CLINICAL HANDBOOK OF SCHIZOPHRENIA

230 IV. PSYCHOSOCIAL TREATMENTAndrew was brought up as a Catholic at home with his parents (he was an onlychild). His father had mental health problems, and was frequently physically andemotionally abusive to both Andrew and his mother. Andrew described his childhoodas relatively happy but reported having trouble with his work at school andhaving no close friends. A neighbor sexually assaulted Andrew when he was 10 yearsold, which he reported to his parents; however, although they suggested that Andrewavoid being alone with that person in future, they did not take any further action,and Andrew was unsure whether they believed him. He left school with several qualificationsand got a job as a clerical assistant for the police shortly thereafter. Andrewreported that his father died from cancer at about the same time, and that he hadmixed feelings: He was upset but also relieved. He described enjoying his work forthe police, which he felt was a worthwhile career, but he had quit the job due to astressful workload and victimization by a new boss who had recently taken over theunit in which he worked.The influence of life experiences on the development of self- and social knowledgeshould be considered. Assessment should include an analysis of clients’ core beliefs,which are unconditional statements about themselves, the world, and other people (e.g.,Andrew believed “I am vulnerable,” “I am useless,” “Other people cannot be trusted,”and “The world is dangerous”). The conditional beliefs or rules that people adopt tocompensate for these core beliefs should also be assessed. These often occur in the formof “if–then” statements; for example, Andrew believed, “If I put others’ needs before myown, then I will be safe.” The compensatory strategies that are the behavioral expressionsof these rules should also be identified (e.g., subjugating personal needs).Procedural beliefs, which guide the selection of information-processing strategies,should also be assessed (Wells & Matthews, 1994). Procedural beliefs that are particularlyrelevant to people with psychosis include beliefs about the utility of paranoia andsuspiciousness (e.g., Andrew believed that “staying on your toes keeps you safe”), beliefsabout unusual perceptual experiences (e.g., Andrew believed that “having odd experiencescan make life more interesting”), and beliefs about unwanted thoughts (e.g., Andrewbelieved, “All of my thoughts must be good thoughts” and “I must try to controlmy thoughts at all times”).Problem and Goal ListAs stated earlier, one of the aims of assessment within CT is the development of a sharedlist of problems and goals. Problem description at the start should be quite general, andbe phrased in a more specific manner after additional information is gained. The goalsthat are set in relation to the problems should then be developed collaboratively.Andrew’s exhaustive problem list was as follows:Voices/spirits (including thought insertion and being touched)Weight gainOvermedicationGet back to workStigma of diagnosisLow mood and self-esteemFrustrationThe problem list was discussed and specific, measurable, achievable, realistic,and time-limited (SMART) goals were set in relation to each problem. For example,Andrew wanted to “get rid of the spirits,” referring to the voices and experiences of