CLINICAL HANDBOOK OF SCHIZOPHRENIA

136 II. ASSESSMENT AND DIAGNOSISOther linked concepts that may be found in assessments are one’s role in the community,social skills and social competence, family relations, as well as personal and professionalgoals. Although self-esteem, social support, expectations, and motivation are importantfor psychosocial functioning, they are not measures of functioning itself, because they donot relate to specific community behaviors, attitudes, feelings, and perceptions. Some authorsargue that subjective quality of life should be considered as part of any social functioningassessment. Though determining satisfaction levels regarding different aspects ofone’s life, or treatment, can be quite relevant because dissatisfaction can at times precedemotivation for change, quality-of-life measures can be misleading. In fact, it has oftenbeen observed that as individuals progress in their recovery and realize they have moreoptions and goals than they originally believed, their satisfaction levels decrease.A wide range of different measures exist for assessing psychosocial functioning.These measures vary in terms of who they were designed for (hospitalized clients, outpatients,first episodes), their purpose (e.g., guide policymakers, assess impact of treatment,obtain broad information on large samples, help consumers self-monitor their progress),the type of assessment (i.e. structured interview, self-rating scale, other-rating scale, behavioraltask), their psychometric properties (reliability, validity), and the length of timeneeded to complete the assessment. The choice of the optimal scale to measurepsychosocial functioning depends on a number of considerations:• In what context is this assessment taking place (e.g., clinical intervention, research,mental health clinic external review)?• What specific question(s) do I hope this assessment will help answer?• If I’m following a specific theoretical model in my work with consumers, is the assessmentstill appropriate?• Do I need specific training to use this assessment?• Do I need to pay the copyright fees for each use of this assessment?• Will I be able to interpret the results easily?• Has this assessment ever been validated with the type of clients with whom I work?• Does this assessment exist in other languages, if needed?When answering all of these questions, it is preferable also to consider specific clientpreferences. For instance, some clients get really anxious if the assessment resembles atest too much, but they do really well in role-play situations. Others prefer self-ratingquestionnaires to semistructured interviews, and still others enjoy receiving a lot of assistanceand very clear, multiple-choice answers. Some clinicians might feel that they knowtheir clients well enough and prefer using clinician-rated scales. Though other-rated scalescan be very useful in specific cases (e.g., research or cost-effectiveness evaluation), theyactually have less therapeutic value than scales with more than one perspective, includingthe client’s and the clinician’s answers, and perhaps even information from familymembers. Not only is the client’s evaluation often more comprehensive than that of theclinician but also the process of answering the questions or thinking about one’s socialfunctioning can by itself produce change or bring about new rehabilitation goals. Furthermore,when the assessment is used in the context of a working relationship betweenthe clinician and client (and sometimes with the family as well), discrepancies in perceptionsand questions regarding the performance, or absence of performance, of certain socialbehaviors can be discussed.In our choice of instruments, we have focused on measures that we believe coveressential aspects of psychosocial functioning, namely, behaviors or difficulties in performingbehaviors in the following domains: independent living skills (or community adjust-