Client Assessment


Edited by: Stephen Palmer & Gladeana McMahon

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  • Professional Skills for Counsellors

    The Professional Skills for Counsellors series, edited by Colin Feltham, covers the practical, technical and professional skills and knowledge which trainee and practising counsellors need to improve their competence in key areas of therapeutic practice.

    Titles in the series include:

    • Medical and Psychiatric Issues for Counsellors
    • Brian Daines, Linda Gask and Tim Usherwood
    • Personal and Professional Development for Counsellors
    • Paul Wilkins
    • Counselling by Telephone
    • Maxine Rosenfield
    • Time-Limited Counselling
    • Colin Feltham
    • Counselling, Psychotherapy and the Law
    • Peter Jenkins


    View Copyright Page


    To the future generations: Kate, Tom, Emma, Leonora and Rebecca (SP)

    To Mike, Thomas and Tigger (GM)

  • Postscript

    Hopefully this book has given the reader some insight into a range of issues on client assessment. Inevitably some issues were not included although it was not the intention to write a complete handbook of client assessment. However, with this idea in mind, we would be interested to hear from readers about what subjects they would like us to cover in such a handbook. Please write to us at the following address with your feedback and ideas:

    • Stephen Palmer and Gladeana McMahon
    • Centre for Stress Management
    • 156 Westcombe Hill
    • London
    • SE3 7DH

    Appendix Multimodal Life History Inventory

    The purpose of this inventory is to obtain a comprehensive picture of your background. In psychotherapy records are necessary since they permit a more thorough dealing with one's problems. By completing these questions as fully and as accurately as you can, you will facilitate your therapeutic program. You are requested to answer these routine questions in your own time instead of using up your actual consulting time (please feel free to use extra sheets if you need additional answer space).

    It is understandable that you might be concerned about what happens to the information about you because much or all of this information is highly personal. Case records are strictly confidential.

    General Information

    Date. Name. Address. Telephone numbers.

    Age. Occupation. Sex. Date of birth. Place of birth. Religion.

    Height. Weight. Does your weight fluctuate? If yes, by how much?

    Do you have a family physician? Name of family physician.

    Telephone number. By whom were you referred?

    • Marital status: single, engaged, married, separated, divorced, widowed, living with someone, remarried (how many times?) Do you live in: house, room, apartment, other? With whom do you live: self, parents, spouse, roommate, child(ren), friend(s), others (specify)?
    • What sort of work are you doing now? Does your present work satisfy you? If no, please explain. What kind of jobs have you held in the past?
    • Have you been in therapy before or received any professional assistance for your problems?
    • Have you ever been hospitalized for psychological/psychiatric problems? If yes, when and where?
    • Have you ever attempted suicide? Does any member of your family suffer from an ‘emotional’ or ‘mental disorder’? Has any relative attempted or committed suicide?
    Personal and Social History
    • Father: name, age, occupation, health. If deceased, give his age at time of death. How old were you at the time? Cause of death.
    • Mother: name, age, occupation, health. If deceased, give her age at time of death. How old were you at the time? Cause of death.
    • Siblings: Age(s) of brother(s), age(s) of sister(s). Any significant details about siblings.
    • If you were not brought up by your parents, who raised you and between what years?
    • Give a description of your father's (or father substitute's) personality and his attitude toward you (past and present).
    • Give a description of your mother's (or mother substitute's) personality and her attitude toward you (past and present).
    • In what ways were you disciplined or punished by your parents? Give an impression of your home atmosphere (i.e., the home in which you grew up). Mention state of compatibility between parents and between children. Were you able to confide in your parents? Basically, did you feel loved and respected by your parents?
    • If you have a stepparent, give your age when your parent remarried. Has anyone (parents, relatives, friends) ever interfered in your marriage, occupation, etc.? If yes, please describe briefly.
    • Scholastic strengths. Scholastic weaknesses. What was the last grade completed (or highest degree)?
    • Check any of the following that applied during your childhood/ adolescence: happy childhood, unhappy childhood, emotional/ behavior problems, legal trouble, death in family, medical problems, ignored, not enough friends, school problems, financial problems, strong religious convictions, drug use, used alcohol, severely punished, sexually abused, severely bullied or teased, eating disorder, others.
    Description of Presenting Problems

    State in your own words the nature of your main problems.

