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- Herausgeber: IVP Academic
- Kategorie: Geisteswissenschaft
- Serie: Christian Association for Psychological Studies Books
- Sprache: Englisch
Assessment in counseling—like its biblical counterpart, discernment—is an ongoing and dynamic routine to encourage movement in a productive direction toward what is truly best. In Assessment for Counseling in Christian Perspective, Stephen P. Greggo equips counselors to put assessment techniques into practical use, particularly with clients who are looking to grow in their identity with Jesus Christ.As a Christian perspective on assessment, this book is designed to supplement standard resources and help counselors navigate challenges at the intersection of psychotherapy and Christian ministry. Greggo charts a course for care that brings best practices of the profession together with practices of Christian discipleship.Key topics include: - Does a Christian worldview offer distinguishing parameters for assessment practice? - Can clinical proficiency in assessment bring glory to God? - How can the crucial psychometric construct of validity be translated into our Christian faith? - In what ways can the inclusion of objective procedures be transformed into a message of hospitality and affirmation? - How can counselors maximize the benefits of a therapeutic alliance to attend to immediate concerns and foster spiritual formation? - How can formal personality measures add depth and substance to the counseling experience? - How can assessment contribute to client retention, treatment completion, and aftercare planning?With Assessment for Counseling in Christian Perspective, clinical and pastoral counselors can bring the best of assessment into counseling that reflects the essence of the Christian faith. Christian Association for Psychological Studies (CAPS) Books explore how Christianity relates to mental health and behavioral sciences including psychology, counseling, social work, and marriage and family therapy in order to equip Christian clinicians to support the well-being of their clients.
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Sommaire
Cover
Title Page
Dedication Page
Contents
Acknowledgments
Abbreviations
Part 1: Reason for Assessment
1 Assessment to Navigate Change
2 Defining the Assessment Task
3 Assessment Basics for Christians Who Counsel
Part 2: Background Information
4 Forming a Theological Foundation
5 Multiculturalism and Assessment Standards
6 Cultural Identity and Habits for Holistic Assessmen
7 The Case for Redemptive Validity
Part 3: Assessment Selection and Administration
8 Artisanship in Conducting Interviews
9 Connecting in Initial Consultations
10 Therapeutic Alliance and the Significant Self
11 The Cutting Edge of Selective Therapeutic Assessment
12 Outfitting the Clinician's Toolbox
Part 4: Results and Interpretatio
13 Gauging Religious Affections
14 Calibrating the Contours of Personality
15 Graduation and Recommendations
Appendix 1: Clinical Assessment Instrument Christian Evaluation Form (CAICEF)
Appendix 2: START Initial Consultation Report
Appendix 3: Counseling Partnership Alliance Check (CPAC)
Author Index
Subject Index
Notes
Christian Association for Psychological Studies
Praise for Assessment for Counseling in Christian Perspective
About the Author
More Titles from InterVarsity Press
Copyright
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Guide
Cover
ASSESSMENTFOR COUNSELINGIN CHRISTIAN PERSPECTIVE
Start of content
Contents
ASSESSMENT FOR COUNSELING IN CHRISTIANPERSPECTIVE
FOR BRIAN FAST
and the extraordinary staff who co-labor with us to nurture hope Soli Deo gloria
Contents
ACKNOWLEDGMENTS
Trinity Evangelical Divinity School (TEDS) provided support through a sabbatical leave and wonderful teaching assistants. Many counselors-in-training made contributions to my research, writing, and supervision on the use of assessments. Special thanks to Sasa Mo Chan, Lucas Tillet, Karen Lawrence, Rainey Ray Segars, Danielle Whitaker, Amanda Geels, Camille Andress, Lauren Fisher, Angela Wessels, Tyler Hudson, Amanda Lai Wai Kuen, and Jenna Metcalfe. Appreciation is also due to TEDS faculty from the Deerfield Dialogue Group, who critiqued select chapters.
These chapters merge assessment technology, Christian theology, and counseling practice. Defining assessment in mental health counseling with a Christian emphasis requires venturing into territory where precedent is limited. Conference presentations and publication along the way generated useful feedback. This enabled fine-tuning of concepts such as redemptive validity, layers of wisdom, clinical application of rapid assessment instruments (RAIs), and corrective emotional relationships (CERs). It is important to thank anonymous reviewers from the Journal for Psychology and Christianity, the Journal of Psychology and Theology, Christian Psychology: A Transdisciplinary Journal, and Journal of the Evangelical Theological Society. Sections of these articles are incorporated here.
Insight was inspired by colleagues, counselor educators, students, and clients. The ideas stimulated by these dialogue partners were absorbed into these pages. The confidence of Andy Le Peau and Jon Boyd from InterVarsity Press was essential. In short, this project benefited from the input of many who are remembered with much gratitude.
Finally, thanks to my pastor, the Reverend Terry Breum. As he prays for me, often when celebrating the Lord’s Supper, he explicitly intercedes by asking the Lord to bless my “teaching and writing ministry.” This effort is indeed an answer to those persistent prayers.
