The Core Competencies:
Domain 3: Exploration (Assessment, Diagnosis & Conceptualization)
A European Psychotherapist is competent to: -
- §3.1: Make an Assessment
- 3.1.1 Make use of assessment tools: which involves - developing a clear policy, and/or implementing agency procedure, for assessment; ensuring these are consistent with aims, ethos and objectives of organisation and theoretical perspective; developing and/or implementing pre-assessment tools; providing clear and transparent information to the potential patient/client about the psychotherapy and forms of assessment; where appropriate, using any pre-assessment information in the initial assessment interview to inform the process and outcome of the interview; etc.
- 3.1.2 Conduct an assessment interview: which involves - ensuring the assessment process is transparent and clearly understood; undertaking an assessment interview in a manner consistent with aims, ethos and objectives of organisation and theoretical perspective; discovering – as far as possible – the patient/client’s issues, problems, insights and difficulties; discovering and recording any significant historical events, or previous history of psychological problems, or significant periods of stress; asking about previous experience of psychotherapeutic help; keeping a detailed record of the assessment; etc.
- 3.1.3 Conduct a risk assessment: which involves - being familiar with any agency/service risk assessment procedures and making use of any tools or guidelines, including ethical ones; recognising language used by the patient/client that might imply harm to self or others; asking direct questions about any intention to harm self or others; facilitating the patient/client’s ability to talk about specific suicide plans and quantifying the likelihood of these being implemented; discussing and assessing the patient/client’s general support system; involving the patient/client in the process using a straightforward, empowering and sensitive approach; etc.
- §3.2: Formulate a Diagnosis *
- 3.2.1 Recognise any possible mental health / illness issues: which involves - remaining alert to possible indications of mental health needs, or of mental illness, or of disorders; assessing or diagnosing whether the patient/client has any social, relational, somatic and/or emotional problems related to mental health / psychic illness and disorders; using previous awareness, training and experience in psychopathology; involving the patient/client in the mental health assessment process; ensuring that any assessment or diagnosis conforms to any organisational policies and procedures, is in accordance with aims, ethos and objectives of one’s theoretical / methodological perspective, and is in accordance with any national medical/psychiatric guidelines; etc.
- 3.2.2 Respond to mental health / illness needs: which involves - discussing possible outcomes or strategies with the patient/client, as far as is possible; recognising any need for advice, support, or for a second opinion, from supervisor, manager or mental health consultant; responding promptly to any indications of mental health needs in order to ensure that an appropriate intervention is made; assessing any immediate risk to the client, self or others that may result from worsening/declining mental health / psychic illness and disorders and taking appropriate action, if necessary; recognising indications of drug/alcohol/substance misuse (including prescribed or over-the-counter drugs) and taking appropriate action, if necessary; working in conjunction with other mental health specialists and in accordance with the aims, ethos and objectives of one’s theoretical perspective and in accordance with any national medical/psychiatric guidelines; etc.
- §3.3: Conceptualize and decide upon an approach
- 3.3.1 Make use of clinical experience, theoretical & methodological insights, and assessment tools: which involves - developing a clear policy, and/or implementing agency procedure, for assessment; ensuring its relevance to the patient/client’s needs and to an on-going professional psychotherapeutic relationship; conducting the assessment process in a manner suitable for the patient/client and consistent with the ethos of the psychotherapy; integrating any pre-assessment information and identifying any relevant issues; etc.
- 3.3.2 Conceptualize the patient/client’s needs: which involves - identifying potential problem areas, including (i) (positive or negative) situations clarified by, or as part of, the assessment process, (ii) the patient/client’s motivation, (iii) different individual needs, relating for example to culture, faith, ethnicity, language, sexuality, disability, age etc., (iv) any areas of potential risks (suicide, self-harm, aggressive or violent behaviour to others), (v) possible negative transference, etc.; using critical appraisal skills and developing a critical understanding of the patient/client’s presenting problems; ‘diagnosing’ if there might be any underlying or long-term issues that might require further (possibly specialist) assessment; evaluating and discussing whether the type of psychotherapy offered, or whether the particular service, might be suitable and beneficial for the patient/client, and if not, making constructive and informed suggestions for an appropriate referral; etc.
- 3.3.3 Make decisions based on assessment: which involves - making a concise formulation of the patient/client’s presentation; analysing and interpreting all forms of information collected in the assessment process; using all available information (including patient/client’s presentation and responses in the assessment interview) to come to a conclusion about possible appropriate interventions; discussing with the patient/client the outcome of the assessment, ensuring language is appropriate and that the person understands; making an estimate of the amount, frequency and extent of any psychotherapy and/or implementing any competent ‘care plan’, or contract, or referral within the service; being clear about other possibilities for the patient/client’s needs to be met; making an external referral, if appropriate, and explaining the reasons clearly; consulting with other colleagues/health professionals, especially if there are indications of potential risk; etc.
- 3.3.4 Conclude the assessment: which involves - in the event of mutually agreeing to proceed with psychotherapy, discussing and being open with the patient/client about their expectations, responsibilities, agreements, payments, etc.; where appropriate, providing an opportunity for the patient/client to review and feedback their experience of the assessment process; and recording the outcome of the assessment process; etc.
* Note: The word ‘diagnosis’ here is used more in a general sense, rather than in a precise medical or psychiatric sense.