The importance of completing a thorough assessment of a client’s social history cannot be minimized as a component of the Biopsychosocial assessment process at the initiation of treatment.
The environment an individual grows up in can have significant impacts on adult life. This is a basic truth most of us as psychotherapists carry as we enter the profession. Understanding those formative years is often key to understanding how adult presenting problems emerge. As part of their article “Family Relationships and and well-being”, published in “Innovations and Aging [2017]” pointed out, “Family relationships play a central role in an individual’s well-being across their lifetime.”
The quality of these family relationships can establish positive social supports, including providing love, advice, support, and care. It can also establish social strains through arguments, critical feedback, or making too many demands. In the complexities of the typical family of origin, it is likely to create both positive and negative structures which will impact an individual’s well-being through psychosocial, behavioral, and psychological pathways. Gaining an understanding, then, of a client’s social stress is central to the etiology of a mental health disorder. This is conceptualized through the understanding of the stress process.
The stress process consists of three basic components: stressors, moderators, and outcomes.
Stressors refer to any specific condition which can disturb the adaptive capacity of the individual. All people experience a range of stressors throughout the life course, some more significant than others, and can range from minor to tragic and monumental.
Moderators, then represent the internal and external resiliency factors which potentially help to mitigate the impacts of these stressors. At least a portion of human learning derives from the experience of stressors and how those stressors are managed throughout life, but particularly within formulative years. These lessons learned frame the complexities of the individual’s psychology which are often represented in outcomes.
The Social History assessment is framed to help begin to understand the framework of the client. The reality is that this assessment will continue to occur long after the first clinical interview with the client. Most clients are not in a position to describe every detail of their life and may not at first understand the importance of specific events. They may also not be ready to share all of these details of their formative years, due to embarrassment or shame. But the work of the initial interview is to at least start that conversation and to introduce the value of these structures to the psychotherapeutic process.