ABBREVIATIONS
16PF
16 Personality Factor Questionnaire
AA
Alcoholic Anonymous
AACE
Association for Assessment in Counseling and Education
AARC
Association for Assessment and Research in Counseling
ACA
American Counseling Association
ADHD
Attention Deficit Hyperactivity Disorder
AERA
American Educational Research Association
APA
American Psychological Association or
APA
American Psychiatric Association
ATGS-9
Attitudes Toward God Scale
ASERVIC
Association of Spiritual, Ethical, and Religious Values Issues in Counseling
BAI
Beck Anxiety Inventory
BDI-II
Beck Depression Inventory II
Brief RCOPE
Brief RCOPE
BSI
Brief Symptom Inventory
CAD
Clinical Assessment of Depression
CAGE
CAGE Substance Abuse Screening Tool (Cut down, Annoyed, Guilty, Eye-opener)
CAICEF
Clinical Assessment Instrument Christian Evaluation Form
CCSM
DSM-5 Level 1 Cross-Cutting Symptom Measure
CERs
Corrective Emotional Relationships
CLOSE
CLOSE Therapy Graduation Dialogue Outline (Change, Lessons Learned, Openness to Others, Spiritual Practices/Support, Expectations)
CPAC
Counseling Partnership Alliance Check
CPE
Clinical Pastoral Education
CR
Celebrate Recovery
CSRI
Clinically Significant Religious Impairment
CUD
Character-Under-Development
DAG
Disappointment and Anger with God Scale
DRI
Duke Religion Index
DSM-5
Diagnostic and Statistical Manual of Mental Disorders-5th edition
DWI
Driving While Intoxicated
EBP
Evidence-Based Practice
EMRs
Electronic Medical Records
FFM
Five-Factor Model
FACT
Spiritual History-Assessment Tool (Faith, Activities, Coping, Treatment)
FICA
Spirituality Questionnaire (Faith, Importance, Community, and Address)
FIT
Feedback-Informed Treatment
FS
Flourishing Scale
GAS
Goal Attainment Scale
GRID-HAMD
Hamilton Rating Scale for Depression
HAM-A
Hamilton Anxiety Rating Scale
IC
Initial Consultation
ICD-10
Classification of Mental and Behavioral Disorders
ISS
Intrinsic Spirituality Scale
JCOPE
Jewish Religious Coping Scale
MBTI
Myers-Briggs Type Indicator
MCCI
Millon College Counseling Inventory
MCMI-III/IV
Millon Clinical Multiaxial Inventory-III/IV
MHPs
Mental Health Professionals
MMPI
Minnesota Multiphasic Personality Inventory
MMPI-2-RF
Minnesota Multiphasic Personality Inventory-2-Restructured Form
MMY
Mental Measurements Yearbook
NEO-PI-3
NEO Personality Inventory-3
NCME
National Council on Measurement in Education
NRC
Negative Religious Coping
O&A
Orientation and Assessment Session
PACE PACE
Treatment Progress Dialogue Outline (Partnership, Affinity, Collaborative Conversation, and Experience)
PAG
Positive Attitudes toward God Scale
PASS
Procrastination Assessment Scale-Students
PBE
Practice-Based Evidence
PCL-C PTSD
Checklist-Civilian Version
PHQ-9
Patient Health Questionnaire Depression Scale
PI
Perfectionism Inventory
PID
Personality-in-Distress
PRC
Positive Religious Coping
PS
Procrastination Scale
PSSI
Pinney Sexual Satisfaction Inventory
PTSD
Post-Traumatic Stress Disorder
QVW
Quickview Social History
RADS II
Reynolds Adolescent Depression Scale
RAIs
Rapid Assessment Instruments
RAPS
Rapid Alcohol Problems Screen
RCI-10
Religious Commitment Inventory
RSS
Religious Support Scale
RV
Redemptive Validity
SAI
Spiritual Assessment Inventory
SCL-90-R
Symptom Checklist 90 Revised
SCOFF
Eating Disorder Screening Questionnaire (Sick, Control, One stone, Fat, Food)
SCSRFQ
Santa Clara Strength of Religious Faith Questionnaire
SDS
Zung Self-Rating Depression Scale
SLA
Spiritual Life Assessment
SMQS
Sacred Moment Qualities Scale
SRF
Session Rating Form
SRS
Springfield Religiosity Scale
START
START Initial Consultation Outline (Story, Therapeutic Alliance, Assessment, Recommendations, and Treatment Plan)
SUDS
Subjective Units of Distress Scale
WAI/WAI-SF
Working Alliance Inventory (or WAI-SF, short form)
PART 1
REASON FOR ASSESSMENT
ASSESSMENT TONAVIGATE CHANGE
And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through him.
THEOLOGICAL THEME
Virtue and Vocational Excellence
PICTURE THE DESTINATION
Assessment starts by listening to someone’s life story, dream, or personal experience and hearing the yearning underneath. The counselor listens earnestly for the key challenge that must be explored. From this point forward, each decision, instrument, and inquiry flows out of the rationale for launching the investigation. The destination for change emerges as a response to the cry of a heart. Assessment then guides the journey.
Mental health evaluations by tradition are descriptive and technical. The scientific legacy of psychological measurement has produced objective means to investigate unique personal characteristics. Polished instruments identify symptoms, gauge functioning, or detect personality patterns. Interviewers probe for detail and take notice of the full range of immediate behaviors. Results are merged into formal reports. This documentation outlines the reason for referral, summarizes background information, lists the measures applied, consolidates findings, and builds to a conclusion with recommendations. Such evaluations rely on expert judgment to generate insight into the essence of the presenting problem. The purpose is to pinpoint an accurate diagnostic profile that tracks smoothly with the treatment options.
Descriptive assessment remains a necessity. For example, health systems allow for care to treat a disease, condition, or injury. The evaluation at the outset justifies eligibility for treatment by establishing the state of the patient. Further, the severity of the detriment dictates the treatment setting, frequency, format, and duration. Nevertheless, although important, this mainstream style of assessment contains a clinical hazard. Professional documents take on the tone of official pronouncements. The findings have power to inadvertently become limitations. The objective survey of the client’s past and present detects a location on a psychiatric map of mental illness. A pin is dropped; a monument is erected.
There is a way forward that embraces the methodology of assessment yet reduces the risk that it will hinder growth. Counselors would do well to view assessment as a real-time navigational system that can expedite the route to a place of flourishing. Instruments can do more than describe; they can estimate proximity to the achievement of change. Or, when treatment is underway, measures may reveal aimless wandering or warn of the dreaded dead end. Awareness of the need to reroute the care plan is far more beneficial than pushing on as if all were well. Assessment, like its biblical counterpart, discernment, needs to be an ongoing and dynamic routine to encourage movement in a productive direction, toward what is truly best (Phil 1:9-10).
