Assessment and Setting the Scene for Cognitive Behaviour Therapy

  • Andrew Jahoda
  • Biza Stenfert Kroese
  • Carol Pert


In this chapter we focus on the early stages of CBT assessment. As clients rarely refer themselves for therapy, their expectations, motivation and possible misconceptions regarding therapy should be addressed at the outset. The usual process of gathering relevant background information will take longer than usual, so the therapist should not set unrealistic expectations of what can be achieved in the first few assessment sessions. Adjustments can be made to the pace of sessions, depth of questioning and the nature of the information conveyed according to the clients’ varying needs. The therapist has to adjust his or her own communication and interaction style rather than trying to ‘improve’ the client. Creative methods such as storyboards are a useful tool to explore emotional understanding and social cognitive skills. This can offer useful information regarding clients’ social understanding and social reasoning abilities. Self-report standardised assessments used to measure change should be chosen to match the person’s difficulties and their level of understanding. Self-monitoring diaries can serve as another important indicator of change. Adaptations should also be made to ensure that the person with intellectual disabilities knows how and when to fill these in. It is important that diaries are fit for purpose and easy to use in order to increase compliance with self-monitoring.


  1. Bachelor, A., & Horvarth, A. (1999). The therapeutic relationship. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 133–178). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  2. Barton, P., Brooks, M., Davies, S., Flynn, T., & Wood, V. (2008). From CORE-OM to CORE-LD through participatory research. Clinical Psychology and People with Learning Disabilities, 6, 27–28. doi: 10.1111/j.1468-3156.2007.00476.x.Google Scholar
  3. Beutler, L. E., Machado, P. P., & Neufeldt, S. A. (1994). Therapist variables. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behaviour change (4th ed., pp. 229–269). New York: Wiley.Google Scholar
  4. Butler, R. J., & Gasson, S. L. (2004). Self image profile for adults (SIP-adult). London: Pearsons Clinical.Google Scholar
  5. Cuthill, F. M., Espie, C. A., & Cooper, S.-A. (2003). Development and psychometric properties of the Glasgow depression scale for people with a learning disability: Individual and carer supplement versions. British Journal of Psychiatry, 182, 347–353.CrossRefPubMedGoogle Scholar
  6. Davis, C., Kellett, S., & Beail, N. (2009). Utility of the Rosenberg self-esteem scale. American Journal of Intellectual Development Disability, 114(3), 172–178.CrossRefGoogle Scholar
  7. Delsignore, A., & Schnyder, U. (2007). Control expectancies as predictors of psychotherapy outcome: A systematic review. British Journal of Clinical Psychology, 46(4), 467–483.CrossRefPubMedGoogle Scholar
  8. Dodge, K. A., & Frame, C. L. (1982). Social cognitive biases and deficits in aggressive boys. Child Development, 53, 620–635.CrossRefPubMedGoogle Scholar
  9. Dunn, A., Stenfert Kroese, B., Thomas, G., McGarry, A., & Drew, P. (2006). Are you allowed to say that? Using video materials to provide accessible information about psychology services. British Journal of Learning Disabilities, 34(4), 215–219.CrossRefGoogle Scholar
  10. Eckman, P. (1993). Facial expression and emotion. American Psychologist, 48(4), 384–392.CrossRefGoogle Scholar
  11. Gilbert, P., & Leahy, R. L. (2007). Introduction and overview: Basic issues in the therapeutic relationship. In P. Gilbert & R. L. Leahey (Eds.), The therapeutic relationship in the cognitive behavioral psychotherapies. London: Routledge.Google Scholar
  12. Haddock, G., Devane, S., Bradshaw, T., McGovern, J., Tarrier, N., Kinderman, P., Baguley, I., Lancashire, S., & Harris, N. (2001). An investigation into the psychometric properties of the cognitive therapy scale for psychosis (CTS-Psy). Behavioural and Cognitive Psychotherapy, 29, 221–233.CrossRefGoogle Scholar
  13. Hare, D. J., Searson, R., & Knowles, R. (2011). Real listening – Using personal construct assessment with people with intellectual disabilities: Two case studies. British Journal of Learning Disabilities, 39(3), 190–197.CrossRefGoogle Scholar
  14. Jahoda, A., Pert, C., & Trower, P. (2006). Frequent aggression and attribution of hostile intent in people with mild to moderate intellectual disabilities: An empirical investigation. American Journal on Mental Retardation, 111, 90–99.CrossRefPubMedGoogle Scholar
  15. Joyce, A. S., & Piper, W. E. (1998). Expectancy, the therapeutic alliance, and treatment outcome in short term individual psychotherapy. Psychotherapy Research, 5, 49–62.Google Scholar
