What is an Initial Assessment in Therapy and Why is it Important?

What is an initial assessment?

An initial assessment in therapy is the first meeting between a client and a therapist. This session serves as an opportunity for the therapist to gather information about your background, current difficulties, and goals for therapy. The therapist uses this information to determine the most appropriate treatment plan for your needs.

Overall, the initial assessment helps the therapist to get a comprehensive understanding of your needs and goals for therapy. 

In summary, an initial assessment in therapy is important because it:

• Helps the therapist to gather information about the client's background, current difficulties, and goals for therapy.

• Allows the therapist to determine the most appropriate treatment plan for the client's needs.

• Provides an opportunity for the client to ask questions, express concerns, and determine whether they feel comfortable working with the therapist.

What does an initial assessment look like?

The initial assessment session usually lasts a little longer than a typical appointment depending on the therapist's approach and your needs. The therapist may begin by asking open-ended questions to help you feel more comfortable sharing your experiences and challenges.

Questionnaires, outcome measures and assessment tools - The therapist may also ask you to fill out questionnaires or assessments to gather more information about your symptoms. Some of these, where appropriate, may be sent to complete ahead of your first appointment. 

During the initial assessment, the therapist may ask questions about your medical history, mental health history, family history, and current symptoms. Current symptoms they may ask you about include the duration, frequency, and intensity of the symptoms. They may also ask about any triggers or situations that exacerbate the symptoms. They will also ask you about any life events that may have contributed to the current difficulties.

The therapist may also discuss the therapeutic approach they plan to use and explain how it can help you manage your symptoms and achieve your personal therapy goals. Additionally, the therapist may discuss logistics, such as the number and frequency of sessions.

By the end of the initial assessment session, the therapist and you should have a better understanding of your difficulties and goals, and the therapist can make recommendations about the best course of treatment. 

The therapist may also discuss any concerns or questions you may have about the therapy.

What is a formulation or a developmental formulation?

A developmental formulation is an important tool for understanding the underlying factors that contribute to a person’s difficulties. By exploring these factors and developing a comprehensive understanding of a person’s experiences, the therapist can develop a more effective treatment plan that addresses the root causes of the difficulties.

The formulation involves identifying the cognitive, behavioural, and emotional patterns that have developed over time and exploring how they relate to a person’s current challenges.

The developmental formulation in CBT considers various factors such as family environment, attachment style, significant life events, cultural background, and personality traits. By understanding how these factors have influenced the client's beliefs, emotions, and behaviours, the therapist can develop a more comprehensive understanding of the client's difficulties and determine the most effective treatment approach.

The developmental formulation involves gathering information about the client's early experiences, including childhood experiences, family relationships, and significant life events. The therapist may also use various techniques such as cognitive restructuring, behavioural experiments, and guided discovery to explore the connections between early experiences and current patterns of thinking, feeling, and behaving.

The developmental formulation is an ongoing process that evolves throughout the course of therapy. As the client progresses through therapy, the therapist may revise the formulation based on new information or changing circumstances.

How is an EMDR initial assessment different to other therapy approaches initial assessments?

The initial assessment process in Eye Movement Desensitisation and Reprocessing (EMDR) therapy has many similarities to a typical therapy assessment needed for the treatment plan, and some differences are explored below. 

EMDR therapy is specifically designed to treat trauma-related disorders, such as post-traumatic stress disorder (PTSD). During the initial assessment in EMDR therapy, the therapist will typically gather detailed information about your traumatic experiences and any related symptoms, such as flashbacks, nightmares, or anxiety. The therapist will also assess your current level of distress and explore your current coping strategies.

During the initial assessment, the therapist will also assess your ability to tolerate distress and identify any potential risk factors that may impact the treatment process, as well as suitability for online therapy. 

EMDR therapy typically involves a structured treatment plan that focuses on specific target memories or events. The therapist will work collaboratively with you to identify the most distressing memories or events and develop a treatment plan that is tailored to your individual needs.

