Collaborative / Therapeutic Assessment

A Casebook and Guide

Stephen E. Finn, Constance T. Fischer, Leonard Handler

• Publisher: Wiley
• Year: 2012
• Print ISBN: 9780470551356
• eBook ISBN: 9781118168646
• Edition: 1
• Topic: Psychology
• Subtopic: Research & Methodology in Psychology
• Index: Psychology

A guide to conducting Collaborative/Therapeutic Assessment to promote client growth

Mental health professionals are increasingly enthusiastic about and ready to use psychological test data, research, and theory in life-relevant ways to improve diagnosis, client care, and treatment outcomes. With Collaborative/Therapeutic Assessment (C/TA), clients participate actively with the assessor in exploring how their test scores and patterns reflect who they are in their daily lives and how they can learn to help themselves cope with life's challenges.

Using a case study approach to demonstrate how to apply C/TA in practice, Collaborative/Therapeutic Assessment provides practitioners with a variety of flexible and adaptable case examples featuring adults, children, adolescents, couples, and families from different backgrounds in need of treatment for assorted concerns.

Designed for both experienced and novice clinicians, the book begins with a brief history of C/TA, and provides clear definitions of the distinctions among many common approaches. It uniquely presents:

• Eighteen diverse C/TA assessments covering: depression, multiple suicide attempts, severe abuse, dissociation, an adolescent psychiatric ward, custody evaluation, a couple in crisis, and collaborative neuropsychology
  
  

• Guidance on how both client and clinician can agree on the best course of action through joint exploration of assessment procedures, results, and implications
  
  

• Closely related approaches to psychological testing, including Individualized Assessment, Collaborative Assessment, Therapeutic Model of Assessment, Collaborative/Therapeutic Neuropsychological Assessment, and Rorschach-based psychotherapy
  
  

• Clearly labeled Teaching Points in each chapter
  
  

Collaborative/Therapeutic Assessment provides psychologists in all areas of assessment, and at all levels of experience, with powerful C/TA examples that can dramatically illuminate and improve clients' lives.

CHAPTER 1

Collaborative/Therapeutic Assessment: Basic Concepts, History, and Research

Stephen E. Finn, Constance T. Fischer, and Leonard Handler

WHAT IS THE HISTORY OF COLLABORATIVE/THERAPEUTIC ASSESSMENT?

Until relatively recently, psychological testing has been thought of exclusively by most mental health professionals as a way to diagnose psychological disorders and plan treatment interventions. Finn and Tonsager (1997) described the goals of this traditional “information gathering model” of assessment as

a way to facilitate communication between professionals and to help make decisions about clients. By describing clients in terms of already existing categories and dimensions (e.g., schizophrenic, IQ of 100, 2g–7 code type on the MMPI-2), assessors hope to convey a great deal of information about clients in an efficient manner. Also, such descriptions are the basis for important decisions, such as whether clients are mentally competent or dangerous, whether they should receive one treatment or another, be granted custody of a child, hired for a certain job, or be given publicly funded special education services. Given the inherent uncertainty involved in such weighty decisions, clinicians and researchers have long emphasized the statistical reliability and validity of their assessment instruments; these characteristics allow one to make nomothetic comparisons (i.e., generalizable across persons and situations and used by a number of clinicians) between a particular client and similar clients who have been treated in the past or studied in research. (p. 378)

However, as early as the middle of the 20th century, some American psychologists were experimenting with ways of using psychological assessment to promote therapeutic change, by engaging clients in discussing their responses to psychological tests. For example, Harrower (1956) devised a method she called “projective counseling,” in which clients discussed their own Rorschach percepts and projective drawings with their assessor/therapists to help them “come to grips, sometimes surprisingly quickly, with some of [their] problems” (p. 86). Similarly, Jacques (1945), Bettelheim (1947), Bellak, Pasquarelli, and Braverman (1949), and Luborsky (1953) all advocated having clients self-interpret their stories to the Thematic Apperception Test (TAT; Murray, 1943) as a way to bypass “resistance” and promote insight.

