Appendix

Interview, Case Formulation, and

Assessment Tools

Focusing Questions
As a reminder, the four focusing questions that can yield maximal information in the limited time available in brief
interventions are as follows:

1. What are you seeking?

2. What have you tried?

3. How has it worked?

4. What has it cost you?

A fifth key question increases motivation to change and helps clients identify valued life directions that are
within their reach:

• What kind of life would you choose if you could choose?

Structured Exercises to Help Clarify Valued Life Directions

The Life Path and Turnaround Exercise and True North Exercise create a visual metaphor of clients’ life direction
and help them identify new behaviors in keeping with those directions. In the pages that follow you’ll find blank
worksheets for both exercises:

• Life Path and Turnaround Worksheet: This version is designed for use in individual brief intervention ses-
sions. A version of this worksheet for use in groups is available at the website address given above.

• True North Worksheet: This worksheet can be used for either individual or group sessions.
Brief Interventions for Radical Behavior Change

Case Formulation Tools

Because FACT is so effective, clients often respond quickly, making formal case formulation unnecessary. With some
clients, however, it may be helpful to evaluate their strengths and weaknesses in a more structured way. The informa-
tion thus obtained can then be used to craft more tightly focused interventions to promote radical change. We’ve
included two tools to aid in case formulation:

• Flexibility Profile Worksheet: Use this worksheet after each session to rate the client’s flexibility in each core
area, where 0 = minimal strength, and 10 = a great deal of strength. In the notes section, include your ideas
about which core area or areas to target in your next visit with the client.

• Four Square Tool: This tool helps you analyze clients’ workable and unworkable behaviors. It can be used to
just describe the client’s strengths and weaknesses, or it can be used as a treatment planning tool in which you
identify behaviors you want to increase (workable behaviors) or decrease (unworkable behaviors).

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 Appendix

Life Path and Turnaround Worksheet

More Control More Meaning

What do you want to control, avoid, or get rid of and What type of life would you choose if you could
how are you trying to do that? choose?

1. Draw an arrow above the line to indicate where you are on your life path these days and which direction you’re
moving in.

2. What, if any, are the costs and benefits of pursuing control?

3. What behaviors would tell you that you’re moving toward more meaning in life?

4. When you get stuck, how can you help yourself keep moving toward more meaning?

5. Who or what helps you move in the direction of more meaning?

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Brief Interventions for Radical Behavior Change

True North Worksheet

What are your values?

What are your current strategies, and are they working?

What skills will you need to make the journey?

Clinical Issues

1. Openness (Accepts private events without struggle? Notices and lets go of unworkable rules?)

2. Awareness (Able to be present? Aware of private experiences? Able to take perspective? Shows compassion for
self and others?)

3. Engagement (Clear values? Can organize for effective action? Can obtain reinforcement? Sufficient interpersonal
skills?)

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 Appendix

Flexibility Profile Worksheet

Openness Awareness Engagement

Able to detach from distressing Able to experience the present Exhibits strong connection
private experience and associated moment with values
rules
Able to take perspective on self Able to sustain values-consistent
Able to take a non-judgemental, and self-story action
accepting stance towards painful
material

Today’s Rating Today’s Rating Today’s Rating

                                      

0 1 2 3 4 5 6 7 8 9 10
Low Strength High Strength

Notes (core areas to target in the next visit):

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Brief Interventions for Radical Behavior Change

Four Square Tool

Workability

Not working More workable

(do less) (do more)

Public
Behavior

Private

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 Appendix

In-Session Assessment of Problem Severity,

Confidence, and Helpfulness
In-session assessment strategies take only minutes and can help the clinician determine whether the intervention is
working, detect possible barriers to change, and assess clients’ perceptions about the helpfulness of each session.
Problem Severity
At the beginning of each session, ask clients to rate the severity of the problem that is bringing them in for help using
a scale of 0 to 10, where 0 = not a big problem, and 10 = a very big problem. Over multiple visits, you can use a graph
to track changes in problem severity ratings as a way of assessing the client’s response to the intervention, as illus-
trated in the case examples. If problem severity scores don’t change over time, this is a signal that you need to change
intervention strategies.
Confidence
Near the end of each session, ask clients to rate their level of confidence that they will do what was planned in that
session using a scale of 0 to 10, where 0 = not at all confident, and 10 = very confident. Generally, a rating of 7 or
above is the target. Ratings below that should trigger an additional interaction about barriers to action that might be
showing up for clients. There might be a need to either identify a new plan or to reduce the scale of the original plan.
Helpfulness
Near the end of each session, ask clients to rate how helpful the session was using a scale of 0 to 10, where 0 = not
at all helpful, and 10 = very helpful. Generally, a rating of 7 or above is the target. Low ratings (0 to 4) signal that
there is a major disconnect between the goals of the therapist and the goals of the client. Midrange ratings (5 to 6)
might trigger a conversation about what the therapist and the client could do to create a more helpful approach for
the client.