This book will explore flexible and vibrant ways to gather and apply information. Assessment informs both counselors and clients. It can tighten the focus of the conversation, reveal the presence of obstacles, stabilize risk from nonproductive expectations, and safeguard good will in the helping partnership itself.
The intersection of psychotherapy and Christian ministry is primed for reconstruction. There are numerous shifts occurring in cultural and spiritual values. Clergy who care for constituents via counseling must reflect on their priorities and purposes. Pastors and congregations will determine an acceptable balance of care implementing interpersonal discipleship, group instruction, or intercessory prayer. Is ministry counseling to be a comprehensive service, an entryway to mental health intervention, or a referral route to formation exercises with a spiritual director? Professional roles and expectations are in flux as specializations continue to evolve. Christians with credentials in mental health settings are prepared to serve diverse clients without imposing faith values. Such neutrality may not be appealing to those with deep Christian convictions. Obviously, the stakes in counseling are high, both personally and socially. Resources continue to fall far short of critical needs. Clinicians, ministry leaders, and medical professionals will continue to explore the potential for teamwork. Clinicians who follow Christ and have eyes to see those who are hurting, hiding, or seeking will feel the compassion of our Lord awaken. The crowds appear harassed and helpless (Mt 9:36).
When educating others, the challenge is to teach forward—that is, to teach with an eye on what is on the horizon. There is little benefit accomplished by merely looking back on what one has come to understand as valuable in the field and then passing that along. Those perceptions may be accurate, insightful, explanatory, and perhaps even entertaining. But unless guidance anticipates, it is functionally and pedagogically useless. The upcoming generation of people helpers and pastoral caregivers will not serve clients under the field conditions that existed five or more years ago. Experience generates knowledge, and this becomes wisdom when combined with vision to prepare learners for what’s looming on the horizon. The next generation needs to be ready to embrace the questions of their day.
Here’s the proverbial good news and bad news. The good news is that counseling is effective; therapy is a valid pathway for clients to resolve issues and pursue change. Clients who complete treatment generally improve. The supporting evidence for this claim is compelling (Lambert, 2013; Nielsen et al., 2004; Wampold & Imel, 2015). Furthermore, when therapeutic methods are accommodated to fit the faith traditions and commitments of religiously oriented clients, these approaches are generally effective (Worthington, Hook, Davis, & McDaniel, 2011). For those in the Christian tradition, there is a variety of therapeutic approaches available (Worthington, Johnson, Hook, & Aten, 2013).
However, despite much evidence for the effectiveness of therapy, there are still opportunities to improve the discipline. This desire for improvement has led to the call for standardization and customization. Standardization is uniformity in how counseling is delivered, while customization refers to how counselors fit approaches to unique clients. Additionally, there is a call for evidence that articulates the potential impact of specific models of treatment. The challenge, though, is that the reliability (e.g., consistency) of success is less predictable than those in the field might hope. Multiple factors contribute to the intricacies of delivering effective service, in particular the fact that no two clients are the same. Each client represents a specific background, family configuration, and cultural community, and skillful counselors recognize subtle distinctions in client presentation and openness. Adept counselors adjust interventions accordingly (Wampold & Imel, 2015). But the impediments to success are real.
How many mental health professionals (MHPs) does it take to change a light bulb? Only one, but the light bulb must want to change. The joke may be stale, but the myth it extols is worth exposing. Failures in counseling are not solely a matter of counselee factors or an unwillingness to commit. A motivational force brings a client in for that first appointment. It takes embracing that impetus to promote success. Extensive research into counselor actions offers insights into what’s likely to go right or wrong (Castonguay & Hill, 2017; Marini, 2016; Swift & Greenberg, 2015). Counselor behavior matters. How will MHPs address uncertainties regarding the reliable delivery of care? Counselors are challenged to recognize and employ information on how the collaboration is proceeding. This is a formidable responsibility. There is much to consider, and there are many aspects to observe—all constrained by limitations on time.
THE HOPE OF PRACTICE-BASED EVIDENCE
Still, there is reason for hope. A robust movement is building momentum in the field of counseling and psychotherapy, described by phrases such as “preventing treatment failure,” “feedback informed therapy,” “patient-focused assessment,” “psychotherapy quality assurance,” and “outcome monitoring” (Prescott, Maeschalck, & Miller, 2017; Duncan, Miller, Wampold, & Hubble, 2010; Lambert, 2010; Swift & Greenberg, 2015). These labels can be summarized by the term “practice-based evidence” (Green & Latchford, 2012). Practice-based evidence (PBE) involves systematically collecting information at all phases of treatment through the use of assorted assessment procedures. Using assessment to monitor and inform the process of change can strengthen the quality of service and increase the likelihood that the desired outcomes will be reasonably achieved. This style of assessment will increasingly inform and empower clients, demonstrate progress, and maximize success by clarifying expectations and focusing on tangible outcomes.
This form of assessment is not about making a diagnosis or discovering an elusive underlying pattern. Rather, this is doing assessment seamlessly, with ease and comfort for the sake of the client. Approaching a clinical case is similar to conducting a research study: even though there is only one subject, it is essential to define the problem, develop a hypothesis, propose an intervention, deliver care, refine the plan as necessary, and review the evidence to see how successful the outcomes are (Glicken, 2005). And rather than diminishing the interpersonal nature of the work, these assessment procedures can contribute to the durability and endurance of the human aspects of care.
The past few decades have seen the establishment of evidence-based practice (EBP) in mental health care. This is typically defined as the implementation of the best current research into explicitly tailored methods to fit client characteristics, culture, and setting. EPB requires clinicians to engage clients with significant interpersonal skill (APA Presidential Taskforce, 2006). Using targeted approaches and adapting them to unique clients requires the application of assessment procedures posing these questions:
What are the options?
What’s the best plan?
Will this work?
How should we proceed?