    • On the [following] scale, please estimate the severity of yourproblem(s): mildly upsetting, moderately upsetting, very severe, extremely severe, totally incapacitating.
    • When did your problems begin? What seems to worsen your problems? What have you tried that has been helpful?
    • How satisfied are you with your life as a whole these days? (not at all satisfied) 1, 2, 3, 4, 5, 6, 7 (very satisfied)
    • How would you rate your overall level of tension during the past month? (relaxed) 1, 2, 3, 4, 5, 6, 7 (tense)
    Expectations regarding Therapy

    In a few words, what do you think therapy is all about?

    How long do you think your therapy should last?

    What personal qualities do you think the ideal therapist should possess?

    Modality Analysis of Current Problems

    The following section is designed to help you describe your current problems in greater detail and to identify problems that might otherwise go unnoticed. This will enable us to design a comprehensive treatment program and tailor it to your specific needs. The following section is organized according to the seven modalities of behaviors, feelings, physical sensations, images, thoughts, interpersonal relationships, and biological factors.

    • Check any of the following behaviors that often apply to you: overeat, take drugs, unassertive, odd behavior, drink too much, work too hard, procrastination, impulsive reactions, loss of control, suicidal attempts, compulsions, smoke, withdrawal, nervous tics, concentration difficulties, sleep disturbance, phobic avoidance, spend too much money, can't keep a job, insomnia, take too many risks, lazy, eating problems, aggressive behavior, crying, outbursts of temper, others.

    What are some special talents or skills that you feel proud of? What would you like to start doing? What would you like to stop doing?

    How is your free time spent?

    What kind of hobbies or leisure activities do you enjoy or find relaxing?

    Do you have trouble relaxing or enjoying weekends and vacations? If yes, please explain.

    If you could have any two wishes, what would they be?

    • Check any of the following feelings that often apply to you: angry, annoyed, sad, depressed, anxious, fearful, panicky, energetic, envious, guilty, happy, conflicted, shameful, regretful, hopeless, hopeful, helpless, relaxed, jealous, unhappy, bored, restless, lonely, contented, excited, optimistic, tense, others.

    List your five main fears

    What are some positive feelings you have experienced recently?

    When are you most likely to lose control of your feelings?

    Describe any situations that make you feel calm or relaxed:

    Physical Sensations
    • Check any of the following physical sensations that often apply to you: abdominal pain, pain or burning with urination, menstrual difficulties, headaches, dizziness, palpitations, muscle spasms, tension, sexual disturbances, unable to relax, bowel disturbances, tingling, numbness, stomach trouble, tics, fatigue, twitches, back pain, tremors, fainting spells, hear things, watery eyes, flushes, nausea, skin problems, dry mouth, burning or itching skin, chest pains, rapid heart beat, don't like to be touched, blackouts, excessive sweating, visual disturbances, hearing problems, others.

    What sensations are: pleasant for you? unpleasant for you?


    Check any of the following that apply to you.

    • I picture myself: being happy, being hurt, not coping, succeeding, losing control, being followed, being talked about, being aggressive, being helpless, hurting others, being in charge, failing, being trapped, being laughed at, being promiscuous, others.
    • I have: pleasant sexual images, unpleasant childhood images, negative body image, unpleasant sexual images, lonely images, seduction images, images of being loved, others.

    Describe a very pleasant image, mental picture, or fantasy.

    Describe a very unpleasant image, mental picture, or fantasy.

    Describe your image of a completely ‘safe place’.

    Describe any persistent or disturbing images that interfere with your daily functioning.

    How often do you have nightmares?

    • Check each of the following that you might use to describe yourself: intelligent, confident, worthwhile, ambitious, sensitive, loyal, trustworthy, full of regrets, worthless, a nobody, useless, evil, crazy, morally degenerate, considerate, deviant, unattractive, unlovable, inadequate, confused, ugly, stupid, naive, honest, incompetent, horrible thoughts, conflicted, concentration difficulties, memory problems, attractive, can't make decisions, suicidal ideas, persevering, good sense of humor, hard working, undesirable, lazy, untrustworthy, dishonest, others.

    What do you consider to be your craziest thought or idea?

    Are you bothered by thoughts that occur over and over again? If yes, what are these thoughts?

    What worries do you have that may negatively affect your mood or behavior?

