In our regular blog articles, ‘Making Head or Tail of…’, our Head of Services, Isabelle Dolis, shares her thoughts and reflections on a topic relevant to counselling and the services we offer at Cogwheel Counselling.
I was called upon recently to contribute to a report evaluating the impact of a grant we were fortunate to receive. This led me to reflect more intentionally on the assessment appointment as a standalone, complex, and significant process. An assessment plays an important role in paving the way for counselling and outlining a starting point for the counsellor and their client to initiate their work and relationship.
The assessment process can often be seen as a necessary if uninspiring step. Additionally, it is also time consuming, as it involves a write-up and may demand a conversation with me in terms of what Cogwheel can and can’t offer or to discuss safeguarding concerns. A good assessment is a nuanced and clinically significant process of its own, that can provide a safe space and instill hope in a client feeling lost, overwhelmed and running out of energy and options. It is a process that both provides information about what to expect next and also gathers information to inform the therapeutic work.
The skill of eliciting sufficient information about past experiences without delving too deep into difficult and often painful times is key. There may indeed be weeks and often months to wait before the counselling starts. Some clients find opening up very challenging as their experiences may have been invalidated or minimised in the past. There may be guilt or shame about what happened, deep sadness for a younger self or anger at what they went through. The warmth and empathy of the assessor is central to facilitating sufficient trust to aid stepping outside of their comfort zone and opening up. Alternatively, some clients have braced themselves for talking about their issues, and present as if a dam of words, experiences and emotions has just burst. It may be that no one else has ever asked or taken the time to listen. The skill then is to listen calmly and openly and stay present to what is being shared and ensure that the necessary information is gathered, providing reassurance there will be time to talk at more length. Managing the flow and level of disclosure is critical as clients can open up too quickly and find it then unbearable to return.
Evaluating and addressing any risk is another important task. Establishing that a client is able to keep themselves safe, understanding who makes up their social support network and how they cope, and providing crisis resources if needed are central aspects of safeguarding. These can be difficult questions to ask that occasionally require immediate escalation when intent or means to act on suicidal thoughts have been identified and protective factors are limited.
Finally, supporting a client in understanding more specifically what it is they would like to achieve in counselling beyond very generic notions of ‘feeling better’ or ‘being happier’ facilitates evaluating and conveying what is realistic. Feeling happier can look very different from one person to the next. Communicating in a sensitive manner that some goals are neither helpful nor achievable is part of being truthful and trustworthy, two important ethical parameters for counselling. A good assessment facilitates reframing goals such as getting rid of intrusive thoughts or eliminating anxiety. The work is then understood as learning to tolerate intrusive thoughts by developing emotional regulation skills or understanding/managing anxiety better.
A good assessment is rooted in attentiveness and sensitivity. Different areas such as presenting issue(s), impact, coping, risk, support, goals and development are discussed so that a picture of what is happening for a client can emerge and be conveyed. Service suitability must be confirmed, and different ways of working considered. My task of allocating a counsellor is greatly supported by the assessor’s ability to convey this initial picture and their reflections on the assessment conversation. Cogwheel offers specific assessment training to ensure that assessors are well prepared and supported in this process and are clear on what their role is. Debrief, joint reflection and spending time entering the clients’ world as painted in the assessor’s write-up is then my remit and privilege so that I can look at pairing up a client with a well-matched counsellor.
