Psychological Readiness Screening for Aesthetic Practice

Patient

First NameLast Name

Procedure

This customized, psychological screening, is a guide used to evaluate a patient's psychological readiness, motivations, body image perception, and emotional resilience before undergoing aesthetic procedures. It integrates aspects from scientifically validated psychological tools while being practical for in-office use.

This assessment evaluates mental readiness and psychological stability, ensuring a balanced approach to aesthetic enhancements and preventing unnecessary risks to patient mental health.

This screening is provided for professional use only. It is not a diagnostic tool.

Intellectual property of

Michelle Göldner | Luminary Collective Co. | Trademark Pending

For Professional guidance on how to use the screening, click below to access.

Psychological Readiness Screening How To Guide

SECTION 1

PATIENT HISTORY & MOTIVATION

This first section gathers background information about the patient's history with aesthetic procedures, the timeframe of their decision-making process, and their motivations. It's crucial to assess the timing and reasoning behind their decision to ensure they are emotionally ready for a transformation.

Question One How long have you been considering this procedure?

Less than three months - 2Three to Twelve months - 1More than a year - 0

Note for Practitioners

While recent/impulsive decisions (less than three months) often indicate higher risk, extremely lengthy preoccupation (several years or more) might also suggest unhealthy fixation or unrealistic expectations. Consider exploring further if the patient mentions obsessing over the procedure for many years.

Question Two What is your primary motivation for this procedure? (Select all that apply)

I want to feel more confident in my own body - 0I want to correct a specific feature that has always bothered me - 0I believe this change will improve my relationships or social interactions - 1I feel pressured by social media, my career, or personal relationships to look a certain way - 2Other

Please Specify Other (Qualitative - no score assigned)

If "Other" is selected, proceed with ADD-ON SECTION A immediately after this question.

Question Three Do you believe this procedure will significantly improve your overall happiness or self-worth?

Yes, I expect it to transform/improve my life - 2Maybe, but I know it's just one part of my confidence journey - 0No, I see it as a minor improvement - 0

ADD-ON SECTION A

FURTHER EXPLORATION OF "OTHER" MOTIVATIONS

If the patient selected "Other" as a primary motivation for the procedure, please use the following open-ended questions to gain a better understanding of their reasons.

a. Could you please elaborate on the "other" motivation you selected?

b. What specific outcome or feeling are you hoping to achieve through this procedure that isn't covered by the other options?

c. How important is this "other" motivation compared to the other potential reasons for seeking this procedure?

Answers

Section 1 Score

SECTION 2

PSYCHOLOGICAL WELL-BEING & BODY IMAGE PERCEPTION

This section addresses how the patient perceives their body and evaluates their mental state in relation to their physical appearance. It's critical to understand body image disturbances and the emotional impact that a patient's appearance has on their well-being. This helps identify those with body dissatisfaction and potential body dysmorphia.

Question Four How often do you think about your appearance in a way that causes distress?

Rarely - less than once a week - 0Sometimes - a few times a week - 1Frequently - daily - 2Constantly - multiple times a day - 3

Question Five How do you feel when you look at yourself in the mirror? (Choose the most accurate statement)

I generally feel neutral or positive - 0I focus on specific flaws that bother me - 2I avoid mirrors or photos because they cause distress - 3

Question Six Have you ever been diagnosed with or believe you may have experienced symptoms of any of the following? (Check all that apply)

Body Dysmorphic Disorder - 3Generalized Anxiety Disorder - 1Depression - 2Eating Disorder - Anorexia, Bulimia, Binge Eating - 3Obsessive Compulsive Disorder - OCD - 2None of the above - 0

ADD-ON SECTION B

BRIEF MENTAL HEALTH SCREENING

Optional - May require additional training to interpret or referral to a Mental Health Practitioner.

These brief screening questions are designed to provide a slightly deeper insight into the patient's current mental well-being. If any responses indicate potential concerns, further exploration or referral to a Mental Health Professional may be warranted.

