Psychological assessment of intrusive thoughts

Meeting a psychologist for an assessment of Intrusive thoughts

This post is part of a series of articles to help you with intrusive thoughts. If you haven’t already read it, the previous post gave you an overview of the article series. Today, I want to outline what will happen if you meet with a psychologist for a psychological assessment.

Why would you want to meet with a psychologist?

Meeting with a psychologist or other mental health professionals for assessment allows you to get a diagnosis.

Getting an accurate diagnosis is crucial to formulate a treatment plan and allowing the mental health professional to formulate a case based on the assessment. 

I understand that it can be challenging to meet with mental health professionals. You might feel anxious about the meeting or concerned about what they will think about you when you say what’s going on with you or feel ashamed or embarrassed. This is perfectly natural to feel this way, and all you have to do is get to the first meeting and trust the clinician to help you with this.

An excellent experienced therapist should put you at ease and help you feel okay to talk. You can change if you feel uncomfortable during the assessment or find it challenging to engage with your therapist. Establishing a good relationship between you and the therapist is down to the skill of the person you are seeing. If they cannot establish this rapport, it might be helpful to look into meeting with someone else.

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The assessment

Most assessments follow a similar pattern to glean the following information.

Presenting problem – this is basically what is going on for you. For example, how are you currently experiencing your obsessions and compulsions? How are intrusive thoughts impacting your daily life?

Mental state – it’s essential to examine your mental state for several reasons, such as ensuring that you’re suitable for therapy. For example, if someone’s mood was severely affected and they were experiencing an episode of psychosis, they would not undertake treatment at this time. It surprises people when we talk about suitability for therapy, especially in the world of private practice.

Sometimes, there is an assumption that you go along and get the treatment you request; for example, you might want a particular model. But for therapy to be effective and do what you want it to do to help you get better, we need to assess your suitability and match up your presenting problem with a recommended model of therapy that is effective with your presenting issues. We will look at your mood, your sleep patterns your concentration ability.

History. We will also discuss your past psychiatric history if any. For example, have you attended therapy before for intrusive thoughts? We will also look at your medical history and any medications you may be taking, as these are necessary to know as they may impact treatment.

Assessment of OCD

You might be surprised during your assessment when your therapist wants to assess you for obsessive-compulsive disorder when you have made the appointment to discuss intrusive thoughts.

Intrusive thoughts are part of OCD. Some people, primarily due to stuff they have read on the Internet, may believe they have pure O, that is, obsessions, and do not have any compulsions that occur with an OCD, but they will be there. Intrusive thoughts are obsessive thoughts you do not want but find difficult to control.

Your clinician, during the assessment, will ask about some or all of the following.

  • Do you worry that something terrible might happen because you forgot to do something?
  • Do you clean excessively?
  • Do you have unwanted thoughts that upset you or disturb you
  • Do you worry about germs or dirt
  • Do you like things done a certain way, such as checking to ensure something has been completed properly?

These types of questions help your therapist to decide if your intrusive thoughts are part of OCD and if so, they will discuss your intrusive thoughts in more depth.

Assessing your intrusive thoughts

Talking about your obsessions. The clinician will ask you about your thoughts and ask if you have any repetitive, unwanted images in your head and any urges to do something upset you—these all fall under what we call obsessions.

Eliciting your compulsions. Like many people who seek treatment for intrusive thoughts, you might not realise that you have compulsions.

Compulsions are the things you do to help you cope with your intrusive thoughts.

During the initial assessment, your psychologist will ask specific questions matching each intrusive thought with a corresponding compulsion.

For example, your mental health professional will choose one of the intrusive thoughts you have already mentioned and ask you what you do when you have this thought to help you cope with how it makes you feel.

  • Do you do anything to reassure yourself that this is false, and if so, how do you do this?
  • Do you perform any mental rituals?
  • Do you say anything repeatedly inside your head?
  • What do you avoid? Are there any people, places or thought processes you avoid when you’re concerned that they might trigger intrusive thoughts?

Quality of life. Your psychologist will wish to understand how your obsessive thoughts impact your day-to-day life. Affect your relationships are your work life.

All psychological formulations have the following.

. The psychologist will ask you questions to ascertain the start of your intrusive thoughts, such as what age you first realised you were experiencing these obsessions. They will also ask you what was happening in your life. Was anything different than usual?

Change over time. Has there been any change over time? Are there any times when they would be less or more than others? What sort of things did you notice helped or made things worse?

Why come to therapy now? Your therapist may ask you questions about why you come to therapy now, and this is to give them an idea of your motivation for undertaking treatment. Did you self-refer? Is this something you want to do, or have you been made to come for therapy?

Previous psychological treatments. Have you attended therapy before, and what type of treatment did you undertake? Who did you see? Was it a counsellor, a psychologist psychotherapist? Your mental health professionals will also ask you about the treatment style you received. This is because sometimes people have been told they are receiving cognitive behavioural therapy, for example, but did not.

Why is this all necessary?

These are a lot of questions to be asked during the assessment, but it helps your psychologist gather all the information to provide you with an accurate diagnosis. The diagnosis decides what treatment you will be offered.

There are guidelines that state what therapy models will help with specific mental health conditions.

I shall talk about some therapy models in the next few posts in this series, specifically Cognitive Behavioural Therapy and Exposure Response Prevention.

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