1. Assessment issues in psychosocial interventions
Steve Wood
Lecturer

2. Client involvement in assessment
Problem statements
Functional analysis
Subjective ratings of distress/impact
Self-assessment
Self-monitoring

3. Problem Statements
detailed description of main affective, physiological, behavioural & cognitive symptoms
initial impression of frequency in preceding week & month
estimation of severity
impact on functioning in broad areas
occupation
home management
private leisure
social leisure
relationships
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4. Problem Statements Should focus directly on difficulties that:
Have been identified by the client during the semi-structured assessment interview
Have been written, whenever possible, in the client's own words; this helps reduce the use of jargon and provides meaning to the client
Describe the problem in observable behaviours
Indicate the impact and consequences the problem has on the client's life-style.
Example

5. “Well, my main problem is that meeting people makes me very anxious.”
Your role is help the client convert this…
Into something like this…
“In terms of your mental health, how would you describe your main problem at the moment?”
“My main problem is my feelings of anxiety and images of making a fool of myself, accompanied by sweating, muscle tension and nausea and an urge to run away whenever I have to meet unfamiliar people. The anxiety and physical symptoms are quite severe and it occurs at least twice each week. This is affecting my employment, as I have to deal with personal enquiries by members of the public; I have stopped going out socially and my friends have started not to invite me; and it is causing rows between myself and my partner.”
“Well, my main problem is that meeting people makes me very anxious.”

6. Activity
You have asked the client what they see as their main current problem in relation to their mental health.
Take each of the following potential responses and refine it into a more useful PROBLEM STATEMENT
“My main problem is…
…I can’t get out because of my panic attacks.”
…I’m so miserable I can’t stop crying.”
…I worry over the slightest thing and it’s wearing me down.”
…the voices get in the way of everything I try to do.”
…I can’t stop worrying about my heart.”
Remember that a good problem statement needs to encompass –
a precise description of how it affects the client’s thoughts, feelings, body, behaviour
frequency
severity
effects on functioning in the following broad areas –
occupation, home management, private leisure, social leisure, relationships
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7. Activity Read the information about the cognitive model of either
panic disorder or
health anxiety
Imagine yourself as someone who has that problem
Being as specific as you can, and giving examples, write a description of how it might affect your
thoughts
emotions
body
behaviour
and what the linkages between these might be
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8. Functional analysis 5W Impact Presenting problem Course FIDO
What
makes it worse?; makes it better?
Where
is the problem worse?; better? 5W
When
is the problem worse?; better?
With whom
is the problem worse?; better?
Why
do you think you have this problem?
Avoidance
What do you find yourself doing less of because of this problem?
Impact
Presenting problem
Behavioural increases
What do you find yourself doing more of because of this problem?
Over the time you have had this problem, has it got any better?; worse?
Course
Is there anything you have found that leaves you feeling better?; worse?
How often have you experienced this over the last month, week, day?
Frequency
On a 0-8 scale, where 8 is the most intense, where would you place this feeling ?
FIDO
Intensity
Duration
How long does the feeling last before it goes away?
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Occurrence
Are there particular instances when it occurs?

9. Subjective Ratings Subjective ratings of distress/conviction/impact
SUDS
Subjective Units of Distress
Use any scale the client is comfortable with, e.g. 0-10, 0-100
can be used during assessment and in-session
Strength of belief – scale
Work & Social Adjustment Scale
Client rates severity of effect of problem on scale from 0 (no effect) to 8 (extremely severe effect)
Life domains rated –
occupation
home management
private leisure
social leisure
relationships
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10. Self-assessment May be used in self-help interventions
May be used to supplement clinician-administered instruments
Should involve client and family/carers if possible
Enables client to develop greater understanding of their problem
Example
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11. Self-monitoring Introduce as early as possible
Underlines client’s active role in treatment process
Assists socialisation into the model
Appropriate self-monitoring measures –
general – mood diary, symptom monitoring
depression - dysfunctional thoughts record
panic – daily panic diary
health anxiety – health anxiety thoughts record
generalised anxiety – worrying thoughts record
OCD – dysfunctional thoughts record
See Wells, 1997 for more detailed information and examples
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12. References & Further Reading
Bellack, A.S. (1986) Schizophrenia: behavior therapy’s forgotten child. Behaviour Therapy, 17,
Bentall, R. (1990) The syndromes and symptoms of psychosis: or why you can’t play 20 questions with the concept of schizophrenia and hope to win. In R. Bentall (Ed.) Reconstructing schizophrenia. London: Routledge.
Bentall, R. (2003) Madness explained: psychosis and human nature. London: Penguin.
Berrios, G ) Delusions as “wrong” beliefs: a conceptual history British Journal of Psychiatry, 159, 6-13.
Chadwick, P., Birchwood, M., Trower, P. (1996) Cognitive therapy for delusions, voices and paranoia. Chichester: John Wiley & Sons.
Gamble, C. & Brennan, G. (2006) Assessments: a rationale for choosing and using. In C. Gamble & G. Brennan (Eds.) Working with Serious Mental Illness (2nd. Ed.). Edinburgh: Elsevier.
Mundt, J., Marks, I., Shear, M.K. & Greist, J. (2002) The Work and Social Adjustment Scale: a simple measure of impairment in functioning British Journal of Psychiatry, 180,
Wells, A. (1997) Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester: John Wiley & Sons. * * * *