Chapter 2: Principles, goals and structure of initial assessment sessions
A primary goal associated with behavioural assessments is the identification of
potentially modifiable contextual features associated with maintenance of problematic
behaviour.
Knowledge of the common contexts for behaviour can suggest hypotheses about why
a person does what he or she does. This knowledge aids with selecting intervention
approaches.
Core features of behavioural assessments:
Must recognize the uniqueness of the individual. BA are idiographic, or person
centered, which is often in contrast to other approaches that are largely centered on
the assessment of variables or constructs.
BA are distinguished from medical models (more variable-centered) and other
approaches by a unique set of goals and features.
Goals of BA:
Clarification of the nature of the problem
Evaluation of the extent to which the client’s problems impair his functioning
Identification of factors that support and maintain problem areas
The collaborative development of a formulation of the client’s problems, and
development of a therapeutic plan based on this formulation
An ongoing evaluation of the effectiveness of the treatment strategy
Distinguishing features of BA and therapy from more traditional approaches:
The level of analysis is the act in context, or the whole person X environment
There is recognition that each person lives in a unique context and has a unique
learning history
Behaviour is viewed as situationally specific rather than cross-situationally general,
which highlights the importance of external influences on behaviour
Limited inference is used
Client’s problem are clearly defined in behavioural terms
Emphasis on the development of effective behaviour and competencies
Client-therapist relationship factors:
A therapist might keep in mind, that the therapeutic relationship is itself a context that
can facilitate behaviour change. Clients who have weak social skills, can benefit from
this relationship that strengthens appropriate social behaviour through natural social
reinforcement.
Therapists can also try to facilitate behaviours that are the opposite of problematic
ones.
CBT is an action-oriented approach to therapy; therefore, it is important for the client
to be an active participant.
, The therapist can develop the relationship by frequently checking in and asking “Do
you have anything you would like to add?”. They can also use “we” statements and
emphasize teamwork.
Conducting initial assessments:
How a therapist conducts initial assessments will vary according to his theoretical
orientation. This is especially true when a therapist forms a case formulation –
hypothesis about the causes of a person’s problems.
Presenting problem or complaint;
When clients initially discuss their problems, therapist should listen without
interrupting or probing. This allows the client to engage in free speech.
After free speech, the therapist needs to probe further and identify
manifestations of the problem, the current contexts within which they emerge,
and their consequences.
Clarify history and severity of the problem.
Assessing response classes on the basis of correlated or descriptive features;
Behavioural summaries captured by diagnostic or construct labels do not
provide guidance as to how behaviour came about or what factors might be
influential in the maintenance of behaviour or why people behave the way
they do.
Diagnostic assessments
Questionnaires are used to understand the client’s experience relative to other
persons.
Checklists and rating scales are completed by someone familiar with the client
and consist of sets of behavioural acts to which the respondent indicates how
frequently the behaviour occurs. Checklist data indicate the severity or
frequency of behavioural problems as well as suggest specific behavioural
targets.
Identifying behavioural repertoires and skills deficits;
During initial stages of assessment, it is useful to categorize problematic
behaviours within one of two broad categories; behavioural excesses and
behavioural deficits.
Behavioural excesses are maintained by positive and negative reinforcers.
Behavioural deficits are due to 2 reasons; past environments did not
adequately model or reinforce such behaviours/ absent behaviours have been
learned at one time and are part of the person’s repertoire.
Individuals who have significant behavioural deficits in important areas tend
to be less skillful in the behaviour they display and less successful in obtaining
reinforcement from the environment for their behaviour.
Evaluating coping behaviours:
Coping behaviours are important to assess because such behaviours reflect how a
person responds to adversity.
Coping skills that are the target of strengthening in CBT:
Problem-solving skills; assisting client to find solutions to problems that
arise.
, Social skills; social skills deficits results in deficits in coping because less
successful in accessing or mobilizing the social environment and less likely to
receive social support.
Self-regulation; defined as any efforts a person uses to alter inner states or
responses.
Mindfulness skills; fostering of a full awareness in the moment. Behavioural
skills that are antithetical to mindfulness include rumination, worry and
dissociation. Adopts a here-and-now focus.
Invalidating environments – teach clients acceptance.
Assessing importance in functioning:
The degree and pervasiveness of impairment indicate the severity of the problem.
The level of nature of impairment can have relevance for the choice or emphasis of
therapy.
Psychological disorders are defined by the presence of behavioural patterns associated
with subjective distress or impairment in occupational or social functioning.
Personal functioning;
Compare with how the person functioned in the past.
This clarifies what coping skills already exist in the behavioural repertoire.
Family and social relations;
Social or family impairments can increase one’s vulnerability and exacerbate
symptoms of a disorder.
Important to distinguish whether problems due to avoidance tendencies,
deficits in social skills, suppression of social behaviour by the environment, or
a low rate of positive reinforcement for social behaviour.
Occupational and school functioning;
First signs of impairment usually appear on day-to-day demands (school or
work).
Legal difficulties or proceedings;
Most likely to occur when a person’ history includes substance abuse, BP, and
antisocial behaviours.
Health and medical status
Quality of life
Suicide risk;
If a client reports suicidal or homicidal thoughts or self-harm behaviours, the
original plan for the initial sessions should be suspended, and these areas
addressed in great detail.
Only when the situation is not urgent can further detailed exploration take
place.
The behavioural interview:
An underlying philosophy that guides the interview is that behaviour is determined –
current behaviour is jointly influenced by immediate environmental factors and the
culmination of a lifetime’s worth of experiences.
