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Why Therapists Do Evaluations

Evaluation. Yuck. Such a clinical, dry term, much like diagnosis, prognosis, and so on. But because evaluations are so integral to effective psychotherapy, I feel it’s important to briefly describe the process here.

When you go to a doctor (or a mechanic or even an accountant), the first thing he or she does is collect data—pieces of information—about you (or your car, or your tax situation). In therapy, this information is collected by a process called the evaluation. By asking directly asking you questions, observing you, and perhaps reading or speaking to others about your mental and physical health history a therapist can learn what he or she needs to know in order to begin working with you.

A mental health evaluation (like a medical evaluation) in part employs a process of elimination in order to arrive at a diagnosis. For example in medical treatment if you don’t have certain symptoms, but you do have others, proven treatments will be prescribed and employed for whatever your problem may be, whether it is acne, flu or gout.


However, a mental health evaluation differs from a medical evaluation in that people come to therapy for a variety of reasons—they don’t always have a major mental illness or addiction; in fact many people simply have a general unspecified type of problem that may be helped by therapy. While I believe that diagnosis is one of the goals of the evaluation process it isn’t the entire goal. A therapist can simply learn much information about the patient that doesn’t fit into a diagnosis—in fact, it is crucial that your therapists gets to really know you, not just your diagnosis.

(In another blog entry I hope to address the vagaries of the diagnostic process and its strengths and limitations).

Also, shockingly different diagnoses can be given by different psychotherapists—there is an amount of subjectivity involved on the one hand, on the other, excellent diagnostic skills do take a while to refine, which is one of many reasons why a therapist do plenty of on-the-job training, usually in the form of supervision and internships.

Your therapist must get to know a lot about you in a relatively short time (otherwise you would be stuck in therapy forever), so he or she will work hard to gently bombard you with questions right from the get go. During your very first visit, after getting basic biographical information (where you live, what you do for a living, and what important relationships you have in your life, etc.), my bias is to continue the next step of the evaluation by asking questions about substance abuse and behavioral or chemical addiction. My reasoning, borne out by decades of experience and studies of successful models currently being used, is that an emotional problem (or mental illness) can’t be effectively treated if the patient is abusing drugs, alcohol or has other addiction issues. Today, the templates of treatment most used by the more successful mental health hospitals  and/or addiction clinics start with the assumption that therapy can’t happen until a patient begins treatment for this common problem. SAMHSA, (the national Substance Abuse and Mental Health Administration) is a federal agency that also acknowledges the primacy of the addiction problem in its very title.

Next, a typical evaluation will focus on either a medical history and/or a mental health history. A medical history is a very important tool—your therapist needs to know if you have a physiological problem that could be contributing to, or causing, an emotional problem. For example, in my book Therapy Revolution, patients share their stories about therapy from a broad variety of perspectives. Some patients have certain medical conditions (such as hyper or hypothyroid, heart conditions, allergies and others), that can actually cause very uncomfortable emotional symptoms. For example, nervousness, depression and insomnia can be caused by a heart condition or thyroid problem, and can even be the product of caffeine abuse, which was the case with Grady, who so generously let me share his story in my book.

In addition to asking about medical conditions, your therapist will ask if you are taking medication for a health problem. Not only can a health issue trigger emotional symptoms, so can medications! Another patient who shared her story had been prescribed a variety of medications that were simply not being monitored properly. Once she was weaned off them, and given either lower doses of medication or different medications as the case may be, she was able to respond rather rapidly to therapy.

In the mental health history portion of the evaluation your psychotherapist will ask you how you perceive your present problem, how long you have had it, have you had this problem or others in the past, does your family of origin have mental health issues, etc. He will also ask if you are on medication for this problem and if you have been or are currently seeing any other mental health professionals.

Non-medical psychotherapists are ethic-bound to encourage you to continue your prescriptions until they have a chance to consult with any M.D. you are seeing, including a psychiatrist. Of course, if one is experiencing uncomfortable side effects that need immediate attention, EMS should be called.

These are the general types of information questions in the evaluation that usually your therapist will ask you during your first and/or second office visit. Sometimes, you might be feeling too raw for the evaluation process and your therapist might determine that it is best spreading it out over two or there sessions. But when most of the information is obtained, your therapist will then use that information to work with you on creating a written treatment plan, something I will discuss down the road. Next time, though, I want to discuss the importance of why written evaluations, treatment plans, and progress notes are the order of the day.

Until then, if you have any questions or comments I will do my best to answer them.

Why Therapists Do Evaluations

Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is licensed in addiction and psychotherapy with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. He is the executive director of an outpatient behavioral health program. Learn more about Richard here.

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APA Reference
& C.R. Zwolinski, R. (2010). Why Therapists Do Evaluations. Psych Central. Retrieved on July 13, 2020, from


Last updated: 17 Jan 2010
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