A Screening Tool: Fount Mental Health Profile - An 11+4-Item Questionnaire
And this brings us to a screening tool developed based on the Fount model, to assist in the process of assessing your clients. This questionnaire incorporates the Fount model of mental health, offering a transdiagnostic screening tool that can be used during your day to day assessment of your clients. This questionnaire is different to a conventional psychosomatic test in several ways.
Unlike a conventional psychometric test, this questionnaire is not designed to give us a definitive score. It’s rather designed as a general guide for the therapist to facilitate the process of assessment, which may take place across multiple sessions. The outcomes of the test are to inform your assessment and ultimately your treatment approach for your client.
As you will see, the questionnaire is divided into two main sections. The first section is to be filled by the clients and the second section (marked as “Office Use”) is to be filled by the therapist. You may notice that the questions within the first section follow the hierarchy of needs, with questions designed to inform you of the current features of your client’s personality as well as their historical/childhood background. In case of a high score on any section, it’s important that the therapist explores with the client the details of their response and its significance to their overall presentation.
Let’s take a closer look at each question.
The first question focuses on the tier of physiological needs in the hierarchy of needs triangle. It reads:
1- Were you ever deprived of basic needs such as food, shelter or warmth in childhood? Or did you deal with any serious or extended health issues?
Yes, I experienced significant deprivation from basic needs or illness.
Yes, I experienced some deprivation from basic needs or illness.
No, I did not experience deprivation from basic needs or any serious illness.
As you can see, the lower the score, the more likely that your client has suffered from a deficit in this area. In the case of any scores other than 3, it is recommended that you explore the ramifications of this deficit with your client. Question 2, follows a similar concept and focuses on the tier of safety needs in the hierarchy of needs triangle. It reads:
2- Did you ever experience lack of physical safety in childhood? This includes issues like war, natural disasters, family violence, abuse or unsafe living circumstances.
Yes, I experienced significant threats to my safety.
Yes, I experienced some threats to my safety.
No, I did not experience any threats to my safety.
3- Can you remember any people in your childhood that made you feel loved or cared for?
No, I cannot think of anyone who made me feel loved.
Yes, I can think of one or several people but their role in my life was minimal or short term (e.g. a school teacher, a neighbour, a family member who died when you were young etc).
Yes, I can think of one or several people who were not my primary caregivers, but their role was larger in my life and I had contact with them long term (a grandparent that you had contact with throughout your childhood, a sibling etc).
Yes, I felt loved by my primary caregivers.
As with the previous questions, the lower the score, the more likely that your client has suffered from a deficit in this area. In the case of any scores other than 4, it is recommended that you explore the ramifications of this deficit with your client. Possible ramifications that you may need to explore in the case of higher scores within this group of questions is personality disorders, including borderline personality disorder. We will learn more about this in module 3.
The next question expands on question 3, with the idea of helping you assess the quality of early relationships for your client. It reads:
4- During your childhood, when at home (around your primary caregivers or siblings), did you ever feel lonely or left out?
All the time
A fair bit of the time
A little of the time
Never
The next 3 questions are aimed at exploring the ramifications of the connection and attachment tier on client's here and now. Question 5 takes a closer look at the quality of relationships in the client's current life. The idea is that broken and unhealthy relationships are both a result of and a cause for deficits in this tier of the triangle. Meaning that childhood issues around attachment and connection with primary caregivers can result in the client being attracted to unhealthy/abusive relationships in adulthood, as well as creating relationship dysfunction due to their sensitivity to criticism, lack of emotional regulation and so on. The question reads:
5- Currently do you have in your life people that you feel treat you well, care about you and have been a part of your life long term?
No, I seem to constantly attract abusive, uncaring or unfriendly people, whom sooner or later break my trust. I still don’t have any strong friendships or relationships.
In general I seem to regularly attract abusive, uncaring or unfriendly people whom sooner or later break my trust. But I do have one or several relationships that have endured through time.
Yes, I have long term satisfying relationships and people in my life that make me feel loved and cared for.
Question 6 looks at chronic emotions of loneliness which can result from past experiences of abandonment and poor attachment. It reads:
6- Are you bothered by feelings of loneliness?
All the time, even if surrounded by people
Some of the time, even if surrounded by people
Some of the time, only if I have lived alone or not had anyone to interact with
Rarely or never
Similar to question 5, question 7 looks at the quality of the client's relationships. It reads:
7- Are you able to speak up for yourself if you are unhappy about something in a relationship?
No, I regularly give into the wishes of others or allow others to take advantage of me; AND/OR I regularly end up in bursts of emotional meltdown when I feel taken advantage of or hurt by others.
Yes, I am able to communicate with others to resolve differences or to voice my concerns.
This brings us to the esteem section of the questionnaire. Questions 8 and 9 are as follows:
8- Do you ever feel like you don’t fit in, are different or generally don’t belong to various community or social groups?
Very often
A fair bit of the time
Very occasionally or Never
9-How often do you feel not good enough, expect yourself to be better, or feel like a fraud when you achieve; Or experience self doubt, self blame or self resentment?
