PT01 Assess the client for cognitive and behavioural therapy

Overview

This standard is about gathering relevant and adequate information about the nature and context of the client’s difficulties in order to gauge whether the therapy is suitable for them. It shows that assessment can form part of the therapeutic work itself, and involves careful listening to the client. It is carried out at the start of the engagement with the client, and can be reviewed at any time during the therapy. This standard describes therapeutic practice that has been shown to benefit adult clients engaged in cognitive and behavioural therapy for healthcare reasons, particularly depression and anxiety disorders (See reference in the additional information section on page 3.) To apply this standard, practitioners also need to take account of the multiple problems and complex co-morbidities that individual clients may bring to therapy. Cognitive and behavioural therapy should be offered as part of an explicit and structured approach agreed within the treatment team and with the client. Users of this standard will need to ensure that they are receiving supervision and that their practice reflects up to date information and policies. This standard should be understood in the context of the Digest of National Occupational Standards for Psychological Therapies. Version No 1

Knowledge and Understanding

You will need to know and understand:

Assessment and measurement for cognitive and behavioural therapy

1. the use of standardised questionnaires and assessment measures
2. standardised measures of common psychological problems
3. how to conduct structured interviews
4. how to move from global to more detailed questions
5. structured diagnostic criteria for the client’s psychological problems
6. methods of measuring behaviour, emotion and cognition
7. clinical indications and contraindications for the cognitive and behavioural therapy approach
8. factors influencing the length of treatment and mode of delivery


Principles and practice of cognitive and behavioural therapy

9. cognitive and behavioural models of depression and anxiety disorders and their underlying mechanisms
10. the principles underlying cognitive and behavioural approaches to common psychological problems
11. how the cognitive and behavioural models are translated into treatment
12. evidence based cognitive and behavioural techniques used in treatment of depression and anxiety disorders
13. the psychological and social difficulties presented by clients with common psychological problems
14. coexisting problems and their interaction
15. the range of cognitive and behavioural therapy models and treatment plans that can be employed
16. the main goals of treatment for the client’s psychological problems
17. the stages of human development throughout a life span and how they affect people and their needs
18. the impact of social relationships and environment on health and wellbeing
19. the changes in cognitive ability and the impact that age related transitions have on interpersonal networks
20. the effects and impact of prescribed medication, non-prescribed drugs and alcohol on the client’s health and wellbeing
21. how to adapt your communication to the client’s individual needs


Working together in cognitive and behavioural therapy

22. verbal and non verbal behaviours
23. listening skills
24. effective and ineffective interpersonal behaviours
25. personal self awareness
26. how to engender trust
27. how to develop rapport
28. professional boundaries and codes of conduct
29. how to ‘read’ and interpret the client’s emotional reactions
30. possible sources of therapeutic impasse

Performance Criteria

You must be able to do the following:

1. match the assessment process to the client’s level of functioning
2. identify through collaboration with the client and other sources:
1. a detailed picture of the client’s specific symptoms and stressors
2. the history and diagnosis of the client’s psychological problems
3. the client’s present life situation and lifestyle
4. the social support the client receives from their family and significant others
5. the client’s current and past treatments
6. social and physical problems relevant to the client’s presentation
3. assess the presence and likely impact on the client and their treatment of:
1. co-morbid psychological problems
2. prescribed medication
3. substance abuse
4. life circumstances
4. assess and act on indicators of risk of suicide, harm to self or others and that of self-neglect in line with your local guidelines
5. evaluate:
1. the context of the client’s difficulties and their impact on daily living in terms of the client’s thoughts, feelings and behaviours
2. the adaptive and maladaptive coping skills employed by the client to manage their problem, their stress tolerance, and level of functioning
3. the relationship between their thoughts, feelings and behaviour
4. their maintenance cycles
6. identify and select , in collaboration with the client, symptoms or problems that are amenable to intervention and which you will work on
7. gain a pre-treatment baseline drawing on valid information from interview and relevant instruments and measures
8. assess the extent to which the client can think about themselves psychologically and what this means for therapeutic work
9. assess the client’s attitude and motivation towards a psychological intervention
10. identify with the client when psychological treatment might not be an effective or best option

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard is derived from research reported in Roth A D and Pilling S (2007) .The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. Department of Health/University College London. This standard has indicative links with the following dimension within the NHS Knowledge and Skills Framework (October 2004). . Dimension: HWB6 Assessment and treatment planning