Steps in therapeutic assessment
The following format of steps for therapeutic assessment were developed by Stephen Finn, Ph.D. and his colleagues at the Center for Therapeutic Assessment in Austin, Texas:
Step 1: Initial Session with client(s)
The process of therapeutic assessment begins with the first contact by phone between the assessor and the client. In this contact, the client is asked to bring questions with him or her to the initial session, questions he or she wants to have answered by the assessment. A form is mailed to the patient or family giving information about the process of therapeutic assessment, and directions to my office. If a professional is referring the client or family for therapeutic assessment, the assessor speaks with the professional before the first session, to elicit questions and background information from that professional.
In the initial session, the client and the assessor meet to discuss the goals, context, and the procedures of the assessment. If the client or family have been referred by another professional, the assessor reveals (with that professional’s permission) the questions that the referring professional hopes will be answered by the assessment process.
The assessor helps clients to develop questions – in their own words- of what they want to learn from the assessment. Questions most often concern persistent problems, puzzles or dilemmas the clients face, such as “Why do I have such trouble having a successful intimate relationship, despite my success in other areas of my life?” or ‘Why does our son have so much difficulty succeeding in school?’
As each question is developed, the assessor collects background information and evaluates the client’s current understanding of the problem.
Practical aspects of the assessment are discussed (the cost, the number of sessions, who will receive the assessment results, etc.). The client has an opportunity to ask questions about the assessment process.
If the client is a child or adolescent, the procedure is somewhat different. If the client is a child, the initial session is with the child’s parents, who help to formulate questions for the assessment. If the child is an adolescent, the first meeting is with the adolescent and the parents together, followed by a meeting between the adolescent and the assessor separately. The adolescent and his or her parents can formulate their own questions. Generally, all of the parents’ questions are known to the adolescent, but the adolescent can have his or her own private questions, and will have private feedback before the parents receive feedback. Experience has shown that this process, which respects the adolescent’s need for autonomy, works best.
In initial sessions and throughout the assessment, the model is for the assessor and the client to act as collaborators who formulate and jointly answer the assessment questions.
Step 2: Client Completes Standardized Psychological Testing
In one or more sessions, standardized psychological tests are administered, using standardized procedures. There is no predetermined battery of tests. Rather, which tests are administered is determined by the nature of the client’s (and referring professional’s) questions for the assessment. Many different types of standardized tests are used in therapeutic assessment, including tests of intellectual and cognitive abilities, personality tests, and career and interest inventories. For example, clients who ask if they have a learning disability will be given intellectual and achievement testing. Clients asking questions about their emotional and interpersonal functioning will be given personality tests (for example, with adults, the MMPI-2 and Rorschach tests).
The adult or adolescent client is told how each test administered is relevant to the questions for the assessment. During the assessment, the client’s response to the tasks employed is solicited, especially those reactions which are relevant to the questions for the assessment. Such opportunities for dialogue during the assessment are useful helping me to understand the client’s behavior and test scores. As Stephen Finn has observed, the method of therapeutic assessment is for the psychologist to get in “our client’s shoes.”
It is best to break the assessment into once-or-twice weekly sessions of one-and-a-half to two hours, so that clients are not overtired and are better able to actively collaborate in the process of therapeutic assessment.
In assessments of children, their parents sometimes observe the child’s testing.
Step 3: Assessment Intervention Session(s)
In this step, I employ non-standardized tests, standardized tests used in novel ways, or techniques such as role-plays, psychodrama, or drawing, to further explore hypotheses developed from the standardized testing.
The main idea of assessment intervention sessions is to bring the client’s problems-in-living into the room, to evoke and to help with the experiences or problems that led to the need for, and the questions for, the assessment.
Assessment intervention sessions can help clients discover the answer to their own assessment questions.
As Stephen Finn has written, assessment interventions helps clients to “rewrite” their own stories about themselves and their worlds, rather than (as in traditional assessment) revisions being suggested by the “expert” assessor at the end of their assessment. Concepts that come across as dry and intellectual when tied to formal test scores become vivid and alive when evoked, enacted, and addressed in a helpful manner in the assessment intervention session. Solutions to the client’s problems can be developed in this context, and opportunities are provided to more adaptively address these problems in the outside world.
In child and family assessments, assessment intervention sessions often involve the whole family.
Step 4: Summary/Discussion Session(s)
In these sessions, clients and assessors meet to review the test results and to discuss their implications for the problems in living reflected in the client’s assessment questions. Assessors discuss what test scores are believed to mean- based upon the normative data and research- and clients are asked if these hypotheses fit their own experience and understanding. Through this dialogue, the meaning of test findings are reached. The client is asked to agree, disagree, revise, and give real-life examples to help us to refine the meanings of the assessment findings. By the end of these sessions, joint “answers” to the clients’ assessment questions are constructed, and the discussion proceeds to steps clients can take to move beyond their persistent problems.
Step 5: Written Feedback is Provided
Shortly after the summary/discussion session (s), the assessor sends the client a written summary of the assessment results, including the jointly developed answers to the client’s questions. This summary is typically in the form of a letter addressed to the client. In some cases, the assessor may write a more formal psychological report to be shared with a school, hospital, or other agency. Even then the results are explained in plain language, and the client is given a copy of the written report. Clients are invited to comment on or to correct the written summary and to give feedback to the assessor about their experience of the assessment.
Young children are typically given feedback about an assessment in the form of a fable, written specifically for them, which describes the results in metaphor, and lays out the growth steps for them and their families to take.
Step 6: Follow-up Session(s)
Many people find it useful to meet again with the assessor 4 to 8 weeks after the summary/discussion session, to talk more about their assessment, and to discuss any questions or developments which have come up. It is my belief that such sessions help the client to consolidate what he or she has learned or experienced during the assessment. Recommendations can be fine-tuned in such follow-up visits.
With children, the follow-up session is typically with the parents alone. With adolescents, the follow-up session is typically with the parents and the adolescent together.