Assessment, Suitability and Referral

Assessment establishes what help a person needs, what explanations require consideration, and whether a proposed intervention is appropriate within the practitioner's competence and service setting. Suitability is therefore a relationship between the person, the intervention, the practitioner and the available support. It is not a permanent characteristic of the client. Someone may be unsuitable for one practitioner's service while being well suited to assessment or treatment elsewhere.

This article addresses adults seeking psychological help, including eye movement approaches. It describes principles of assessment and referral rather than providing a diagnostic checklist or authorising a non-clinician to undertake specialist psychiatric assessment. UK guidance is identified where relevant; pathways and statutory responsibilities vary between jurisdictions.

The following table is an editorial distinction intended to prevent common category errors.

The US National Center for PTSD emphasises that a positive PTSD screen requires further assessment. Screening can open a discussion and support referral, but its usefulness depends on what happens after the result. A screening programme without a workable route to assessment does not complete the clinical task. ¹⁾

For example, a person may report intrusive images but not meet criteria for PTSD, or may meet criteria while also requiring attention to another urgent difficulty. A practitioner should resist fitting every presentation into the explanatory model of the technique they offer. The question is what accounts for the problem and what service can address it, not merely whether a familiar procedure can be performed.

NICE's depression guidance recommends a comprehensive assessment extending beyond symptom counts to severity, previous history, duration and course. This illustrates a general reason to examine how a difficulty affects daily life rather than relying exclusively on a score. The recommendation concerns depression assessment; it does not validate a generic IEMT screening form. ²⁾

NICE's PTSD guidance likewise addresses symptom patterns, functional effects and coordinated assessment. For people with additional needs, it recommends considering circumstances that may affect engagement, including stability and barriers to trauma-focused work. Co-occurring drug or alcohol misuse should not, on its own, exclude someone from PTSD treatment. That recommendation should not be misread as permission to conduct a session when someone cannot participate safely. ³⁾

An initial account should establish the person's own description of the difficulty, its onset and course, current impact, previous help and what they hope will change. Relevant physical health, prescribed treatment, substance use, sleep and current pressures may influence interpretation or referral. The depth of enquiry should match the purpose and the assessor's role. Collecting an elaborate trauma narrative without a clinical reason is not inherently a more thorough assessment.

An editorial way of organising uncertainty is to record three categories: what the person reports, what the practitioner observes, and what remains a hypothesis. For example, 'reports feeling detached after poor sleep' is more precise than 'dissociates because childhood trauma has been activated'. The latter introduces both a diagnosis-like interpretation and a cause that may not have been established.

Assessment should also identify resources: supportive relationships, previous coping, existing care and the person's ability to seek help. These observations contribute to planning but do not cancel concerning symptoms. A person can have considerable strengths and still need urgent medical or specialist mental health assessment.

The PCL-5 is a 20-item self-report measure of PTSD symptoms. The National Center for PTSD describes uses including screening, monitoring and provisional diagnostic assessment, while identifying a structured clinical interview such as CAPS-5 as the diagnostic reference standard. Interpretation depends on the setting and purpose; a cutoff is not a universal diagnostic verdict. ⁴⁾

A session rating of distress, a diagnostic interview and a questionnaire collected over a defined recall period answer different questions. Improvement in one does not establish improvement in all three. As an illustrative example, a client may report very little distress while recalling one image yet still experience disrupted sleep and difficulty travelling. The discrepancy is information to investigate, not a reason to discard the less favourable result.

Measures should be selected for the intended population and question, administered consistently, and interpreted within their stated limits. Relevant training and use conditions matter. A score copied into a record without discussion can give a misleading appearance of precision. Recording the version, date, reference period and reason for use makes later comparisons more interpretable.

NICE's self-harm guideline states:

Do not use risk assessment tools and scales to predict future suicide or repetition of self-harm.

