Ghaffari prelims correx 20/4/04 12:30 pm Page i CHAPTERTITLE I 111 2 3 4 5 6 THE FUNCTION OF 711 8 ASSESSMENT WITHIN 9 PSYCHOLOGICAL 10 1 THERAPIES 2 3 4 5 6 7 8 9 211 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 7 8 911 Ghaffari prelims correx 20/4/04 12:30 pm Page ii 111 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 711 8 9 20 1 2 3 4 511 6 7 8 9 311 1 2 3 4 5 6 7 8 911 Ghaffari prelims correx 20/4/04 12:30 pm Page iii 111 2 3 4 5 6 711 THE FUNCTION OF 8 9 ASSESSMENT WITHIN 10 1 2 PSYCHOLOGICAL 3 4 THERAPIES 5 6 7 A PSYCHODYNAMIC VIEW 8 9 211 1 Kamran Ghaffari 2 Luigi Caparrotta 3 4 5 6 7 8 9 30 1 2 3 4 5 6 7 8 911 Ghaffari prelims correx 20/4/04 12:30 pm Page iv 111 2 3 4 5 6 7 First published in 2004 by 8 H. Karnac (Books) Ltd. 9 6 Pembroke Buildings, London NW10 6RE 10 1 2 3 Copyright © 2004 Kamran Ghaffari and Luigi Caparrotta 4 5 6 The rights of Kamran Ghaffari and Luigi Caparrotta to be identified as the 711 authors of this work have been asserted in accordance with §§ 77 and 78 of 8 the Copyright Design and Patents Act 1988. 9 20 All rights reserved. No part of this publication may be reproduced, stored 1 in a retrieval system, or transmitted, in any form or by any means, 2 electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. 3 4 British Library Cataloguing in Publication Data 511 6 A C.I.P. for this book is available from the British Library 7 8 ISBN 1 85575 954 3 9 311 Edited, designed and produced by The Studio Publishing Services Ltd, 1 Exeter EX4 8JN 2 3 Printed in Great Britain 4 10 9 8 7 6 5 4 3 2 1 5 6 www.karnacbooks.com 7 8 911 Ghaffari prelims correx 20/4/04 12:30 pm Page v 111 CONTENTS 2 3 4 5 6 711 8 9 10 1 2 3 4 5 6 7 8 9 211 ACKNOWLEDGEMENTS ix 1 PREFACE xi 2 FOREWORD BY PHILRICHARDSON xiii 3 4 Introduction 1 5 National Health Service model and expectations 6 Mental Health and the role of psychological therapies 7 The role of assessment within psychological therapies 8 9 CHAPTER ONE 30 Definitions 7 1 Definition of assessment 2 Definition and function of the assessor 3 4 CHAPTER TWO 5 The referral process 13 6 Pre-referral stage 7 Referral source and reasons for referral 8 Referral letter 911 v Ghaffari prelims correx 20/4/04 12:30 pm Page vi vi CONTENTS 111 Referral route 2 Questionnaires 3 Assessment attendance rate and waiting time 4 5 CHAPTER THREE 6 Pre-specialist opinion 21 7 Is psychological intervention the treatment 8 of choice? 9 Is psychological therapy an alternative to 10 pharmacological therapy? 1 Is psychotherapy a suitable adjunct to other 2 therapeutic modalities? 3 Is the patient’s poor compliance with medication 4 amenable to a psychological therapy intervention? 5 Is the clinical picture confounded by disturbance 6 of the personality hampering therapeutic 711 engagement? 8 Can an assessment help to unravel a therapeutic 9 stalemate? 20 1 CHAPTER FOUR 2 Specialist assessment 27 3 What are the patient's key problems and 4 difficulties? 511 Listening and history taking 6 Diagnostic assessment 7 Risk assessment 8 9 CHAPTER FIVE 311 Suitability for psychological therapy 39 1 Is psychological intervention a suitable form 2 of treatment for this particular patient? 3 Motivation for change 4 Capacity to form a working relationship 5 6 CHAPTER SIX 45 7 Psychodynamic assessment 8 Is the patient suitable for psychodynamic 911 psychotherapy? Ghaffari prelims correx 20/4/04 12:30 pm Page vii CONTENTS vii 111 Capacity to think psychologically (psychological 2 mindedness) 3 Ego strength 4 Relationship to reality 5 Quality of object relationships 6 Affective capacity 711 Frustration tolerance and impulse control 8 Capacity to form a therapeutic relationship 9 10 CHAPTER SEVEN 1 Case formulation 61 2 If the patient is deemed suitable for 3 psychodynamic psychotherapy what is then 4 the psychodynamic formulation? 5 6 CHAPTER EIGHT 7 Post-assessment routes 69 8 What treatment modality, where and by whom 9 can the patient best be helped? 211 Post-assessment options 1 Availability of resources 2 3 CHAPTER NINE 4 Concluding remarks 73 5 6 APPENDICES 75 7 REFERENCES 83 8 9 INDEX 95 30 1 2 3 4 5 6 7 8 911 Ghaffari prelims correx 20/4/04 12:30 pm Page viii 111 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 711 8 9 20 To our wives, Farnaz and Sara 1 2 3 4 511 6 7 8 9 311 1 2 3 4 5 6 7 8 911 Ghaffari prelims correx 20/4/04 12:30 pm Page ix A ix 111 ACKNOWLEDGEMENTS 2 3 4 5 6 711 8 9 10 1 2 3 4 5 6 7 8 9 211 This book is the result of many years of training and clinical expe- 1 rience and we are indebted to our analysts, supervisors, teachers, 2 colleagues, friends and, most of all, our patients. Although we have 3 endeavoured to be as objective as possible, we cannot deny the 4 impact of our personal and cultural background. 5 We are particularly grateful to Professor Phil Richardson for his 6 warm encouragement and suggestions, to Amaryllis Holland for 7 her diplomatic and brilliant editing skills, to Dr Sheilagh Davies for 8 taking the time to read our first draft, and for their valuable com- 9 ments. 30 Most of all we would like to thank our wives, Farnaz and Sara, 1 who tolerated our moods and sporadic absences while supporting 2 our endeavour. 3 4 5 6 7 8 911 ix