Reviewed by Alison Byrne, Senior Speech and Language Therapist, St Augustine's School, Blackrock, Co. Dublin


The Visual Analogue Self-Esteem Scale (VASES) has been designed specifically for use among people presenting with aphasia. It is an assessment tool intended to aid psychologists and speech and language therapists in rating an aphasic individual’s level of self-esteem.

The assessment comes with a 15-page user manual and a set of high-quality A4 picture cards, presented in a ring binder. The ring binder serves as a stand for the picture cards, making it easy to use, sturdy and secure.

The user manual is comprehensive and easy to read. It contains very useful information about the nature of self-esteem, clarification of terms, influences on self-esteem, and the relationship between self-esteem, depression and anxiety.

Also included in the user manual is a brief background explaining where the concept of VASES originated and the rationale behind it. The authors make reference to the lack of materials available to address a patient’s ‘personal predicament’ when speech, language or communication skills are impaired, as in the case of aphasia. VASES is intended as ‘a measure of self-esteem that does not require sophisticated linguistic ability’ and is considerate of the kinds of skills that can be affected by aphasia–including ‘profound difficulties with reading and auditory comprehension’.

The patient is presented with ten different picture cards containing two pictures on each page and words that match each picture, e.g. ‘being understood–not being understood’, ‘trapped–not trapped’, ‘frustrated–not frustrated’. Underneath the two pictures is a rating scale:

   ++                                 +                                 0                           +                             ++

Very true of me       True of me                 In between          True of me           Very true of me

The patient is asked to rate which picture is most true of them. Varying degrees of assistance may be required, depending on each individual’s level of difficulty. Each symbol corresponds to a score (from 1 to 5). When the patient has completed the ten picture cards, the scores are added up, with a maximum of 50 and a minimum of 10-

It is clearly stated in the manual that VASES is not intended for diagnosing, as might be the case with rating scales for depression. There are no norms. It is based on the notion that most people have positive views of themselves; scores below the mid-point suggest low self-esteem.

I like the way this assessment is presented. The layout and content of the manual are very user-friendly. It could be a useful resource during the early stages of therapy, and as a measure of progress over time. It would certainly be a valuable tool for giving the patient an opportunity to express his/her feelings through different stages of recovery.

I work in a school for children aged 8-18 years of age who have mild learning disabilities. I was interested in trying VASES with some of the students, in particular those who have significant difficulties in expressing their feelings and thoughts about themselves. I really liked the idea of having pictures to support written and verbal explanation. However, I found that a considerable amount of adaptation was required. Some of the emotions in the assessment were not relevant or were too complicated for my particular client group, e.g. ‘optimistic–not optimistic’. In addition, the method of rating using the + or ++ symbols was a difficult concept for the students to grasp.

The concept behind VASES, and the way it is presented, is very appealing. While it may not be particularly relevant for my present client group, I feel it would certainly be a worthwhile resource for speech and language therapists working in the field of aphasia.

VASES: Visual Analogue Self-Esteem Scale, by Shelagh Brumfitt and Paschal Sheeran. Bicester, Oxon. Winslow Press Ltd (1999). ISBN 0 86388 216 1. Stg£32.50 +VAT.