Overview of Therapeutic Assessment

What is the format of a Therapeutic Assessment?

    The semi-structured format of Therapeutic Assessment varies slightly depending on the type of client assessed, but assessments generally involve the following steps. (Not all steps are used in every assessment.)
Initial Sessions
    In the initial session, clients meet with the assessor to define the contract for the assessment. The assessor assists clients in formulating questions—in their own words—of what they wish to learn from the assessment. Most questions concern persistent problems, puzzles, or dilemmas the clients face, such as “Why have I never had an intimate relationship for longer than two months, although I’m very successful in other areas of my life?” or “Why does our daughter have such problems concentrating in school?” As each question is gathered, the assessor collects background information and evaluates the client’s current understanding of a problem. The assessor and client also discuss and negotiate practical aspects of the assessment, such as cost, duration, confidentiality, and to whom the results will be reported.
Standardized Testing Sessions
    Following the initial session, the assessor selects standardized psychological tests that are relevant to the client’s presenting concerns, and the client and assessor meet one or more times to complete these tests. In most cases, each test is administered first according to standardized procedures, so the clients’ test performance may be compared to established norms. Then, following the standardized administration, the assessor invites clients to observe, reflect on, and hypothesize about their test responses, especially if those responses bear upon the problems clients asked about in their initial assessment questions.

Many different types of standardized tests are used in Therapeutic Assessment, including tests of intellectual and cognitive abilities, personality tests, and career/interest inventories.

Assessment Intervention Sessions
    In assessment intervention sessions, the assessor employs non-standardized tests, standardized tests in novel ways, or techniques such as role-plays, psychodrama, or drawing, to further explore with clients hypotheses developed from the standardized test scores. For example, the client who asked about not succeeding at intimate relationships might appear on standardized testing to be highly cynical and distrustful of others. The assessor might ask the client to tell stories to TAT cards depicting people in relational situations. If a number of the client’s stories had themes of cynicism, the assessor could help the client observe this trend, and then explore the source and reasons for the client’s distrust. The assessor might even invite the client to tell a story of someone trusting another person, to see how the client responded. Assessment intervention sessions can help clients discover answers to their own assessment questions—one of the main goals of collaborative psychological assessment. Finn (2007) has likened this process to helping clients revise and edit their existing “stories” about themselves and the world. In child and family assessments, assessment intervention sessions often involve the whole family (Tharinger, Finn, Austin, Gentry, Bailey, Parton, & Fisher, 2008).
Summary/Discussion Sessions
    In these sessions, clients and assessors meet to review the test results and discuss their implications for the problems in living reflected in the client’s assessment questions. Assessors talk about what test scores are believed to mean--based on normative data and research--and clients are asked if these hypotheses “fit” their own experience and understanding. Assessors carefully plan how assessment results are presented to clients, drawing upon research on this topic and on their empathic understanding of clients. By the end of the summary/discussion sessions, assessors and clients ideally will have constructed joint “answers” to the clients’ assessment questions, and end by discussing next steps clients can take to move beyond their persistent problems.
Written Feedback
    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. Typically, this summary is in the form of a letter directly addressed to the client. In some instances, the assessor may write a more formal psychological report, to be shared with a hospital, school, or other agency. Even then, however, the test results are explained in plain language and the client is given a copy of the written report. Finally, clients are invited to comment on or 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 growth steps for them and their families to take. Tharinger, Finn, Wilkinson, DeHay, Parton, Bailey, and Tran (2008) have described in detail how to write feedback fables for children.
Follow-up Sessions
    One to two months after the summary/discussion session, clients are invited to meet with the assessor again, to discuss the written summary and any recommendations, and reflect again on what they have learned from the psychological assessment. It is believed that this meeting helps clients consolidate what they learned and experienced during the assessment.