Assessment Protocol at a Couple and Family Therapy Clinic-Isabelle Cronin

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1 Assessment Protocol at a Couple and Family Therapy Clinic Isabelle Cronin Capella University MFT5106: Assessments, Tests Measures for MFT Practice Dr. Raquel Campbell December 10, 2023

2 Assessment Protocol at a Couple and Family Therapy Clinic Assessments help us gather valuable information that can help a therapist provide both efficient and ethical care for their clients. Each client is unique making it important to gather as much information as possible about the client/s so appropriate treatment plans can be developed. While each individual is different from the next there is vital information that must be gathered from each client that steps into the room. Assessments allow the therapist insight into the strengths/weaknesses of the client/s, and the interpersonal and intrapersonal relationships that surround them (Lavee & Avisar, 2006). Developing an assessment protocol that can be referred to for every client will make sure accurate and useful information is collected to create a basis for the therapist to work off of to provide care. For detailed information to be included, we must first have a basic protocol in place to make sure a basis of the client/s is available to work from. Assessment protocol The first area of information that is collected when the client/s enters the therapy room is regarding their presenting concern. The presenting concern is gathered from each person involved in the therapy (Sperry, 2019). Presenting concern is the reason for the client/s to seek treatment, gathering this information from each client can help the therapist see the full picture of how each views the situation and what the main area of concern is (Sperry, 2019). Questions such as “What brought you in today?” What made you seek treatment?”, can be used to gather this information and develop a starting point. This area is the most important because no treatment can be provided if the therapist isn’t aware of what situation/issue is present. This creates a starting point for the therapist to grow off of. Within this first area of information gathering it is also important to put the therapeutic alliance as the priority. Make sure to grow a connection with the client so they feel more comfortable sharing and answering questions

3 throughout each session. Without a therapist-client relationship, the therapeutic process would not get far. The client's previous therapeutic experiences are an important area for information to be gathered. This can help the therapist know if the client has tried to seek help in the past and why or why not it helped, why they sought treatment at that time, and what brought them to find someone else for treatment this time. If they have not sought treatment before this information can bring insight into why they are now, and how they feel about therapy. If someone has not had previous experience with a therapist or negative previous experience it can take longer for the client to open up and discuss their struggles. Understanding their relation the the therapeutic experience can give more insight into who the therapist is working with and how to guide treatment. A client's Relational History/dynamics is important to understand the dynamics and history of a client whether individual, family, couple, or any relationship. (Sperry, 2019). The information gathered in this area can inform the therapist of boundaries, power, stressors, intimacy, etc. Deeper knowledge can be gained concerning the client's presenting problem and the environment that surrounds it. For couples questions such as “How did you meet?”, “What attracted you to another?’. These questions can give you an idea of some aspects that are important to the couple or that give insight into aspects of their relationship. This is also a great area to use a genogram to get a better picture of the family. Genograms can show patterns, and connections, and show many different histories present in the family. Genograms provide information about the family in all areas from health, emotional issues, and relational patterns (Sperry, 2019).

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4 Cultural Dynamics is another area of importance to gather when working with clients. Making sure to include questions that look at the differences that can arise from cultural perspectives is very important (Sperry, 2019). Culture and family structure have a big influence on who an individual; is, their morals, beliefs, etc. (Sperry, 2019). One’s culture influences many aspects of who that individual grows up to be and how they structure their lives. A lot can be missed in an assessment if information is not gathered in this area. Questions such as “What shapes your decisions in life?”, “Tell me about the structure of your family at home, the roles that each member has”, “Tell me about traditions you hold”, and “Do you and your family hold similar beliefs?”. Cultural background can affect the assessment process by indicating how certain information should be interpreted. Some cultures value independence while others don’t, some cultures have more traditional roles while others don't. This is important to understand when interpreting information from assessments, and when choosing treatment methods and interventions. If this is not recognized it could lead to the client feeling misunderstood and inaccurate treatment being provided. Treatment expectations are another important area to gather information from your clients. One's expectations can affect the overall outcome of the therapeutic experience. Knowing upfront what each client's expectations are for the therapeutic experience and outcome can help gauge treatment plans and interventions. The therapist can get a better idea of the beliefs, strengths, weaknesses, and determination of the clients based on their expectations. This is also a helpful area for the therapist to be able to explain the process and how the explained expectations align with the process. This can allow for a better connection with the clients and a transparent experience for the clients.

