Opportunity in Assessment: Benefits of Therapeutic Assessment

This week's blog was contributed by Sierra Iwanicki, PhD. Sierra is a clinical psychologist and project director in the research and development department at PAR.

In the mid-20th century, humanistic psychology emerged in direct response to perceived limitations of psychoanalysis and behaviorism. Contrary to those earlier theories, humanism focused on the individual as a whole person, with the cardinal belief that perceived experiences fundamentally shaped us as human beings. In the 1940s and 1950s, clinicians began to encourage the collaborative use of projective instruments (e.g., drawings, Rorschach, TAT) to develop insight with clients.

A few decades later, clinicians began to write about the use of psychological assessment within a humanistic frame. Ray A. Craddick criticized the approach of treating a person primarily as a series of building blocks of traits, factors, habits, etc. [calling] the separation of man into parts antithetical to both the humanistic tradition and to personality assessment. Drawing from a phenomenological perspective, researchers like Constance Fischer first wrote about the testee as a co-evaluator, and later articulated a model of collaborative, individualized psychological assessment. In subsequent years, clinicians continued to write about the therapeutic benefits and collaborative approaches of assessment.

In 1993, Stephen Finn coined the term therapeutic assessment to describe a semi-structured, systemized method for using assessment in a collaborative, therapeutic fashion. Since then, he and psychologists like Constance Fischer and others have promoted collaborative methods to conduct assessments.

According to Finn and colleagues, defining elements of collaborative and therapeutic assessment include:

• Having respect for clients (e.g., providing them with comprehensible feedback)
• Taking a relational view of psychological assessment (e.g., acknowledging the vulnerability of clients in the assessment situation)
• Maintaining a stance of compassion and curiosity rather than judgment and classification (e.g., fully understanding clients in all their complexity, not just summarizing them in terms)
• Having a desire to help clients directly (e.g., not just providing helpful information to other stakeholders)
• Taking a special view of tests (e.g., viewing tests as tools and results as ways to understand and help clients)
• Staying flexible (e.g., conducting a home visit as part of an assessment)

Fast forward to 2021: A multidisciplinary database search yielded more than 4,000 peer-reviewed journal articles related to psychological assessment as a therapeutic intervention, therapeutic assessment, or collaborative assessment. However, Kamphuis et al. note that the treatment utility of assessment has long been controversial, stipulating a broader view of relevant outcome metrics, more powerful research designs, and use of stepped assessment, taking into account the complexity of the patient's psychopathology. Nevertheless, there is consensus that therapeutic assessment tends to yield more useful psychological assessment data as well as increase the effectiveness of assessment feedback.

In fact, a meta-analysis found the therapeutic benefits of individualized feedback following psychological assessment yielded a notable effect size of .42. More recently, a meta-analysis compared well-defined therapeutic assessment compared to other forms of intervention and showed three areas where it was superior: 1) decreasing symptoms (effect size .34), 2) increasing self-esteem (effect size .37), and 3) fostering therapeutic alliance and engagement and satisfaction with treatment (effect size .46). Overall,

research has shown that collaborative and therapeutic assessment is effective for adults, couples, children, adolescents, and families. According to the Therapeutic Assessment Institute, more than 35 studies have demonstrated that collaborative/therapeutic assessment is generally effective at improving outcomes for a wide range of clients with diverse clinical problems across various settings.

The Therapeutic Assessment Institute was formed in 2009 to promote and coordinate training in Therapeutic Assessment. Learn more.