Intake, Diagnosis, and Treatment

MHS 6620 Lorayne Thayer &TeresaTilden

Diagnosing the Problem• Effective problem solving and decision

making involves the ability to collect and select the information that is necessary to solve the dilemma.

• The nature of the interaction must be controlled by the helper, who is trained to collect and select the information necessary to solve the dilemma, he/she helps the client facilitate change.Gazda, G.M., Asbury, F.R., Balzer, F. J., Childers, W. C., Phelps, R.E., Walters, R. P., 2003 p.10

Intake and Diagnosis• Before a helper can be of any assistance to a

helpee, he or she must understand the helpee’s problem in depth.

• An intake interview is the first step to understanding, and then diagnosing the problem.

Gazda, G.M., Asbury, F.R., Balzer, F. J., Childers, W. C., Phelps, R.E., Walters, R. P., 2003 p.10

What is an intake? An initial interview used to gather data

about a client.

Can be conducted by an intake worker or a counselor.

MacCluskie, K.C., Ingersoll E.R., 2001 chapter 5

What is the purpose of an intake? To provide information to guide diagnosis

and selection of a treatment plan.

Helps to match the client to a counselor.

MacCluskie, K.C., Ingersoll E.R., 2001 chapter 5

What to do during Intake Interviews?!

Have a clear idea of why the individual is being interviewed.

Be concerned about the physical setting or environment.

Empathize and be warm to help establish good rapport with the client.

Be alert to verbal and nonverbal behavior. Be in charge and keep the goals of the

interview in mind.

Information Obtained During Intake

Demographic Information Presenting Problem Past Psychiatric History Medical History Mental status Personal & Social History

*Pay attention to how the client speaks, thinks, feels, and evaluates situations.

How to Obtain Information: Models of Clinical Assessment

During an intake, there are two ways of gathering information, or two models of assessment to help diagnose the client.

!. Psychodiagnostic Model---holistic and intended to describe the client in a variety of ways.

2. Psychometric Model---emphasizes more objective use of tests and assessment instruments.

Drummond, R. J., 2004

Types of Intake Interviews Structured---A set of specific questions. Each

client is asked exactly the same questions in the same manner.

Unstructured---Does not follow any specific format. Allows the client to determine what is important to talk about.

Drummond, R. J., 2004

Tools for Structure:Data vs. Multimodal Schemas Initial Client Contact Form (ICCF)

(DATA)

(Basic ID) (Multimodal)

Mental Status Exam (MSE) (Multimodal)

MacCluskie, K.C., Ingersoll E.R., 2001

chapter 5

Multimodal Therapy Multimodal therapy was one of the

first attempts at comprehensive assessment and treatment. It was developed by J. Lazarus who saw it as an effective way of tailoring the treatment to the client rather than the other way around.

Structure: Initial Client Contact Form (ICCF) Used by the counselor to gather general

data about a potential client, often used during phone interviews.

Used by the client in order to access treatment or receive further information about treatment options at an agency.

Is not usually fully comprehensive in terms of putting together a diagnosis or treatment plan.

MacCluskie, K.C., Ingersoll E.R., 2001 chapter 5

Structure: Basic ID Acronym for the seven elements of the

clients experience. Follows the psycho diagnostic model. Comprehensive in initial assessment

and treatment. Guides counselor’s thinking in

determining a diagnosis and treatment plan.

Basic ID continued…Comprehensive initial assessment and treatment.

Behavior Interpersonal relationships

Affect Drug (biological)SensationsImageryCognitions

Structure: Mental Status Exam (MSE)

Component of diagnostic interviewing. Observation and documentation of:

appearance, attitude, activity, affect, speech, language, thought process, content, perception, cognition, insight and judgement.

Remember to secure the client’s approval to do a mental status exam, or to document that an MSE is being done if you are in an emergency situation.

Tools for Structuring Intake The ICCF can be used for quick intake over

the phone or in brief interviews that have time constraints.

The ICCF is not as comprehensive as Basic ID and MSE which are used to provide general structure for data gathering while the client shares his/her concerns as he/she feels most comfortable.

Basic ID and MSE guide the counselor’s thinking in determining a diagnosis and treatment plan.

What is a Crisis?

Hoff (1995) defines crisis as: “acute emotional upset arising from situational, developmental, or sociocultural sources and resulting in a temporary inability to cope by means of one’s usual problem solving device.”

Symptoms of Crisis Lowered attention span. Introversion. Emotional reaching out. Impulsive and unproductive

behavior. Subjective sense of extreme

vulnerability.

Assessing a Client in Crisis Assess lethality and safety needs. Establish rapport and communication;

reflect feelings. Identify the major problem. Process feelings and provide support. Explore possible alternatives. Formulate an action plan. Follow-up.

Other Assessment Tools: DSM-IV Merck Manuel Treatment and intake forms and

resources available:

http://www/4ulr.com/products/counseling/treatmentplannerbooks.html

http://www.coedu.usf.edu/zalaquett/ccs/ccsp.htm intake presentation number two.

Treatment Modes Individual Couple Group Family

Models of Treatment: Psychotherapy v Counseling

Counseling stresses the giving of information, advice, and orders by someone considered to be an expert in a particular area of human behavior or in redirecting human behavior in positive ways .

Psychotherapy is the process of helping people discover why they think, feel, and act in unsatisfactory ways.

Corsini, R.J., Wedding, D., 2005 ch. 1

Psychotherapy v Counseling

What may seem to be a simple problem at first can become more complicated as counseling goes on and may require the more in depth approach of psychotherapy.

Counseling focuses on problem solving while psychotherapy focuses on the person.Corsini, R.J., Wedding, D., 2005 ch. 1

Techniques:Psychotherapy v Counseling

Person-centered Cognitive Behavioral Rational Emotive

Behavior Therapy Gestalt Eclectic

Brief Solution Focused Eclectic

Treatment: Final Thought

Your careful assessment of the clients condition and prognosis determines the extent and type of intervention that needs to occur and helps your clients reach their goals.

References Corsisni, R. J., and Wedding, D. (2005). Current Psychotherapies. 7th ed. Brooks/Cole.

Gazda, G.M., Asbury, F.R., Balzer, F. J., Childers, W.C., Phelps, R.E., Walters, R.P.(1999).HumanRelations Development.6th ed. Needham Heights, MA: Allyn and Bacon.

MacCluskie, K.C., and Ingersoll, R.E., (2001). Becoming a 21stCentury Agency Counselor. Belmont, CA: Wadsworth/Thomson.

Thomson, R. A.(2003) Counseling Techniques. N.Y.,N.Y.:Brunner-Routledge.

Drummond, R.J. (2004). Appraisal Procedures for Counselors and Helping Professionals. 5th ed. New Jersey:Prentice Hall.