Assessment Session Protocol

The counselor welcomes the client and provides an overview of the session. In this session, the counselor assesses the client's marijuana use while laying the foundation for a positive client-counselor relationship.

Build Rapport and Give an Overview of the Assessment Process

To build rapport and engage the client during the assessment session, the counselor informs the client about the sequence of events for this session and what to expect in the overall treatment approach. Introducing session topics, providing information, and responding to client concerns are the primary tasks during this part of the session. The counselor could begin the first session of BMDC with the following introduction:

Counselor (C): Let's talk about what we'd like to accomplish in the assessment session. We need a clear description of your marijuana use—how much marijuana you use, how often you use it, and what types of problems marijuana might be causing you. I'll ask you detailed questions about your marijuana and other drug and alcohol use, and I'll also ask you questions about how marijuana use has affected your daily life.

I'll summarize this information in the Personal Feedback Report that I'll give you during our next session. We'll use the PFR to compare your marijuana consumption with national averages and to get an idea about how to set your treatment goals. The session will take about 1 hour and 20 minutes. Some questions may be difficult to answer and a real test of your memory; just do your best to be honest and patient! Remember that the information is confidential and is used only to help you accomplish your therapy goals.

Conduct an Overview Assessment Using Open-Ended and Summary Questions

Most assessment tools, including a few presented later in the session, use closed-ended questions (How many days in the past month did you smoke marijuana?), but the counselor starts the session by using open-ended questions to engage the client (Tell me about your marijuana use pattern over the last month) before transitioning to more detailed tasks. Open-ended questions allow the counselor to establish a dialog with the client and build rapport by

• Showing genuine interest

• Conveying a nonjudgmental and accepting attitude

• Demonstrating the ability to track accurately what the client is saying

• Expressing empathy with the client.

The dialog might go as follows: C: How did you hear about this program?

Shirley (S): I've seen the ads in the paper for several weeks. Originally my husband the kitchen table for me.

C: You've worked with your husband to get here, and the two of you have given deal of thought. Have you tried to quit on your own?

left one on this a great

S: I try to quit almost every day, or at least I think about it. I'm going to be an elementary school teacher; in fact, I'm doing my student teaching now. I feel that quitting is the right thing to do—to be a good example to the kids. But nothing ever changes.

C: But you keep trying. What brings you here today?

S: Well, I know someday I will quit, and I've been looking at the ad for this program. I never thought anyone would offer treatment for pot smokers!

C: This was the opportunity you were waiting for. What would you like to see happen as a result of coming to treatment?

S: I guess I thought I'd get help on how to quit. But I realize that ultimately it's up to me, and it's way past time to do something.

C: You understand that it's your decision on what to do, but you also think that being here might help you. How confident are you at this point that you'll succeed?

Use the TLFB Method To Assess Marijuana Use

The assessment or evaluation component of this session can be a powerful element of treatment. Marijuana Treatment Program (MTP) participants reported increased motivation after receiving feedback from assessment-related activities.

During the session the counselor and client complete several forms to assess the client's marijuana use. Quantity of marijuana use is difficult to measure because of varying potency levels and smoking methods (e.g., pipe, joint); therefore, frequency of use is the most reliable criterion for consumption measures. The TLFB method helps the counselor and client identify patterns and possible consequences of use (Sobell and Sobell 2000; Sobell et al. forthcoming). For instance, a person who uses heavily on weekends may be at risk of driving an automobile while high. A chronic, daily use pattern might indicate that an individual has developed cannabis dependence. In addition to providing a precise measure of marijuana consumption, the TLFB method can assess changes in a client's marijuana use and helps the counselor determine treatment effectiveness. The counselor begins by asking the client to estimate generally how many days and how many times a day he or she smoked marijuana in the past month:

C: In the past month, about how many days did you smoke marijuana? [Waits for client's response before asking the next question.] In the past month, on a typical day when you smoked marijuana, about how many times per day did you smoke?

Once the counselor has a general sense of the client's use, the formal TLFB assessment process begins. The counselor uses the following instruments to assess the pattern, severity, and nature of the client's marijuana use:

• TLFB Calendar for the past month (form AS1)

• TLFB Marijuana Use Summary Sheet (form AS3).

The counselor uses the TLFB Calendar to help the client recall his or her marijuana use and the TLFB Grid to record summary information from the completed calendar. When completed, the

TLFB Marijuana Use Summary Sheet provides an overview of basic information about the client's marijuana use, alcohol consumption, and tobacco smoking. (The TLFB Calendar and TLFB Marijuana Use Summary Sheet procedures are modified from procedures developed by Sobell and Sobell [1992, 2000, 2003] and Sobell and colleagues [forthcoming]. Some administration guidelines are adapted from the Form 90 procedure developed by Miller [1996].)

Complete the TLFB Calendar

The counselor begins by developing a detailed history of daily marijuana use for a specified period, called the assessment window. This manual suggests an assessment window of 1 month. To arrive at a diagnosis of dependence or abuse, the DSM-IV advises that symptoms be present for 12 months. However, assessing symptoms for the last 12 months may tell little about the client's current use, especially if the client's use pattern has changed significantly over the year prior to entering treatment. (If the client had attempted to quit using or cut back usage in preparation for treatment, the counselor should ask the client to recall a period of usual marijuana use.) Understanding marijuana use at treatment entry is helpful for treatment planning and for motivating the client to change. The TLFB method uses memory aids (exhibit IV-3) to help the client recall his or her marijuana use. The counselor and client select a month to investigate. The counselor fills in the days on the TLFB Calendar (form AS1) and indicates which days in that particular month are holidays or other special days for the client (see exhibit IV-4 for a sample).

Continue reading here: Exhibit IV3 Key Events To Record on the Calendar

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