Therapeutic Assessment

ASSESSMENT AS AN INTERVENTION: The Real Opportunity of Psychological Assessment (white paper)
Parth Gandhi, Ph.D., 2012 

Intent:  
- To clarify the greater purpose and opportunity associated with assessment (Intervention)
- To clarify that Psychologists and Neuropsychologists are best qualified to conduct assessments
- To describe a “gold” standard for testing, report writing, and feedback intervention
- To recommend best practice guidelines in the delivery of feedback (increase reliability)

Thesis:
Psychological Assessment has the potential to be a therapeutic process when incorporated into a multidisciplinary model.  1) Accurate Assessment performed by 2) Competent Clinicians can result in 3) Interventional Feedback with 4) Prescriptive Protocols. Assessment is most often used to clarify diagnosis and guide treatment, but when carried out in accordance with PTS standards, it can also increase client motivation, positively affect the therapist-client relationship, and thereby decrease client sessions in psychotherapy.

In 1997, Finn and Tonsager noted that psychological assessment had suffered considerable declines in use as well as status. They suggested that curtailed training, questionable practices, and in-fighting among psychologists boded further decline, and argued for research and reform to preserve this area of psychological expertise (Finn & Tonsager, 1997). Since then, a number of authors have sounded similar alarms. For instance, Poston and Hanson (2010) argued that assessment and testing practices are “at a pivotal point in their history” and must be helped to survive through research on their validity and clinical utility (p. 211). Such statements underscore the depth of the crisis as well as the necessity of action. There is a growing need for psychologists to unite in clarifying the purposes, advantages, and standards of quality assessment in order to safeguard the reputation of the field and ensure that clients continue to benefit from what psychological assessment can offer.

In the first place, we must adhere—and in some cases recommit—to high ethical and professional standards of psychological assessment. As noted above, some of the problems are “in house.” A short list might include inadequate training in the administration and interpretation of tests, indiscriminate administration of large test batteries, rushed or mechanical interviews, over-reliance on generic computer-generated output, and limited discussion of results with clients (Finn & Tonsager, 1997; Meier, 1994). At best, such issues represent sterile impersonal procedures that fail to consider the client as a unique individual. At worst, they constitute serious ethical violations. As psychologists, we must rigorously ensure that our assessment activities are grounded in adequate training, informed by current research, and carried out according to the standards of excellence that our field demands. (I guess this could lead into a discussion of best practices in terms of report writing and stuff, but it might also interrupt the flow.)

Continued adherence to (and refinement of) our own standards and best practices will maximize the precision and utility of the psychological assessments we conduct, enhancing our interactions in both public and professional arenas and facilitating greater incorporation of assessment into a multidisciplinary model of care. Indeed, psychological assessment will survive and thrive so long as its unique strengths are accurately characterized and communicated to others, particularly our nonpsychologist colleagues and those whom we seek to serve.

Therapeutic assessment
Consistent with these goals, a number of psychologists and researchers have promoted a paradigmatic shift in our approach to conducting assessments and investigating their clinical utility. At the heart of this movement is the notion of assessment as an intervention, with potential to not only clarify diagnosis and guide treatment planning, but also provide appreciable therapeutic benefit. This notion of assessment provides a framework for conceptualizing, studying, and implementing assessment procedures that goes beyond a mere information-gathering model (Finn & Tonsager, 1997; Fischer, 2000; Gorske, 2008).

History and Development Section

1. Specific models
a. Therapeutic assessment (http://www.therapeuticassessment.com)
b. Collaborative individualized assessment (http://www.collaborativepsychology.com/services-therassess.html)

2. Commonalities among these (client-centered values: empathy, information-sharing, and client involvement at all phases of assessment)
See Gorske (2008) 

Integration with therapeutic models
Many authors have endorsed an integrative mindset, discussing the similarities between therapy and assessment. For instance, Clair and Pendergast (1994)

Brief therapy principles applied to assessment:
1.  Entering a relationship
2.  Establishing a focus
3.  Providing feedback

Psychologists have also incorporated and investigated these ideas within a family systems approach. (Examples: Child assessment—Tharinger, 2007, Couples assessment—Worthington et al.,1995) These integrative approaches suggest plausible benefits:

1. Support for dual-diagnosis clients)
2. Helping involved parties move past blaming by providing an explanation for/understanding of the problem (where we are, how we got here, where we’re going)

Feedback and Collaboration
Most empirical studies have focused on the effects of providing individualized feedback to clients and have yielded encouraging results relative to treatment processes, client variables such as self-esteem and optimism, and symptom reduction. For instance…

Development of rapport and therapeutic alliance (Ackerman et al., 2000; Allen et al., 2003; Hilsenroth et al., 2004)
Indeed, a recent meta-analysis of related research suggests that the most beneficial psychological assessment procedures involve a high degree of collaboration and personalized feedback (Poston & Hanson, 2010).