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 Sample FACT Group Protocols

Sample FACT Group Protocols

Class 1
Meet others and talk about the Life Path Class. Discuss your answers to these questions about your life path:

1. Do you have a problem?

2. What have you tried to solve it?

3. What do you want more than anything? In your heart, what matters most?

4. What keeps you from getting what you want?

5. What do you do when stuff gets in your way and makes it hard for you to walk on your life path?

6. Do you get into fights with the stuff that gets in your way?

7. What happens when you fight with that stuff?

Homework: Notice when bad stuff shows up and when you want to fight it. Try to just let it be there and
watch it. Take notes about what happens:

• What gets in your way?

• When did it happen?

• How did you do with just noticing it and not trying to fight it or get away from it?

Class 2
Learn a new way to look at stuff that gets in your way and how you deal with it:

• Come up with ideas about how to be a good observer.

• Come up with tender names for things you don’t like.

• Think about what other people do when they see the stuff you don’t like about yourself.

Homework: Plan to do something that’s important to you even if it’s hard.

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Life Path Class for Children

Class 3
Learn to say what you mean and do what you say:

• Imagine walking the life path you care about.

• Make a promise to yourself.

• Make a plan for how to follow through on your promise.

• Think about how you can pay attention so that you’ll learn from your experience.

• Figure out your next steps.

Homework: Continue to be brave and do what’s important to you.

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 Life Path Class for Teens

Life Path Class for Teens

Class 1
Meet others and talk about the Life Path Class. Discuss your answers to these questions about your life path:

1. Why are you taking this class? What do you hope to get from it?

2. What have you tried before to help with your problems? Did it work?

3. What do you want in your life right now? What’s important to you?

4. What blocks you from doing what you want in life?

5. What do you do when things get in your way on your life path?

6. Do you fight, run away, space out, pretend you don’t care, or give up?

7. What are the consequences of what you do when things block you on your life path?

Homework: Notice when you get blocked on your life path and what you do. Study your experience and
watch it closely. Just try to observe what’s happening; don’t try to change it. Take notes about what happens:

• What blocked you?

• When did it happen?

• What did you do? Were you able to just study what happened?

Class 2
Learn to step back and have a different perspective on barriers along your life path:

• What helps you just watch barriers?

• What are your tender names for barriers?

• What do you notice when you look into the eyes of others with your barriers known and accepted?

Homework: Plan to do a valued activity and practice accepting a barrier that’s likely to come up when doing
the activity.

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Life Path Class for Teens

Class 3
Learn to make promises about how you’ll walk your life path, and how to discover as much as you can based
on your experience:

• Symbolically walk your life path in the room, heading in a direction you care about and facing the
barriers that might come up.

• Make a promise to yourself about what you’ll do next in life to keep moving in the direction you care
about.

• Identify goals you can set that will tell you you’re following your life path.

• Identify how you can pay attention so that you’ll learn from your direct experience, rather than just
following rules in your head.
• Come up with a plan for how to continue walking on your life path after this class ends.

Homework: Continue to make intentional choices, do what’s important for your life, practice self-compas-
sion, and learn from your direct experience.

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 Life Path Class for Adults

Life Path Class for Adults

Class 1
Meet others and discuss your answers to these questions about your life path:

1. How long have you had the problem that brings you here?

2. What have you tried? Have you previously been treated for this problem? If so, what was the result?

3. What do you want from life?

4. What are the barriers to doing what you want in life?

5. What do you do when those barriers show up?

6. Are you at war with the barriers?

7. What are the consequences of being at war with the barriers?

Homework: Notice when the war starts and what you do. Just try to observe what’s happening; don’t try to
change it. Take notes about what you experience:

• What was your war or struggle against?

• When did it happen?

• How did you do with just noticing your barriers and not trying to get away from them?

Class 2
Learn to step back and have a different perspective on your suffering:

• What ideas do you have about how you can be more mindful?

• What are your tender names for your suffering or barriers?

• What did you notice when you looked into the eyes of others with awareness of your barriers?

Homework: Plan to do a valued activity and practice accepting a barrier that’s likely to come up when doing
the activity.

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Life Path Class for Adults

Class 3
Learn to make public commitments, and learn to learn from your direct experience.

• Symbolically walk your life path in the room, heading in a valued direction and facing the barriers that
might come up along the way.

• Make a commitment to yourself about what you’ll do next to keep moving in your valued direction.

• Identify goals you can set that will tell you you’re following your life path.

• Notice how others respond to you as you symbolically walk your life path.

• Identify how can you pay attention so that you’ll learn from your direct experience.

• Come up with a plan for how to continue walking on your life path after this class ends.

Homework: Continue to make intentional choices, pursue valued directions, practice self-compassion, and
learn from your direct experience.