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I am delighted to continue this conversation. The feedback I've received confirms just how important the issue of assessment is in our work. I have described the pressure that many clinicians feel when supervisors insist upon thorough assessments that delve deeply and quickly into a client’s background. Working in this way often stirs up emotionally loaded memories that can easily overwhelm and re-traumatize.
We all understand the value of getting a trauma history, but what if there was a way to open that door with greater respect and care as well as a commitment to preserve the client’s right to privacy and emotional stability? I'd like to offer some questions that can be woven into the assessment process. They are designed to get beginning information about issues such as family of origin attachment and safety, dysfunctional family dynamics, healthy and unhealthy coping strategies, and potential sources of emotional and psychological struggle.
As always, when asking potentially triggering questions, I encourage clinicians to pay as much attention to the client’s non-verbal responses, such as dissociation, lack of eye contact, muscle tension, change in voice tone and posture, psychomotor agitation, and shifts in emotional states. These responses can be more telling than the verbal ones. In the earliest stages of assessment, don't ask for specific details in regards to these questions, sometimes just the “title” of the experience is enough.
- When you think about growing up, do you have pleasant or unpleasant memories about mealtime?
- Do you have happy or unhappy memories about holidays?
- Do you have good or bad memories about family vacations?
- How did various family members handle stress?
- Without specifically identifying them, are there things that have happened in your life that you find difficult to talk about?
- Are there times when you struggle with thoughts, feelings or behaviors and you’re not sure why?
- Are there times when you feel troubled or angry by your thoughts, feelings or behaviors?
- Are there times when you feel disconnected from other people?
Even if the client does not directly answer these questions, when a therapist asks them he or she communicates a willingness and an ability to explore the answers with the client when the time feels right. These questions can also evoke curiosity in clients, and than can serve as a catalyst for memory retrieval and subsequent healing.
Can you offer some additional questions that offer this same “backdoor approach” for assessing and treating traumatic experiences?
Missed previous posts from this series? Click on the corresponding link here: Part 1 - Part 2 - Part 3 - Part 4 - Part 6