Very often
A fair bit of the time
Very occasionally or Never
Question 10 looks at the "superiority" side of the coin. Meaning any conditions in which the client could be impacted by feelings of grandiosity or excessive self esteem. You may find that at times social norms cause clients to be reluctant to answer this question with full honesty. This is an example of why therapists are encouraged to treat this questionnaire as a general therapy aid, providing the questions to clients at their discretion and at any pace deemed helpful. You may also like to assure the client of the safety of the therapy space and your lack of judgement around whatever response they are to provide to various questions. Another method is to go through the questions with the client and provide any explanations you deem necessary to aid with their responses. The question reads:
10-How often do you look down on others because you feel that you are better than them in important respects, have done better in life, are more worthy as a person or deserve more?
Very often
Sometimes
Never
Some potential conditions that a low score on this question indicates include narcisistic personality disorder, bipolar disorder, and so on.
The next question assesses potentially high self focused attention. The question reads:
11-On a normal day, how much time do you spend thinking of those aspects of yourself that you like or dislike? Examples include: thoughts around how others see you, your successes or failures in life, what you admire about yourself or what you dislike about yourself, worries around doing well or being good enough, comparing yourself to others and so on.
These sorts of thoughts are on my mind most waking moments.
These sorts of thoughts are on my mind a fair bit of time.
These sorts of thoughts cross my mind some of time.
I rarely have these kinds of thoughts.
Question 12 looks at the client's coping with criticism. It reads:
12-How do you cope with with criticism? This includes how you cope inwardly (whether or not you experience strong negative emotions when criticised) OR in your behavior (whether or not you are able to act calmly when criticised - accepting fair criticism or calmly disagreeing and negotiating when receiving unfair criticism).
I rarely cope well with criticism.
I can sometimes cope well with criticism.
I usually cope well with criticism.
And finally, question 13 looks at the client's history around self image. In case of a low score, explore the details of their stories, including the events of their middle childhood.
13-As a child, how do you feel you were evaluated by your school and family members?
My school and family members gave me the impression that I was less than my peers in one or several ways.
My school and family members gave me the impression that I was superior to my peers in one or several ways.
I had conflicting experiences where at times/in certain areas/by certain people I was given the impression that I was superior to my peers and at other times/in other areas/by other people I was given the impression that I was inferior to my peers.
My school and family members never gave me the impression that I was better or worse than my peers. We were all treated equally and praised in our own areas of strength.
The following questions are to be completed by the therapist based on their observations of the client. A low score on any of the following questions may indicate an overall poor mental health state. Question 1 in this section reads:
1-Client displays low levels of connection with their surroundings, poor awareness, or lack of mindfulness:
Severe - client can often be so lost in their thoughts that they fail to hear questions or instructions, or show a marked absence and disconnection from their surroundings.
Moderate - Client displays moderate degrees of being lost in thoughts and disconnection from their surroundings. However, when prompted or clearly instructed, they can gather enough attention to hear the therapist or process conversations.
Mild - Client displays some level of being lost in their thoughts or poor awareness/low levels of mindfulness.
Client has good awareness of their surroundings as well as good internal insight.
In case of a moderate to severe score on this, as well as the next two questions, investigate psychosis - if any risks of self harm or harm to others are present, these risks should be taken seriously. Question 2 and 3 explore the client's organisation of thought and speech.
2-Client demonstrates poor thought organisation (flight of ideas, derailment, going on tangents, getting lost in insignificant details, difficulty answering questions directly or succinctly, etc):
Severe
Moderate
Mild
No accelerated thinking displayed
3-Client demonstrates accelerated thinking, marked by rapid flow of ideas and accelerated speech:
Severe
Moderate
Mild
No accelerated thinking displayed
And finally, question 4 explores client empathy. It reads:
4-Client demonstrates poor empathy - this means that client displays little awareness or care around other people’s emotions or discomfort:
Severe lack of empathy
Moderate lack of empathy
Good display of empathy
How to interpret this data:
An overall low score on this test indicates higher levels of mental health disturbance. However, unlike most psychometric testing, where only results over or below a certain threshold are considered clinically significant, this questionnaire is designed with the idea that every single question may provide the therapist with meaningful indications that may be clinically significant. So a low score on any question should be carefully explored with the client in session in order to further assess its ramifications in the overall assessment of that client.
Please note: Only therapists who have completed the Fount Clinician training are qualified to accurately interpret the outcomes of this test and the test is to be used in accordance with the copyright conditions. As part of completing this course, you are now permitted to use this material for the purpose of treating your clients at your personal practice. We ask that participants do not, without the prior approval of copyright holder, disclose, publish, disseminate or use for any purpose other than providing therapeutic services at their own personal practice.
This concludes module 1 of the Fount Clinician course. Congratulations for completing this module! We recommend that you follow the completion of this unit with some supervision time with an approved Fount therapist in order to more closely examine the concepts, ask any questions you may have and explore any case complications. I look forward to speaking to you in module 2 of this training.