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Department of Psychiatry

Early in Treatment Roadmap

The outline below provides a roadmap for the early stages of CBTp. The roadmap provides direction in the following areas: Engagement, Assessment, Psychoeducation, Goal Setting, and Case Formulation. Under each section, we list publicly available resources to assist with this early stage of treatment. These resources include:

Engagement

The goal of engagement is to build the therapeutic alliance (TA). The focus should be on getting to know the clients and having them tell their story. We have included the Working Alliance Inventory (WAI) short form, as it provides questions that tap into the three domains of the TA, namely “tasks,” “goals,” and bond.”

General Assessments

The measures below tap into a variety of domains. We are agnostic about which are the “best” measures but provide several options within each domain. Please not that you do no have to use all these measures. You can choose measures from a single or multiple domains.

  • General Assessments (to guide treatment planning)
    • Stress/Trauma
      • Perceived Stress Scale (PSS) (PhenX)
      • PTSD Scale (IRT Manual, pp.395-396)
    • General Symptoms
      • Modified Colorado Symptom Index (CAB)
      • Persistent Symptom Assessment Scale (IRT Manual, pp. 466-467)
    • Anxiety and Depression
      • Depression and Anxiety Stress Scall (DASS) (IRT Manual, pp. 397-398)
      • Beck Hopelessness Scale (BHS) (IRT Manual, p. 401) or (PhenX)
    • Paranoia/Troubling Thoughts
    • Auditory Hallucinations
      • Beliefs about Voices Questionnaire-Revises (BAVQ-R) (IRT Manual, p. 399)
      • Symptoms of Hallucinations Checklist (IRT Manual, pp. 489-490)
    • Social/Role Functioning
    • Psychological Well Being
      • Personal Well Being Index (PhenX)
      • Quality of Life Enjoyment and Satisfaction (PhenX)

Psychoeducation

It is important to determine what the client knows about their illness and their level of insight. You need not got through all the IRT modules below. At the very least, consider the first two modules as a starting point.

  • Psychoeducation (to determine what the client knows about their illness)
    • Basic Information about Psychosis (IRT Manual, pp. 133-138)
    • Stress-Vulnerability Model (IRT Manual, pp. 140-144)
    • Coping with Stress (IRT Manual, pp. 178-192)
    • Medications for Psychosis (IRT Manual, pp. 164-175)
    • Optional – If client has substance use issues
      • Basic Information about Substance Use (IRT Manual, pp. 148-163)

Goal Setting

Goal setting is the foundation of any psychosocial intervention for schizophrenia. Goals also provide traction for addressing residual symptoms. For example, a client who wants to make more friends might be more inclined to address residual auditory hallucinations if they interfere with them going to places where they might meet others. We recommend using brief strengths test as it provides another way of understanding your client (i.e., not from an impairment perspective).

  • Goal Setting
    • Brief Strengths Test (IRT Manual, pp. 83-92)
    • Satisfaction with Area of my Life (IRT Manual, pp. 93-95)
    • Goal Setting (IRT manual, pp. 103-109)

Case Formulation

Case formulation refers to how you understand or conceptualize the client’s symptoms: what are the triggers or antecedents? What is maintaining them? How do they impact behaviors and feelings? We have provided a brief overview on case formulation from Kingdon and Turkington’s 2008, Cognitive Therapy for Schizophrenia, as well as handouts that will help guide this process.