Ethical considerations
As this approach to assessment is further developed and refined, it will be important to address associated ethical consideration:

  1. Informed consent—how would it need to be couched/presented to the client? (What are the risks of therapy?)
  2. Overlap of roles (therapist and evaluating psychologist)
  3. Collaboration with therapist—In cases where the client is already working with a therapist, the above issues may be easier to navigate. For instance, the therapist could help create assessment questions, provide interview data, and participate in the feedback and follow-up sessions.

Need for Outcome Research 


Conclusion

A psychological evaluation represents the potential for a golden opportunity to initiate client change, especially if sophisticated testing procedures are combined with therapeutic knowledge, skill, and sensitivity.

Gold Standard

Customer-service orientation—concierge-level service (Not sure if you want to address this along the way or lead up to it as more of a conclusive point/ideal/recommendation).

 

Collaboration, competence, accuracy, follow-through, quick turnaround/prompt feedback, follow-up on recommendations. Enhanced trust and openness


References

Ackerman, S. J., Hilsenroth, M. J., Baity, M. R., & Blagys, M. D. (2000). Interaction of therapeutic process and alliance during psychological assessment. Journal of Personality Assessment, 75, 82-109.

Allen, A., Montgomery, M., Tubman, J., Frazier, L., & Escovar, L. (2003). The effects of assessment feedback on rapport-building and self-enhancement processes. Journal of Mental Health Counseling, 25, 165-181.

Clair, D. & Pendergast, D. (1994). Brief psychotherapy and psychological assessments: Entering a relationship, establishing a focus, and providing feedback. Professional Psychology: Research and Practice, 25, 46-49.

Clay, R. A. (2006). Assessing assessment: Psychological assessment enjoys new respect, applications and approaches. Monitor on Psychology, 37, 44 (http://www.apa.org/monitor/jan06/assessment.aspx)

Finn, S. E., & Tonsager, M. E. (1997). Information-gathering and therapeutic models of assessment: complementary paradigms. Psychological Assessment, 9, 374-385.

Fischer, C. T. (2000). Collaborative, individualized assessment. Journal of Personality Assessment, 74, 2-14.

Gorske, T. T. (2008). Therapeutic neuropsychological assessment: A humanistic model and case example. Journal of Humanistic Psychology, 48, 320-339. (Turns out I had been spelling Gorske wrong in my lit searches. This article seems like a great find. For the first few pages, it almost follows the outline we made! I’m working my way through it, and I sent you a copy.)

Gorske, T. T. & Smith, S. R. (2009). Collaborative therapeutic neuropsychological assessment. New York, NY: Springer Science + Business Media.

Hayes, S. C., Nelson, R. O., & Jarrett, R. B. (1987). The treatment utility of assessment: A functional approach to evaluating assessment quality. American Psychologist, 42, 963-974.

Hilsenroth, M. J., Peters, E. J., & Ackerman, S. J. (2004). The development of therapeutic alliance during psychological assessment: Patient and therapist perspectives across treatment. Journal of Personality Assessment, 83, 332-344.

Michel, D. M. (2002). Psychological assessment as a therapeutic intervention in patients hospitalized with eating disorders. Professional Psychology: Research and Practice, 33, 470-477.

Poston, J. M. & Hanson, W. E. (2010). Meta-analysis of psychological assessment as a therapeutic intervention. Psychological Assessment, 22, 203-212.

Tharinger, D. J. (2007). Therapeutic assessment with a child as a family intervention: a clinical and research case study. Psychology in the Schools, 44, published online in Wiley InterScience (www.interscience.wiley.com).

Ward, R. M. (2008). Assessee and assessor experiences of significant events in psychological assessment feedback. Journal of Personality Assessment, 90, 307-322.