BMFT 602: Internship IFebruary 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

Setting up the Client File

Assessment Definitions

General Assessment Plan

General Psychosocial Assessment

Significance of Spiritual Assessment

Definitions

Spiritual Assessment Options

Assessment Decision TreeAssessment Decision TreeHodge (2005)Hodge (2005)

Brief AssessmentBrief Assessment

Brief assessment sufficient or is a comprehensive assessment warranted?Brief assessment sufficient or is a comprehensive assessment warranted?

SufficientSufficient

AssessmentAssessmentCompleteComplete

WarrantedWarranted

Are generational/historical factors important?Are generational/historical factors important?

YesYes

Are generational factors the primary focus or are Are generational factors the primary focus or are current relationships also of interest?current relationships also of interest?

GenerationalGenerational

Spiritual GenogramSpiritual Genogram

Generational & PresentGenerational & Present

Spiritual EcogramSpiritual Ecogram

NoNo

Are current relationships the primary focus or is life Are current relationships the primary focus or is life history also relevant?history also relevant?

Current RelationshipsCurrent Relationships

Spiritual EcomapSpiritual Ecomap

Life HistoryLife History

DiagrammaticDiagrammatic

Spiritual LifemapSpiritual Lifemap

VerbalVerbal

Spiritual HistorySpiritual History

Other Topics of Assessment

Advantages of Formal Assessment Tools

MFI Assessment Protocol

Instruments Used

Other Instruments Available in MFI

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)▫ 3rd leading cause of death for young people 15-24▫ 4 times as many males as females ages 15-19▫ More than 6 times as many males as females ages 20-24▫ Per 100,000:

1.3 Children ages 10-14 8.2 Adolescents ages 15-19 12.5 Young adults ages 20-24

▫ 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!!