Therapeutic Assessment with Adults

Using Psychological Testing to Help Clients Change

Francesca Fantini, Filippo Aschieri, Raja M. David, Hale Martin, Stephen E. Finn

• Editore: Routledge
• Anno: 2022
• ISBN:
  9780429514838
• Edizione: 1
• Argomento: Psicologia
• Categoria: Consulenza psicoterapeutica

This book is a comprehensive guide to Therapeutic Assessment (TA) with adults, showing how to collaboratively engage clients in psychological testing to help them achieve major and long-lasting change.

This guide clearly lays out each step of TA with adults, including its rationale and detailed instructions on how to handle a range of clinical situations. Additionally, in part one, the authors fully describe the development of TA, its theoretical bases, and the most up-to-date research on the model. In the second part of the book, the authors describe the structure and techniques of TA, and illustrate each step with transcripts from a clinical case. Further clinical illustrations help the reader understand how to conduct a TA with different types of clients, including those from culturally diverse backgrounds.

This book is essential for all clinicians, therapists and trainees working with adult clients; along with students in assessment courses.

Part I Theoretical Bases, Development, and Research on Therapeutic Assessment

1 How Can a Psychological Assessment Be Therapeutic?

DOI: 10.4324/9780429202797-2

Dear Emma,

As promised, in this letter I have written down the results of the testing that we put together in our last meeting so that you will have something to look back on. I believe we came to important understandings of your questions that will be helpful to you as you move ahead with your life. I hope this letter will serve as a good point of reference for the things we spoke about. As we agreed, I am also sending a copy of this letter to Jeanne, your therapist.

First, I want to reiterate how much I enjoyed working with you and getting to know you. Thank you for trusting me enough to collaborate in this important work we did. I also want to thank you for all the effort you put into the testing. I know I asked you to do a lot, but you always worked hard, even though you sometimes had had a hard day, and sometimes our work touched on difficult issues. I believe your willingness to extend yourself in difficult areas is a good sign for your future endeavors. I want to do the best I can to summarize the answers to the questions you asked of the assessment.

[…]

Why have I never been able to maintain a long-term position in a career I am passionate about, like teaching?

Your self-doubt and fears make it difficult to commit passionately to a career—even if you suspect you would succeed. Some of your fears may stem from being very averse to anger and the threat of rage, especially when it is directed at you by an unhappy boss, a disgruntled co-worker, or a dissatisfied parent.

Maintaining a solid career would also require some ability to be appropriately adversarial. As strange as that may sound, sometimes just having the confidence to stand up for yourself, if need be, causes others to treat you better. It's like you have a sign on your back that says, “I am friendly, but I can protect myself, so don’t mess with me.” As you mentioned in one of our sessions, your anger (and also its close cousins: Irritation, resentfulness, dissatisfaction, etc.) may “come out sideways,” without you even being aware of it. If this happens, it can also interfere with work relationships.

[…]

Again, Emma, it was a great pleasure to work with you. I was touched by your honesty in the face of your fears and your earnest efforts to understand and improve. It is clear you have done a lot of work on yourself, and this is the best sign that you will continue to grow and become the best version of yourself. I hope this testing is helpful in your future work.

Best wishes for a bright future,

Hale

If you have no previous exposure to TA and have been trained in traditional clinical psychological testing, the preceding letter may startle you or even make you uneasy. Some people in our field are concerned about the very idea of writing a letter to a client about test results, especially given that such a procedure has not been mentioned in well-known assessment textbooks (e.g., Anastasi, 1988; Maloney & Ward, 1976; Sattler, 1988; Tallent, 1992). The content of the letter to Emma also often generates questions in clinicians unfamiliar with TA: “Why does the clinician reveal his own emotional reactions to the client?” “Doesn’t the conversational tone make the report less professional?” and “Couldn’t a letter like this disrupt the relationship between the referring therapist, Jeanne, and the client Emma?” We will address these concerns later in the book. But for now, we ask you to look beyond your initial reaction to this written feedback to get a deeper sense of TA itself, as it embraces a different set of goals and processes.

What is Therapeutic Assessment

TA is a semi-structured intervention designed by Stephen E. Finn, who provided assessment and therapy to many types of clients in different settings for over twenty years as he developed this model. TA incorporates the use of psychological testing and addresses the goals of a traditional assessment (i.e., assessing clients’ psychological functioning to understand their presenting problems, identifying a diagnosis, planning subsequent treatment) but it also goes further. Clinicians practicing TA build a collaborative and therapeutic relationship with clients, and use specific techniques and methods to help them reach a more accurate and compassionate understanding of themselves. At the end of a TA, clients often feel more hopeful and have improved self-esteem, and their daily functioning may be enhanced to the point that they do not need subsequent treatment. In other cases, TA helps clients better understand why and how they should continue treatment. The research shows that these clients are more likely to follow through with clinicians’ recommendations than those who undergo a traditional assessment and that they show greater alliance with treatment professionals and a greater rate of change in psychotherapy than clients who have not taken part in TA (see Chapter 3 for a summary of research on the efficacy of TA with different types of clients).