5 Safety should always be considered when assessing a client, making sure to pay attention to the scoring of the assessments, while also acknowledging appearance, conversational patterns, body language, etc. Noticing these aspects can help the therapist in indicating if there is a safety concern or not. This is an area that should be assessed fluidly throughout the whole therapeutic process. Questions such as “What does a disagreement look like, what happens before and after?”, “Do you or anyone in your family have a history of suicidal tendencies?”, “Do you have anyone you turn to in a time of need?”. It is important to be direct when asking questions regarding safety so that the questions are fully understood by both the client and therapist. In some instances, separation for questioning regarding safety may need to occur, especially if there is violence expected in the relationship. Assessment Instruments I have indicated important items that should be a part of the assessment protocol when working with all clients. Making sure to choose instruments that can gather sufficient information in these areas is important. Some instruments I would choose to use when working with clients are the Minnesota Multiphasic Personality Inventory-Revised Version (MMPI-2-RF), and Systemic Clinical Outcome and Routine Evaluation (SCORE). The Minnesota Multiphasic Personality Inventory-Revised Version or MMPI-2-RF is one of the most widely used clinical testing instruments in the US (Sperry, 2019). It contains 338 True or False items that assess psychological, emotional, and psychopathological patterns. The assessments can be used to help diagnose and choose appropriate treatment methods (Sperr, 2019). The assessment can be taken by any client that is 18 years or older, there is a Related assessment Minnesota Multiphasic Personality Inventory–Adolescent (MMPI-A) that can be taken by those who are ages 14-18 to help provide more flexibility in the age range for the

6 assessment. I would use this instrument because I believe it assesses all the major areas I stated previously. It has good validity and reliability scores and is one of the most widely used measures. While it is a particularly lengthy assessment it assesses many important areas that provide the therapist with a surplus of information, while also helping with diagnosis and treatment methods. The Systemic Clinical Outcome and Routine Evaluation or SCORE is a self-report instrument that can be completed by those of the age of 7 and older (Carr & Stratton, 2017). The assessment contains between 15-40 items that describe different aspects of a family. Responses to these items are indicated by a Likert scale that measures on a scale “ from 1 = describes my family very or extremely well, to 5 or 6 = describes my family—not at all.” (Carr & Stratton, 2017). This assessment is shorter and able to be applied and get her information more quickly. This one could be used in a situation where there is not enough time to implement an assessment like the MMPI-2-RF. Reliability and validity scoring for this assessment is high and is sensitive to change allowing it to be a good assessment to indicate change occurring in a relationship over time. The SCORE-15 provides high reliability and validity while also providing a shorter version of the SCORE assessment and is good to apply periodically to monitor change over time (Carr & Stratton, 2017). Safety and Cultural Dynamics The results from both of these tests can highlight both strengths and weaknesses present in the clients being assessed. In addition, scoring can indicate areas of concern where safety might need to be assessed for a client. The MMPI-2-RF scores on one of its scales for depression give important information regarding the client's state of mind, morals, lack of hope, and overall dissatisfaction. Outcomes can indicate if the client shows any scores that concern should be

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7 shown and if safety precocious should take place (Lamoreux, 2022). The gathering of information about the celibate relationship structure, and information about different aspects of the client's relationship can help the therapist gather information and assess safety concerns. Make sure to pay attention to the cues the clients are giving, their demeanor, the way they look, talk, body language, and who talks more. All of these aspects can be assessed while giving the assessments and talking with the clients to assess for safety and overall well-being. The MMPI is one of the most commonly used assessments, because of this it is also known for its cultural sensitivity. As it looks at personality and psychological aspects that are often used similarly throughout cultures the MMPI-2-RF is seen as a generally unbiased instrument (Whitman et al., 2019). This makes it suitable for those of many cultures. Using tools such as Genograms as discussed to look at relational histories/dynamics can also help the therapist understand and identify cultural factors present with clients. Seeing how a family is laid out can show the patterns that show and the many different aspects of the family that a genogram can depict can bring to light many cultural influences and important aspects within a family/client. The SCORE has been assessed for its abilities of systemic family therapy across cultures. Measures from this assessment have been shown to provide valid measurements of progress and outcomes for different current cultures around the world (Stratton & Low, 2020). This assessment has proven cross-cultural applicability to assess families from many different backgrounds and can provide measures for progress and outcomes for families of different cultures (Stratton & Low, 2020). This shows that the assessment can address the issue of diversity and provide accurate measures despite differences in this area. Ethics in Assessment

