Assessment routines raise the bar for novice clinicians
Updated: Mar 28, 2020
My supervision cohort is buzzing over the challenge to formulate convincing case conceptualizations - succinct mental maps of the forces demanding and hindering change. These intern mental health professionals (MHPs) are only a short way into their journey; most have logged less than 75 direct service hours. Novice clinicians struggle to articulate a narrative to connect the dots on what’s driving a client’s struggle. One false start is to rehearse a diagnosis or descriptive phrase applied by a previous therapist or present supervisor. There’s no ownership and the gaps are glaring. Another disappointing trend is to zoom in on a defining event described with the presenting problem. Early career MHPs find it daunting to generate a comprehensive, dynamic, and compelling description of internal factors triggered by relationships and other external pressures. This is no surprise.
In all candor, stuttering over case conceptualization at this stage of professional development is entirely expected. This is the season where the skill set will come together to hear stories, form diagnostic impressions, recognize strengths, and initiate a productive therapeutic partnership. The ability to recognize schemas, sense interpersonal patterns, sequence behavior chains, and identify enactments requires practice and nurture to become intuitive.
One intern speaks up who does not sound like the others. Is this lone supervisee a noteworthy exception? He rehearses his clinical session notes from the previous session. The thematic links are plain: anemic friendships, excessive passivity, failure to offer assertive communication, and burgeoning resentment. Observations arise from the story that unfolds. The intervention efforts are basic. Nonetheless, features of social skills training, experimental role play, and cultural awareness exercises emerge within a remarkably well-informed helping dialogue. What gives this particular intern his running start? Perhaps he is simply ahead of the curve.
My attribution goes to how the host site implements its unique in-depth assessment plan. Clients move stepwise through a set routine. The begins at the outset of care with a semi-structured initial consultation, a formal symptom screening, a written social history, and a digital personality screening. The insights are reviewed before the first actual clinical session. This wealth of organized data can assist even a novice to generate a broad grasp of the underlying dynamics. As the assessment summary is shared back to the client during the goal-setting process, it transitions naturally into an invitation to mutually establish a treatment plan. The client and counselor forge a mutual conceptualization.
Interested in jump-starting the professional development of novice therapists? Gather resources and establish expectations regarding what constitutes a well-balanced initial consultation and assessment (see ACCP, Chapter 9: “Connecting in Initial Consultations” 148-177)!