Initial contact: contracts and assessments

CONTRACT

A contract is necessary to protect both the client and the therapist. This is especially done through the setting up of boundaries, particularly to avoid attachment issues with the client. Another important aspect of the contract is the part dealing with confidentiality, which also emphasises boundaries and client protection. However it also highlights the fact that the therapeutic relationship is a professional one, enabling the therapist to break confidentiality in the case of the client posing a real danger to self or to others.

ASSESSMENT

Assessment is there to get information from the client in order to gain a better understanding of the client’s situation and expectations. This enables the therapist to establish a baseline measure which helps in the planning and evaluation of the therapeutic process. Assessment also helps locate the presenting problem within the client’s context. This helps the therapist to empathise with the client and to ensure the client’s safety even outside sessions.

Assessment can be done by relating it to a timeline, starting with the present, going into the past and moving onto the future.

  • What is the current problem? (presenting problem, risk assessment, current enironmental support)
  • What are the roots of the problem? (early experiences, critical incidents, attachments, core beliefs, rules of living, what maintains the problem)
  • What are the client’s expectations?

In each aspect, one must look at the BASIC ID, keeping in mind the link between:

  • behaviour
  • emotions
  • cognitions & images
  • sensation & drugs

These are always considered within the matrix of the environment and of biological factors (e.g. the family).

MY REACTION

Coming from Malta I initially felt that contracts and assessments are just formal aspects which are mainly there to protect the therapist in the case of legal proceedings. I also saw them as being set up due to overemphasis on outcomes and that they may actually restrict the client’s freedom (e.g. due to number of sessions being predetermined).

However, I now realise that they are important first and foremost by setting up boundaries and deciding on a path to follow that provides a (flexible) framework within which the client can feel safe. The only unknown variable becomes what will actually come out of the sessions, which can be quite terrifying. So having all other parameters clearly defined can reduce the overall anxiety of the unknown.

Assessment also prevents the therapist from straying involuntarily from the presenting problem and from the client’s expectations. It enables the therapist to have in mind where one is and where one is heading in the therapeutic process. It also helps check out whether the client is consciously or unconsciously moving away from the presenting problem. This may either signify that the client is feeling uncomfortable about the subject (in which case one must examine why), or it may signify that there is another problem, or that there are actually multiple presenting problems. In this case the counsellor should reformulate the assessment in such a way as to include the new aspects that have emerged. Assessment is after all an ongoing process.

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