    On each of the following items, please circle the number that most accurately reflects your opinions [scale against each item: 1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly Agree]:

    • I should not make mistakes.
    • I should be good at everything I do.
    • When I do not know something, I should pretend that I do.
    • I should not disclose personal information.
    • I am a victim of circumstances.
    • My life is controlled by outside forces.
    • Other people are happier than I am.
    • It is very important to please other people.
    • Play it safe; don't take any risks.
    • I don't deserve to be happy.
    • If I ignore my problems, they will disappear.
    • It is my responsibility to make other people happy.
    • I should strive for perfection.
    • Basically, there are two ways of doing things – the right way and the wrong way.
    • I should never be upset.
    Interpersonal Relationships Friendships

    Do you make friends easily? Do you keep them?

    Did you date much during high school? College?

    Were you ever bullied or severely teased?

    Describe any relationship that gives you: joy; grief.

    Rate the degree to which you generally feel relaxed and comfortable in social situations: (very relaxed) 1, 2, 3, 4, 5, 6, 7, (very anxious).

    Do you have one or more friends with whom you feel comfortable sharing your most private thoughts?

    Marriage (or a Committed Relationship)

    How long did you know your spouse before your engagement?

    How long were you engaged before you got married? How long have you been married?

    What is your spouse's age? His/her occupation?

    Describe your spouse's personality. What do you like most about your spouse? What do you like least about your spouse?

    What factors detract from your marital satisfaction?

    On the [following] scale, please indicate how satisfied you are with your marriage: (very dissatisfied) 1. 2, 3, 4. 5, 6, 7, (very satisfied).

    How do you get along with your partner's friends and family? (very poorly) 1, 2, 3, 4, 5, 6, 7, (very well).

    How many children do you have? Please give their names and ages.

    Do any of your children present special problems? If yes, please describe.

    Any significant details about a previous marriage(s)?

    Sexual Relationships

    Describe your parents' attitude toward sex. Was sex discussed in your home?

    When and how did you derive your first knowledge of sex?

    When did you first become aware of your own sexual impulses?

    Have you ever experienced any anxiety or guilt arising out of sex or masturbation? If yes, please explain.

    Any relevant details regarding your first or subsequent sexual experiences?

    Is your present sex life satisfactory? If no, please explain.

    Provide information about any significant homosexual reactions or relationships.

    Please note any sexual concerns not discussed above.

    Other Relationships

    Are there any problems in your relationships with people at work?

    If yes, please describe.

    Please complete the following: one of the ways people hurt me is …; I could shock you by …; my spouse (or boyfriend/girlfriend) would described me as …; my best friend thinks I am …; people who dislike me ….

    Are you currently troubled by any past rejections or loss of a love relationship? If yes, please explain.

    Biological Factors

    Do you have any current concerns about your physical health? If yes, please specify.

    Please list any medications you are currently taking.

    Do you eat three well-balanced meals each day?

    Do you get regular physical exercise? If yes, what type and how often?

    Please list any significant medical problems that apply to you or to members of your family.

    Please describe any surgery you have had (give dates).

    Please describe any physical handicap(s) you have.

    Menstrual History

    Age at first period. Where you informed? Did it come as a shock?

    Are you regular? Duration. Do you have pain? Do your periods affect your moods? Date of last period.

    • Check any of the following that apply to you [scale against each item: never; rarely; occasionally; frequently; daily]: muscle weakness, tranquilizers, diuretics, diet pills, marijuana, hormones, sleeping pills, aspirin, cocaine, pain killers, narcotics, stimulants, hallucinogens (e.g., LSD), laxatives, cigarettes, tobacco (specify), coffee, alcohol, birth control pills, vitamins, undereat, overeat, eat junk foods, diarrhea, constipation, gas, indigestion, nausea, vomiting, heartburn, dizziness, palpitations, fatigue, allergies, high blood pressure, chest pain, shortness of breath, insomnia, sleep too much, fitful sleep, early morning awakening, earaches, headaches, backaches, bruise or bleed easily, weight problems, others.
    Structural Profile

    Directions: rate yourself on the following dimensions on a seven-point scale with 1 being the lowest and 7 being the highest.

