Clients, whether individuals, couples, or families, are often hesitant to share difficulties when they first join treatment. Furthermore, they are not honest about their problems. Counselors can use evaluation tools to assist their clients in opening up about their relationships and family dynamics during therapy. The most frequent mental health issue in the United States is social anxiety disorder (SAD), which affects 12.1 percent of people throughout their lives (Aluh et al., 2022). Those with SAD endure extreme anxiety and shame in social and performance circumstances due to the worry of being exposed as faulty and unfairly evaluated. Symptoms are frequently linked to problematic emotional patterns, and the emotional freedom technique tries to assist clients in accessing, recognizing, expressing, comprehending, directing, and eventually rearranging these patterns. Evaluations have a purpose other than shaping lesson plans; they also serve as credentialing. Accurate assessments are required for convincing instruction and proving the sufficiency of administrations (Sperry, 2019). In the present assessment protocol, three tools are chosen, namely the systemic assessment of the family environment (SAFE), personal assessment of intimacy in relationships (PAIR), and brief dyadic adjustment scale (BDAS).
SAFE
Yingling, Miller, McDonald, and Galewaler created SAFE to assess the intergenerational functioning of the family unit for clinical and empirical purposes. The SAFE evaluation is a self-reporting tool for all family members aged ten and up completed on paper and pencil (Sperry, 2019a). Families can use SAFE with or without children because it enables independent completing and scoring of connection elements for each family subsystem (Smith et al., 2013). The phrasing of the parts is altered to reflect the various target audiences, including children, parents, and grandparents (Sperry, 2019). The evaluation instrument has been designed to efficiently fulfill the demands of persons of diverse ages.
All the designs have been published in various languages, including Spanish and French. Because of their widespread availability, the constructs can be useful in several social settings (Smith et al., 2013). For example, if the designs were translated into a range of regularly spoken languages, they may be used in less educated communities. The 21-item pencil-and-paper version of the semantic assessment takes the average respondent about five minutes to complete (Smith et al., 2013). Based on these findings, the SAFE framework is effective in application and can help create comfort in assessing relationship issues facing different clients.
PAIR
PAIR is another assessment instrument for academics, researchers, and therapists when dealing with couples and families. PAIR delves deeply into five facets of intimacy, including emotional, sexual, social, recreational proximity, and intellectual areas (Moore et al., 1998). Individuals characterize their relationships, whether married or not, in terms of the present (current experiences) and future expectations. The PAIR approach benefits married couples enrolled in marriage therapy or enrichment programs (Lafontaine et al., 2018). When a client arrives unaccompanied, gender is considered in selecting the appropriate approach.
PAIR assesses both the individual and the couple in terms of their closeness to one another. Family life educators and marriage counselors can use this profile to do two things with their clients and students. First, it can clearly explain the different kinds of closeness in their relationships. Second, it can give feedback on how close their clients expect to be and how close they actually are to their partners. Depending on how each partner feels about these disparities, intimacy regions with a wide gap between experience and expectation may be a source of individual and joint worry.
The PAIR does not completely depict a person’s feelings about marriage. It is unique to the pair in question since it stresses the two people in the relationship. Partner intimacy scores on perceived and anticipated intimacy may reveal the couple’s shared and diverging opinions of the relationship’s aims, wishes, and expectations (Walsh & Neff, 2018). Clients may find confirmation and reinforcement of their existing opinions about the pair and new insights into objectively observable areas of their life. It may be utilized to critically examine their unmet requirements and build upon their connection’s positive portions. It is effective for clarifying aims and focusing on relationships’ current experiences. As a result of these benefits, this assessment tool was selected for the development of the assessment protocol.
BDAS
The BDAS assesses the dynamism of a relationship between two people. The 32-item Likert-scale survey provides the basis of the evaluation (Sperry, 2019). It is not a surprise that the DAS corresponds with the LockeWallace Marital Adjustment Test, given that most of the items on the DAS were drawn verbatim from that instrument. The DAS was designed to conduct surveys of married couples’ interpersonal abilities. It may be broken down into component elements to measure factors like coherence, agreement, satisfaction, and display of emotion. Total scores have been adopted as a standard indicator of marital contentment. It is trilingual since it comes in English, Mandarin Chinese, and Canadian French. The evaluation can be completed in as little as five to ten minutes as a self-reporting tool. The DAS has swiftly become one of the most prominent social deviants used in psychotherapy today (Sabourin et al., 2005). Analyzers still employ the tool throughout the world despite its great renown in therapeutic practice. Because of its good psychometrics and accessibility of use, it is commonly applied in research for proposals and theses in studies concerning couples and family therapies.
