Psychoanalytic Assessment Applications for Different Settings

Jed A. Yalof, Anthony D. Bram, Jed A. Yalof, Anthony D. Bram

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000291612
• Topic: Psicologia
• Subtopic: Psicologia clinica

In this edited book, expert assessors illustrate through case examples how they apply psychoanalytic theory to different clinical settings. These settings include private practice, neuropsychological, medical, forensic, personnel, custody, school, and psychiatric-residential.

Psychoanalytic Assessment Applications for Different Settings allows the reader to track the assessor's work from start to finish. Each chapter presents a description of the clinical setting in which the assessment occurred; a detailed review of the referral and patient history; test selection and test findings with supporting data drawn from self-report, and cognitive and personality performance-based measures; psychiatric and psychodynamic diagnoses; implications and recommendations; discussion of the feedback process; and assessor-self reflections on the case. Throughout the book, psychodynamic concepts are used to help understand the test data. The authors are experts in the psychodynamic assessment of clients in private practice, educational, medical, neuropsychological, and forensic settings. The findings are derived from methods particular to each setting, with supporting data highlighted and woven throughout the interpretive process.

Students, educators, practitioners, and the professionals who collaborate with assessors will benefit from this book's offerings.

1 Introduction

Jed A. Yalof

As psychoanalytic clinicians who specialize in psychological testing, we draw our inspiration from a legacy of psychologists (Lerner, 2007) who found a way to nurture and evolve professional identities that included their work as psychoanalysts and assessors. At the top of that list is Roy Schafer, whose many contributions to psychoanalytic psychology, psychoanalysis, and psychological testing continue to set the standard for how to comport an analytic attitude (1983) and think psychoanalytically across what is often the uneasy tension between psychoanalysis and psychological testing (Bram, Yalof, & Gottschalk, 2018). Schafer (1954) introduces his classic book Psychoanalytic Interpretation in Rorschach Testing with this statement

No matter how helpful a clinical tool it may be, a psychological test cannot do its own thinking. What is accomplishes depends upon the thinking that guides its application. This guiding thought is psychological theory, whether explicit and systematized or implicit and unsystematized.

(p. xi)

Schafer’s statement brings into focus the two main aims of Psychoanalytic Assessment Applications in Different Settings. First, the book is decidedly psychoanalytic in its focus and unique in the sense that it is setting-specific. That is, our concern is with the application of a theoretical model across clinical settings and patients who are seen at that setting, rather than the way theory informs a particular test. A psychoanalytic theoretical approach to psychological testing includes such central concepts as defenses, reality testing, object relations, affect regulation, self-image, and interpersonal relations (Bram & Peebles, 2014). The interpretive process considers test variables, test content, response sequence, test behavior, and the relationship between patient and examiner (e.g., Berg, 1984; Schafer, 1954; Sugarman, 1981)¹

Second, writing reports for multiple audiences while remaining true to a psychoanalytic mindset is not always easy. Consumers of psychological assessments want reports that are informative, applicable, and readable. Clinical settings that are not supportive of psychoanalytic ways of thinking and writing require the assessor’s flexibility and adaptation to whatever the work culture expects. Schools, courts, medical, and primary care settings each require different styles of writing. Other settings, such as private practice or residential, might be more open to the use of overt psychoanalytic terminology, but that, too, depends on the extant culture of the workplace or preference of the referral source. Using theory is more often silent and implicit, rather than emboldened and vocal. There are a variety of psychoanalytic theories that inform a psychoanalytic approach to psychological testing (e.g., Yalof, 2017) and data points from which to draw (Sugarman & Kanner, 2000), but modalities must interface with focused applications (e.g., Acklin, 1992; Bram & Yalof, 2015; Cogan, Porcerelli, & Dromgoole, 2001; Kleiger, 1997; Schafer, 1967; Shectman & Smith, 1984; Smith, 1983; Yalof, 2020) in order to be useful. The assessor must convey an empathic and fair-minded tone when developing inferences and writing reports. Although there are several report writing strategies (e.g., Appelbaum, 1972; Bram & Peebles, 2014; Harty, 1986; Lerner, 1991; Schafer, 1948) that have a psychoanalytic bent, professional settings differ and require the assessor’s versatility when thinking about how to use theory in a way that organizes an extensive array of data points (e.g., Bram, 2010; Meloy, 1992; Rothstein, Benjamin, & Eisenstadt, 1988; Yalof & Rosenstein, 2014). Again, this is not an easy task. Much like a psychoanalytic psychotherapy session, a psychoanalytically informed test report holds as its ideal a jargon-free, balanced, and understandable written intervention that is databased and responsive to the immediacy of clinical need (i.e., the referral question). It is the assessor’s thinking that permits conceptual titration in a manner that fits the data and audience, including the patient.

