Assessment: A Tool for Connection and Support

By Sybil Cummin, MA, LPC, ACS

Does the term “Assessment” make you want to put your head down and take a snooze?  Does it seem like assessment is something we HAVE to do just to CYA?  I’m wondering if we can shift that perspective to provide our clients with the best care.
 
As clinicians, assessment is one of the most important jobs we do for our clients.  During the assessment process, we gather data, which then determines the level and severity of our clients’ presenting issues and guides our treatment planning and process.  Remember that assessment is a dynamic and ongoing process.  A process that does not end after your initial intake and creation of a treatment plan.  This is especially true for those who are living in or are surviving domestic violence.

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​Just as our assessment process is dynamic and ongoing, so is the path of an abusive relationship.  There is an ebb and flow to our clients’ safety based on the patterns in their relationship.  This is true whether they continue to live with their abusive partner or after they have left.  Is there an upcoming family function that the couple will attend together?  Is there an upcoming court date regarding divorce?  Each of these life events may shift the ways in which we work with our client based on how we are assessing.  

Many therapists I know feel like “assessment” is dry and clinical.  I disagree.  As long as you are not just doing a formal assessment and reading it like the printed score is a picture of your client, assessment can lead to improved connection with your clients.  Assessment shows your curiosity in truly knowing where your client is coming from and how things have affected their lives.  You are putting your client in the expert position; asking them to share their life as they know it.  With proper assessment, you are attuning to your client each and every session.  For survivors of domestic violence, this is a gift.
 
How Do I Assess?

1. Educate Yourself.  While it is important for clients to be able to share their lives from an expert position, it is extremely important that you know A LOT about the situations and issues that your client is presenting.  I cannot count the number of clients who have shared relief and gratitude that they don’t have to explain themselves to me when it comes to truly understanding the nuances of domestic violence.  When you don’t have a higher than basic knowledge in a subject area, specifically domestic violence, your questioning may feel like you do not believe them.
2. Listen Attentively: Attunement.  This may sound ridiculous that I am sharing this with trained therapists.  We know this.  Isn’t this what we are supposed to do?  An inherent process?  Yes, we are listening to content.  We also need to remember that we need to listen to more than content.  We are listening to changes in tone, body language, intensity, what our client is saying and what our client is not saying.  How is our behavior affecting our client?  We need to listen to our own emotional gauge.  Is our gut trying to tell us something?  How do we feel with our clients?  How do we feel after our clients have left?  Are we coming into the session with an agenda so that we are hearing what fits with our agenda?
3. Open Ended Questions Based on our Education and Experience (see #1).  Open ended questions allow us to get more information than single word answers.  These questions, however, need to be tactical in the sense that you are getting the information that you need to fully assess and plan for safety and treatment.  You can only do this if you have a good amount of knowledge and experience about the situation your client finds themselves in. 
4. Use Maslow’s Hierarchy of Needs.  Yes, do you remember this from Psychology 101?  Assessing with this one tool can help guide you and your client to the appropriate level of treatment and can prevent frustration and misinterpretation of the lack of progress.  Are you and your client working to improve self-confidence and self-worth with little change?  Is there still a tangible threat of psychological abuse even though they have left the relationship?  Do they have significant and credible financial concerns or housing concerns?  These issues on the lower level of the pyramid need to be addressed before self-esteem can be tackled.  Stability and safety need to be addressed before trauma work commences.
5. Formal Assessment.  There is definitely a place for formal assessments.  I am a strong advocate for them with one or two reminders.  First, the score sheet is not a holistic picture of your client.  And second, specifically with victims and survivors of domestic violence, we need to be aware that they may not be accurate.  Even after a client has left an abusive relationship, the shame felt may prevent them from answering your questions honestly.  And if they are doing an assessment as a couple, the answers WILL NOT be accurate.  Our clients know how to stay safe and will answer your assessment accordingly.
6. With Each Session, You Should Be Assessing.  Do you use a SOAP note or DAP note style to record your sessions?  Well, both of those have an “A” for a reason.  We are to assess each session.  Are we on track?  Is there something we are missing?  Has something shifted?  Are safety plans working?  What are the current barriers to treatment?  Take the “A” seriously as things are constantly in motion.

 
With a new perspective on assessment, you will find that you can be more attuned to your clients and have greater outcomes.  Our work is a dynamic process as are the clients we have the honor to serve. Our assessment process should reflect this. ​