Assessment: A Personal Overview

The author offers personal rather than scholarly reflections on the sometimes difficult process of assessment. He discusses aims of assessment which include risk assessment, and an assessment of the prospective patient's ability to engage in the therapeutic process as indicated by their engagement with the assessor's interpretive remarks, albeit oppositionally or defensively, and whether consciously or unconsciously. Implicit or explicit in this engagement will be the issue of the patient's habitual ways of relating, the transference. Consideration is also given to how we can evaluate the nature of the patient's motivation, not only with regard to insight and change, but also to dependency and malignancy. The issue of treatment choices is discussed, along with the desirability of any management decisions being offered as interpretations. The author also addresses the issue of note and record writing in the light of the scope this gives for countertransference enactment, as well as the issue of what records are kept for what purposes and of how and when these are communicated to GPs. Vignettes illustrate some of the difficulties and pitfalls of the process.