Ethics in Assessment
Therapists conduct evaluations by talking to their clients and imagining themselves in their client’s shoes to better appreciate their perspectives and the logic behind them. Therapists embrace this sensitivity, known as sympathy in the field (Code of ethics, n.d). Sympathy is a means of communicating with clients but also an integral part of the therapeutic approach, a crucial tool for understanding the multifaceted layers of clients’ circumstances and mindsets and for making potentially life-or-death clinical decisions. Therapists who work with couples and families must make decisions based on the AAMFT code of ethics and other laws and rules. They must also support laws that require them to report unethical behavior (Charlot et al., 2022; Shuper-Engelhard & Vulcan, 2019). In some cases, therapists may take reasonable steps to resolve conflicts so that the code of ethics can be followed to the fullest extent possible. For clients to feel safe revealing their thoughts and feelings during therapy, their counselors need to be able to keep that knowledge to themselves. There must be a guarantee of secrecy for the clients.
Finally, the counselor’s principal role is to preserve the participants’ basic freedoms. The burden of getting each participant’s informed permission rests firmly on the shoulders of the counselors, who must pick their group members with great care (Shuper-Engelhard & Vulcan, 2019). The therapist may find it challenging to verify that everyone in the group follows their legal rights when they have limited influence over their behavior outside group meetings. Therapists must show judgment when assessing what topics are appropriate to discuss with group members outside of the group context. Based on this discussion, the counselor must seek consent and abide by the AAMFT code of ethics, which includes maintaining the confidentiality of the information shared in the present assessment protocol.
Safety and Diversity
The dependability of the assessment protocol may be affected by various cultural and societal views. Every culture does have its own set of social norms and traditions. People with mental illnesses exhibit themselves differently depending on their social and cultural contexts. It could affect people’s capacity to express their symptoms, attitude toward their health, coping mechanisms, and the therapies they seek. One thing to remember is that generalizing someone based on their cultural customs and beliefs (Shahin et al., 2019) risks stereotyping them. As a result, it is critical not to generalize about an entire race, ethnicity, or culture. Individual age, money, health, and social standing disparities can impact how different cultures are seen.
Numerous studies have found that patients’ cultural backgrounds influence how they explain their symptoms to clinicians. Asian patients, for example, have been shown to prioritize discussing their physical health over their mental health (Lee et al., 2021). As a result, they may reconsider their diagnosis and treatment plan and refuse to open up to therapies. Cultural standards also influence people’s judgments of the importance of their sickness. This determines whether a patient believes their sickness is mental or physical, whether it is worthy of sympathy or investigation, and so on (Shahin et al., 2019). Cultural factors can either increase or decrease treatment motivation.
This highlights the need to develop new frameworks for dealing with culturally diverse populations, even if some cultural conventions impede successful mental illness management. Cultural norms and values have a big impact on many parts of mental health, such as how it is seen, sought out, and treated. As a result, a culturally diverse population may struggle to be met by simple mainstreaming of mental health techniques (Farokhzadian et al., 2018). Therefore, it is critical to establish transcultural training for therapists before implementing the assessment protocol. Therapists might emphasize treatments that integrate various health concepts with positive conventional and community-based practices. This is due to the fact that everyone’s experiences and cultural systems vary fundamentally.
The current assessment protocol is designed to be applied to individuals from diverse cultural and ethnic groups. The BDAS assessment tool, for example, is not culturally biased, and therefore accurate results are obtained. Assessment tools can be interpreted in different languages to achieve this goal. The tools have different packages that could be used for people of different ages and sex. As a result, clients from diverse age brackets can be assessed and helped. To create a sense of safety, therapists must be empathetic with clients. They are supposed to form a personal relationship that leads to opening up so that patients can receive the best form of treatment.
