the sand to illustrate the principles of cognitive behavioural therapy. Another counsellor could easily look at this and describe it as a form of play therapy. Without an effective approach, the teachings of any clinical modality can become completely lost on the client. At the same time, a great approach can be ineffective if it is not supported by an evidence based clinical modality.
Parent Involvement
The most effective treatment plan for children & youth is one that involves their parents/caregivers. Young people sometimes have a hard time implementing skills they learn in counselling. The younger the child, the more this can occur. This is why it’s very important for parents to be involved in their child’s assessment and treatment plan. Parents also play an important role when it comes to understanding how mental health issues impact their child, as they often observe changes and behaviours that the child is unware of or doesn’t report their counsellor. Lastly, parents can sometimes help shape the success of their child resolving their mental health issues by implementing different behavioural modification/parenting strategies in the home. It is not uncommon for child & youth counsellors to sometimes work exclusively with the parents/caregivers of a younger child or a teenager who is not willing to attend counselling. Whenever this is the case, I am willing to work specifically with a child/youth’s parents/caregivers as a means of helping them create strategies to resolve their child’s mental health concerns. Parent/caregiver involvement in the counselling process isn’t just exclusive to children and youth who aren’t able to participate in counselling. Even in cases where I am working individually with a young person, conducting regularly scheduled appointments and updates with their parents/caregivers can be essential for best practice. Of course, parent/caregiver involvement should always be done in a way where it doesn’t jeopardize the client’s confidentiality.
Clinical Supervision
Clinical supervision is a very important part of any counsellor’s practice, as it offers an opportunity to engage in well informed case formulation so the counsellor can develop the most effective, evidence based treatment plan for their client. As counsellors, it can sometimes be hard to objectively assess or formulate best practices for our clients when we’re the only one assessing our client’s needs. I provide clinical supervision to other counsellors, either online or in-person.
I know what it’s like to feel stuck or alone, having worked in remote communities with extremely complex cases that present risk to both the client and community. I understand how challenging it can be to find good supervision and how equally important it is to receive supervision from someone who is well-informed, calm & patient, listens, enjoys problem solving, and has in-depth clinical experience.
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