English for Psychotherapy and Counselling: Handbook for Practitioners. Английский для психотерапии и консультирования: практическое руководство

4. Delusion

5. Hallucination

6. Insight

7. Labile affect

8. Tangentiality

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a) Observable emotional expression

b) False belief firmly held despite evidence

c) Awareness of one’s condition

d) Rapidly changing emotions

e) Awareness of time, place, and person

f) Perceiving something that isn’t there

g) How thoughts are organized and connected

h) Going off-topic when speaking

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Discussion Questions

1. In your country, how is the first psychology session typically structured?

2. What cultural factors might influence how clients describe their presenting problems?

3. How can psychologists establish rapport with clients who are reluctant to share personal information?

4. Do you think it’s appropriate to ask about suicidal thoughts in every initial assessment? Why or why not?

5. What challenges might arise when gathering psychosocial history from clients of different cultural backgrounds?

6. How would you feel about asking personal questions during an intake interview?

7. Which area of the mental status examination do you think is most important? Why?

8. How might the Four Ps formulation help in understanding a client’s difficulties?

GRAMMAR FOCUS:

Past Simple and Past Continuous for Client History / Question Forms

A. Past Simple for Completed Events in Client’s History

We use Past Simple to ask about and describe completed events, experiences, and situations in a client’s past:

Form:

• Affirmative: Subject + verb + -ed (regular) / irregular form

• Negative: Subject + didn’t + main verb

• Questions: Did + subject + main verb?

• Wh-questions: When/Where/Why + did + subject + main verb?

Examples from Assessment:

✓ When did your symptoms first start?

✓ The client experienced anxiety attacks for the first time in 2020.

✓ She didn’t seek help until last month.

✓ Did you have any support during that time?

✓ How did you cope with the loss?

✓ He received therapy three years ago.

Time expressions with Past Simple:

• yesterday, last week/month/year, ago, in 2020, when I was…, at that time

Exercise 1: Complete the intake questions

Use the correct form of the verb in brackets:

1. When _______ (do) you first notice these symptoms?

2. How long _______ (do) the symptoms last?

3. _______ (you/try) any strategies to manage the problem?

4. What _______ (happen) after you lost your job?

5. How _______ (you/feel) when that happened?

6. The client _______ (not/experience) depression until recently.

7. He _______ (have) several panic attacks last month.

B. Past Continuous for Background and Context

We use Past Continuous to describe ongoing situations or actions in the past that provide context for events:

Form:

• Affirmative: Subject + was/were + main verb + -ing

• Negative: Subject + wasn’t/weren’t + main verb + -ing

• Questions: Was/Were + subject + main verb + -ing?

Examples from Assessment:

✓ What were you doing when the panic attack started?

✓ She wasn’t sleeping well during that period.

✓ Were you experiencing any stress at work?

✓ He was going through a difficult divorce when the symptoms began.

Using Past Simple and Past Continuous together:

We often use both tenses to show how events relate to each other:

✓ I was driving to work when I had my first panic attack. (Past Continuous for background + Past Simple for main event)

✓ While she was dealing with her mother’s illness, she started having sleep problems. (Past Continuous for context + Past Simple for specific problem)

Exercise 2: Past Simple or Past Continuous?

Choose the correct form:

1. When (did the symptoms start / were the symptoms starting)?

2. What (did you do / were you doing) when you felt the anxiety?

3. She (didn’t cope / wasn’t coping) well with the stress at that time.

4. While he (studied / was studying) for exams, he (developed / was developing) insomnia.

5. (Did you experience / Were you experiencing) any major life changes before this?

6. The problems (began / were beginning) when I (worked / was working) at my previous job.

7. (Did she take / Was she taking) medication when she (came / was coming) to see you?

8. They (had / were having) financial difficulties when their relationship (broke down / was breaking down).

C. Question Forms: Open-ended vs. Closed-ended

Closed-ended questions require yes/no or brief factual answers:

✓ Do you have any children?

✓ Are you currently employed?

✓ Have you been hospitalized before?

✓ Did you finish high school?

Open-ended questions encourage detailed, narrative responses:

✓ What brings you here today?

✓ How would you describe your relationship with your family?

✓ What happened when you lost your job?

✓ How have you been coping with these feelings?

