Psychotherapeutic Assessment

Standard practice among psychologists begins with a comprehensive assessment of the patient's needs and strengths. Depending on the type of therapy practiced (e.g., cognitive-behavioral, dialectical behavioral, interpersonal social rhythm, psychodynamic), assessment may focus on underlying thoughts and behaviors, coping strategies, former and current relationships, daily schedules, and so forth. Identification of key problem areas (e.g., loss of income, social isolation, insomnia), and specific emotional (e.g., low or expansive mood) and behavioral (e.g., suicidal thoughts) difficulties, leads to clarification of treatment goals and decisions about interventions. Regardless of whether a DSM-IV1 diagnosis or a narrative description is established, it is important to get a clear and agreed-upon understanding of the issues that will be targeted for treatment.

Assessment often starts during the first telephone conversation, with a brief discussion of the reasons for seeking treatment, impact on current functioning, and identification of resources, supports, and existing services. This conversation provides both therapist and patient with a sense of "goodness of fit" based on personality characteristics, theoretical orientation and professional skills, and offers an opportunity to decide whether or not to schedule an office-based consultation.

Many clinicians, especially those implementing evidence-based treatment (i.e., treatment protocols developed through empirical research, producing consistent positive outcomes), utilize a variety of assessment tools. These range from questionnaires describing personal, family, academic, work, and psychiatric histories, to depression and other symptom inventories. Though important, these instruments do not replace a good face-to-face "clinical interview." The interview includes: discussing information provided on the forms; assessing mental status (e.g., mood, nature and quality of one's thinking and judgment) and current level of functioning (e.g., self-care, school/work performance); and discussing the individual's view of the problems and assessing his/her ability and willingness to participate in treatment. It also is important to identify personal strengths and other resources that bolster treatment outcomes, such as family/social supports, stable income, structured routines, etc. Since many people with bipolar conditions may not have accurate perceptions of their own lives, input from others who know them in various capacities and roles is helpful in providing a context for past and present functioning. Lastly, a discussion of previous treatment efforts and problem solving strategies facilitates informed decisions about current and new interventions.

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