In contrast, PBE shifts the focus to consider how things are working in a live, multifaceted therapeutic effort. PBE is a complementary undertaking that extends the principle of relying on evidence to determine the direction of care by mapping the progression of the change experienced by the client. PBE prefers these questions:
Is this option working?
What’s our best plan?
Are we working?
How can we adjust to improve our plan or partnership?
Both EPB and PBE seek improved quality of service, but the distinction between the two is that although EBP looks to researchers to demonstrate efficacy, PBE turns the spotlight on the counseling dyad, making the argument that quality care will provide the evidence that treatment was indeed effective. PBE is collected, calibrated, and interpreted in the counseling room, not in the laboratory.
We live in an era when customers rate everything, from the burger they ate at lunch to a new piece of luggage to their medical services. It’s common sense to check with clients before they depart our offices to ascertain if our procedures and services were close to their expectations. In fact, this sort of evaluation can help shape counselee expectations, even from the earliest contact. Incorporating practice-based evidence allows counselors to evaluate progress alongside clients so that accomplishments and the ongoing strategy for growth are understood and agreed on mutually.
This form of assessment becomes a means to sharpen our craft while improving the connection and tracking results in real time. My goal in this book is to equip clinicians to come to terms with the necessity and advantages of bringing a productive blend of assessment strategies into our interpersonal helping conversations.
TOWARD A THEOLOGY OF ASSESSMENT
When I began teaching counseling in a seminary, my core assignment was to teach two psychological testing courses for future counselors with pastoral ambitions. However, each course encountered ample resistance: “Loving God and listening to others has no resemblance to statistics, standardization, or psychological surveys!” The force of the impasse prompted me to wonder, is there a definitive theology of assessment practices?
This question led me to consult with a well-regarded and published expert on the merger of assessment and Christianity. He explained that psychological testing is where the field relies on scientific methods. Christian theology is religious activity and has its own structure. In this curricular area, it’s best not to conflate the two.
The consultant continued with his assertion. There are two subjects where it does not matter if the instructor is a person of faith: research and assessment. The methodologies rely on science, evidence, and systematic interpretation. These are not domains for theology. As jarring as this was, his central contention does remain sound. Given the demands on MHPs to grapple with special terminology and statistical material, courses in assessment must require learners to press hard into matters of technical import. Fluency in the language of test construction and proper implementation is indeed a requirement (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 2014).
Yet while instrument construction may be a methodology of science, its application raises issues related to worldview, values, and religious tradition. When assessment procedures are used in ministry, there is value in pondering how theological thinking can contribute to right speaking and doing. From the standpoint of Christian anthropology, there may be risks that arise from the promotion of instruments devised to reduce complex human characteristics into comprehensible, discrete quantities. Can these measures be put to use in ways that continue to respect the agency and holistic nature of human beings?
The serious reminder delivered in that consultation has not been forgotten. People helpers must grasp the power and risk embedded in assessment before bringing any measure to a client, and this requires mastery of basic concepts and the language related to psychometrics. Still, my passion follows the charge of another mentor who reminds that no matter the activity, the process of people helping is a means for the Lord to accomplish his perfect will through imperfect people (Collins, 2000). Therefore, selecting and applying assessment technology is not exactly value neutral or a venture in pure objectivity.
These pages do not offer a comprehensive theology of assessment. However, a theocentric foundation, supported by sound biblical theology, should guide the application of any and all applied technology. Scripture provides the basis for this theology as it addresses themes such as stewardship, discernment, wisdom, hospitality, the kingdom of God, sanctification, and the redemptive activity of the Holy Spirit. These theological domains can be addressed through the use of assessment. After years of interacting with future Christian and pastoral counselors on how to apply standardized psychological instruments, I offer these pages to share my attempt to bring biblical directives into this clinical discipline.
MAXIMIZING ASSESSMENT WITHOUT MINIMIZING CHRISTIANITY
When assessment furthers the planning of the helping effort, goals, and exit strategy, it enhances communication. Assessment procedures can establish a built-in mechanism to evaluate how the partnership is progressing toward the goals. Viewed in this light, assessment becomes the pursuit of excellence in counseling and pastoral care.
Assessment in clinical practice is nothing new, but it is currently being rethought. However, this is not an exhortation to simply comply with the latest trends. There are reasons why it may be particularly important for Christians in the field of mental health to become proficient in demonstrating practice-based evidence. Counseling committed to a ministry orientation can utilize assessment to confront several unfortunate contemporary pressures.
Medicalization. An unrelenting tendency in our day is to categorize matters of human experience hastily and exclusively in medical terms. A young child who places inedible items in his mouth may automatically have this behavior tagged as pica. The term denotes a legitimate medical condition with mental health associations. This language classifies the behavior as a craving, compulsion, and disease. But there are normal alternatives to a medical diagnosis, alternatives such as boredom, curiosity, rebelliousness, or hunger. Assessment determines when and if the line of disease is crossed. Ordinary human experiences such as feeling down, anxious, restless, fatigued, excited, or dissatisfied can be a symptom of an extensive array of issues, but a disease model with medical causes and cures tends to be the default route.
Without a doubt, the range of medical treatments in behavioral healthcare has removed needless and unnecessary suffering. The challenge for Christians who counsel, however, is to recognize the blessing of medical advances while still acknowledging a holistic view that includes existential, religious, and spiritual matters. Counselors are often in a prime position to sit with clients and consider the psychological, behavioral, relational, and cultural domains. Christian therapists may also wish to raise awareness regarding lifestyle, family priorities, ethics, values, and spirituality in conjunction with exploring a stated concern.
The key to distinguish when a behavior or experience lies within the normal or atypical range is to investigate its frequency, severity, and duration. Such analysis is fundamental in assessment. Comprehensive and systematic assessment encourages practitioners to resist the urge to close in on a physical or biological explanation too readily or absolutely. To be certain, there are times when medical concerns are legitimate, and well-rounded assessment makes this evident. But routine and targeted data collection with quantification directs client treatment toward holistic care.
