On Friday we posted the following question on assessments, and today we have the answer and rationale for you!
A 50-year-old male client meets with a therapist on the advice of his husband. The client shares that he has been out of work for almost a year, losing his job after his company completed mass layoffs. He reports feeling discouraged by his job prospects, feels lost without a place to go each day, and feels increasing hopelessness with each passing month he is unemployed. He states, “I feel completely useless and am questioning the point of it all. I feel completely dependent on my husband and I know he’s sick of being the sole breadwinner.” Which of the following actions should the therapist take to assess this client?
A. Explore job history, identify existence of somatic concerns, identify familial coping patterns
B. Explore job history, determine current risk of self-harm, explore support systems
C. Explore mental health history, identify existence of somatic concerns, explore coping mechanisms
D. Explore mental health history, determine current risk of self-harm, explore coping mechanisms
This question provides information that should raise a red flag regarding the client’s safety and influence the therapist’s priorities for assessment. First, the client reports he is feeling hopeless and helpless, and makes the alarming statement, “I feel completely useless and am questioning the point of it all.” With this in mind, let’s look at the answer choices and evaluate which answer choice is the best.
The best answer for this question is D.
The question is asking which actions the therapist should take to assess this client. With this type of question, it’s possible several answer options include items we would want to assess, but we need to prioritize what is most important in this case. We’ve already noted that the client’s expressions of hopelessness and helplessness should raise red flags regarding danger to self. The client is expressing thoughts and feelings that are indicators of potential suicidality. Client safety is our priority and we must immediately assess for risk of harm to self. If an answer does not include a focus on the client’s risk of self-harm or suicidality, we can eliminate it. Therefore, answers A and C can be ruled out. This leaves us with answer B) Explore job history, determine current risk of self-harm, explore support systems, and D) Explore mental health history, determine current risk of self-harm, explore coping mechanisms.
A strong consideration when assessing risk is the client’s prior mental health as well as the coping mechanisms available to the client. These two items included in answer D would help the therapist better understand the client’s level of risk based on prior mental health AND help the therapist identify strategies to manage safety. While there is nothing inherently wrong with answer B, the client’s job history is not as important a factor to consider, making it the weaker answer choice between B and D.
Which answer did you choose? Does the rationale fit with your understanding of assessment, or did you learn something new with this scenario? If you have any further questions feel free to check in with a TDC coach. We are here to support you all along the way. And if you came up with the same answer-great job! You are on the right track to getting licensed.
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