Please ask the following questions and note the patient's responses and the score for each.

a. Over the past two weeks, have you felt down, depressed, or hopeless?

Not at all - 0Several days - 1A week or more - 2Nearly every day - 3

b. Over the past two weeks, have you felt little interest or pleasure in doing things?

Not at all - 0Several days - 1A week or more - 2Nearly every day - 3

c. Do you often feel anxious or worried about things?

Rarely - 0Sometimes - 1Frequently - 2Constantly - 3

Note for Practitioners

A total score of 4 or more may warrant further inquiry or referral.

Section 2 Score

SECTION 3

EXPECTATION MANAGEMENT & POST-SURGERY ADAPTATION

This section focuses on expectations and psychological adaptation post-surgery. It helps gauge if the patient is mentally prepared for the change and how they envision the outcome. Unrealistic expectations can lead to dissatisfaction after surgery.

Question Seven What do you believe this procedure will change for you emotionally? (Check all that apply)

I already feel confident in social situations, but this may enhance it - 0I will feel better about my overall appearance - 0I believe it will help me overcome deep-seated self-doubt or uncertainties - 2I am unsure but hopeful - 1

Question Eight How do you typically handle change in your life and with your appearance?

I adapt easily to changes and accept them quickly - 0It takes me some time to adjust, but I usually adapt - 1I struggle with changes and have difficulty adjusting - 2

Question Nine Have you undergone aesthetic procedures or surgery before? If yes, were you satisfied with the results?

Yes, and I was satisfied - 0Yes, but I was dissatisfied and pursued additional procedures and/or sought alternative opinions - 3No, this is my first procedure - 0

Section 3 Score

SECTION 4

SUPPORT SYSTEM & POST-SURGERY CONSIDERATIONS

This section assesses the patient's support network and their social environment post-surgery. Having a strong support system is essential for emotional recovery. This section also looks at how the patient plans to handle the external pressures and reactions they may encounter.

Question Ten Have you discussed your decision with anyone close to you?

Yes, and they are supportive - 0Yes, but they are unsure, hesitant or have questions - 1No, I have not discussed it with anyone - 2

Question Eleven How do you anticipate handling others' reactions post-surgery or procedure? (Check all that apply)

I don't care what others think; this is for me - 0I am excited to see positive reactions from others - 1I feel anxious about people noticing the change - 2I prefer to keep my procedure private - 0

Section 4 Score

SECTION 5

CONSISTENCY AND RESPONSE PATTERNS

This section evaluates the consistency of the patient's responses throughout the assessment. Identifying patterns in how they answer related questions can reveal emotional complexities, shifts in self-perception, or a tendency to present themselves in a particular way. By assessing these patterns, practitioners gain deeper insight into the patient’s motivations and psychological readiness.

CONSISTENCY CHECK

These questions compare responses across different areas to detect variations that may warrant further discussion. Inconsistencies can suggest underlying emotional conflicts, uncertainty about appearance, or social anxiety related to body image. Conversely, consistent responses often indicate a more stable self-perception and reliable reporting.

Question A How often do you think about your appearance? (Repeated) Compare this answer to Question Four in Section Two.

Same answer - 0Rarely or Sometimes here, but Frequently or Constantly in Section Two - 2Frequently or Constantly here, but Rarely or Sometimes in Section Two - 1

Question B How often do you avoid social situations because of how you look? (Repeated)

If Question Four in Section Two was Rarely or Sometimes AND Question Eleven in Section Four was I don’t care what others think; this is for me - 0If Question Four in Section Two was Frequently or Constantly AND Question Eleven in Section Four was I don’t care what others think; this is for me - 0Any other combination - 1

Question C Do you avoid mirrors or photos due to distress?

