Promoting Individualized Assessment

Our main rationale for developing this text is the idea that clinicians should base treatment on a detailed assessment of their client's unique individual needs, rather than simply administering a structured treatment package. Cognitive-behavioral assessment of PTSD and other trauma-related problems remains centered on a functional analysis of behavior, outlined in Chapter Two by Follette and Naugle. Their approach is that there is no "average" patient. It is necessary to develop an individualized understanding of the functional relationships among a person's behaviors, life conditions preceding the trauma, how those factors are maintained after the trauma. For the clinician wrestling with trying to understand a complex human being in a set of complex social environments, these authors' emphasis on identifying important, controllable, and causal factors is critical: what are the specific variables that, when changed, will lead to large improvements in the behaviors of clinical interest, that can be affected by the clinician and client working together, and that when modified, reliably produce changes in the target problem?

Cognitive-behavioral practitioners also believe that it is important to assess changes in problem behaviors and symptoms and thereby evaluate the effectiveness of their helping efforts. In their review of recent advances in psychological assessment of PTSD in adults, Pratt, Brief, and Keane in Chapter Three conclude that the assessment devices available for evaluating PTSD are comparable to or better than those for other psychological disorders. They identify a variety of measures that are helpful in assessing the effectiveness of treatment, as do most of the chapter authors with regard to their particular interventions.

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