Makeover madness. Reality shows bring the fantasy of a complete makeover within the range of plausibility. Home makeover shows often portray a run-down, money-pit of a house being transformed into the neighborhood sweetheart in a matter of weeks. Dramatic and nearly instantaneous makeovers are all the rage.
Buoyed by these makeover stories, clients may show up for that first appointment with the unspoken expectation that a magical phrase or savvy advice is going to rock their world. Counseling can be transformative, and there are occasions when a homework assignment leads to a series of outlook-altering revolutions. The norm, however, usually involves contemplation of change over time; rarely does it happen so completely or rapidly as the makeovers in media accounts. Our mission in helping, therefore, is to stir hope. The dialogue work will entail getting a good picture of the present scenario and resources in order to help clients turn wishes for change into realistic and recognizable goals.
Assessment can be critical in this process of helping clients set a reasonable outlook on what can be accomplished in the counseling journey. For Christian counseling, assessment can also provide insight in how to pray for the courage to heal, grow, and transform. This can temper clients’ hopes for miraculous change with the recognition that the Lord will provide daily bread to sustain them on their sojourn toward wholeness.
Marginalization. The embrace of spirituality and religion by the broad therapeutic community over the past two decades is a radical shift. Whereas spirituality and religion were once viewed as irrational defenses or as an irrelevant rabbit trail in psychotherapy, faith is now viewed as a central individual, cultural, and transcendent resource.1 The counseling profession has integrated spirituality and religion into its helping process and produced its own resources (Cashwell & Young, 2011), and in 1993 the Association of Spiritual, Ethical, and Religious Values Issues in Counseling (ASERVIC) became a division within the American Counseling Association (ACA). This moved a formerly Catholic organization into a broad and diverse community of over four thousand counselors within the ACA who express an interest in spiritually sensitive counseling. Spiritual competencies were established in 1995 and updated in 2009 (Cashwell & Watts, 2010).
This new enthusiasm regarding spirituality is confirmation of the important place that transcendence has in human experience. There is also a profound recognition that in times of turmoil, clients are open to exploring their spiritual/religious perspectives and practices (Young & Cashwell, 2011). Yet this shift has resulted in a growing uneasiness among those committed to the vital and historic Christian tradition. The discomfort arises from indications that, as a generic and individually defined spirituality is on the rise, orthodox Christianity with its grounded moral code and religious authority may be marginalized or rejected completely. Christianity speaks to the immediate and eternal salvation of broken persons, not to the humanistic fulfillment of an autonomous individual (Rom 1:16-17). According to the Christian tradition, human beings are dependent on an external source for renewal. This perspective can be viewed by some as primitive, judgmental, and archaic.
Christians who counsel need to develop a thoughtful perspective to clinical assessment. Counselors who represent ministry traditions need not be hesitant in supplying credible evidence for the value of a distinctly Christian therapeutic approach. One way to confront the cultural pressure to marginalize authentic Christian approaches is to demonstrate their effectiveness via practice-based evidence. This will require that counselors reach routinely for instruments. Doing so will affirm for Christian counselors that their work is effective and worthy of recognition.
Mediocrity. Counselors may be torn in trying to address the expectations of the mental health system, the professional guild, and Christian ministry. There can be a reluctance to adopt procedures that appear secular, trendy, or overtly scientific. Or, alternately, there may be hesitation to make biblical themes or Christian discipleship a central focus in counseling. The trouble with seeking a middle ground between competing expectations is that it can lead to mediocrity.
Strategic assessment is a means to examine a client’s experience, expectations, and views. This can be done not only to enhance therapeutic alliance but also to discern openness to the direction of the Holy Spirit. This allows for agreement about what determines quality service as well as a means to evaluate outcomes.
For clients who come with fervent Christian commitments of their own, there is an opportunity to chart a course for care that brings best practices together with the conventions of Christian discipleship (Vanhoozer, 2014). Counselors can make wise use of what is known about fostering excellence in a therapeutic encounter in a manner that is thoughtful, respectful, and thoroughly Christian. This moves away from the middle ground to higher ground.
PLANNING THE APPROACH
The purpose of this book is to enable counselors to put assessment into practical use, particularly with clients who are looking to grow their identity with Jesus Christ. It seeks to bring the best of assessment into counseling that reflects the true essence of the Christian faith. The main goal is to display how to implement measures in treatment for the sake of a mutual therapeutic relationship. As a Christian perspective on assessment, this book is designed to complement and supplement. This is not intended to be a comprehensive text on assessment in counseling.2
The four parts of this book, purposefully titled Assessment for Counseling in Christian Perspective, follow the typical outline of an assessment report: (1) reason for assessment, (2) background information, (3) assessment selection and administration, and (4) results and interpretation. Here are the central questions and topics to anticipate.
Reason for assessment. How can a counselor clearly and uniquely formulate a strategy to assess with purpose in the throes of a genuine helping relationship? Part one identifies the value of assessment. Chapter two defines key terms and clarifies the purpose of assessment in therapeutic partnerships in contrast to a full psychological evaluation. The role of a mental health professional as both client advocate and ally becomes the overarching value when introducing measures into the helping process. Assessment done right can bring necessary past and present details to the surface, increase awareness of the dynamic interpersonal forces that are in play, and establish a means to speak with precision to invested parties about treatment progress.
Does a Christian worldview offer distinguishing parameters for assessment practice? Scripture has a good deal to say about gaining understanding on the inner ways and leanings of the heart. The pursuit of wisdom is the central frame of reference that governs counseling with Christian intentions. Thus, chapter three connects the search for wisdom with discerning the desires of the heart. In Christian counseling, Scripture is the ultimate “norming norm”; therefore, this chapter addresses customs for counselors to implement in order to “interrogate” the Word.
Background information. Can clinical proficiency in assessment bring glory to God? Part two lays the foundation for a theology of assessment. A response to the question of how systematic data collection can be an act of worship begins by expanding the theological layers for wisdom in counseling (chap. 4). Wisdom is intricately bound to artisanship. A craftsperson is one who is “wise” in the use of hands when demonstrating handiwork. Counselors are encouraged to use the finest tools available with well-executed artisanship for the benefit of clients.
