PTSD Assessment and Treatment Planning: A Clinical Guide

Semi-Structured Clinical Interview

The foremost component of an informal evaluation of traumatized individuals is the semi-structured interview, in which the following details about the patient ought to be gathered:

• Demographic information
• Employment history
• Medical history
• Educational history
• Social history
• Several other specific details

Such an interview must be closely grounded in both minor and major trauma disorder facets (James, 2008). Particular questions to be posed to the patient are linked to:

• The nature of the trauma and the level of exposure
• Definite trauma integral to post-traumatic stress (PTS) symptoms
• Intrusive thoughts, recollections, emotions, and imagery; responsiveness or awareness freezing; avoidance responses; and other similar symptoms
• Related elements of anxiety, depression, drug or alcohol abuse, anger, or violent behavior
• Pre-morbid family and social life and adjustment
• Familial history of psychological illness

Essentially, therapists must seek comprehensive information on individual PTS symptomatology elements, identifying the nature, seriousness, content, rate, and duration of symptoms, as well as concise explanations for each.

The semi-structured interview is crucial because the information gathered through patient interviewing may serve as the foundation for diagnosis and examination. With increased knowledge of the patient's particular symptoms, PTSD subtypes, and disorder trajectory, the assessor's likelihood of validly and accurately diagnosing the condition increases. Such a fundamental system may be implemented for individual kinds of traumatic stressors and distinct reactions, and it can be extended to encompass more in-depth information and secondary aspects (Peterson, Prout, & Schwarz, 1991).

Screening for Post-Traumatic Stress

Trauma-related and event-connected questions are vital to pose to clients from both evaluation and intervention perspectives. Key screening questions include:

• Which life experience would you consider most traumatic?
• How did this experience affect your life?
• Did you believe, at any point during that experience, that your life or safety was seriously in jeopardy — that is, that you would be physically harmed or killed? What are your thoughts and feelings regarding that particular experience? (Peterson, Prout, & Schwarz, 1991)
• Have you ever experienced an excessively disturbing, terrifying, or awful situation, because of which, within the last month, you:
  • Remained constantly alert, vigilant, cautious, or quick to startle?
  • Had nightmares or unwelcome recollections of the incident?
  • Experienced numbness or detachment from your surroundings, other people, or activities?
  • Worked hard to keep thoughts about the incident out of your mind, or avoided situations that call it to mind? (Wallace & Cooper, 2015)

The above questions are deliberately broad but effectively assume that an individual has experienced some traumatic event and prompt him or her to identify the worst one. To answer these questions, the patient must undertake a comparison of several distressing scenarios, which may yield various associations. Posing such questions is vital because one of the factors most highly correlated with trauma is the victim's cognitive appraisal that his or her life or physical wellbeing was gravely threatened. This is precisely why it is important to ask whether the victim sensed a likelihood of being killed or physically injured (Peterson, Prout, & Schwarz, 1991).

Despite the importance of these questions, therapists must carefully seek details about traumatic events from clients. A common but mistaken assumption — held by professionals and non-professionals alike — is that evaluating a patient's trauma history involves an indifferent attempt to surface detailed memories of possible traumatic events. Therefore, prior to interviewing the client, he or she should explicitly understand that there is no compulsion to reveal anything too uncomfortable or distressing to disclose. Therapists must also ensure they avoid complex academic jargon or colloquial language that might cause anxiety or be misinterpreted. Furthermore, the client must be therapeutically guided when revealing possibly traumatic experiences, so that the assessment process does not leave him or her feeling mentally overwhelmed, pressurized, or stigmatized (Rosen & Frueh, 2010).

Mental Status Examination and Formal Assessment Measures

Formal evaluation of the patient's mental health status within the assessment process involves a standard procedure. This procedure entails interviewing the patient on orientation, motor functioning, sensory experiences, mathematical ability, moods and feelings, delusional behavior, judgment, proverb interpretation, spatial-visual abilities, and visual and auditory memory. The facts gathered in mental status assessments typically offer key details connected with the patient's cognitive functioning (Peterson, Prout, & Schwarz, 1991).

Clinicians may employ the following formal PTSD evaluation measures:

• Structured SCID-IV/DSM-IV Clinical Interviews. The PTSD module of the Structured Clinical Interview for DSM-IV (SCID; Spitzer, Gibbon, & Williams, 1996) represents the most frequently employed clinical interview for various types of trauma patients.
• Impact of Event Scale (IES). This fifteen-item scale may be used for indexing both avoidance and intrusive symptoms in acute PTSD patients. The tool has strong psychometric properties and demonstrates good correlation with PTSD (Zilberg, Weiss, & Horowitz, 1982).

Any details that were missed during the mental status assessment and structured interview stages may be captured through formal assessments. Numerous formal assessment instruments for trauma-related conditions are available (Bryant & Harvey, 2000).