Patient Evaluation – Approach Discussion
In psychological counseling, evaluation of the patient – their mental state, possible substance use, medical history, and other factors – remains critical in the process of differential diagnosis. The counselor relies on the data acquired from the initial and subsequent evaluations during each session to determine and adjust the course of the therapy. Moreover, evaluation also allows the counselor to assess patient’s current disposition, their reactions to specific topics, and possible trigger themes. Thus, the importance of proper patient evaluation and the need to implement new, more fitted tools for it gets increasingly more attention lately, as patient-based assessments gain more popularity, as well. During these assessments, patient provides valuable feedback about their feelings and moods, and shares his point of view on their issues with the counselor. This is an important step in identifying the right kind of therapy for the individual in accordance with their perception of situation and problem. The evaluation represented in Dr. Todd Grande’s (2016) video shows exactly how a counselor can use targeted questions to gather as much information from a patient as possible without upsetting or disturbing them.
However, one must note that in order to be useful and ethically correct, the evaluation process has to be culturally tailored and be performed in an as much non-judgmental way as possible. If the counselor fails to remain neutral during the assessment, the patient might experience distress which may cause them to refuse discussion about particular issue or withdraw from therapy completely. Thus, it is crucial to understand that such approach cannot be executed lightly as the ability to withhold one’s judgment and maintain neutrality needs to be learned and trained, as well.
Key Therapeutic Communication Techniques Used
In the video, Dr. Grande (2016) uses several therapeutic communication techniques that allow him to establish trusting relationship with his patient. In general, he demonstrates calm acceptance towards everything the patient says, showing her that she was heard and understood without being judged. He also listens to her actively, re-stating some of her words and asking thought-provoking questions on the matter, engaging her further in the conversation. It is clear from the video that over time, the patient becomes more and more comfortable with talking about her substance use issues and how she herself feels about it. Dr. Grande encourages her to give her own descriptions of what and how she perceives, for example, when asking her how, in her opinion, her family feels about her use of alcohol. In addition to that, he prompts the patients to compare her perceptions and feelings for alcohol and marijuana use, allowing her to look for similarities in them.
Most forms of counseling have chosen conversation as their main tool. In the case of Dr. Grande’s (2016) video, it is not just a dialogue, but a narrative one. Such form of discourse – a colloquial replicating dialogue – implies equal participation of communicants in the creation of a communicative space. In a narrative dialogue, one of the communicants voluntarily transfers the communicative initiative to the partner, leaving behind the function of maintaining contact in the form of emotional reactions, speech supports, and clarifications. In the video (2016), the patient is given the freedom to speak about her substance use record, with only clarifying comments and pointing questions from Dr. Grande. He simply gives recognition to her assessment of the issue and refrains from any and all conclusions on the matter, which allows the patient to feel more comfortable. Overall, his approach shows consideration for patient’s feelings and mood, as well as provides significant results and valuable information about her issues.
I could approach the case in a different way: perhaps, it could be useful to detach from it completely as to not put the patient in an uncomfortable position. For example, I could give her a substance use questionnaire to complete during the session so that she would not feel the pressure of having to talk about it. Only after the completion of questionnaire, I would ask her whether she would like to talk about it and discuss her feelings.
Reference
Grande, Dr. T. (2016). Intake and assessment role-play – substance use appraisal. YouTube. Web.