Wh-questions for assessment:

• What = specific information about problems, situations, thoughts

• When = timeline, onset, duration

• Where = location, context, settings

• Who = people involved, support system

• How = manner, coping strategies, severity

• Why = reasons, motivation (use carefully – can sound judgmental)

Exercise 3: Rewrite as open-ended questions

1. Are you stressed at work? → _______

2. Do you have a good relationship with your parents? → _______

3. Did something bad happen in your childhood? → _______

4. Are you sleeping well? → _______

5. Do you drink alcohol? → _______

6. Are you worried about anything? → _______

Exercise 4: Correct the mistakes

Find and correct the mistakes in these assessment questions:

1. When was happening the problem?

2. What you were doing when you felt anxious?

3. Did you was experiencing stress at that time?

4. She wasn’t cope well with the situation.

5. Were you felt depressed last year?

6. What did happened after you lose your job?

7. He didn’t was sleeping well during that period.

8. While I working, I had a panic attack.

COMMUNICATION:

Conducting an Initial Assessment: Sample Interview Excerpts

Excerpt 1: Opening and Presenting Problem

Psychologist: Good morning, Maria. Thank you for coming in today. Before we begin, I’d like to explain that everything we discuss is confidential unless there’s a risk of harm to yourself or others. Do you have any questions about that?

Maria: No, that’s clear. Thank you.

Psychologist: Great. So, what brings you here today?

Maria: Well, I’ve been feeling really anxious for the past few months. It’s getting worse, and I’m having trouble concentrating at work.

Psychologist: I see. When did you first notice these anxiety symptoms?

Maria: It started around March, I think. I was working on a big project at work, and I began having trouble sleeping.

Psychologist: And you mentioned it’s been getting worse. What’s been happening recently?

Maria: Last week I had what I think was a panic attack. My heart was racing, I couldn’t breathe properly, and I thought I was having a heart attack. It was terrifying.

Psychologist: That sounds very frightening. Where were you when this happened?

Maria: I was at work, in the middle of a meeting. I had to leave the room.

Psychologist: What did you do after you left the meeting?

Maria: I went to the bathroom and tried to calm down. A colleague found me and sat with me until I felt better. That’s actually when she suggested I should talk to someone.

Psychologist: It’s good that you had support. Before this panic attack, had you experienced anything like that before?

Maria: Not to that extent, no. But I’ve been feeling on edge for months now.

Excerpt 2: Psychosocial History

Psychologist: Maria, I’d like to understand more about your background. Tell me about your family.

Maria: Well, I’m 32 years old. I live alone, but my parents and younger brother live in the same city. We’re quite close.

Psychologist: How would you describe your relationship with your family?

Maria: It’s good, mostly. My parents are supportive, but they can be rather demanding. They have high expectations, especially about my career.

Psychologist: And you mentioned you have a younger brother. How is your relationship with him?

Maria: We get along well. He’s five years younger than me, so we weren’t that close growing up, but now we talk regularly.

Psychologist: What about your social life outside of family? Tell me about your friendships.

Maria: I have a few close friends from university. We try to meet up regularly, but with work being so busy, it’s been difficult lately. I’ve actually been avoiding social activities because I feel so anxious.

Psychologist: You mentioned work several times. Tell me about your job.

Maria: I’m a marketing manager at a tech company. I’ve been there for four years. I used to love the job, but lately the pressure has been intense. We had layoffs last year, so those of us who remained have much heavier workloads.

Psychologist: That sounds stressful. Were you working there when the anxiety started?

Maria: Yes, the anxiety definitely got worse after the layoffs. I kept worrying that I might be next.

Excerpt 3: Past Psychiatric History and Substance Use

Psychologist: Have you ever experienced symptoms like this before, Maria?

Maria: Not really. I mean, I’ve always been a bit of a worrier, but nothing like this.

Psychologist: Have you ever sought help for mental health concerns before?

Maria: No, this is my first time seeing a psychologist. I always thought I could handle things on my own.

Psychologist: Have you ever been prescribed medication for anxiety or any other mental health condition?

Maria: No, never.

Psychologist: Is there any history of mental health issues in your family?

Maria: My mother has always been anxious too, but she’s never gotten treatment. She just says it’s “her personality.”

Psychologist: I see. Now I need to ask you some questions about substance use. Do you drink alcohol?

Maria: Yes, socially. Maybe a glass of wine with dinner once or twice a week.

