Challenges & Pitfalls

Potential Challenges​​

• A common challenge with conducting comprehensive assessment is time. If time is limited in your context, we recommend prioritizing the sections on cultural understanding of the problem and previous treatment experiences given that aligned perception of the problem and early discussion of potential treatment barriers can increase initial engagement. However, inclusion of the additional cultural assessment sections are necessary prior to case conceptualization and treatment planning. Additionally, we have provided a sample integrated biopsychosocial assessment intended to combine standard intakes with cultural assessment to reduce time burden, and ensure thorough cultural assessment.  

• If you suspect the client may have stressors, but is not able to discuss them, brief measures may be useful to incorporate, in addition to the clinical interview (e.g., measures of racial stress, acculturation stress; see Additional Measures section).  ​

• Additionally, if you begin the assessment with the caregiver in the room and notice that the client or caregiver appears uncomfortable, you can re-ask those items when you are with the client or caregiver alone and remind them of confidentiality and its limits.   

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Potential Pitfalls​​

• Clinicians may be hesitant or uncomfortable discussing topics related to identity or identity related stressors for many different reasons (e.g., have different positionalities than the client). This can be a form of “co-avoidance” that can actually hinder important conversations that are ultimately beneficial for the client’s well-being, particularly if they have experienced racism identity related stressors and need to discuss this in therapy. Please consult guidance in the Cultural Humility and Relationship Building section and in Augmentation Strategies and identity with clientsfor how to discuss aspects of identity and identity-related stressors with your clients. It can also be helpful to consider your own positionality to increase your confidence in navigating these discussions, guidance for self-reflection to help with this can be found here. 

• Many clinicians are concerned about “prying into” client’s identity and background, and share sentiments like, “Won’t clients share these topics if they want to, when they are ready?”   ​

  • Clients may not always bring up aspects of their identity even if they want to talk about it. Given inherent power dynamics in the clinician–client relationship (see Relationship-Building Strategies), it is important that the clinician initiate these conversations to demonstrate their interest and the value of the client’s perspectives and experiences.   

  • Respecting a client’s refusal to disclose specific information is also a way of demonstrating you value and respect their autonomy, so if the client does seem hesitant, don’t push disclosure especially early on in treatment.