    • Behaviors Some people may be described as ‘doers’ – they are action oriented, they like to busy themselves, get things done, take on various projects. How much of a doer are you?
    • Feelings Some people are very emotional and may or may not express it. How emotional are you? How deeply do you feel things? How passionate are you?
    • Physical sensations Some people attach a lot of value to sensory experiences, such as sex, food, music, art, and other ‘sensory delights’. Others are very much aware of minor aches, pains, and discomforts. How ‘tuned into’ your sensations are you?
    • Mental images How much fantasy or daydreaming do you engage in? This is separate from thinking or planning. This is ‘thinking in pictures’, visualizing real or imagined experiences, letting your mind roam. How much are you into imagery?
    • Thoughts Some people are very analytical and like to plan things. They like to reason things through. How much of a ‘thinker’ and ‘planner’ are you?
    • Interpersonal relationships How important are other people to you? This is your self-rating as a social being. How important are close friendships to you, the tendency to gravitate toward people, the desire for intimacy? The opposite of this is being a ‘loner’.
    • Biological factors Are you healthy and health conscious? Do you avoid bad habits like smoking, too much alcohol, drinking a lot of coffee, overeating, etc.? Do you exercise regularly, get enough sleep, avoid junk food, and generally take care of your body?

    Please describe any significant childhood (or other) memories and experiences you think your therapist should be aware of.

    Editors and Contributors

    The Editors

    Stephen Palmer is Director of the Centre for Stress Management and the Centre for Multimodal Therapy, London. He is a Chartered Counselling Psychologist, a UKCP registered psychotherapist, a BAC Fellow, an Associate Fellow of the Institute of Rational-Emotive Therapy, New York, and a certified supervisor for training in REBT. He edits Counselling Psychology Review and The Rational Emotive Behaviour Therapist and has authored or edited 13 books and manuals. He edits three book series including Stress Counselling (Cassell). His recent books include Counselling: The BAC Counselling Reader (with Dainow and Milner 1996), Dealing with People Problems (with Burton 1996) and Stress Management and Counselling (1996 with Dryden).

    Gladeana McMahon is a BAC accredited counsellor and recognised counselling supervisor, is a BABCP accredited cognitive-behavioural psychotherapist and is UKCP registered. She has run a successful private practice since 1988 providing counselling, training and counselling supervision and has worked in a variety of voluntary, medical, statutory and private sector settings. She is the author of Starting Your Own Private Practice (1994).

    The Contributors

    Patricia Armstrong has a BSc (Hons) in Psychology and an MSc in Counselling Psychology. She currently works as a Manager/ Counsellor for an alcohol counselling agency in Kent. She supervises students on Counselling Diploma and MSc Counselling Psychology courses. She also guest lectures at universities in London and Kent. Patricia runs a private practice from home.

    Mark Aveline has been a consultant medical psychotherapist in Nottingham since 1974. His chief interests are in the development of a range of effective psychotherapies, suitable for NHS practice, and teaching the necessary skills at undergraduate, postqualification and specialist levels. He is a member of the Governing Board of the United Kingdom Council for Psychotherapy (1992–). Chair of the Training Committee of South Trent Training in Dynamic Psychotherapy (1984–), President of the British Association for Counselling (1994–), Chair of the Psychotherapy Training Specialist Advisory Committee of the Royal College of Psychiatrists (1995–) and UK Vice–President of the Society for Psychotherapy Research (1996–). His books include Croup Therapy in Britain (1988), From Medicine to psychotherapy (1992) and Research Foundations for Psychotherapy Practice (1995).

    Berni Curwen is a cognitive–behavioural psychotherapist accredited by the BABCP and registered with the United Kingdom Council for Psychotherapy. She has a psychiatric nurse background and has worked in both the NHS and private practice.

    Peter Ruddell is a cognitive–behavioural psychotherapist accredited by the BABCP and the Association for Rational Emotive Behaviour Therapists and registered with the United Kingdom Council for Psychotherapy. He has worked in both the private and voluntary sectors.

    Carole Sutton is a Principal Lecturer in Psychology at De Montfort University, Leicester, where she teaches psychology and counselling skills. She is also a Chartered Counselling Psychologist. She is particularly interested in the evaluation of practice and is a former Chair of the Research Sub–committee of the British Association for Counselling. Her publications include A Handbook of Research for the Helping Professions and Social Work, Community Work, and Psychology.

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