Psychologist: Has your alcohol use changed recently?

Maria: Actually, yes. I’ve been drinking more in the evenings to help me relax. Maybe three or four glasses a few times a week.

Psychologist: And do you use any other substances – tobacco, cannabis, or anything else?

Maria: No, just alcohol.

Excerpt 4: Risk Assessment

Psychologist: Maria, I need to ask you some important questions about how you’ve been coping. Have you had any thoughts of harming yourself?

Maria: [pause] Sometimes I feel so overwhelmed that I just wish I could disappear. But I haven’t actually thought about hurting myself, if that’s what you mean.

Psychologist: Thank you for being honest. When you say you wish you could disappear, what do you mean by that?

Maria: I just mean I want a break from all the pressure and anxiety. I want to feel normal again.

Psychologist: That makes sense. Have you had any specific thoughts about ending your life?

Maria: No, nothing like that. I would never do that to my family.

Psychologist: That’s important to know. What helps you get through difficult moments?

Maria: Talking to my best friend helps. And sometimes I go for walks to clear my head.

Psychologist: It sounds like you’ve found some helpful strategies. I’m glad you have some support and coping methods in place.

TASK 1: True / False / Not Mentioned

Read the statements below about Maria’s interview. Decide if each statement is:

• TRUE (T) – the statement agrees with the information

• FALSE (F) – the statement contradicts the information

• NOT MENTIONED (N/M) – the information is not given

Statements:

1. Maria’s anxiety symptoms began in March.

2. Maria had her first panic attack at home.

3. Maria has seen a psychologist before.

4. Maria’s mother has been treated for anxiety.

5. Maria lives with her parents.

6. Maria’s workplace had layoffs last year.

7. Maria has been avoiding social activities recently.

8. Maria drinks alcohol every day.

9. Maria has suicidal thoughts.

10. Maria finds that talking to her best friend helps her cope.

TASK 2: Comprehension and Note-Taking

Read the interview excerpts carefully. Complete Maria’s intake form:

Client Intake Form

Name: Maria

Age: _______

Presenting Problem: _______

Onset: _______

Recent Crisis Event: _______

Living Situation: _______

Family: _______

Occupation: _______

Work-related Stressors: _______

Past Mental Health Treatment: _______

Family Mental Health History: _______

Substance Use: _______

Current Coping Strategies: _______

Suicidal Ideation: _______

Protective Factors: _______

TASK 3: Analyzing Question Types

Review the interview excerpts. Identify five open-ended questions and five closed-ended questions the psychologist asked. Discuss why each type was used at that moment.

Open-ended questions:

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

Closed-ended questions:

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

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TASK 4: Role-Play Practice

Work in pairs. Student A is the psychologist; Student B is the client.

Scenario 1: Client presenting with sleep problems and work stress

Scenario 2: Client presenting with relationship difficulties and low mood

Scenario 3: Client presenting with social anxiety and isolation

Psychologist tasks:

• Open the session and explain confidentiality

• Ask about the presenting problem using open-ended questions

• Explore onset, duration, frequency, and severity

• Gather brief psychosocial history

• Ask appropriate risk assessment questions

Client tasks:

• Create a brief background story for your character

• Respond naturally to questions

• Provide enough detail but also some ambiguity that requires follow-up questions

After the role-play, switch roles and try a different scenario.

PROFESSIONAL PRACTICE:

Structuring an Initial Assessment Session

Sample Assessment Structure

A typical initial assessment session (usually 60—90 minutes) follows this general structure:

1. Introduction and Informed Consent (5—10 minutes)

• Introduce yourself and explain your role

• Explain confidentiality and its limits

• Discuss the structure and purpose of the session

• Answer any questions the client has

• Establish initial rapport

2. Presenting Problem (15—20 minutes)

• Use open-ended questions to understand why the client is seeking help

• Explore onset, duration, frequency, severity

• Identify triggers and patterns

• Understand the client’s perspective on the problem

• Explore previous attempts to address the issue

3. Psychosocial History (20—30 minutes)

• Developmental and family background

• Educational and occupational history

• Relationship and social history

• Medical history

• Past psychiatric history

• Substance use

4. Mental Status Examination (Ongoing throughout session)

• Observe appearance, behaviour, speech

• Assess mood and affect

• Note thought process and content

• Evaluate cognition, insight, and judgment

5. Risk Assessment (5—10 minutes)

• Assess suicidal ideation, intent, plan

• Assess risk of harm to others

• Identify protective factors

6. Summary and Next Steps (10 minutes)

• Summarize key information gathered

• Share preliminary impressions (when appropriate)

• Discuss treatment options and recommendations

• Schedule follow-up appointment

• Answer questions

Useful Phrases for Conducting Initial Assessment

Opening the Session:

• Thank you for coming in today.