If Question Five was I generally feel neutral or positive AND answers No here - 0If Question Five was I avoid mirrors or photos because they cause distress AND answers Yes here - 0Any other combination - 2

Section 5 Score

SECTION 6

COGNITIVE & EMOTIONAL RESILIENCE

Evaluating decision-making and emotional resilience ensures that the patient has the mental fortitude to handle changes in their life and appearance. This section is crucial for understanding how well the patient can handle the emotional stresses of the procedure.

Question Twelve Decision-Making Pattern Analysis

These questions assess how the patient approaches, making decisions.

Scenario One Imagine a friend is considering the procedure you are planning. What advice would you give them?

Response focuses only on the positive aspects and potential benefits - 2Response includes a balanced perspective, mentioning both potential benefits and risks/challenges - 0Response is vague or unclear - 1

Scenario Two If you were to recommend the procedure to a friend, would you highlight only the positives, or would you include potential risks?

States they would highlight only the positives - 2States they would include potential risks - 0States they are unsure - 1

Question Thirteen Emotional Resilience Test

This short test evaluates the patient's ability to handle stress and change.

How do you typically react when faced with stressful situations?

I stay calm and look for solutions - 0I feel overwhelmed and may have difficulty handling the situation - 1I often become anxious and emotional - 2

When faced with a difficult change in your life, how long does it usually take for you to adjust?

I adjust quickly and move forward - 0I need time, but eventually adapt - 1I struggle with adapting and often feel stuck - 2

Note for Practitioners

Consider integrating the questions from ADD-ON SECTION C into the discussion during Section 6 to gain a deeper understanding.

ADD-ON SECTION C

EXPLORATION OF COPING STRATEGIES

Understanding how a patient typically copes with stress and challenges can provide valuable information about their ability to navigate the emotional aspects of the aesthetic procedure and recovery.

When you are feeling stressed or facing a difficult situation, what are some of the things you usually do to cope?

Can you recall a time when you faced a significant change in your life? How did you handle that situation, and what helped you to adjust?

Do you feel you have healthy ways of dealing with negative emotions or setbacks? If so, can you provide an example?

Section 6 Score

SECTION 7

PAST SURGERIES/PROCEDURES AND COMPLICATIONS

This section is important for understanding the patient's previous experiences with aesthetic procedures and any potential complications they may have faced. Previous dissatisfaction or complications may indicate higher psychological risk for this surgery.

Question Fourteen Have you had previous surgeries, including aesthetic procedures?

Yes, and the results were satisfying - 0Yes, but I was dissatisfied and pursued additional procedures and/or sought alternative opinions - 3No, this will be my first surgery and/or procedure - 0

Question Fifteen Have you experienced any complications from previous surgeries or procedures?

Yes - 2No - 0

Section 7 Score

SCORING & INTERPRETATION FOR PRACTITIONERS

The points for each patient response is automatically calculated as the Total Score.

The Optional Brief Mental Health Screening (Add-On Section B) is automatically added to the Total Score, if completed.

Total Score

Total Assessment Score Interpretation

Low Psychological Risk (Good Candidacy)

0 - 13 points

Patient generally demonstrates realistic expectations, minimal emotional distress, and healthy body image. Patient has intrinsic motivation (confidence, self-driven) rather than relying on external validation. No significant indicators of body dysmorphia or severe psychological conditions.

Score on Brief Mental Health Screen is low (0-3).

Moderate Psychological Risk (Needs Further Discussion)

14 - 26 points

Patient may exhibit some body image distress or have some external pressures influencing their decision. Moderate concerns about identity adjustment or reliance on external validation. Some history of dissatisfaction with previous procedures but no severe signs of emotional instability or Body Dysmorphic Disorder (BDD).

Score on Brief Mental Health Screen is in the moderate range

(4-6).

High Psychological Risk (Requires Referral/Counselling)

27+ points

Relatively high emotional distress related to appearance, with constant preoccupation and unhealthy fixation on flaws. Severe dissatisfaction with previous aesthetic procedures, with a history of repeated surgeries or dissatisfaction. Possible signs of Body Dysmorphic Disorder (BDD), depression, eating disorders, or high anxiety. Lacks an emotional support system and shows elevated anxiety about social perceptions.

