Counseling: Gathering Info & Accurate Diagnoses, Study notes of Clinical Psychology

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Initial Intake/Interview and

Diagnosis

Class Presentation

Adeeb Saleh

Purpose of Intake

1. To gather information about the client

that would allow the agency to

understand what the underlying

problem is, and to match up the client

with the appropriate treatment and

or/counselor.

2. To assess and respond to urgency of

client’s situation.

3. To familiarize client with agency and

counseling process.

Gathering Information:

What?

• (^) Demographic information such as:

Age, Sex, Race, Marital Status, Area

of Residence or address etc. Also

called preliminary information.

• (^) After gathering the preliminary

information the staff member begins

the initial interview in which he/she

gathers information related to the

problem at hand.

Gathering Information: What? (cont.)

• (^) The staff member would ask about

the presenting problem, how long it

has been occurring, treatment

history, family of origin, educational

history, employment history, medical

history, and any relationship issues.

• (^) Collateral Contacts

Gathering Information

(cont.)

• (^) Multimodal assessment: focuses on 7 elements of client’s problem: (BASIC ID)
• (^) B – Behavior
• (^) A – Affect
• (^) S – sensations
• (^) I – imagery
• (^) C – cognitions
• (^) I – Interpersonal relationships
• (^) D – Drug (Substance use, fitness, diet, ect.)

Things to Consider

• (^) Length of time it takes to complete

intake assessment depends on the

client, available time, and assessor.

• (^) The need for a positive and

supportive environment for the client

is very important (Not too friendly

and not too forward)

Diagnosis: Why? (Cont.)

• (^) If a client relocates or is transferred from one counselor/agency to another, the use of a shared diagnostic language can promote continuity of service.
• (^) Diagnosis also helps agencies classify the clients they serve in order to determine needed services, demonstrate accountability, and justify the agencies role in the community
• (^) Also, counselors in private practice settings or fee-for-service agencies will have to provide diagnoses for clients with health insurance coverage

Diagnostic Process

• (^) In order to make an accurate diagnosis , counselors must gather information on clients’ prsenting concerns, their backgrounds and history, and their present situation (Intake process).
• (^) Using the Mental Status Exam is a good way to assess mental and emotional disorders. The MSE focuses on issues related to the client’s current signs/symptoms, affect, behavior, and cognition.
• (^) The process of reaching a diagnosis also allows the clinician to rule out a certain diagnosis due to a predisposing medical condition or recent substance abuse which could have caused the presenting problem.

DSM-IV

• (^) For each disorder, the DSM-IV seeks to provide a general description which includes:
  1. A list of the disorder’s essential features and a clinical sketch.
  2. A summary of characteristics usually associated with the disorder.
  3. Information on the typical onset and course of the disorder, the impairment caused, and potential complications.
  4. Information on known predisposing factors and frequency of occurrence of the disorder.
  5. Information on similar disorders to facilitate differential diagnosis.
  6. Lastly it provides diagnostic criteria for the disorder

Multiaxial System

• (^) A full diagnosis of the client requires the use of a 5 axes system described in the DSM-IV. Each axes signifies a different aspect of the client’s presenting case/problem.
• (^) Axis 1 describes the main presenting problem or psychiatric disorder that the client is presenting
• (^) Axis 2 generally describes any personality disorders or developmental disorders which are generally not considered to be mental health illnesses by insurance providers
• (^) Axis 3 describes physical conditions or disorders as mentioned by clients (not a medical diagnosis made by clinician)
• (^) Axis 4 describes the severity of psychosocial stressors that may be putting pressure or disrupting the client’s life
• (^) Axis 5 describes the client’s current GAF score/level of functioning.

Things to Consider (cont.)

• (^) There are five causes of low reliability in the diagnosis of mental health disorders (Seligman, 1986):
  1. Subject Variance: the client may exhibit different conditions at different times.
  2. Occasion Variance: Clients are at different stages of their conditions at different times
  3. Information Variance: Different clinicians have different pieces and sources of information about their clients
  4. Observation Variance: Clinicians view and notice different pieces of information and/or behavior as more or less important than another.
  5. Criterion Variance: Clinicians may use different criteria for coming up with a diagnosis from the available data.

Practical Issues

• (^) Waiting time to actually have an

initial intake appointment

• (^) Labeling in Diagnosis
• (^) Dealing with Different Clients:

Voluntary, involuntary, Motivated,

reluctant.

• (^) “Breaking the Ice”

Annotated Bibliography

• (^) MacCluskie, K., & Ingersoll, R. (2001). Becoming a 21st Century Agency Counselor. Wadsworth/Thomson learning, Belmont, CA. The authors of the book discuss and cover relevant material about the initial intake process, information gathering strategies, and the use of the Mental Status Exam to gather information for the purpose of diagnosis.
• (^) Seligman, L. (1986). Diagnosis and Treatment Planning in Counseling. Human Sciences Press, Inc. New York, NY. The author of this book goes over many important aspects related to the initial intake process, as well as the process of diagnosis. The author covers issues related to the different types of clients that may be seen for an initial intake interview, as well as the many different settings an initial intake interview may take place. The author also discusses the importance of diagnosis, the use of the DSM, and things to consider when making a solid diagnosis.

Annotated Bibliography

(cont.)

• (^) Whittenhall, J. (2007). The medical model of mental illness: Ethical and practical implications for diagnosis. Eye on Psi Chi, 11 (2), pp. 16-17. The author discusses the issues and concerns related to using the medical/categorical method of diagnosing mental illness and the reasons to why clinicians should instead use a more dimensional approach. He explains that the medical approach overlooks many important factors related to a client’s problems and tends to pile all the factors into one diagnosis/disorder. A dimensional approach looks at many aspects of the person and takes into consideration more than just the symptoms, but the external factors as well. Gallucci, G., Swartz, W., Florence, H. (2005). Impact of the wait for an initial appointment on the rate of kept appointments at a mental health center. Psychiatric Services, 56(3), pp. 344-346. The authors of this article look into the relationship between waiting periods to have an initial intake appointment schedule and the rate of those appointments being kept by clients over time. The authors found that when waiting periods to get appointments were shortened, the rate of kept appointments would increase over time.