Will counselors promote social justice as they come alongside their clients? The goal of developing standards to construct measures is not only to build better measures but to ensure that these measures are used justly across various cultural groups and diverse populations. Chapter five challenges counselors to personalize the core value of using honest and fair scales in ways that keep righteousness central in their own heart. Chapter six continues the press to account for cultural identity and diversity with unique clients by using illustrations from important biblical commands (Heb 12:14; Jas 2:9). The challenge to Christian clinicians to adopt specific disciplines as clinical habits is suggested to accomplish open-minded, holistic, and impartial assessments.
How can the crucial psychometric construct of validity be translated into our Christian faith?Chapter seven then builds the case for an explicit review of all measures through the lens of redemptive validity (RV). RV offers a way for clinicians to evaluate how a measure will function when applied to clients who value the Christian faith. RV is not a concern for those who develop measures, so this term will not show up in any test manual or prominent assessment text. Rather, RV goes beyond looking at an instrument’s items, construct, or predictive criterion; it extends validity considerations to the renewal taking place in a client’s life. Instrument evaluation, selection, and utility must first be viewed through a psychometric lens. Then, a theological perspective may be advantageous when a Christian viewpoint is desired.
Assessment selection and administration. In what ways can the intrusion of objective procedures in therapy be transformed into a message of hospitality and affirmation? Part three, “Assessment Selection and Administration,” lays out practical applications. Chapter eight explores the assessment aspect of two vital elements of counseling: interviewing and dialogue. These skills are put to use in a tailored approach to reveal a client’s faith orientation along polarities such as extrinsic or intrinsic, seeking or dwelling, Scripture or experience. Chapter nine follows by making the case to employ both subjective and objective assessment. The START model for initial consultations is introduced: story, therapeutic alliance, assessment, recommendations, and treatment plan. This rubric for a semi-structured interview provides an approach to demonstrate hospitality to a stranger with the hope of becoming an ally.
How can counselors maximize the benefits of a therapeutic alliance to attend to immediate concerns and foster spiritual formation?Chapter ten explores the concept of the therapeutic alliance and how to assess it. For clients who want counseling that is both restorative and spiritually transformative, the therapeutic partnership takes on special meaning. This is done through the lens of viewing the self as striving to live out one’s role in God’s great Gospel narrative—that is, the self that performs as a child who images God by displaying divine characteristics and enacting God’s redemptive story. There are efficient ways to monitor the alliance and progress in therapy. This helps to address both a client’s chief request while seizing the opportunity to cultivate character. The PACE rubric for ongoing progress evaluation of the therapeutic process is offered: partnership, affinity, collaborative conversation, and experience. This treatment review procedure can assist the dyad to stay true to both its clinical and formative mission.
Can assessment measures be implemented that enhance the precision and potency of the counseling conversation? There is a world of opportunity to access assessment instruments that are short, sweet, and tightly targeted (chap. 11). This brings the use of semi-standardized measures to the attention of clinicians. Selective therapeutic assessment is defined as a strategy for combining instruments into a unified package that covers the critical areas for diagnosis and treatment planning. Selective assessment can expand by uncovering and evaluating credible resources. Rapid assessment instruments (RAIs) can be overlooked by MHPs as these are not commercially marketed or comprehensibly normed. The use of RAIs is a way to affordably and purposefully enlarge one’s assessment toolkit. There are even measures of religious commitment and spirituality that can be applied to foster formation.
Results and interpretation. Part four shows how these measures can contribute not only to good counseling but also to conversations that are distinctively Christian.
What are the best practices to assess a client’s spirituality or specific Christian tradition?Chapter thirteen provides interview techniques and measures to conduct a spiritual assessment. Clinicians are shown how to adopt a stepwise procedure to grasp clients’ spiritual commitments, practices, and history as a means of ascertaining clients’ desire for counseling that ultimately influences their spiritual journey.
How can counselors incorporate formal personality measures to add depth and substance to the counseling experience?Chapter fourteen transitions to explore well-established, self-report personality measures, namely, the NEO Personality Inventory-3 (NEO-PI-3); Sixteen Personality Factor Questionnaire (16PF); Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF); and the Millon Clinical Multiaxial Inventory IV (MCMI-IV). Measures such as these are definitely worth considering. Each one can bring light and language to enrich a clinical dialogue aimed at resolving immediate concerns and can also have a lasting impact on how the self relates to others. This is a key priority—to restore health while increasing conformity to the image of Jesus Christ.
How can assessment done well contribute to client retention, treatment completion, and aftercare planning?Chapter fifteen challenges the common closure terminology for counseling (termination) and offers a productive alternative (graduation). The chapter highlights lessons learned from the literature on how best to reach the graduation milestone and what steps counselors can take to prevent treatment failure. The CLOSE model is explained as an outline to recollect and remember the key events of treatment: change in chief concern, lessons learned, openness to others, spiritual practices (or support), and expectations. Bringing therapy to a meaningful close allows for a retrospective review of the relationship. Treatment concludes with plans for postgraduation maintenance, development, and fellowship (aftercare).
A VISION OF QUALITY CARE
The phrase quality care is often associated with mission statements and organizational mottos. This provocative term is far easier to claim than it is to demonstrate. What does quality actually look like in counseling? Care, respect, empathy, empowerment, restoration, and mutuality are lofty ideals. These need a firm grounding in client-friendly enactments. Further, for the disciple of Christ who counsels, we have a heavenly partner whom we wish to honor with the fruit of our labor. Service to clients is our service to him.
Through the promotion of an active, practice-based evidence approach to care, quality is cultivated in each conversation and in each session. There will be clearly defined benchmarks to set the course, to check for a good-enough partnership, and to track progress. In the chapters ahead, counselors will be shown ideas to synthesize a standardized program of assessment rituals. The result should fit your style, setting, and clientele. Further, the beauty and kindness of bringing grace into each counseling experience flows through the way treatment is customized to match the special features of the client on an exacting journey.