  16. Kellett, S. C., Beail, N., Newman, D. W., & Frankish, P. (2003). Utility of the Brief Symptom Inventory (BSI) in the assessment of psychological distress. Journal of Applied Research in Intellectual Disabilities, 16, 127–135.CrossRefGoogle Scholar
  17. Kellett, S. C., Beail, N., Newman, D. W., & Hawes, A. (2004). The factor structure of the Brief Symptom Inventory: Intellectual disability evidence. Clinical Psychology and Psychotherapy, 11, 275–281.CrossRefGoogle Scholar
  18. Kellett, S., Beaill, N., & Newman, D. W. (2005). Measuring interpersonal problems in people with mental retardation. American Journal on Mental Retardation, 110(2), 136–144.CrossRefPubMedGoogle Scholar
  19. Kelly, G. A. (1955). The psychology of personal constructs. New York: Norton.Google Scholar
  20. Kilbane, A., & Jahoda, A. (2011). Therapy expectations: Preliminary exploration and measurement in adults with intellectual disabilities. Journal of Applied Research in Intellectual Disability, 24, 528–542.CrossRefGoogle Scholar
  21. Lindsay, W. R., Tinsley, S., Beail, N., Hastings, R. P., Jahoda, A., Taylor, J. L., & Hatton, C. (2015). A preliminary controlled trial of a trans-diagnostic programme for cognitive behaviour therapy with adults with intellectual disability. Journal of Intellectual Disability Research, 59(4), 360–369.CrossRefPubMedGoogle Scholar
  22. McDonald, J., Sinason, V., & Hollins, S. (2003). An interview study of people with learning disabilities experience of, and satisfaction with, group analytic therapy. Psychology and Psychotherapy Theory Research and Practice, 76, 433–453.CrossRefGoogle Scholar
  23. McGurk, K. A., & Skelly, A. (2006). A quick guide for psychologists working in learning disability on the available clinical outcome measures currently in use. The Bulletin of the Faculty for People with Intellectual Disabilities, 12(1), 28–45.Google Scholar
  24. Mindham, J., & Espie, C. A. (2003). Glasgow anxiety scale for people with an intellectual disability (GAS-ID): Development and psychometric properties of a new measure for use with people with mild intellectual disability. Journal of Intellectual Disability Research, 47(1), 22–30.CrossRefPubMedGoogle Scholar
  25. Moss-Morris, R., McAlpine, L., Didsbury, L. P., & Spence, M. J. (2010). A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychological Medicine, 40(1), 85–94.CrossRefPubMedGoogle Scholar
  26. Novaco, R. W., & Taylor, J. L. (2004). Assessment of anger and aggression in male offenders with developmental disabilities. Psychological Assessment, 16, 42–50.CrossRefPubMedGoogle Scholar
  27. Pert, C., & Jahoda, A. (2008). Social goals and conflict strategies of individuals with mild to moderate intellectual disabilities who present problems of aggression. Journal of Intellectual Disability Research, 52, 393–403.CrossRefPubMedGoogle Scholar
  28. Pert, C., Jahoda, A., & Squire, J. (1999). Attribution of intent and role-taking: Cognitive factors as mediators of aggression with people who have mental retardation. American Journal on Mental Retardation, 104(5), 399–409.CrossRefPubMedGoogle Scholar
  29. Pert, C., Jahoda, A., Stenfert Kroese, B., Trower, P., Dagnan, D., & Selkirk, M. (2013). Cognitive behavioural therapy from the perspective of clients with mild intellectual disabilities: A qualitative investigation of process issues. Journal of Intellectual Disability Research, 57, 359–369.CrossRefPubMedGoogle Scholar
  30. Reed, J., & Clements, J. (1989). Assessing the understanding of emotional states in a population of adolescents and young adults with mental handicaps. Journal of Mental Deficiency, Research, 33, 229–233.Google Scholar
  31. Rose, J. L., & Gerson, D. F. (2009). Assessing anger in people with intellectual disability. Journal of Intellectual Developmental Disability, 34(2), 116–122.CrossRefPubMedGoogle Scholar
  32. Skelly, A., Delicata, J., & D’Antonio, M.-L. (2006). Are CTPLDs effective? Use of the HoNOS-LD and LEC as outcome measures in community teams. Clinical Psychology and People with Learning Disabilities, 7, 28–33.Google Scholar
  33. Trower, P., & Chadwick, P. (1995). Pathways to defense of the self: A theory of two types of paranoia. Clinical Psychology Science and Practice, 2(3), 263–278.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2017

Authors and Affiliations

  • Andrew Jahoda
    • 1
  • Biza Stenfert Kroese
    • 2
  • Carol Pert
    • 3
  1. 1.Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
  2. 2.School of PsychologyUniversity of BirminghamBirminghamUK
  3. 3.Learning Disabilities ServiceNHS Greater Glasgow and ClydeGlasgowUK

Personalised recommendations