This chapter outlines a range of methods for developing a comprehensive schema therapy assessment, including clinical interview, identification of key problem areas and related therapy goals, functional assessment of key problem areas, self-monitoring forms, mode assessment, questionnaires and psychometric data, diagnostic imagery, and process assessment. The assessment process largely continues throughout the entire therapeutic process, as more information is understood and revealed, allowing for reformulation and fine tuning. Throughout the assessment process the schema therapist suggests possible links between current presenting issues and interpersonal patterns, early attachment processes and schema development. This process is aimed at building rapport through deep attunement and transparency, whilst providing education about schema development, thereby gradually strengthening the client’s capacity to self-reflect. A shared formulation (even if tentative) provides the groundwork for the therapeutic process. It is therefore essential to spend sufficient time exploring childhood and adolescent issues and the way in which these link to presenting issues.

Identifies the important characteristics of clinical assessment. Describes the various tests that psychologists use. Explains the way psychologists organize information in an intake report. Explains the purpose and limitations of diagnosis. Summarizes the way diagnostic manuals have changed over time. Describes the research evaluating the effectiveness of psychotherapy.

I very much admire Stephan Heckers’ framing of ‘four forms of scientific reductionism in psychiatry’ and their relation to the autonomy of the patient.Stephan seems to be using ‘reductionism’ in a legitimate, but perhaps non-standard way.‘Reduction’ in his sense has to do with loss of information.There is, first, the ‘clinical encounter’ in which the patient’s lived experience is translated into the third-person account given by the therapist.Then there is classification, identification of a biological problem, and causal implications.Each of these steps misses out something about the ‘lived experience’ of the patient.I find the discussion somewhat tantalizing, and suggest the real reason for acknowledging autonomy may be the need for a ‘Jaspersian engagement’ with the patient, which identifies the one-off idiosyncracies of the patient’s mental life, rather than merely those aspects that fall under generalizations.

Clinical interviewing is a flexible method for gathering assessment information and initiating psychotherapy. Clinical interviews can be used to establish therapeutic relationships, provide role inductions for psychotherapy, gather assessment information, develop case formulations/treatment plans, and for implementing therapeutic interventions. When used for assessment or intake purposes, clinical interviews focus on specific content, such as psychodiagnosis, mental status, and suicide risk. Although central to psychodiagnostic assessment, interview reliability and validity can be adversely affected by noncredible client responding (e.g., the over- or underreporting of symptoms). To address noncredible client responding, clinicians need to (1) be aware of the potential for inaccurate reporting, (2) adopt a “scientific mindedness” approach, (3) manage their countertransference, (4) use specific questioning or interpersonal strategies, and (5) triangulate data by using information from multiple sources. Undoubtedly, technology and other forces may change how future clinicians conduct clinical interviews; however, it is likely that clinical interviews will remain foundational to psychological assessment and treatment.