Catch this vision. Quality in care can be demonstrated. It is on display when we establish a plausible starting point to begin the work. It shines on when there is a readiness to share informed insights into the challenge of the moment. Quality prevails in the courage to explore the intricate dynamics of the immediate helping partnership. Further, it is expressed by ease in adapting evidence-based interventions into practical helps to fit a client who is known and understood. It is to these ends that the benefits of assessment will connect. It is to this higher level of craftsmanship that clinicians will be called.
Here are clinical habits, techniques, and strategies to navigate the complexity of the therapeutic encounter. The intent is to employ assessment as a flexible activity to inform, focus, and enliven helping conversations. What follows is a way to make counseling conversations not only edifying but to make its outcomes transparent. Counselors can show clients, or even outside parties, evidence of the therapeutic work that the Lord has enabled.
Christian theology will be prominent in selecting and shaping the questions, not merely as an aid to make sense of a string of responses. This is what it means to be a follower of Christ who is ready to bring healing to others who may or may not hold to our convictions. Our deepest conviction is this: to serve the other as neighbor and to love God in each moment.
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DEFINING THE ASSESSMENT TASK
But the LORD said to Samuel, “Do not consider his appearance or his height, for I have rejected him. The LORD does not look at the things people look at. People look at the outward appearance, but the LORD looks at the heart.”
THEOLOGICAL THEME
Affections of the Human Heart
ENVISIONING BEST PRACTICE
Every story has a beginning. The story of my work in clinical practice begins with an ordinary decision with a receptive client. At the time, it seemed like nothing—a ridiculously basic intervention decision: I determined to build more, not less, standardized assessment into my therapeutic services. In retrospect, this marked the start of an irreversible journey toward the integration of assessment procedures into counseling for the purpose of enhancing the quality of care and encouraging Christ-glorifying spiritual growth. This decision continues to define any counseling care that I undertake personally or influence via supervision.
One particular case displays how this commitment to assessment was solidified in my practice. Dan was a typical client who openly claimed Jesus Christ as Lord.1 Despite our common faith, we were often deadlocked in a bewildering struggle to achieve and maintain a mutual alliance. In our initial meeting Dan presented as a well-functioning individual with marked success in multiple spheres: career, marriage, friendships, and the church. He had an accomplished career as an engineer and had recently been promoted. The board of elders at his church was making inquiries to bring him into a leadership role. This father of two had a schoolteacher wife who adored him. His depictions of her devotion could make other husbands groan with envy. The recognition of these blessings heightened his sense of shame. Despite all appearances, crippling anxiety would overtake him, and he sought relief in dark outlets. There were extensive compulsive, self-destructive patterns that his outward success could easily mask. Furthermore, each behavioral tactic that Dan used to gain relief was defeated by his own actions before its effectiveness could be realized. In ordinary conversation, Dan exuded self-assurance. When alone, however, hypocrisy and self-doubt would explode out of him. His anxiety and shame could leave him weeping like an inconsolable infant.
After ten therapy sessions, only modest gains were evident to justify the benefit of our work together. My erroneous prediction early on was that counseling with Dan would be complete in less than three months. Now there were glaring indications that an entrenched lifestyle concern and chronic, self-defeating propensities reflected an inward, fragile identity. The impetus to take a closer look came from the novel requirement to submit a formal treatment plan. This client had a top-quality insurance plan that included external managed-care review procedures in order to request additional sessions. As Dan left that tenth session, I was utterly perplexed. It was as if checkmate had been declared in an arduous game of relational chess. During our very next meeting, I administered a standardized, self-report personality measure. I gave Dan an orientation to the assessment and made a commitment to discuss how the results would be useful for his care.
A nagging discomfort provoked me to introduce the use of assessment methodology. In schools and social service settings, assessment expertise was central to my work; conducting bio-psycho-social-educational evaluations was my primary function. At community agencies, I would routinely generate formal evaluations prepared with extensive reliance on standardized measures to inform special education teachers, caseworkers, psychiatrists, child-care staff, and court personnel when making care decisions. Beyond a clinical interview, the comprehensive battery would be informed by collaborative discussions, behavioral observations, projective tests, interest inventories, ability measures, and standardized questionnaires. By design, the reports used the insight generated to formulate a care plan, prepare a prognosis, and establish benchmarks for success. In stark contrast, when it came to my own outpatient mental health practice, with its unique ministry orientation, assessment instruments were kept in their cases. Could it be that I was leading a double professional life? In Christian counseling, where I bore the sole responsibility for client care, my case files contained information gleaned exclusively via interview. There was not a shred of data from formal, standardized assessment procedures.
The striking inconsistency in my role and function was troubling. Did it make sense to tout the value of formal psychological measures in educational and community agencies but then set those identical tools aside for the very clients whom I was eager to offer my very best knowledge and skill? Were secular assessment measures irrelevant when engaging in Christian-oriented, ministry-enhancing, counseling care? And could my slow therapeutic movement with Dan benefit from selecting measures to answer pointed questions, clarify symptom severity, identify behaviors, and decipher interpersonal patterns relevant to his troubling bouts of anxiety?
Dan was not merely searching for relief and increased intimacy; he was eager to grow in his Christian faith. Sinful behavior and obstructive interpersonal patterns were stubborn cords tying him down and holding him back. Our helping relationship became too easily tangled. So, Dan completed a single, broad-based personality measure. We also took a deliberate pause to fill in the essential details regarding his bio-psycho-social history. Upon careful review, the patterns of his customary style of relating were no longer so mysterious. In fact, his unique profile characteristics were strikingly pronounced. The resulting personality sketch confirmed my subjective observations. The assessment results yielded an explicit language to describe his interpersonal tendencies and external scores to highlight the pervasive patterns.