8 First and foremost informed consent must take place before anything can progress in the therapeutic process. Ethics code 1.2 states that a therapist must obtain informed consent or proceed with therapy or assessments. The client must understand the process and accept the assessments that will take place (AAMFT, 2001). Paperwork must be filled out before any steps occur. Confidentiality must also be discussed with clients, ethics code 2.1. Clients must understand their limits of confidentiality and in what intubation confidentiality can be broken (AAMFT, 2001). This is also important when working with more than one client, especially if individual sessions must take place. In terms of assessments, clients must understand that if certain results indicate any danger or safety concerns or are retrieved by law for court the information gathered will be provided and a limit to confidentiality will be present (AAMFT, 2001). Providing this information, in the beginning, helps limit issues regarding consent or confidentiality that could arise at a later time. Making sure the clients fully understand the process and that the therapist can be trusted with their information. Making sure to choose and provide an assessment that is ethically backed is very important. Making sure the assessment and its results are accurately represented to make sure the correct information is provided to the client. If this is not done properly ethical standards can be broken, affecting the therapist due to broken ethical codes, and a hurt lie that has been provided with an incorrect assessment or results. Clients must have access to their records and the providing of this information can only be provided with a waiver indicating their ability to view the information, ethics code 2.3. Protection of the client's records, ethics code 2.5, must be followed unless there is a limit of confidentiality present as stated in code 2.1 (AAMFT, 2001). Making sure appropriate assessment measures are used can also relate to ethics codes 3.1 and 3.2 as the therapist must make sure they pursue knowledge of new developments and maintain education (AAMFT,

9 2001). In addition, the therapist pursues appropriate consultations and training to make sure they have adequate knowledge and are adhering to applicable laws, ethics, and professional standards (AAMFT, 2001). Conclusion Assessments are important tools to gather information about clients. They help therapists get to know their clients better, assist in diagnosis, and help with choosing effective treatment methods. Creating an assessment protocol helps make sure each client is assessed to their fullest potential and provides basic aspects for the therapist to dig further into. Assessments can help contribute to the effectiveness of the therapeutic experience and can help demonstrate the effectiveness of the treatment implemented (Bray & Stanton, 2010; Williams, et al., 2014). Assessments provide knowledge to the therapist about the client that they can work off of and alter treatment plans and interventions to increase the effects of the treatment. Using assessment measures throughout the therapeutic process can also indicate the effects of treatment and show the change that has occurred. Having an assessment protocol helps increase the effects of the therapeutic process for each client, while also helping create a more positive therapist-client relationship.

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10 References American Association for Marriage and Family Therapy. (2001, July 1). AAMFT code of ethics. Retrieved from http://www.aamft.org/resources/lrm_plan/ethics/ethicscode2001.asp Bray, J., & Stanton, M. (Eds.). (2010). The Wiley-Blackwell handbook of family psychology . Blackwell. Carr, A., & Stratton, P. (2017). The Score Family Assessment Questionnaire: A Decade of Progress. Family Process , 56 (2), 285–301. https://doi.org/10.1111/famp.12280 Lavee, Y., & Avisar, Y. (2006). Use of standardized assessment instruments in couple therapy: The role of attitudes and professional factors. Journal of Marital and Family Therapy , 32 (2), 233–244. https://doi.org/10.1111/j.1752-0606.2006.tb01602.x Lamoreux, K. (2022, April 29). What is the Minnesota Multiphasic Personality Inventory (MMPI)? . Psych Central. https://psychcentral.com/lib/minnesota-multiphasic-personality-inventory-mmpi#clinical-scales Sperry, L. (2019). Couple and family assessment: Contemporary and cutting-edge strategies . Routledge, Taylor & Francis Group. Stratton, P., & Low, D. C. (2020). Culturally sensitive measures of family therapy. The Handbook of Systemic Family Therapy , 77–101. https://doi.org/10.1002/9781119438519.ch86 Whitman, M. R., Tarescavage, A. M., Glassmire, D. M., Burchett, D., & Sellbom, M. (2019). Examination of differential validity of MMPI-2-RF scores by gender and ethnicity in predicting

11 future suicidal and violent behaviors in a forensic sample. Psychological Assessment , 31 (3), 404–409. https://doi.org/10.1037/pas0000677 Williams, L., Patterson, J., & Edwards, T. M. (2014). Research methods in family therapy: Foundations of evidence-based practice. Guilford.

Assessment Protocol at a Couple and Family Therapy Clinic-Isabelle Cronin

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