“Why am I so stuck?”: A Collaborative/Therapeutic Assessment Case Discussion

Assessors from 3 continents worked together on a single multimethod case study. Their goal was to hold the client at the center and forefront of their attitudes and thinking as each assessor focused on a specific measure or group of measures. The adult client requested a neuropsychological assessment and completed a full battery of cognitive measures as well as the MMPI–2, the Rorschach, and the Wartegg. A basic tenet of collaborative/therapeutic assessment holds that the client is a full partner in the assessment process; he or she is also seen as the final arbiter of the usefulness of the ideas derived. With that in mind, the client worked with the lead assessor to create 6 questions she wished answered by the assessment. Feedback and discussion occurred in a number of ways: through discussion sessions with the lead assessor that included extended inquiry; individualized letters from the other assessors, each addressing her 6 questions; a summary letter from the lead assessor; and a metaphorical, therapeutic story that stressed key findings from the assessment. Results converged powerfully, with similar findings from each assessor. The client stated that she felt heard and understood in the process, even by individuals who she had never met personally.     

What Torture Survivors Teach Assessors About Being More Fully Human

This article illustrates the complex sociocultural components in the forensic psychological assessment of a young Ethiopian woman's claim for political asylum due to a well-founded fear of persecution and for relief under the Convention Against Torture. It draws attention to the subtle social and cultural influences in the practice of forensic psychological assessment with an emphasis of reflective practice, which is contextualized in the interpersonal theory of Sullivan. In the interpersonal approach, the essential work of the assessor is to pay careful attention to the microinteractions between the client and the assessor as reflections of the interpersonal (meaning social and cultural) processes, eschewing the illusion of objectivity.

In this case study, I illustrate the particular cultural dilemmas for client and assessor in conducting a forensic assessment of psychological trauma, including cross-cultural, gender, and legal difficulties in arriving at an informed, objective, and compassionate assessment of an individual seeking asylum after an especially brutal experience of torture. I argue that collaborative therapeutic assessment methods adapted for forensic practice offer an approach to assessment of psychological trauma that provides more accurate and compassionate assessment than so-called neutral standard forensic assessment practice.     

Existential Assessment

Present day psychological assessment stems from a philosophy of sicence that values objectivity but fails to comprehend the existence of the person being evaluated. A humanistic-existential model shifts the focus from omnipotence to encounter and encourages client responsibility. The vehicle for this conceptualization is the nature and meaning of the encounter between clinician and client. New questions are posed for the assessor by altering the assessment goals, the stance toward interpretation, and the criterion for validation.     

Crossing the cultural divide: issues in translation, mistrust, and cocreation of meaning in cross-cultural therapeutic assessment

This article examines cross-cultural therapeutic assessment in a community mental health clinic. The first case describes the work between a Caucasian assessor and a Mexican American family. The authors explore the metaphorical and literal translation of the findings from English to Spanish and the parallel process of translation of the self, experienced by both assessor and client. The second case describes the work between a Caucasian assessor and an African American adolescent. We describe the inherent challenge between the Eurocentric "task" orientation of the evaluation and the Afrocentric "relationship" orientation. We suggest that bridging the gap between cultures and overcoming cultural mistrust lay in the building of the assessor-client relationship. Fischer's concepts of rapport and intimacy are emphasized and expanded on as we emphasize the importance of cocreated meaning in cross-cultural assessment work.     

The Relevance of the Rorschach and Patient–Examiner Relationship in Treatment Planning and Outcome Assessment

In this era of evidence-based mental health care, traditional forms of depth-oriented psychotherapy and psychological assessment have been marginalized in graduate training in clinical psychology. As a counterpoint, this article presents the evaluation and treatment of an adolescent client, along with an outcome assessment, and illustrates ways that aspects of traditional psychological testing, including the Rorschach (Exner, 1986) and the patient–examiner relationship, can enhance psychodiagnosis and treatment planning. Additionally, this case illustrates ways that test data can illuminate the concept of underlying disturbance and its utility in diagnostic formulation, treatment planning, and outcome assessment.     

Optimism as an Indicator of Psychological Health: Using Psychological Assessment Wisely

Healthy aspects of psychological functioning are often overlooked in traditional psychological assessment. When this happens, the client may become discouraged with his or her testing results, or perhaps worse, may feel that the assessor was not interested in obtaining a complete picture of who he or she is. Assessing healthy aspects of psychological functioning can be problematic, however; adding new instruments that only speak to one aspect of psychological functioning is not practical. A system is proposed in which one aspect of healthy psychological functioning--optimism--can be assessed using a standard projective test. Use of this scale can aid the assessor in conceptualizing the client's functioning and can also be a helpful tool to draw on in the course of treatment.     

