“Many workers and agencies fall into the assessment trap, as though it were necessary to know a lot of information before being able to help … the usefulness of all this questioning is not necessarily apparent to the client, who already knows the information being conveyed.”
Miller and Rollnick, Motivational Interviewing, 3rd Ed.
Assessment is an integral part of what ACT clinicians do. But is it possible to do too much assessment?
One of the most interesting additions to the 3rd edition of Motivational Interviewing (yes, I know you’re sick of Shalom always writing about M&R) is on The Assessment Trap under the section Some Early Traps That Promote Disengagement (pg 40)
As a psychiatrist I’m always doing assessment – assessing risk of self-harm and suicide, of violence, of substance use etc… I’m doing this in my conversation with my patient. I have not used paper and pen assessments enough. On the other hand I’ve also worked in settings where clients are bombarded with paper assessments to complete. If I were the client I would certainly endorse the idea that I “already know the information being conveyed”.
There are different ways of doing assessments. There are the questionnaires, given to clients to complete on their own, ticking boxes, sometimes endlessly. For example the Personality Assessment Inventory which the company website points out its “Fast, cost-effective administration. Clients generally complete the 344 items in less than an hour.” I can hear the client commenting “boy, that hour went by so fast!”
Then there are assessment templates that a clinician can take into an interview, not to rigidly dictate what’s discussed but as a reminder of different areas to explore.
M&R include a quote from Rogers who, in 1942, observed:
“The disadvantage of using tests at the outset of a series of therapeutic contacts are the same as the disadvantages of taking a complete case history. If the psychologist begins his work with a complete battery of tests, this fact carries with it the implication that he will provide the solutions to the client’s problems… Such “solutions” are not genuine and do not deeply help the individual.”
For most ACT clients there are rarely simple solutions.
The other drawback of overly focussing on ‘assessment’ is that it can set the client into a passive role of answering the clinician’s questions rather than exploring the issues collaboratively. M&R write:
“The structure of an assessment-intensive session is clear; the interviewer asks the questions and the client answers them. This quickly places the client in a passive and one-down role”
How does your agency fare? Have you found the sweet spot for the right amount of assessment?