A primary goal associated with behavioural assessments is the identification of
potentially modifiable contextual features associated with maintenance of problematic
behaviour.
Knowledge of the common contexts for behaviour can suggest hypotheses about why
a person does what he or she does. This knowledge aids with selecting intervention
approaches.
Core features of behavioural assessments:
Must recognize the uniqueness of the individual. BA are idiographic, or person
centered, which is often in contrast to other approaches that are largely centered on
the assessment of variables or constructs.
BA are distinguished from medical models (more variable-centered) and other
approaches by a unique set of goals and features.
Goals of BA:
Clarification of the nature of the problem
Evaluation of the extent to which the client’s problems impair his functioning
Identification of factors that support and maintain problem areas
The collaborative development of a formulation of the client’s problems, and
development of a therapeutic plan based on this formulation
An ongoing evaluation of the effectiveness of the treatment strategy
Distinguishing features of BA and therapy from more traditional approaches:
The level of analysis is the act in context, or the whole person X environment
There is recognition that each person lives in a unique context and has a unique
learning history
Behaviour is viewed as situationally specific rather than cross-situationally general,
which highlights the importance of external influences on behaviour
Limited inference is used
Client’s problem are clearly defined in behavioural terms
Emphasis on the development of effective behaviour and competencies
Client-therapist relationship factors:
A therapist might keep in mind, that the therapeutic relationship is itself a context that
can facilitate behaviour change. Clients who have weak social skills, can benefit from
this relationship that strengthens appropriate social behaviour through natural social
reinforcement.
Therapists can also try to facilitate behaviours that are the opposite of problematic
ones.
CBT is an action-oriented approach to therapy; therefore, it is important for the client
to be an active participant.
, The therapist can develop the relationship by frequently checking in and asking “Do
you have anything you would like to add?”. They can also use “we” statements and
emphasize teamwork.
Conducting initial assessments:
How a therapist conducts initial assessments will vary according to his theoretical
orientation. This is especially true when a therapist forms a case formulation –
hypothesis about the causes of a person’s problems.
Presenting problem or complaint;
When clients initially discuss their problems, therapist should listen without
interrupting or probing. This allows the client to engage in free speech.
After free speech, the therapist needs to probe further and identify
manifestations of the problem, the current contexts within which they emerge,
and their consequences.
Clarify history and severity of the problem.
Assessing response classes on the basis of correlated or descriptive features;
Behavioural summaries captured by diagnostic or construct labels do not
provide guidance as to how behaviour came about or what factors might be
influential in the maintenance of behaviour or why people behave the way
they do.
Diagnostic assessments
Questionnaires are used to understand the client’s experience relative to other
persons.
Checklists and rating scales are completed by someone familiar with the client
and consist of sets of behavioural acts to which the respondent indicates how
frequently the behaviour occurs. Checklist data indicate the severity or
frequency of behavioural problems as well as suggest specific behavioural
targets.
Identifying behavioural repertoires and skills deficits;
During initial stages of assessment, it is useful to categorize problematic
behaviours within one of two broad categories; behavioural excesses and
behavioural deficits.
Behavioural excesses are maintained by positive and negative reinforcers.
Behavioural deficits are due to 2 reasons; past environments did not
adequately model or reinforce such behaviours/ absent behaviours have been
learned at one time and are part of the person’s repertoire.
Individuals who have significant behavioural deficits in important areas tend
to be less skillful in the behaviour they display and less successful in obtaining
reinforcement from the environment for their behaviour.
Evaluating coping behaviours:
Coping behaviours are important to assess because such behaviours reflect how a
person responds to adversity.
Coping skills that are the target of strengthening in CBT:
Problem-solving skills; assisting client to find solutions to problems that
arise.
, Social skills; social skills deficits results in deficits in coping because less
successful in accessing or mobilizing the social environment and less likely to
receive social support.
Self-regulation; defined as any efforts a person uses to alter inner states or
responses.
Mindfulness skills; fostering of a full awareness in the moment. Behavioural
skills that are antithetical to mindfulness include rumination, worry and
dissociation. Adopts a here-and-now focus.
Invalidating environments – teach clients acceptance.
Assessing importance in functioning:
The degree and pervasiveness of impairment indicate the severity of the problem.
The level of nature of impairment can have relevance for the choice or emphasis of
therapy.
Psychological disorders are defined by the presence of behavioural patterns associated
with subjective distress or impairment in occupational or social functioning.
Personal functioning;
Compare with how the person functioned in the past.
This clarifies what coping skills already exist in the behavioural repertoire.
Family and social relations;
Social or family impairments can increase one’s vulnerability and exacerbate
symptoms of a disorder.
Important to distinguish whether problems due to avoidance tendencies,
deficits in social skills, suppression of social behaviour by the environment, or
a low rate of positive reinforcement for social behaviour.
Occupational and school functioning;
First signs of impairment usually appear on day-to-day demands (school or
work).
Legal difficulties or proceedings;
Most likely to occur when a person’ history includes substance abuse, BP, and
antisocial behaviours.
Health and medical status
Quality of life
Suicide risk;
If a client reports suicidal or homicidal thoughts or self-harm behaviours, the
original plan for the initial sessions should be suspended, and these areas
addressed in great detail.
Only when the situation is not urgent can further detailed exploration take
place.
The behavioural interview:
An underlying philosophy that guides the interview is that behaviour is determined –
current behaviour is jointly influenced by immediate environmental factors and the
culmination of a lifetime’s worth of experiences.