Optimism as an indicator of psychological health: using psychological assessment wisely.

Healthy aspects of psychological functioning are often overlooked in traditional psychological assessment. When this happens, the client may become discouraged with his or her testing results, or perhaps worse, may feel that the assessor was not interested in obtaining a complete picture of who he or she is. Assessing healthy aspects of psychological functioning can be problematic, however; adding new instruments that only speak to one aspect of psychological functioning is not practical. A system is proposed in which one aspect of healthy psychological functioning--optimism--can be assessed using a standard projective test. Use of this scale can aid the assessor in conceptualizing the client's functioning and can also be a helpful tool to draw on in the course of treatment.     

Therapeutic assessment of a man with "ADD"

In this article I present the first published complete case study of a psychological assessment done by the methods of Therapeutic Assessment. A client-therapist pair had been working together for several years but felt "stuck" in the treatment. The man had been previously diagnosed with attention deficit disorder (ADD) and sought help for disorganization and difficulties in romantic relationships. The therapist asked for diagnostic clarification but gradually revealed a deeper confusion about how to work with the client. Through the collaborative process of the assessment, the client gradually concluded that he did not have ADD, and he and the therapist reached a joint understanding of their next steps in treatment. This case illustrates how collaborative psychological assessment (a) can help clients revise their "stories about themselves and the world" and (b) provides an effective, non-threatening way for a consultant to intervene in a client-therapist system that has reached an impasse.     

Les représentations mentales de l’enfant chez les parents : situation,illustrations et réflexions sur les catalyseurs de changements en évaluation thérapeutique de l’enfant

Therapeutic assessment of the child (TA-C) is a model of psychological assessment that allows for collaborative work with parents and child on their reasons for consultation, a collaboration that breaks away from a traditional double separation (parent/assessor, and assessor/therapist) in child assessment. This paper, grounded in a contemporary psychodynamic viewpoint, presents clinical illustrations to support a conceptualization of change processes in TA-C. It is argued that, in order to revitalize empathy in parents, work focusing on the parents’ mental representation of their child is central. We propose a hierarchy of assessment/therapeutic goals that allows for a better distinction between TA-C and standard assessment in work with children.     

Family sessions as part of child psychological assessment: goals, techniques, clinical utility, and therapeutic value

Including a family session in a child assessment can significantly advance the assessor's and parents' understanding of the child's problems and enhance the likelihood that parents will follow through on recommendations after the assessment. A family session allows the assessor to observe the child in the family context, test systemic hypotheses, better understand the meaning of individual test results, and try out possible interventions. A family session may also help parents see systemic aspects of their child's problems, help the child feel less blamed, foster positive experiences among family members, and offer the family a glimpse of family therapy. We describe methods and techniques for structuring family sessions and offer guidance on preparing for and conducting such sessions depending on one's case conceptualization. Detailed case examples illustrate each technique and demonstrate the immediate and subsequent impact of family sessions as well as their therapeutic value. We also address common clinical and pragmatic issues.     

Developing a Culturally Sensitive Treatment Modality for Bilingual Spanish-Speaking Clients: Incorporating Language and Culture in Counseling

The article examines the role of language and culture in the mental health treatment of Hispanics. Although mental health practitioners and researchers have turned their attention to developing culturally sensitive therapeutic practices, an integrative framework is lacking. The proposed conceptual framework illustrates how the dimensions of acculturation, language dominance and preference, and cultural norms, values, and beliefs affect the assessment ofpsychological and physical health. Furthermore, a number of intervention strategies are described in a cultural context. This framework provides a meaningful method of developing an effective treatment program for the bilingual Spanish-speaking client.     

Cognitive-Behavioral Treatment of Depression with Comorbid Borderline Personality Traits

Personality dysfunction can influence the onset and maintenance of depressive symptoms. When both depression and personality dysfunction are present, it is important to develop an integrated treatment plan that addresses both conditions. A case example is used to illustrate how features of borderline personality disorder can influence the assessment and treatment of major depression. Specific challenges encountered by the therapist include: 1) differentiating borderline personality from depressive symptoms, 2) maintaining the therapeutic alliance, 3) managing impulsivity and self-destructive tendencies, 4) staying focused on long-term therapeutic goals, and 5) coping with noncompliance. Over the course of 27 sessions, the client was able to make positive changes in mood, self-image, and impulsive tendencies. Although the client's borderline personality traits complicated the course of treatment for depression, neglecting these personality problems would have left the client vulnerable to depressive relapse.     

