ITMHD - psychological assessment & formulation

overview of assessment.

Concept	Definition / Function	Analogy
Assessment	Process of collecting psychological information to understand causes of behavioural, emotional, or cognitive symptoms.	Like an x-ray for the mind— helps identify “what’s causing” psychological distress.
Cycle	Assessment → Formulation → Treatment → Reassessment (or → Recommendation if outside your remit).	like a cycle— continuous process.

• Key Point: assessment ≠ therapy itself, but it’s the foundation for all psychological work — you cannot formulate or treat ethically without assessing first.

the “Three P’s” of Assessment Planning.

Area	Key Question	Examples
Purpose	What’s the goal of the assessment?	Inform CBT/psychodynamic therapy, diagnosis (e.g., learning disability, neurodivergence), cognitive capacity, environment change.
Possibilities	What info can we possibly get?	Therapist competence, access to tests/informants, service limitations, interagency collaboration.
Person	What info do they consent to me collecting?	Consent, understanding, burden, likely benefit, contextual relevance.

• best practice: assessment = the intersection (middle of Venn diagram) of purpose, possibilities, and person.

Components of a Psychological Assessment.

Component	Description
Clinical interview	Information-gathering and rapport-building; flexible and central to all assessments.
Questionnaires	Standardised self-reports that quantify symptoms or functioning.
Psychological tests	Structured, norm-referenced measures (e.g., intelligence, memory, neuropsych tests).

the clinical interview.

Purpose	Function
Information Gathering	Social context, developmental history, presenting problem, risk, goals.
Information Giving	Explain confidentiality, service scope, therapist role.
Therapeutic Alliance	Build trust, empathy, and hope (Ackerman & Hilsenroth, 2003).

enhancing vs limiting therapist-client relationship quality.

Enhancing Behaviours	Limiting Behaviours
Empathy, warmth, predictability, validation, hope, clear communication.	Judgement, inconsistency, lack of emotional attunement, defensiveness, over-control.

perceptual & expectation biases in clinical interviewing

Bias	Definition	MCQ Tip
Anchoring	Locking onto initial impression, ignoring later contradictory info.	Early “gut read” bias.
Confirmation Bias	Seeking info that confirms your first hypothesis, ignoring disconfirming data.	“See what you expect to see.”
Similar-to-me Effect	Positively evaluating clients who resemble you (age, background).	“Oh, they’re just like me!” bias.
Visceral Reasoning	Relying on gut feeling over evidence.	Affects objectivity.

common questionnaires.

Domain	Measure	Notes
Anxiety	GAD-7; Beck Anxiety Inventory (BAI); HADS-A; DASS; Screen for Child Anxiety Related Disorders	Short screening, sensitive to treatment change.
Depression	Beck Depression Inventory (BDI); HADS-D; DASS	Benchmark symptom severity.
OCD	Yale-Brown Obsessive Compulsive Scale (Y-BOCS)	Severity and type of obsessions/compulsions.
Phobia/Panic	Social Phobia Rating Scale; Panic Rating Scale	Common in anxiety studies.
Child/Youth	Strengths & Difficulties Questionnaire (SDQ)	Behavioural/emotional functioning.
Functioning/Outcomes	CORE (Clinical Outcomes in Routine Evaluation)	Service audit tool.
Acceptance/Flexibility	AAQ-II (Acceptance & Action Questionnaire)	Used in ACT-based research.

why use questionnaires?

Advantage	Explanation
Benchmarking	Quantify baseline symptom severity.
Reveal non-disclosed info	Clients may write what they won’t say.
Facilitates difficult inquiry	Useful for trauma, shame-based topics.
Inter-professional communication	Consistent scoring aids referrals.
Service accountability	Required for audits, outcome evaluation.
Therapist reflection	Allows review of your own effectiveness.
Change evaluation	Compare pre/post-scores → clinical significance.

commonly used tests/batteries.

Domain	Example Tests
Intelligence (Adult)	WAIS (Wechsler Adult Intelligence Scale)
Memory	WMS (Wechsler Memory Scale); RBANS (Repeatable Battery for Assessment of Neuropsychological Status)
Cognition / Neuropsychology	Addenbrooke’s Cognitive Examination (ACE-R); Trail-Making Test; FAS (Verbal Fluency); Doors & People Test
Autism / Neurodivergence	ADOS (Autism Diagnostic Observation Schedule)
Child / Adolescent IQ	WISC (Wechsler Intelligence Scale for Children)

what is a psychological formulation.

Definition	Core Aim
“Summation and integration of assessment data (psychological, biological, and systemic), using theory to describe how a problem developed and is maintained.” — BPS, 2011	To explain a client’s difficulties (“what, why now, what can change”).

formulation → treatment → assessment loop.

Stage	Aim
Formulation	Explain the problem’s development and maintenance. (“What? Why now?”)
Treatment	Use explanation to guide change. (“What can we do about it?”)
Assessment (again)	Evaluate if treatment has produced change.

core elements of a good formulation.