• Before we begin, I’d like to explain how our session will work.

• Everything we discuss is confidential, with a few exceptions I’ll explain.

• Do you have any questions before we start?

• I’m here to listen and help you understand what’s been happening.

Exploring the Presenting Problem:

• What brings you here today?

• Tell me what’s been happening.

• When did you first notice this problem?

• How has this been affecting your daily life?

• What have you tried so far to address this?

• What made you decide to seek help now?

Gathering History:

• I’d like to learn more about your background.

• Tell me about your family.

• How would you describe your childhood?

• Walk me through your work history.

• Have you experienced mental health difficulties before?

• Is there any family history of mental health issues?

Asking Sensitive Questions:

• I need to ask some important questions that I ask everyone.

• These questions might feel uncomfortable, but they’re important for understanding your situation.

• Have you had any thoughts of harming yourself?

• Have you had thoughts of ending your life?

• Tell me about your alcohol use.

Showing Empathy and Building Rapport:

• That sounds very difficult.

• I can understand why that would be distressing.

• Thank you for sharing that with me.

• It takes courage to talk about these things.

• You’re not alone in experiencing this.

Clarifying and Following Up:

• Can you tell me more about that?

• What do you mean by…?

• Help me understand…

• Can you give me an example?

• How did that make you feel?

Transitioning Between Topics:

• Now I’d like to ask about a different area…

• Let’s talk about your work situation…

• I’d like to shift to discussing your family background…

• Moving on to another topic…

Closing the Session:

• We’re coming to the end of our time today.

• Let me summarize what I’ve heard…

• Based on what you’ve shared, I think we can work on…

• What questions do you have for me?

• Let’s schedule our next appointment.

Practice Exercises

Exercise 1: Create Your Opening Statement

Write your opening statement for an initial assessment session. Include:

• Introduction

• Explanation of confidentiality

• Structure of the session

• Invitation for questions

Exercise 2: Sequence the Assessment

Put these assessment components in the most logical order:

a) Risk assessment

b) Introduction and informed consent

c) Psychosocial history

d) Mental status examination

e) Presenting problem

f) Summary and treatment planning

Exercise 3: Open-Ended Question Practice

For each closed-ended question, write an open-ended alternative. There may be more than one variant:

1. Do you get along with your family?

2. Are you stressed?

3. Did you like school?

4. Do you have friends?

5. Are you taking any medications?

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Exercise 4: Case Formulation – The Four Ps

Read this brief case and identify the Four Ps:

Tom is a 28-year-old software developer presenting with symptoms of depression. His father had depression, and Tom experienced bullying in high school. Three months ago, Tom’s long-term relationship ended, and shortly after, he began experiencing low mood, loss of interest, and sleep problems. Tom has been isolating himself from friends, spending most evenings alone, and has stopped exercising – activities that previously helped his mood. However, Tom has a supportive sister, a stable job, and expressed motivation to feel better.

Predisposing factors: _______

Precipitating factors: _______

Perpetuating factors: _______

Protective factors: _______

Exercise 5: Role-Play Assessment Practice

Work in groups of three: Psychologist, Client, Observer.

Instructions:

• Psychologist: Conduct a 10-minute initial assessment focusing on presenting problem

• Client: Use one of the scenarios provided or create your own

• Observer: Note down question types used, rapport-building techniques, and areas that could be explored further

After the role-play, the observer provides feedback.

Vocabulary and Collocations for Unit 3

presenting problem – предъявляемая проблема

intake interview – первичное интервью

chief complaint – основная жалоба

psychosocial history – психосоциальный анамнез

risk assessment – оценка риска

mental status examination (MSE) – исследование психического статуса

rapport – раппорт

confidentiality – конфиденциальность

initial assessment – первичная оценка

comprehensive background information – полная биография (клиента)

therapeutic relationship – терапевтические отношения

treatment process – процесс лечения

gather essential information – собирать существенную информацию