Family Sessions as Part of Child Psychological Assessment: Goals,Techniques, Clinical Utility,and Therapeutic Value

Including a family session in a child assessment can significantly advance the assessor's and parents' understanding of the child's problems and enhance the likelihood that parents will follow through on recommendations after the assessment. A family session allows the assessor to observe the child in the family context, test systemic hypotheses, better understand the meaning of individual test results, and try out possible interventions. A family session may also help parents see systemic aspects of their child's problems, help the child feel less blamed, foster positive experiences among family members, and offer the family a glimpse of family therapy. We describe methods and techniques for structuring family sessions and offer guidance on preparing for and conducting such sessions depending on one's case conceptualization. Detailed case examples illustrate each technique and demonstrate the immediate and subsequent impact of family sessions as well as their therapeutic value. We also address common clinical and pragmatic issues.     

The practice of rational emotive and cognitive behavior therapy with offenders

The case for rational emotive behavior therapy (REBT) and cognitive behavior therapy (CBT) with offenders is reviewed. Philosophical and practical problems in conducting REBT assessment and treatment with this population are identified. Suggestions regarding offender treatment address goals and content of therapy, the therapeutic relationship, overcoming client resistance, and self-care for the practitioner. Therapists of offenders are encouraged to apply REBT to themselves to increase effectiveness and reduce risk. In this regard, clinicians are offered suggestions regarding accepting the offender, maintaining a goal-oriented focus, and taking responsibility for the quality but not the outcome of their work.     

Family Traditions,Cultural Values,and the Clinician's Countertransference: Therapeutic Assessment of a Young Sicilian Woman

Despite recent advances in models and instruments to understand the role of a client's cultural background, clinical psychologists are not immune to implicit cultural biases that are potentially damaging to the therapeutic alliance. In this article, I present a Therapeutic Assessment with a young Sicilian woman conducted in a university-based student clinic in Italy. During the assessment, I assumed that because we were both Italians, my client shared my perspective (northern Italian) about family and individual values, which resulted in a therapeutic impasse when I responded on the basis of my individual and culturally shaped view of interpersonal and family relationships without appreciating important differences between my own and my client's microcultures. To overcome the impasse, I had to openly acknowledge such differences and reorient myself to my client's goals. I discuss the core processes involved in such a repair in the context of a cross-cultural psychological assessment.     

A Cross-Contextual Construction of Clients' Therapeutic Practice

This study demonstrates how gathering data from a different context can significantly change how an object of study may be viewed. Data from a qualitative diary study of psychotherapeutic practice were used to construct a cross-contextual view of psychotherapy. Data about clients’ everyday lives as well as psychotherapy sessions were analyzed. Examples of how extra-therapeutic factors are significant to client change are presented. Six types of extra-therapeutic information sources that clients use to develop their personal stances while in therapy were identified. The case of one client's abundant use of extra-therapeutic sources of information offers a different construction of how psychotherapy works, emphasizing client activities outside sessions. The implications of the study for psychotherapy research are addressed.     

Testing and Assessment Issues With Spanish‐English Bilingual Latinos

This article critically examines and integrates previous research in cross‐cultural and cross‐linguistic assessment. Issues that apply to the assessment of Latinos who speak both Spanish and English are examined. For ease of presentation, testing concerns with this population are divided into 3 broad areas: client issues, test issues, and clinician/assessor issues. Recommendations are made to assist in the provision of cross‐culturally and cross‐linguistically valid testing of Spanish‐English bilingual Latinos.     

Strategies for Securing Commitment to Treatment from Individuals Diagnosed with Borderline Personality Disorder

Individuals diagnosed with borderline personality disorder (BPD) are notoriously difficult to engage in treatment. The purpose of this paper is to highlight therapeutic strategies that are likely to facilitate early alliance in therapy with individuals diagnosed with BPD. The seven strategies include, collaborative assessment, the use of contracts, motivational interviewing, linking treatment targets to client goals, commitment strategies, validation, and the use of metaphors. Clinical vignettes are presented to elucidate the concepts described and demonstrate their use in clinical practice.     

A service-delivery paradigm for personality assessment

This paper describes a human science approach to the delivery of the feedback component of assessment services. The feedback process is now central to a collaborative assessment that is integrated with intervention. Research has suggested that subject, situational, and assessor variables are relevant for feedback, but such research has been unsystematic. A service-delivery paradigm for feedback of assessment findings is described that includes four levels of increasing client participation: information, emotional contingencies, transfer of power, and functioning of an assessment system. Communication of assessment findings has been incomplete historically because motivation for feedback, resource accessibility for feedback utilization, and criteria for adequate feedback have been considered as unrelated ingredients. The components of Antonovsky's Sense of Coherence construct--meaningfulness, manageability and comprehensibility--provide one conceptualization for interaction of these ingredients. It is now feasible to do systematic research on assessment that includes feedback of assessment findings and the service-delivery process.