To accomplish these two ends, we invited as chapter contributors a group of psychoanalyst-psychologists and psychoanalytically oriented psychologists who test, write reports, teach, supervise, and conduct evaluations in different settings, and have found a way to find a psychoanalytic voice in their assessment work. We made some decisions along the way that we thought would keep the reader’s focus on the report itself. The test batteries used by different assessors are quite diverse and reflect the way each clinician made decisions and adaptations in response to patient, referral question, and setting. Chapters are written by senior-level psychologists with dedicated assessment practices and a history of contribution to the assessment literature. We decided that reproducing and presenting verbatim protocols for each test would be both cumbersome and a less efficient method of accomplishing our aims of allowing the reader to track the thinking of each psychologist and reflect on the data, which is parenthesized to support each inference. As such, we opted for the latter, and hope that the reader finds this approach instructive. One test that required special attention was the Rorschach; some authors used Exner’s (CS; 2003) Comprehensive System, whereas others preferred the newer Rorschach Performance Assessment System (R-PAS; Meyer, Vigilione, Mihura, Erard, & Erdberg, 2011). We decided to prioritize the integrity of each method and each author’s ability to interpret the method’s data sensibly, while also recognizing differences (Bram & Yalof, 2018).

Chapters 2–9 each include a (a) brief introduction with literature review that orients the reader to the clinical setting, (b) referral and history, (c) rationale for test selection, (d) recommendations, (e) post-assessment reflections, (f) diagnoses, using two systems: The more traditional International Classification of Diseases (ICD-10; World Health Organization, 1992) system preferred by third-party payers, and The Psychodynamic Diagnostic Manual (PDM-2; Lingiardi & McWilliams, 2017) as a specific diagnostic model that captures various dimensions of psychological functioning in accord with a psychoanalytic viewpoint. Regarding the PDM-2, each chapter includes a three-axis diagnosis (personality, mental functioning, and symptoms) but did not require authors to report specific scores on the associated rating scales. Chapter10 differs in format because of its focus on teaching an approach to psychoanalytic formulation that can be applied to report writing.

The diversity of chapters will be of interest to practitioners whose psychoanalytic work covers different applications. Three chapters address the often-perplexing overlap of neurocognitive, academic achievement, and personality considerations with differential emphasis. In Chapter 3, Sharon Leak, presents a psychoanalytically sensitive portrayal of an adult woman’s “equivocal” attention-deficit problems, neurocognitive compromise, and internal conflict. In Chapter 4, James Kleiger presents a case that integrates the psychological profile of an adolescent girl’s struggle with specific learning disabilities, concurrent with very salient psychodynamic concerns. In Chapter, 8, Alan Schwartz and David York, working in a primary care facility in a hospital setting, present the evaluation of a medical student experiencing a mix of inattention, mood difficulties, and internal stress embedded within a conflict of ethnic cultures. They provide a culturally sensitive psychoanalytic synthesis of these problems.

Other chapters similarly address the application of psychodynamic principles but within very different settings. In Chapter 2, Anthony Bram, writing from the perspective of a private practitioner, uses a psychoanalytic approach when discussing the evaluation of a young man who suffered academic and emotional difficulties, including psychotic-like symptoms, associated with separating from his family and going to college. The test report is data-driven but theory-informed, attends to the patient-examiner relationship as a data source, and involves treatment-centered diagnosis. In Chapter 5, Jeremy Ridenour illustrates how his assessment of a young man with a history of trauma and psychotic symptoms demonstrates a fit between psychoanalytic assessment and a residential setting culture deeply immersed in psychoanalytic thinking. In Chapter 6, Diana Rosenstein applies psychoanalytic principles but in a custody assessment. In Chapter 7, Ali Khadivi focuses on the application of psychoanalytic assessment in a criminal case. In Chapter 9, Mark Waugh does the same but for a fitness-for-duty assessment. In Chapter 10, Christina Biedermann presents a case and model for teaching students to think psychoanalytically about assessment work.

Throughout the book, psychoanalytic concepts are woven skillfully within case illustrations. We invite the reader’s psychoanalytic immersion in each chapter.

Note

1 The terms “testing/psychological testing,” “evaluation/psychological evaluation,” and “assessment/psychological assessment” are used interchangeably throughout the book. Also, the terms “tester,” “assessor,” “evaluator,” and “examiner” are used interchangeably throughout the book, as are “client” and “patient.” The authors also do not make distinctions between the terms “psychoanalytic” and “psychodynamic.”

References

1. Acklin, M. L. (1992). Psychodiagnosis of personality struct...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• Acknowledgements
• 1 Introduction
• 2 Psychoanalytic assessment in private practice
• 3 Through a psychoanalytic lens: A sharpened view of neuropsychological assessment
• 4 A psychoanalytic approach to psychoeducational evaluations
• 5 Psychoanalytic psychological testing in residential and hospital-based settings
• 6 A psychoanalytic approach to custody evaluations
• 7 Psychoanalytic assessment in a forensic setting: A case of an incomplete murder-suicide
• 8 Simple questions with complex answers: Digging deeper into primary care assessments
• 9 Psychoanalytic aspects of the fitness for duty psychological evaluation
• 10 Teaching a model of formulation for psychoanalytic assessment reports
• 11 Conclusion
• Index