Overall, the initial assessment process in EMDR therapy is focused on identifying and assessing traumatic experiences and developing a treatment plan that is specifically designed to address symptoms and needs. The therapist will work collaboratively with you to ensure that the treatment is safe, effective, and tailored to your individual needs.

Why does a therapist set homework tasks to do between therapy sessions?

Homework is a valuable tool that therapists very often use to help their clients achieve their therapeutic goals, develop new skills and strategies, and deepen their self-awareness and understanding of their thoughts, emotions, and behaviours.

Below we explore these reasons.

• Goal Setting: This is typically one of the first tasks a therapist might set. Homework can be used to set specific goals and action plans that clients can work on between sessions. Setting clear and agreed therapy goals early on can help clients to stay focused and motivated, and provide a sense of structure and direction to their therapy.

• Reinforcement of Therapy: Homework can reinforce the work done in therapy sessions and help clients to integrate the insights and skills learned in therapy into their everyday lives. By practising the skills and strategies learned in therapy, clients can develop new patterns of thinking and behaviour that can lead to lasting change.

• Practice: Homework provides an opportunity for clients to practice new skills and strategies in a safe and supportive environment. This can help clients to build confidence and reduce anxiety about applying these skills in real-life situations.

• Deepening Self-Awareness: Homework can be used to deepen clients' self-awareness and understanding of their thoughts, emotions, and behaviours. For example, clients may be asked to journal or reflect on their experiences, which can help them to identify patterns and triggers that contribute to their difficulties.

• Continuity: Homework can help clients to maintain continuity between therapy sessions, reducing the risk of regression or loss of progress between appointments.

  
  
  
  
  

How can I prepare for my first assessment?

• Find a quiet and private space: Make sure you have a quiet and private space where you can talk openly with your therapist and will not be interrupted for the full 50-60 minutes. This will help you to feel more comfortable and at ease during the session.

• Test your technology: Ensure that you have a stable internet connection and that your computer, camera, and microphone are working properly with a good and clear view of your full face. You can test this by doing a trial run on the video conferencing platform that your therapist has recommended.

• Prepare any questions you may have: Take some time to think about any questions you may have for your therapist. This could include questions about the therapeutic process, what to expect in future sessions, or any concerns or goals you have for therapy.

• Reflect on your reasons for seeking therapy: Take some time to reflect on why you are seeking therapy and what you hope to achieve through the process. This can help you to articulate your goals and concerns more clearly to your therapist.

• Be open and honest: It's important to be open and honest with your therapist, even if it feels uncomfortable or difficult. Remember that your therapist is there to support you and that they are bound by confidentiality and ethical guidelines to protect your privacy and well-being.

Other things to consider.

• Some people like to wear headphones, which means what your therapist says remains for your ears only; it can also help block out any background noise.

• If you are expecting a delivery; you could consider leaving a note on your door to deliver to a neighbour or safe place.

• If you are expecting someone to return midway through a session, you could also leave them a note reminding them that you have an online meeting.

• Turn your mobile phone onto silent or ‘do not disturb mode’, if it has this function.

• Try to be on time - Online therapy sessions work in exactly the same way as an in-office appointment, they will start and end on time. So it will be worth logging on five minutes before your appointment.

• Bring a notepad and pen to take notes of any useful points discussed or home work agreed.
  
  
  
  

An initial assessment in therapy is the first session that a client has with a therapist. During this session, the therapist gathers information about the client's background, current difficulties, and goals for therapy to determine the most appropriate treatment plan for their needs. 

The therapist may ask open-ended questions, use questionnaires or assessments, and discuss the therapeutic approach they plan to use. 

The developmental formulation is an important tool for understanding the underlying factors that contribute to a person's difficulties, and EMDR therapy has its own unique initial assessment process, focused on identifying and assessing traumatic experiences. 

Homework is a valuable tool that therapists use to help their clients achieve their therapeutic goals, develop new skills and strategies, and deepen their self-awareness and understanding of their thoughts, emotions, and behaviours.

Lisa Johnston

CBT & EMDR Therapist

Director MY Therapist Online