TA can be useful as a therapeutic intervention or as a first step before therapy begins. Given its flexible nature as a brief intervention grounded in assessment procedures, clinicians can employ it as a method of consultation when other interventions have been less successful. Treatment professionals at an impasse with their clients may refer them for a TA with an assessor who then helps answer questions posed by both the referring professional and the client about how to make more progress. In these situations, an assessor conducts a TA with the client while keeping the referring professional involved in ways that will be described in Chapters 4–11. As a result, TA can provide new ways of understanding clients’ struggles and the reasons for treatment impasses that often lead to a positive shift for clients, treating professionals, and the treatment process.

Last, when clients—or clients and referring professionals—are curious about how clients are doing at the end of an intervention or after a period of no intervention, an assessor can use TA to look at how certain variables of interest (e.g., levels of anxiety and depression) have shifted and also delineate areas where more work could be done.

To achieve its goals, TA is structured around eight steps (see Figure 1.1) that will be described in Chapters 4–11 of this book. A TA begins with the first contact with a client (see Chapter 4), which often happens by phone. This is an important moment as the clinician begins relating to the client and sharing information about TA. Then, during the first session (see Chapter 5), the assessor continues to build a therapeutic relationship with the client while collecting their goals for the assessment, framed as “Assessment Questions” (AQs) to be answered by the end of the TA. Addressing the AQs becomes the agreed-upon goal of the TA, and the client and assessor collaborate on this joint project throughout the assessment process. To fulfill this goal, the clinician and client spend several sessions completing and discussing selected psychological tests and engaging in activities that help answer the AQs (see Chapters 6, 7, 8). Finally, the clinician and client discuss the results of the testing and jointly construct answers to the client's AQs during the Summary/Discussion Session (see Chapter 9), and eventually a Follow-up Session (see Chapter 11). Before the follow-up, the clinician sends the client a written report, typically in the form of an individualized letter, similar to the one presented at the beginning of this chapter (see Chapter 10). The structure of TA was designed to meet clients’ needs by using specific theoretical lenses, and was developed based on client input, research, and years of clinical experience. The theoretical lenses TA assessors most commonly use frame how we understand why most clients are searching for psychological help and how best to respond to them.

Figure 1.1 Steps of Therapeutic Assessment with an Adult Client.

Common Features of Clients Undergoing a Therapeutic Assessment

The extract of Emma's feedback letter (see Chapter 10 for the complete text) provides an example of the possible questions that might motivate a client to ask for a TA. In the 30 years since its initial description in a publication by Finn and Tonsager (1992), many clients have undergone a TA with questions mirroring those that bring clients to traditional assessment or psychotherapy. They wonder, for example, how to make relevant choices in their lives (“Should I go to medical school?”), how to find more satisfaction (“Why am I so unfulfilled even though I have a good job and a lovely family?”), how to change behaviors and symptoms that concern them (“How can I stop cutting myself?” “Why do I drink so much?”), and how to solve problems in close relationships (“How can I get over the death of my mother?” “Why haven’t I been able to have a successful long-term relationship?”).

Clients' Narratives

In TA, we see all “voluntary” clients (i.e., self-referred or agreeing to be referred by a mental health professional) as sharing a common feature: Their narratives (or stories) about themselves—their identity, goals, or relationships—generally are not accurate, useful, or satisfactory. We define a narrative as the “internalized, evolving story of the self that each person crafts to provide their life with a sense of purpose and unity” (Adler, 2012, p. 367). Personal narratives are created through human beings’ never-ending work of elaborating and making meaning of their life experiences to create a “map” for themselves about the world and others. Narratives help people understand and navigate the world and are essential for adapting to various environments. Typically, we create personal narratives during childhood, and they reflect our early life contexts, but all of us continue to elaborate (and potentially revise) our narratives throughout our lives.

Narratives may vary in how accurate, coherent, useful, and self-compassionate they are at different points during a person's life. Adverse childhood experiences may lead people to develop self-blaming narratives or narratives devoid of self-compassion. For example, children who are neglected by their parents often develop a deep sense of being unlovable, and this explains why their parents did not provide better care. Over time, and especially if there are no other adults to care for these children in meaningful ways, they may develop a narrative in which they themselves are flawed (“I am a bad person, and my feelings and needs are excessive”) and their identity may be permeated by shame (“I am so damaged that I cannot be loved and accepted”). Frequently these narratives are not conscious, yet they are still expressed in how the person behaves in relationships and in the world.

Many people who grow up in difficult life circumstances and who develop inaccurate and negative self-narratives (i.e., ones lacking in self-compassion) cannot appreciate the impact their experiences had on them. We all only know the lives that we have led, and cannot understand how things might have been (or still could be) different if our environments were different. As a result, we “take ourselves personally” and attribute our problems to “personal” or “global” causes. Such individuals may develop a self-narrative that asserts, “I am not intelligent,” rather than “Learning is difficult for me because lifelong depression has made it hard to concentrate and remember things.” The latter thought takes context into account, and thus is likely to be more realistic and compassionate. There is a saying that TA assessors often use to capture this issue: “A fish doesn’t know it is wet.” In short, our self-narratives are limited by our restricted perspectives. It is impossible for the individual above to know what learning would have been like if he had not been depressed. Moreover, these negative, personal narratives were often logical in the past because (1) they fit with the ...