PSYCHOLOGICAL ASSESSMENT -- PURPOSE, PROCESS, PRINCIPLES

PURPOSES

How is Therapeutic Assessment different from other types of psychological assessment?

Therapeutic Assessment is a paradigm in which psychological testing is used to help people understand themselves better and find solutions to their persistent problems. Therapeutic Assessment differs from traditional psychological assessment, whose main goal is to diagnose disorders, plan treatments, and evaluate the effectiveness of interventions; Therapeutic Assessment can serve all these purposes as well, but its primary goal is to facilitate positive changes in clients.

Therapeutic Assessment is a semi-structured approach developed by Stephen Finn and his colleagues at the Center for Therapeutic Assessment in Austin, Texas, which has been shown in a series of research studies to have a positive impact on clients. The term “therapeutic assessment” has also been used descriptively to refer to an attitude toward psychological assessment where the assessor intends to be helpful to clients. Finn and Tonsager (1997) -- [LINK] -- contrasted therapeutic assessment and traditional (information-gathering) assessment on a number of dimensions. Therapeutic Assessment has incorporated techniques of collaborative psychological assessment, an approach to psychological assessment based in humanistic and human-science psychology, where the power differential between the client and assessor is reduced as much as possible, and clients and assessors work together to understand clients’ life problems and explore new ways of thinking and being. Collaborative assessment techniques were not initially recognized as promoting therapeutic change, but have been integrated into Therapeutic Assessment because they have been found to be essential to its therapeutic impact.

In Therapeutic Assessment clients are involved in all parts of an assessment, from determining its goals, discussing the possible meanings of test results, preparing written summaries, and disseminating results to other professionals. Therapeutic Assessment can be used with many types of clients: inpatients, outpatients, adult individuals, couples, young children, adolescents, families, and business or work groups. Generally Therapeutic Assessment is most suited for clients being assessed voluntarily, but its usefulness in other assessment contexts (e.g., forensic or employment-screening situations) is currently being explored.

There has been some debate in the literature as to whether or not Therapeutic Assessment procedures are consistent with evidence-based practice, and thus, in the United States at least. whether or not such services are compensable by medical insurance companies:

In a recent article in this journal, Poston and Hanson (2010) reported a meta-analysis of 17 studies on the use of psychological assessment as a therapeutic intervention (PATI) and concluded that "psychological assessment procedures--when combined with personalized, collaborative, and highly involving test feedback--have positive, clinically meaningful effects on treatment" (Poston & Hanson, 2010, p. 203). Although extant data suggest that PATI can sometimes exert positive effects, Poston and Hanson's (2010) meta-analysis may overstate the magnitude of these effects because the authors (a) included several studies that combined assessment with treatment components that are irrelevant to PATI, sometimes rendering it impossible to attribute any observed effects to PATI per se and (b) excluded numerous nonsignificant results. Moreover, the studies Poston and Hanson (2010) reviewed neglected to rule out Barnum effects as alternative explanations for client improvement, raising the possibility that PATI works for reasons other than those proposed by its advocates. We conclude that Poston and Hanson's (2010) review leaves a number of lingering questions concerning the treatment utility of PATI unanswered.

Lilienfeld, Garb, and Wood (2011) commented on our recently published meta-analysis (Poston & Hanson, 2010). In their thorough, fine-grained critique, they questioned the study's inclusion criteria, sampling, and results, suggesting the latter are “overstated” (p. 1048). Additionally, they discussed the Barnum effect, suggesting that it accounts, at least partially, for the potential efficacy and/or effectiveness of psychological assessment as a therapeutic intervention (PATI). In addressing Lilienfeld et al.'s (2011) concerns, we incorporate their suggestions and present new findings based on the original data set, including 15 independent and 56 dependent effect sizes (ESs). Upon reanalysis, a comparable, significant overall Cohen's d ES of 0.403 (95% CI [0.302, 0.503]) was found, thus building confidence in our original results, as well as the overall efficacy of PATI. Given PATI's potential treatment utility, we mention possible change mechanisms, above and beyond Barnum effects. And finally, in hopes of launching the field forward, we offer suggestions for future research and collaboration.