In recent years, these early efforts have been superseded by various highly developed models of psychological assessment, which we are broadly calling Collaborative/Therapeutic Assessment. Let us trace some of the major models encompassed by this term.

Fischer’s Collaborative, Individualized Assessment

Constance Fischer began in the 1970s (e.g., 1970, 1971, 1972, 1979) articulating a coherent model of psychological assessment grounded in phenomenological psychology, which she at times called collaborative psychological assessment (1978), individualized psychological assessment (1979, 1985/1994), or collaborative, individualized psychological assessment (2000). At that time, Fischer regarded collaborating with clients as a major means of individualizing the assessment process, so the descriptions and suggestions were about this person in his or her life context. She regarded collaboration as therapeutic in process; she also regarded much of standardized testing practice as objectifying the test taker.

Fischer (2000) defined the major principles of her approach as:

1. Collaborate: The assessor and client “co-labor to reach useful understandings” (p. 3) throughout the assessment, which are constantly revised in a hermeneutic, interpersonal process. “The client is engaged as an active agent” (p. 3) in discussing the purposes of the assessment, the meanings of her or his own test responses, useful next steps, and the written feedback that results at the end of the assessment.

2. Contextualize: Clients are not seen as “an assemblage of traits or even as set patterns of dynamics” (p. 4), but rather as persons “in lively flux” (p. 4). Their problems are explored in the context of their lived worlds, “from which they extend, grow, and change” (p. 4).

3. Intervene: The goal is “not just to describe or classify the person’s present state but to identify personally viable options to problematic comportment” (p. 5). Although Fischer clearly differentiated between assessment and psychotherapy in her early writings, she always was clear that a goal of assessment was to assist clients in discovering new ways of thinking and being.

4. Describe: From the beginning, Fischer eschewed the use of “constructs” such as traits or defenses to explain clients’ behavior and advocated the use of thick descriptions in written reports, using clients’ own words whenever possible, to help assessors and the readers find their way “into clients’ worlds” (p. 6).

5. Respect complexity, holism, and ambiguity: Assessors should “respect the complex interrelations of our lives; they do not reduce lives to a variable or to any system of explanation. The goal is understanding rather than explanation” (p. 6).

Fischer hoped that readers of her assessment reports would recognize the clients as described, but would come to see them in new ways. She hoped to capture the many contradictions that each one of us embodies, rather than oversimplifying our complex ways of being.

Fischer’s work was important in providing an eloquent and coherent exposition of a new paradigm of psychological assessment. In addition, she also pioneered many innovative practices that are now widely used within the Collaborative/Therapeutic Assessment (C/TA) community. Finn (2007) and others mined Fischer’s writings and adopted such techniques as (1) writing psychological assessment reports in first person, in language that is easily understood, and then sharing them with clients; (2) asking clients for comments at the end of an assessment, which are then routinely shared with readers of the assessment report; (3) writing fables for children at the end of an assessment, which capture in metaphor the results and suggestions resulting from the assessment; and (4) engaging clients in “mini-experiments” during psychological assessment sessions (e.g., retelling stories to picture story cards to help clients discover new ways of approaching typical problem situations).

Fischer continues to teach, advise, and write about her approach to assessment, as well as the overlap between C/TA and qualitative research. Fischer published an early, now classic, empirical phenomenological study (Fischer & Wertz, 1979). She published qualitative studies she undertook because of their relation to C/TA, for example, Toward the Structure of Privacy (1971) and Intimacy in Psychological Assessment (1982).

Fischer’s method and philosophy are illustrated in this volume in her case example (Chapter 5) and also in the case written by McElfresh (Chapter 9), who is one of Fischer’s former students.