References
Charlot, L. A., Washington, K., & Hall, C. (2022). Exhumed: reckoning with the history of eugenics in marriage and family therapy. The Family Journal, 10664807221104113.
Code of ethics. (n.d). American Association for Marriage and Family Therapy. Web.
Farokhzadian, J., Dehghan Nayeri, N., & Borhani, F. (2018). The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses. BMC health services research, 18(1), 1-13.
Lafontaine, M. F., Hum, L., Gabbay, N., & Dandurand, C. (2018). Examination of the psychometric properties of the Personal Assessment of Intimacy in Relationships with individuals in same-sex couple relationships. Journal of GLBT Family Studies, 14(4), 263-294.
Lee, M., Lu, W., Mann-Barnes, T., Nam, J. H., Nelson, J., & Ma, G. X. (2021). Mental health screening needs and preference in treatment types and providers in African American and Asian American older adults. Brain Sciences, 11(5), 597.
luh, D. O., Azeredo-Lopes, S., Cardoso, G., Pedrosa, B., Grigaitė, U., Dias, M.,… & Caldas-de-Almeida, J. M. (2022). Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative. Psychiatry Research, 315, 114734.
Moore, K. A., McCabe, M. P., & Stockdale, J. E. (1998). Factor analysis of the Personal Assessment of Intimacy in Relationships Scale (PAIR): Engagement, communication, and shared friendships. Sexual and Marital Therapy, 13(4), 361-368.
Sabourin, S., Valois, P., & Lussier, Y. (2005). Development and validation of a brief version of the dyadic adjustment scale with a nonparametric item analysis model. Psychological assessment, 17(1), 15.
Shahin, W., Kennedy, G. A., & Stupans, I. (2019). The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review. Patient preference and adherence, 13, 1019.
Shuper-Engelhard, E., & Vulcan, M. (2019). Introducing movement into couple therapy: Clients’ expectations and perceptions. Contemporary Family Therapy, 41(1), 102-114.
Smith, D. B., Whiting, J. B., Karakurt, G., Oka, M., & Servino, D. (2013). The self-assessment of future events scale (SAFE): Assessing perceptions of risk for future violence in intimate partner relationships. Journal of Marital and Family Therapy, 39(3), 314-329.
Sperry, L. (2019). Choosing effective couple and family assessment methods. In couple and family assessment. Routledge, 1-19.
Sperry, L. (2019a). Parent-child assessment strategy and inventories. In couple and family assessment. Routledge, 215-242.
Walsh, C. M., & Neff, L. A. (2018). We’re better when we blend: The benefits of couple identity fusion. Self and Identity, 17(5), 587-603.
Assessment Protocol Questions
SAFE
Assess Relationship with Spouse
- How sincere are you with your partner?
- How often do you talk with your partner?
- Do you listen to each other?
- Do you understand each other?
- How often do you argue?
- How often do you apologize to each other?
Assess Relationship with Kids
- Do you love your children?
- How much time do you spend with your children?
- What do you discuss with your children?
- Do they approach you for advice?
Assess Relationship with Own Parents
- Do you have a comfortable relationship with each other?
- Do you tell each other important things?
- Do you listen and understand each other?
- Do you work together when necessary?
- Do you treat each other with respect?
PAIR
Then answer the same questions regarding what you expect in the future (1 sentence for each question).
- My partner listens to me when I need someone to talk to.
- My partner has all the qualities I need in a mate.
- I am satisfied with our sex life.
- We enjoy playing together.
- My partner and I share hobbies.
- We like spending time with other couples.
- We mostly travel together.
- I feel neglected emotionally sometimes.
- My partner’s friends are also mine.
- We understand each other completely.
- We endlessly find things to talk about.
- We enjoy each other’s company.
- My partner is disinterested in sex.
- My partner is unavailable.
- My relationship does not meet all my needs.
BDAS
Agree by indicating 1 or 2 at the end, where;
- 1- I agree
- 2-I disagree
- My partner and I treat each other as equals.
- My partner considers my opinions in decision-making.
- My partner caters to my needs.
- My partner demands privacy.
- Our relationship is peaceful.