In the formal assessment, in order to get a full picture of what a person is bringing into the interview room, I try to look at their whole self: physical, mental, emotional, and spiritual.

1. Physical Level

At the Mental Health Urgent Care Center, I saw how important good health is to a person’s overall mental health. Shoot, my grandmother got very depressed in her 60s, and after a medical appointment, her doctor discovered she had some difficulties with her thyroid. She was put on medication, and grandma was grandma again!

In performing a physical level assessment, therapists look for substance use, level of exercise, sleep patterns, and diet to name a few. If you are caring for your body, your body will care for you.

2. Mental Level

“Whether you think you can, or you think you can’t—you’re right.” — Henry Ford.

How many negative thoughts do you have in your head a day? The average person has 30,000 to 80,000 thoughts and what percentage of them are negative? In an assessment, we also look for the unwritten rules that a person has. For example: “All people must, should, needs to…” (fill in the blank). “All wives must be subservient.” Should they? There was one seminar where a doctor of psychology was telling women this. This is what we refer to as a “limiting belief”. It is an error in logic. Should all wives be subservient? There may be a group of people who actually believe this to be true, but it will limit how successful the relationship with them can truly be. And where does this limiting belief come from? Because of the family system we grew up in, the norms in society, norms in religion, and in the media, we buy into these faulty beliefs, make them the gospel truth, and get upset when a woman stands up for herself and says no to domestic violence and coercion.

One of the most beneficial tools I learned in therapy was this: When you judge other people, you are actually judging yourself. This is formally called “projections”. Like a film projector, we project our own negative qualities onto another person. But in owning our projections—which actually means realizing that we also do what we see in them—it marks the first step toward healing and growth.

Why should people be the way you want them to be? Who elected you God? By allowing people the “dignity of their (learning) process,” they naturally develop and grow–just like you did. Even with children, if you tell them the perfect answer, they will not listen because they need to figure out things on their own.

In the mental-level assessment, professionals look at how you judge yourself and others, your limiting beliefs, your communication skills, and, if an argument with your partner takes place, the method in which you try to work things out. If you try to bully the person into thinking like you, avoid dealing with something, or simply run and hide, then ongoing problems will result. Narrative Therapy believes we create stories of what has happened that make ourselves out to be victims. They place effort in therapy on changing your negative interpretations and may point out how you survived through creativity and strength—thus tossing away your victimization story.

Cognitive Behavioral Therapy helps you understand that if you behave a certain way and get bad results, you then need to change your behavior in order to improve.  

3. Emotional Level

To be honest, I believe this is the most important level because you may think you are logical, then you realize that your partner and friends are nuts, but you love them anyway!

Emotionally, we want to discover if you trust people, and if you have a good relationship with yourself. Here is an exploration of your family of origin and if you had your nurturing needs met by them. Also, we want to find out if you ever suffered from trauma or abuse. Ask yourself if you feel other people are better than you. If so, there needs to be an exploration of where this feeling comes from.

Object Relations Therapy believes that all mental illness has its roots in early childhood experiences. Lacking the ability to process through difficulties at a young age, children will stuff issues into their subconscious mind and make believe that that situation is behind them. However, this is not so. Issues tend to bubble up from our depths in dreams, memories, or the way we react to other people in our world. If that driver on the freeway puts you into a rage, there is an old wound underneath the anger that needs to be processed through.

4. Spiritual Level

Our spiritual level may be of the most significance if you have no higher power in life. If not, why are you alive? Why do we suffer? Why do we face the same problems over and over again? What happens when we die? Does the soul move on, or is there nothingness?

Blending spirituality and psychology is new to the industry, but those of us who have been trained in this undertaking go from the gut, listen to our inner counselor, and speak from a place of insight, inspiration, and guidance. And honestly, I don’t know what is going to come out of my mouth, but I just go with it as the inspiration hits, day in and day out. We had an expression in school: “The Father does the work.” Is this big-headed and egotistical? No, it is selfless.

In graduate school, we learned about yin/yang, seeing the polar opposites inside of ourselves, and learned to mine through the negatives to embrace the positives. Why do we continue to sabotage our success? Why do we glory in the failure of important people and great athletic teams? Because we love the underdog. We are the underdog and can relate to the question, “What is the worst thing that can happen?” What about the best things? Can something good take place in your world? Can you see problems as a blessing? Life is trial and error and that’s how we learn and grow. Hey, that thing in the past that may have been shitty, may be a blessing now if it inspired a change in you. This happened to me and because of the abuse I suffered, countless clients I have counseled have healed.

The other subjects dealt with in the assessment are the big red flags where some drastic action must take place. Here, we are looking for whether a person wants to kill themselves or others, is in desperate need of detox, and whether the person is there because they are choosing to be there, or if they are being forced to go through treatment against their will. Many court-ordered assessments involve a person lacking motivation or involvement, which may lead the therapist to make a therapeutic guess. This is where personality tests come into play and are fantastic in determining the character of a person.  

When I am assessing somebody new, I am also assessing if they are a good fit for me. Do I feel I can help? Do they push me away? Are they a good fit for my approach which tends to take place at a very sensitive level? People with psychotic disorders I tend to turn away, because their minds can fragment if put under undue pressure. With these folks, I will refer them to a psychiatrist for medication management.

Now it is up to you: assess your therapist, right from the start. Do you feel comfortable with them? Can you open up and talk about the things that lay underneath your anger, anxiety, and sadness?