The Dimensions of Assessment in 3-D: What We Didn’t Know Before We Started Doing Trauma Therapy
To begin, there will be an overview of how an initial assessment of a patient/client ought to be done, what ought to be included in any clinical assessment of a patient/client in assessing diagnosis and judging appropriate treatment recommendations. The breadth and depth of any assessment will depend on the patient/client concerned, but also on the clinician: the clinician’s profession and competences; what the clinician judges to be their role and responsibility in the assessment. The ‘bare minimum’ will be covered, followed by how different client and clinician variables would call for more depth or breadth in the various components of an overall assessment. The overall concern is with what person has this “illness,” and not with what “illness” this person has. Apart from historical and symptomatic ‘checklists’, which remind us what ought to be considered, ways to elicit useful information will also be explored: how to do it, how not to do it, facilitating collaboration, fostering openness. Special attention will be given to the typical history and symptomatology of chronic posttraumatic and dissociative conditions.
From there, the webinar moves to focus on assessment tools, from screening tools to in-depth structured interviews. Having taken a comprehensive history, the clinician will begin to formulate questions about the nature of the person’s distress. Is this person dissociative, and if so, in what way? Assessment tools are useful throughout therapy, to help clarify the person’s experience and how they have attempted to manage their behavior and emotions. These tools assist the therapist and client, and when used appropriately, enhance the therapeutic relationship.
Following formal assessment, the webinar will continue with discussion on “psychodynamic case formulation” – conceptualizations that will inform therapy. Having obtained an in-depth assessment, the therapist now needs to reflect on the client, what the experienced interactions might disclose, what may have been revealed in how they answered questions and told their history or perhaps seemingly omitted; any repeating patterns they present, and then putting together a “story” to make some hypotheses or inferences, however tentative. These formulations will continue throughout the therapy, but will mostly be discussed in terms of the information gained from the first assessment phase. Some of the issues explored include: pre-existing “transference”, especially if the client was in previous therapy; their experience of the treatment frame and any frame “violations”; the shifts in affective states within the formal assessment; transference, countertransference and enactments; verbal and non-verbal cues, possible manifestations of unconscious material, how trauma and dissociation impact their lives and the assessment process, and other phenomena. Examples will be discussed to illustrate the concepts. The final part of the webinar will focus on a summary of the salient issues raised by each of the presenters and a round-table discussion by the moderator and presenters. Time will be left for questions and answers with all four presenters.
90 Minutes - How to do an in-depth office assessment in general and applied to complex trauma and dissociation (O’Neil)
30 Minutes - Break
90 Minutes - Assessment and diagnostic tools for complex trauma and dissociative disorders and their clinical use (Danylchuk)
90 Minutes - What is psychodynamic formulation of case material, and how to utilize office assessment and diagnostic and assessment tools for the psychodynamic formulation of complex trauma and dissociative disorder patients. (Baker and Turkus)
45 Minutes - Summary of the concepts and applications to clinical material (Turkus)
45 minutes - Round-table discussion and Q&A (All)
At the conclusion of this webinar, participants will be able to:
- Conduct an initial case history appropriate to client and clinical context
- Identify what counts for a diagnostic assessment and to one’s choice of an optimal treatment plan for complex trauma and dissociative clients
- Identify the assessment tools most commonly used in the diagnosis of trauma and dissociation
- Define psychodynamic formulation
- Identify the purpose of the assessment tools - from initial screening to in-depth structured interviews - as integral parts of the therapeutic process
- Apply psychodynamic case formulation theory to clinical assessments of complex trauma and dissociative clients
Presenter: Joan Turkus, MD
Presenter Bio: Joan A. Turkus, MD maintains a consulting and clinical practice in psychiatry and traumatology in McLean, Virginia. She is the Medical Director, TraumaSci: Complex Trauma Disorders Program at Dominion/HCA Hospital in Falls Church, Virginia and Co-Founder/Past Medical Director of The Center: Posttraumatic Disorders Program at the Psychiatric Institute of Washington, DC. Dr. Turkus has years of experience in the trauma field and maintains a national profile with teaching and consultation. She is a graduate of Rutgers University with a degree in pharmacy and graduated from The George Washington University School of Medicine with honors. She is a Distinguished Life Fellow of the American Psychiatric Association and a Fellow of the International Society for the Study of Trauma and Dissociation, of which she is a Past President. She has been awarded a Lifetime Achievement Award, the Cornelia Wilbur Award for clinical contributions, and a Distinguished Achievement Award by the International Society for the Study of Trauma and Dissociation. She is a Diplomate of both the American Board of Psychiatry and the American Board of Forensic Psychiatry. She is trained in psychiatry, traumatology, clinical hypnosis and EMDR. She maintains a keen interest in neurobiology and psychopharmacology, particularly in their application to the complexity of Posttraumatic Stress Disorder.
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