Engineers respect data, and Dan was invested in the findings. Using ordinary language and relevant illustrations from our ongoing dialogue, Dan and I strove to make sense of the puzzle pieces. His traits, relational leanings, and action-oriented trends were considered in light of his calling as a Christ-follower, father, husband, and church leader. Confession began to flow into the clinical setting as candor and transparency gradually increased. Dan postponed taking a leadership position with his congregation with the full support of his pastor. Critical clinical explorations began to center on traumatic losses and underlying fears. He faced these from the safety of our steady therapeutic relationship and his awareness of his position within the family of God. It was beautiful to acknowledge strengths, potential, and, most of all, his experience of the Lord’s grace.
I will say more regarding the therapeutic use of self-report personality measures in chapter fourteen. What’s important to observe here is that we had breached the barriers between psychological assessment and Christian counseling. The assessment measure itself did not supply the breakthrough or ignite change. It yielded nothing mysterious, magical, or miraculous. But those results did raise my confidence in recognizing the deeply rooted interpersonal ploys already evident in our relationship. We were able to find words to describe these actions, which helped to strengthen the therapeutic bond and focus our mission. We experienced joy as we predicted, named, and dismantled disabling behaviors and relational roadblocks. The therapeutic process fortified my awareness that good tools should never be left untouched when they can provide information that will improve a clinical connection.
A hard look at trends in practice reveals that too often mental health professionals are willing to offer outpatient therapy without tapping into the available array of assessment measures. For most, this avoidance stems from system mandates to contain costs. For others, this omission is linked to suspicion of the measures themselves or a lack of competence in interpretation.
My practice partner and I made hard choices over the years regarding the allocation of resources, initial procedures, and the use of technology. There is a cost to clients and the practice when including formal assessment in the helping process. We firmly agreed to use assessment tools discriminately, strategically, and, without question, cooperatively. Our decision flowed from the confidence that purposeful investigative procedures provide tangible evidence of our calling to offer quality mental health services with a distinctively Christian approach. Those who provide counseling from within a Christian worldview will recognize that it is a shared venture with the great Comforter, whether a client is striving to grow, struggling to overcome adversity, or following the Holy Spirit’s leading through the sanctification process.
After three decades of implementing selective assessment into counseling relationships and learning from others who have taken a similar path, the opportunity is ripe to share lessons learned. It’s exciting to see the benefit of having comprehensive information for making clinical decisions and understanding how best to come alongside clients with empathy, love, and dedication. This is the backstory to this theological and practical consideration of assessment use by Christian counselors.
COUNSELING: IN SEARCH OF A DEFINITION
Before exploring the purpose and principles of assessment it’s important to have a firm understanding of what is meant by the broad term counseling. The label is applicable in numerous settings, can refer to an infinite range of discussion topics, and can reflect an assortment of roles and helping arrangements (ACA, 2018; Rollins, 2010). For starters, ponder this official, twenty-one-word definition established by thirty renowned counseling experts who invested a year in this communication exercise using a systematic, Delphi research procedure to arrive at consensus: “Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals” (Kaplin, Tarvydas, & Gladding, 2014, p. 366).
Three features of this definition are worth exploring. First, the counseling relationship has clear boundaries and assigned roles. The phrase professional relationship recognizes that a set of ethical boundaries and procedures govern the undertaking. Second, counseling by design is intended to benefit, equip, and increase the recipient’s experience of personal power. One or more participants in the counseling arrangement are on the receiving end of the pact. Third, counseling aims to accomplish a particular purpose.
No matter how these essential components are organized or where one places the emphasis, a counseling relationship ultimately depends on quality assessment. For the sake of simplicity, and to provide a definition that works for both ministry and generic counseling, we will use the following definition in this text: Counseling is strategic dialogue within a defined relationship for the purpose of cultivating growth.
COUNSELING THAT IS CHRISTIAN
The aim throughout these chapters is to consider information collection procedures as they apply to a variety of counseling settings and as practiced by mental health professionals (MHPs), including credentialed counselors, social workers, psychologists, marriage and family therapists, and other healthcare providers. In addition, Christian counseling functions as an umbrella term to reference talk-based care offered by pastors, biblical counselors, chaplains, and ministry leaders (Collins, 2007; Malony & Augsburger, 2007; Powlison, 2010). Churches and other organizations with conservative roots and evangelical commitments tend to favor the use of this identifier over that of a close cousin, pastoral counseling (McMinn, Staley, Webb & Seegobin, 2010). Of course, the label pastoral counseling is used informally to reference any supportive service conducted by clergy or lay leaders functioning in a pastoral role. It also can have a more restricted meaning. Those within the helping professions associate this phrase with a specific approach that has a lengthy history dating back more than half a century (American Association of Pastoral Counselors, 2018; Snodgrass, 2015).
The Reverend Anton Boisen (1876–1965), founder of the clinical pastoral education (CPE) movement, sought to reverse the unwavering secular trend in psychiatry (Vacek, 2015). He was once a patient with mental illness, and his pain and struggle meant he couldn’t imagine psychiatric care without the incorporation of one’s faith. Boisen envisioned that CPE would equip ministers to provide clinical assistance that addressed moral, religious, and spiritual matters. Faith was to be esteemed as an asset, not as a liability, an indication of pathology, or a reflection of personal weakness. Notice the implication for assessment in this shift of perspective. For those who provide pastoral counseling services, a prescribed training sequence and necessary supervised field experience are required. Pastoral counselors seek to provide sound psychological therapy that is thoughtfully combined with a spiritual and religious dimension. Across its history, pastoral counseling has been predominantly associated with mainline denominations, with less conservative theological positions, and with the medical, psychiatric establishment. The label is not popular within the evangelical wing of the Protestant spectrum.
Another important categorization to highlight is biblical counseling. This is the contemporary identifier for nouthetic counseling, a long-respected, ministry-oriented approach prevalent in church settings. This significant movement is associated with Jay Adams, a Presbyterian minister and author of many books such as Competent to Counsel