Score on Brief Mental Health Screen is high (7-9).

Note on Score Interpretation

The scoring ranges provided (0-13, 14-26, 27+) are based on clinical judgment and psychological principles rather than formal empirical validation.

Practitioners should consider these scores as helpful guidelines rather than definitive categorizations or diagnosis, and should integrate them with their qualitative assessment of patient responses, observational cues, and clinical impressions. Individual patient context is essential when making clinical decisions based on this screening tool.

PSYCHOLOGICAL ASSESSMENTS INTEGRATED INTO THIS SCREENING

This screening tool incorporates a range of psychological tools adapted and designed to help identify key emotional and behavioural factors that may influence a patient's decision-making process regarding aesthetic procedures. These tools are based on well-established psychological frameworks and scientifically validated measures where applicable.

This guide serves as a quick reference to highlight areas for further exploration and is NOT a diagnostic tool, but rather a preliminary screening to help inform further assessment and/or professional consultation and referral.

Body Image Disturbance Questionnaire (BIDQ)

Evaluates body dissatisfaction, fixation, and emotional distress related to appearance, with a focus on identifying potential risk factors for aesthetic procedures and/or surgery.

Body Dysmorphic Disorder Questionnaire (BDDQ)

A screening tool to help identify tendencies towards Body Dysmorphic Disorder (BDD), which is a potential red flag for patients considering elective surgery.

Note: This tool provides a preliminary indication and should be followed up with professional diagnosis where needed.

Perfectionism Scale

Aims to assess unrealistic expectations and dissatisfaction even after technically successful procedures, signalling risk for post-surgical unhappiness.

Self-Determination Theory (Motivation Assessment)

Adapted from validated scales such as the Treatment Self-Regulation Questionnaire (TSRQ) and the Aspiration Index (AI), this tool helps differentiate between intrinsic (healthy) and extrinsic (risky) motivations for seeking surgery. Patients' responses are evaluated for autonomous vs. controlled motivations.

Expectation Alignment Theory

This is based on research in realistic vs. unrealistic expectations surrounding aesthetic surgery, drawing from psychological literature on cognitive distortions and surgical satisfaction. It helps assess the realism of the patient's expectations, which is a primary predictor of post-surgical satisfaction.

Social Adjustment Scale

Measures the social pressures and desire for validation that may influence the decision to undergo unnecessary procedures, using an adapted framework for social comparison and self-esteem.

Coping Style Assessment

Evaluates the patient's ability to manage stress and emotional challenges, which are crucial for successful post-surgery adaptation and recovery.

CONCLUSION & FINAL RECOMMENDATIONS

This assessment is adapted and customized from various frameworks and provides a holistic view of the patient's psychological readiness for aesthetic procedures by combining body image evaluation, emotional well-being, social factors, and realistic expectations.

It is intended as a preliminary screening guide, NOT a diagnostic tool, and should be used to inform further exploration and referral for consultation.

By identifying potential risks early, this tool helps practitioners minimize psychological risks and ensure a positive outcome. It is recommended that practitioners apply professional judgment in conjunction with this tool to provide appropriate psychological support and facilitate post-surgery adaptation.

This assessment forms part of the article "Understanding the Psychology of Post-Surgery Perception and Satisfaction," published in collaboration with the Aesthetic Appointment Journal.

For patients who may require additional mental health support, assistance with emotional resilience, or help adapting post-surgery, please contact your preferred Mental Health Therapist.

Alternatively, you may reach out to:

Michelle Göldner

Luminary Collective Co.

info@michellegoldner.com

www.michellegoldner.com

+27 81 459 3552

This screening is currently available as a complimentary resource for licensed aesthetic professionals.

Formal licensing packages for aesthetic practitioners, and salons will be available soon.

Copyright & Usage Notice

Reproduction, duplication, or distribution without explicit written permission is prohibited.

This screening is intended for professional use only.