Problem ratings

A term long used particularly by behavioural therapists but absolutely not limited to them. Means what it says: asking the client to rate the severity of problems that the client and clinician have fairly carefully defined. For behavioural therapists the rating might be particularly of behavioural impact, for say an emotion focused therapist it might be of the strength of the problematic emotions.

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Traditionally these were per client/therapy ratings and used simply to track progress of lack of it and perhaps to map that change to other things going on either things within the therapy or external events. Now problem ratings are at the heart of many “user generated measures” like the problem ratings in PSYCHLOPS (and the rating of how much the problem has made it hard to do something … but not the overall state rating in PSYCHLOPS, that’s what makes it strictly a hybrid rather than a purely user generated measure: see the entry about PSYCHLOPS).

Ratings are often made on a numerical scale, 0 to 5, 1 to 5, 0 to 10 etc often called, perhaps not very historically accurately a “Likert scale”. The ratings are often anchored to some definitions of the worst and best scores. Ratings can also be made using a VAS (Visual Analogue Scale) where the person marks a point on a line between worst and best scores (often on a 10cm line and quite often with the ends labelled “0” and “100”).

In family systemic therapy and in solution focused therapies (SFTs) problem ratings are counterposed against ratings of positives with the adage “problem ratings are problem ratings”, i.e. they lock the work in the therapy into focusing on the problems, not on solutions and/or resources. Some SFT therapists would class “goal attaintment scaling” as a rather poor form of positive rating as goals, particularly defined early in therapy, tend to be so much anchored as the opposite of the problem rather than as something less linearly related to the problem.