Finn’s Therapeutic Assessment

Finn (2007) defined Therapeutic Assessment (TA; capital “T” and “A”) as a semistructured form of collaborative assessment originally developed by him and his colleagues at the Center for Therapeutic Assessment in Austin, Texas, and later refined on the basis of ongoing research and practice. From the outset, Finn wanted to explore psychological assessment as a brief therapeutic intervention. He initially focused on how to make feedback from psychological assessments therapeutic, and based his techniques and theory on results from a series of studies (e.g., Schroeder, Hahn, Finn, & Swann, 1993) with his colleague at the University of Texas, William Swann, Jr., the developer of self-verification theory (Cf. Swann, 1997). This research led to the distinction made in TA between what is called “Level 1, 2, and 3” information resulting from an assessment. That is, Finn and colleagues discovered that clients found assessment feedback most impactful and therapeutic when they were first presented with information that was close to their current self-schemas, then with information that was mildly discrepant from these schemas, and finally with information that was highly discrepant from the ways they already thought about themselves (Cf. Finn, 1996, 2007, for further exposition of this principle).

As explained in a later book (Finn, 2007), Finn then began to focus on the role of other steps in the assessment process in helping clients change, and he deliberately incorporated many of Fischer’s techniques and underlying principles after he encountered her work and the two of them began collaborating. Basically, Finn discovered that if you wanted to make psychological assessment therapeutic, it helped greatly to engage clients as collaborators. This fit with Swann’s self-verification theory, which posited that clients’ self-schemas would be more amenable to change if clients were actively involved in revising the ways in which they viewed themselves.

Finn was also interested in teaching collaborative assessment to his graduate students at the University of Texas and in doing controlled research on this topic. Thus, he began to standardize many of the techniques developed by Fischer (and later, Handler) into series of steps that could be taught in an orderly fashion. These steps included (1) gathering “assessment questions” from clients at the beginning of an assessment about what they hoped to learn about themselves; (2) involving clients in “extended inquiries” of standardized tests, after a standard administration had been completed; (3) “assessment intervention sessions,” in which assessors planned assessment “encounters” near the end of an assessment during which clients would discover information that was emerging from the standardized sessions; (4) closing “summary/discussion sessions,” in which clients’ assessment questions were addressed according to the Level 1, 2, 3 schema mentioned earlier; (5) sending clients letters instead of reports at the end of an assessment; and (6) holding follow-up sessions several months after the close of a psychological assessment, during which clients and assessors continued to discuss and process the experience of the psychological assessment. This structure is not seen as fixed or absolute, however. Finn has repeatedly emphasized that it can and should be altered to fit each client and setting, and that the well-being of the client always takes priority. The study by Finn and Tonsager (1992) was the first to test this method as a therapeutic intervention, with positive results (more below).

After he left the University of Texas to found the Center for Therapeutic Assessment, Finn was largely free to travel and present his semistructured model of collaborative assessment around the world. Many psychologists first heard about collaborative assessment and about Fischer’s seminal work through Finn’s presentations. This happened about the time that managed care providers started greatly restricting psychological services and particularly, psychological assessment services, to clients in the United States. All of these factors led to a surge in interest in the therapeutic potential of psychological assessment, and many new applications and much new research ensued. We will review this research shortly.

In recent years, Finn’s work and thinking has centered on connecting TA to other important therapeutic models, such as attachment theory (Finn, 2011d), Control Mastery Theory (Finn, 2007), and intersubjectivity theory (Finn, 2007). He also is attempting to integrate theories of Therapeutic Assessment with recent research on infant development and neurobiology (Finn, 2011a, 2011b). Finn’s theory and model are illustrated in his own case example (Chapter 18) on Therapeutic Assessment with couples, and in the chapters by...

Table of contents

• Cover
• Contents
• Title
• Copyright
• Preface
• About the Contributors
• Chapter 1: Collaborative/Therapeutic Assessment: Basic Concepts, History, and Research
• Part I: Assessments of Individual Adults
• Part II: Assessments of Children, Adolescents, and Young Adults
• Part III: Special Applications
• Afterword: Forward!
• Author Index
• Subject Index