The description of concerns

This article seeks to provide a rationale, and review a strategy, for descriptive assessment in routine clinical practice. The basis of the rationale is a distinction drawn between assessment priorities in research and clinical work. It is argued that if clinical work is to take account of the broad coverage and specificity of patients' self-reported difficulties, initial assessments need to sample content, rather than measure constructs. Personalized problem lists provide a strategy for sampling content, when adopted by clinicians with systematic description in mind. The article reviews the use of Shapiro's Personal Questionnaires (PQs) to achieve this. The results of a literature search suggest a decline in their use, particularly for systematic description. Three proposals are made to revive it: first, a focus on 'concerns'; secondly, the pursuit of alternative interview coverage; and thirdly, the treating of assessment as a process rather than an event. The main purposes of the strategy for clinical practice - outcome assessment and clinical formulation - are illustrated. The concluding discussion raises the wider implications of descriptive assessment for the use of ordinary language, the application of descriptive hypotheses, the status given to idiographic variables, and the adoption of an inductive strategy.