From Chapter 3: Multi-layered assessment: Assessing symptoms, stressors and resiliency factors

Typically, cognitive-behavioral therapists working with clients struggling with BFRBs assess primarily for symptom severity and type (automatic, focused or a combination of the two) and for co-morbid conditions such as depression or anxiety. In ComB, the enhanced cognitive-behavioral treatment recommended for this population (Trichotillomania Learning Center, 2011), the assessment process stops there. In a review of treatments that address the emotional regulation components of BFRBs, Roberts, O’Connor & Belanger (2013) explain, “the (ComB) model does not attempt to explain why an individual begins to pull hair, pick skin, or bite nails,” (p. 749).

In contrast, I am interested in understanding the full pictures of my clients’ lives, from sensory processing issues to relationships, from trauma to successes. I conduct an on-going and multilayered assessment process with each person who walks into my office. I think of BFRBs as guides to the inner map of each person’s life experience. Following this map allows me to help clients to process emotions, needs, and losses that arise along the way. Thus, assessment of symptom frequency, severity and type and co-morbid conditions is only the first part of my assessment process.

Throughout treatment, I continue my assessment of symptoms on a deeper, ongoing level, seeking to understand how and when symptoms developed for each client as well as times when they have lessened or worsened and how these changes may relate to everyday triggers. This process helps me to understand the specific stressors and sensory and emotional needs of each client.

My assessment of each client covers at least eleven items: (1) symptom severity and consequences (2) symptom frequency (3) symptom type (4) co-morbidity (5) self-compassion (6) sensory processing issues (7) precipitating event (8) environmental stressors (9) attachment style (10) trauma history (11) resiliency factors.

In the full chapter, I explicate each of these categories, exploring how the assessment process with four clients informs the creation of their individualized treatment plans.

References:

Roberts, S., O’Connor, K, & Belanger C. (2013). Emotion regulation and other psychological models for body-focused repetitive behaviors. Clinical Psychology Review, 33, 745-762.