Post #13: Clinical Assessment

              This week’s reading on clinical assessment helped me to put some pieces together.  I recently read an intake report for one of my students who came to us right after inpatient treatment.  While reading the report, I noticed that the student was assessed using the multiaxial diagnostic system, but at that point I was not clear on what the axes actually were.  The process of using this system reminded me of the process a medical doctor might take when trying to diagnose a patient’s illness or condition.  A doctor would have their patient describe their symptoms, when the symptoms had started, the severity of the symptoms, and any changes in the patient’s environment that might be contributing to the patient’s symptoms.  Of particular interest to me while reading about the 5 axes of the mental diagnostic system was Axis IV: Psychosocial and Environmental Problems.  Last week, I wrote about the importance of environmental assessment in education.  Drummond and Jones (2010) point out that environmental problems can “(a) be a factor in initiating mental disorder, (b) be a factor in exacerbating a mental disorder, or (c) develop as a consequence of the mental disorder” (p. 281).  The interrelatedness of environment and mental disorders is somewhat fascinating to me.  The unfortunate reality is that changing one’s environment is not always within one’s power.  Many of my current students are in that position.  The environments that they are coming from are not ideal in many ways; however, since they are minors, their options are somewhat limited.  My heart breaks for my students when they tell me their stories.  The hardest thing for all of us to do is to figure out how to cope with whatever situation we find ourselves in.  If we can’t change our environment or situation, how might we change ourselves in order to survive?  What things do we actually have control over and how can we make the best of difficult situations?  As a mandated reporter, I also have to decide when it might be time to make a call to Child and Family services if a student’s situation warrants that.  This is a responsibility that I believe will only grow when I become a school counselor.

                Another point that I found interesting in this week’s reading was that “unstructured interviews are the most frequently used type of interview in clinical assessment” (Drummond & Jones, 2010, p. 284).  Upon further consideration, I guess this makes sense, as counselors are most likely doing unstructured interviews when clients or students first come to their office to ask for help.  While not following a script, counselors should be well-versed in addressing all of the bases in assessing a student’s problem.  The axes of the multiaxial diagnostic system could provide a good framework for creating questions that address all the domains of the presenting problem(s).

Reference

Drummond, R.J. & Jones, K. (2010). Assessment procedures for counselors and helping professionals ( 7^th ed.). Upper Saddle River, NJ: Pearson.