Just what is an initial evaluation at the CBT Center and why would I want to do it?
When in the course of speaking to someone on the phone or conversing with them through email, people often ask us about our initial consultation, what it is, and how it is different from others they might have been though. They often ask how the CBT Center’s initial evaluation might be helpful to them? Here we try to answer those questions.
The initial cognitive behavioral evaluation: What is it? What does it consist of?
Understanding the issues: the view from 35,000 feet. Apart from filling out our practice forms (often sent out in advance via email, so as not to take valuable time from the evaluation itself), the bulk of the initial consultation consists of the person telling his or her story of what the issues are and what they are seeking to get from the therapy. During the initial consultation, we want to get an overview of the situation. In other words, we want the “view from 35,000 feet “– it needs to be comprehensive with enough detail to get the lay of the land. The therapist functions like a “midwife” in this process, helping the person draw out their story. The therapist might ask of the person: Describe what is going on now. When did the current difficulty start and what has been its course? We often try to do a targeted history: what in the individual’s upbringing made them vulnerable to the current concern? Was there a particular atmosphere in the family or with peers that strongly affected how the person viewed himself and others? How are those events or situations related to the current difficulties?
Summing up. During the initial consultation, the therapist and the individual work together to develop a shared view of the problem and its origin, with the therapist repeatedly checking out his/her conceptualization of the issues with the person. This is to make sure the person is heard and that the therapist accurately understands what the issues are from the client’s point of view.
After the therapist and the individual arrive at a full picture of the issues, the therapist will give the individual a verbal summing up of the issues and provide his/her clinical impression. This might take the form of a diagnosis. For example, the therapist might say, “I think that you have Obsessive Compulsive Disorder, and here is why…” Or, in the case of a young child, the parent might be told, “No, I don’t think that your child has ADHD but I think instead that your child has a behavioral issue that may be caused by inconsistent signals between the parents, and here is why…”
Recommendations. We also want to give you, in plain English, our treatment recommendations, so that you can think over what you have heard during the evaluation and decide, in an informed way, what you would like to do. We often say, “If you’d like to work with us on this difficulty, then this is how we would approach the issue…” We would then spell out what treatment with us would look like. For example, as in the case of the person with OCD above, we would explain that we would deepen the assessment of the OCD through the client’s logging of OCD situations that pop up in the time between then and the following session. And that would be followed by developing an order and sequence of how to begin to face the fear situations and to start to learn to live fully again. Or, in the case of the young child with behavior problems described above, in future sessions, we would do observations of the parents with the child while the therapist coaches the parents on developing consistent parenting skills.
Taking the mystery out of initial cognitive behavioral evaluations.
We hope that this article helps to take the mystery out of the process of the initial consultation at the CBT Center.
If you are considering treatment and would like to schedule an initial cognitive behavioral evaluation at one of our Southern California locations, please contact us here.
Check out our Initial Evaluations at the Cognitive Behavior Therapy Center – Part 2 to read about some other reasons you might want to schedule a consultation.