Assessment

The functions of the initial assessment sessions with any client are twofold, involving both the collection of basic information about the individual's background and history, and testing likely problems in the establishment of the collaborative therapeutic relationship (see Power, 2002). The cognitive model of depression (Beck et al., 1979) highlights issues about the individual's early background and relationships with significant others (see Figure 8.1); therefore, careful attention needs to be paid both to early losses that have been followed by experience of neglect (cf. Rutter, 1972), and to subtler issues about the acceptability of the individual or characteristics of the individual to those significant others. Of course, it is not uncommon for clients initially to report that they had happy childhoods with loving parents. However, as Bowlby (e.g., 1980) and a number of subsequent commentators have observed, clients may often report what they have been instructed to say by parents—"I'm doing this because I love you, dear". Thus, the client may have conflicting schematic models (Power & Dalgleish, 1997), and it may only be in the reporting of specific incidents from childhood that the nature of the different and inconsistent parental models comes to light.

Turning to more specific aspects of the assessment, it is necessary for the therapist to assess the severity and chronicity of depression. Severity is commonly measured with the Beck Depression Inventory (BDI) (Beck et al., 1961), though, as Kendall et al. (1987) noted, the BDI is not a diagnostic instrument, and it is only in conjunction with a clinical diagnosis of depression that the scale can be assumed to measure depression. In conjunction with assessment of the severity of depression, particular care needs to be taken with the assessment of suicide risk in depressed individuals; thus, an estimated 15% of depressed individuals succeed in killing themselves, and upwards of 40% of depressed clients may attempt suicide (e.g., Champion, 2000). It is incumbent on the therapist, therefore, to help a client feel safe about the discussion of current suicide ideation and any past attempts, in order both to gauge the severity of the attempts and to identify the high-risk situations in which such attempts are likely to occur in the future. Where such a risk is identified, clear action plans must be in place and agreed with the client and other key individuals, where appropriate.

Other features of depression that should be addressed during the assessment include the experience of recent negative life events, which are known to be significantly increased prior to the onset of depression (e.g., Brown & Harris, 1978). One of the risks of depression, however, is that not only may there have been an increase in so-called independent events prior to the episode of depression, but also, subsequent to the episode, there may have been an increase in the number of dependent events (that is, events dependent on the individual's own actions). These dependent events may be especially destructive of the person's relationships and career, but may be preventable with an appropriate intervention in therapy (Champion, 2000).

Information should also be collected about the individual's current sources of social support; in particular, whether or not the person is able to mobilise support during a crisis, or, indeed, whether, for example, the lack of support from the person's partner may be one of the reasons for the depressive episode.

In our own recent attempt to put the emotion back into cognition (Power & Dalgleish, 1997), an additional feature that we emphasised for assessment for therapy is people's beliefs about their own emotional states. In the case of depression, we have suggested that the maintenance of the depressed state may, in part, be due to the coupling of emotion states, especially sadness and shame (that is, self-disgust in our analysis). The experience of self-disgust may arise in a number of ways, not only in the ways emphasised traditionally in cognitive therapy; that is, because of a belief of being worthless, unlovable, or a failure. In addition, people may be depressed because they have, in their own view, allowed themselves to experience an unacceptable emotional state. For example, in many cultures, men are not supposed to experience or express sadness because it is a weak, effeminate emotion, and women are not supposed to express anger because it is not "ladylike" (Power, 1999). Although we know better, clients often enter therapy ashamed of the emotions that they are experiencing, perhaps because, for familial and societal reasons, they have been brought up to reject these emotions. The task of the therapist is to enable the person to accept the experience and expression of these rejected emotional states and to integrate the states into the normal experience of the self (cf. Greenberg et al., 1993).

Understanding And Treating Bipolar Disorders

Understanding And Treating Bipolar Disorders

Are You Extremely Happy One Moment and Extremely Sad The Next? Are You On Top Of The World Today And Suddenly Down In The Doldrums Tomorrow? Is Bipolar Disorder Really Making Your Life Miserable? Do You Want To Live Normally Once Again? Finally! Discover Some Highly Effective Tips To Get Rid Of Bipolar Disorder And Stay Happy And Excited Always! Dont Let Bipolar Disorder Ruin Your Life Anymore!

Get My Free Ebook


Post a comment