The surrounding recommendations also oppose using such scales, or global low/medium/high categories, to determine treatment or discharge. They favour assessment of needs and safety, with risk formulation by mental health professionals as part of psychosocial assessment. This guidance concerns self-harm; it does not prohibit symptom questionnaires used for other appropriate purposes. ⁵⁾

The practical implication is that a reassuring number cannot replace attention to a person's current circumstances. A service needs a plan for responding to information that exceeds its capacity, including who can provide urgent assessment, how contact is made and who remains responsible for the immediate response. A routine booking system is not an emergency pathway.

The VA/DoD PTSD clinical pathway explicitly directs urgent attention to instability, danger to self or others, and urgent medical or surgical needs before routine PTSD care proceeds. This is US healthcare guidance, but it illustrates the priority of immediate needs over completion of a therapy protocol. Acute emergencies require the relevant local emergency response; they should not be managed by continuing an eye movement exercise. ⁶⁾

Presentations suggestive of psychosis require appropriate specialist assessment rather than assumption that unusual experiences are simply an expected therapy response. NICE recommends prompt referral when specified concerning experiences occur with distress and declining social functioning, and access to early intervention for a first episode or first presentation. Referral is for assessment; it is not a declaration that every unusual perception is psychosis. ⁷⁾

Likewise, depersonalisation-like experiences may occur in psychiatric, substance-related or physical conditions. The Merck clinical review describes medical and psychiatric assessment to consider alternatives, with investigations guided by the presentation. A practitioner should not prescribe a universal battery of scans or tests from a wiki article, nor assume every episode is trauma-related. ⁸⁾

A useful distinction is between recognising a concern and resolving its differential diagnosis. A practitioner can recognise that a new, unexplained change needs assessment without claiming to know its cause. The referral can state the observations, onset and relevant circumstances while leaving diagnosis to an appropriately qualified professional.

HCPC guidance describes scope of practice in terms of an individual's knowledge, skills and experience, which develop over time. For registrants, expanding into an unfamiliar area requires appropriate preparation; a professional title alone does not establish competence in every clinical presentation. ⁹⁾

An editorial suitability review can therefore consider four linked questions: is there a defensible rationale for this intervention; does the practitioner have relevant competence; can this setting provide the necessary support; and does the person want the proposed work after discussion? If any answer is unclear, the uncertainty should be resolved or reflected in the plan. The presence of a technique certificate does not answer all four.

Remote work introduces additional practical questions, such as whether the practitioner knows the person's location, whether communication is private and what happens if contact fails during a difficult moment. These are service-planning considerations, not evidence that remote therapy is intrinsically unsuitable. Their purpose is to make the proposed setting part of the decision rather than an invisible assumption.

A referral is more useful when it explains why another service is needed, what information is known, what remains uncertain and what degree of urgency is being communicated. Appropriate consent and information-sharing rules apply. Merely telling someone to find a different therapist may leave important gaps in responsibility and understanding.

The following is an editorial example of a concise referral summary: the person's stated concern; relevant onset and course; functional impact; observations or findings requiring further assessment; current care and relevant medication information if known; the reason for referral; and agreed follow-up arrangements. The summary should avoid speculative mechanisms and include only information needed for its purpose.

Consider a fictional client, Priya, seeking help for frightening episodes of unreality. The practitioner learns that the episodes are new and have not been medically assessed. Rather than labelling them as evidence of dissociated trauma, they explain the limits of their role and support an appropriate assessment. Any later therapy decision can then incorporate the findings and Priya's preferences. Referral here improves the quality of the decision; it does not imply that her experience is being dismissed.

Assessment continues after treatment begins. New symptoms, deteriorating function, changing circumstances or lack of progress may alter the original judgement. A defensible plan therefore includes review points and an explanation of what would lead to modification, consultation or referral.

Sources were checked on 8 October 2026. This selective educational review distinguishes official guidance from original organising examples. It is not a validated suitability instrument, an exhaustive list of contraindications or a clinical practice guideline, and has not undergone independent clinical peer review. Individual decisions require applicable professional competence and local care pathways.

• Informed Consent and Shared Decision-Making
• Dissociation, Depersonalisation and Derealisation
• Stabilisation, Grounding and Therapeutic Pacing
• Therapeutic Boundaries and Scope of Competence
• Treatment Plans
• Start Here

Brief quoted extracts remain attributable to their original authors and rights holders.