How much should I ask about the trauma in the assessment?

The amount of information needed about the trauma will depend on the purpose of the assessment. To make a diagnosis of PTSD, sufficient information about the trauma to decide whether it meets the diagnostic criterion (criterion A in DSM-5) will be needed. To produce a medico-legal report, more detailed information is usually required. However, if the goal of the assessment is to make a clinical decision about treatment suitability, it isn’t essential to ask for a detailed description of the traumatic event.

To decide whether trauma-focused treatment is appropriate, it can also be useful to ascertain during the assessment whether the client is able to talk about the trauma, and would be willing to discuss it in detail during treatment (even if they do not feel able to in the assessment). So, we usually ask for a brief description of the trauma as part of the assessment.

Some clients will be readily able and willing to talk about the trauma in detail, but many will find this distressing, especially with an unknown person. Establishing a rapport and a collaborative therapeutic relationship is essential to creating the conditions to do so during therapy, but initial assessments may provide limited time. Assessments are important opportunities to engage a client in the idea of treatment and for them to feel encouraged to return to further appointments, so pushing clients to talk about the trauma in a lot of detail when they are distressed will be counter-therapeutic, especially if there is likely to be a long wait between the assessment and start of treatment. Clients should always be given control over when and how much they disclose and should never feel coerced.

Further information about the trauma will be needed to create a cognitive formulation, including understanding the client’s idiosyncratic appraisals that about the trauma. Therefore, if the purpose of the assessment is to gather information at the start of treatment, beginning the process of exploring the details of what happened and how the client understood it is appropriate, but only at a level of detail that the client finds manageable.

Practice points:

• The level of detail about the trauma required depends on the purpose of the assessment

• To make a PTSD diagnosis, sufficient information to determine if criterion A is met is required

• Medico-legal reports usually require more detailed assessments

• Assessments for treatment suitability usually include asking for a brief description of the trauma to assess whether the client can engage in a trauma-focused approach

• Assessments to gather information at the start of treatment may include discussion of the trauma to begin to develop a conceptualisation

• Clients should feel in control of disclosure and not feel coerced.