Element	Description
Explanatory model	Identifies maintaining factors (biological, cognitive, systemic).
Joint construction	Built collaboratively with client (not imposed).
Incorporates strengths	Acknowledges resilience and coping.
Dynamic	Updated as therapy progresses.

formulation: explains the problem’s development and maintenance. (“What? Why now?”)

example of good formulation — CBT formulation (hot cross buns).

Domain	Example	Intervention
Thoughts	“I’m useless”	Thought records, evidence-for/against, cognitive restructuring
Emotions	Sad, anxious	PMR, pleasant activity scheduling
Bodily sensations	Muscle tension, fatigue	Psychoeducation, reattribution of body states
Behaviours	Withdrawal, avoidance	Behavioural experiments, exposure

• ACT vs CBT Distinction:

  • CBT: change content of thoughts.

  • ACT: change relationship to thoughts.

example of good formulation — ACT formulation (psychological flexibility model).

Core Process	Description	Goal
Be Open	Acceptance of internal experiences	Reduce avoidance
Be Aware	Present-moment awareness, self-as-context	Increase mindfulness
Do What Matters	Committed, values-driven action	Enrich life meaning
Inflexibility	Avoidance, fusion, disconnection from values	Target for change

• ACT vs CBT Distinction:

  • CBT: change content of thoughts.

  • ACT: change relationship to thoughts.

theoretical & philosophical assumptions.

Dimension	CBT	ACT
View of Distress	Caused by unrealistic beliefs	Caused by narrowing life (experiential avoidance)
Philosophy	Positivism; cognitive primacy; “emotion as symptom”	Pragmatic truth; radical behaviourism; “emotion as information”
Assessment Focus	Identify dysfunctional thoughts, biases, links between thought-emotion	Identify values, behavioural avoidance, flexibility
Formulation Type	Longitudinal (core beliefs, schemas)	Psychological flexibility map (values central)
Intervention Style	Cognitive restructuring, behavioural experiments	Values clarification, mindfulness, acceptance

reliability, validity, and harm in formulation.

Question	Findings / Cautions
Are formulations reliable?	Only slight–substantial inter-rater reliability (Flinn et al., 2014). Training can improve it.
Are formulations valid (true)?	Unclear — cannot be proven “true”; aim is usefulness, not truth.
Can formulations be harmful?	Yes — risk of bias, mislabelling, client distress.
How to reduce harm?	Use evidence-based practice, client collaboration, supervision, bias awareness, humility.

formulation vs diagnosis.

Concept	Focus	Example
Diagnosis (medical)	Categorical classification; symptom checklist; label.	“Major Depressive Disorder”
Formulation (psychological)	Individualised understanding; mechanism-based.	“Depression maintained by avoidance and guilt.”

alternative to diagnosis — power threat meaning framework (PTMF).

Framework	Description
PTMF (Johnstone & Boyle, 2018)	Replaces diagnostic labels with formulations based on: Power (social context). Threat (what has happened to you?). Meaning (how you make sense of it).
Purpose	Offers non-pathologising, contextualised understanding of distress.
Used by	Clinical psychologists who critique medical model reliance.

exam trick areas.

Topic	Common MCQ Confusion
Assessment vs Formulation	Assessment = gather info, Formulation = integrate info.
Anchoring vs Confirmation bias	Anchoring = first impression fixation, Confirmation = selective attention to confirming data.
CBT vs ACT	CBT = change thoughts; ACT = change relationship to thoughts.
Questionnaire vs Test	Questionnaire = self-report; Test = standardised, normed, objective.
Validity vs Reliability	Validity = truth; Reliability = consistency.
PTMF	Emphasises context and meaning, not medical diagnosis.

quick reference — need to know.

Term / Research	Key Detail
Ackerman & Hilsenroth (2003)	Therapist warmth, empathy, genuineness build alliance.
Flinn et al. (2014)	Formulation reliability only “slight to substantial.”
Johnstone & Boyle (2018)	Developed PTMF — alternative to diagnosis.
Iowa / APA definitions (2018)	Assessment = data integration to identify cause + plan.
CBT vs ACT frameworks	“Hot Cross Bun” vs “Psychological Flexibility.”

mcq summary.

• Three “P’s” of Assessment = Purpose, Possibilities, Person.

• Assessment Components = Interview + Questionnaires + Tests.

• Biases in Interview = Anchoring, Confirmation, Similar-to-me, Visceral reasoning.

• Questionnaires = Benchmark + reveal non-disclosed info + enable service accountability.

• Formulation = “What, why now, what can change.”

• CBT vs ACT = Thought correction vs Values-driven flexibility.

• Reliability vs Validity = Consistency vs Truth.

• PTMF (Johnstone & Boyle, 2018) = Power, Threat, Meaning → non-diagnostic alternative.

• Formulation harm = mitigated by supervision, collaboration, humility.

• ACT goal = “Do what matters” — life enrichment through openness and awareness.