Why Assessment Needs to be
the First Step in Treatment
Dr. Maddy’s Clinical Philosophy
How Therapy in the Wilderness Became Wilderness Therapy
When Wilderness Therapy was just developing, the basic idea was to take people who were struggling into the wilderness to help them heal. While the elements of wilderness naturally do aid in neuroplastic healing of the brain, being more intentional in facilitating that process increases positive and lasting change. Using a medical metaphor, when you are ill and come in to see your doctor for help, she doesn’t just throw a bunch of treatments or medicines at you, hoping one of them will help. That just wouldn’t make sense.
When I was developing my conceptualization of Wilderness Therapy in 1988, as a psychologist, I knew how much time and effort can be saved in treatment if we have an accurate understanding of the client, their family background, their history, and current objective testing to formulate accurate diagnoses and treatment issues. With this crucial information, a treatment plan can be designed for the individual needs of the client. I administered psychological evaluations to all our clients, and we used the information to dig deeper into the needs of each client and chart the course for their treatment.
This clinical approach became the standard for Wilderness Therapy and began to move the field from helpful excursions in the outback to the research-supported, effective treatment option it is today. As the field developed, we found that not every client needed a full psychological evaluation, but many did. Many clients are misdiagnosed, or come in with a plethora of labels that may or may not fit. For example, severe substance abuse clients are actually struggling with undisclosed trauma and must have a more in depth assessment in order to get the help they need.
The role of Assessment at Legacy Treatment Center
During the intake process, all our clients receive a Comprehensive Diagnostic Assessment and BioPsychoSocial Interview conducted by our therapists. This assessment leads to an individualized Treatment Plan which is then implemented by the client’s primary therapist and the whole treatment team. If the therapist has concerns regarding the client’s assessment, they consult with me as the Clinical Director, as well as the entire clinical team. When necessary, the family is then advised to get a more indepth evaluation. We offer the opportunity for clients to receive comprehensive psychological evaluations here at Legacy, working with contracted psychologists. We also administer several objective assessments at little or no cost to the client, including the Campbell Skills & Interest Inventory (CISS) (a vocational assessment), the Mood Disorder Questionnaire (a screener for Bipolar Disorder), the Connors Adult ADHD Rating Scale (CAARS) , the Social Communication Questionnaire (SCQ) (an autism screener), the Gillian Autism Rating Scale-Third Edition (GARS-3), and the Millon Clinical Multiaxial Inventory (MCMI-IV) (a personality test). These assessments aid us in determining if more testing is needed and help to clarify client diagnoses and treatment needs.
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