Psychological Assessment As A Treatment Intervention

The use of psychological assessment as an adjunct to or means of therapeutic intervention in and of itself has received more than passing attention during the past several years (e.g., Butcher, 1990; Clair & Prendergast, 1994). Therapeutic assessment with the MMPI-2 has received particular attention primarily through the work of Finn and his associates (Finn, 1996a, 1996b; Finn & Martin, 1997; Finn & Tonsager, 1992). Finn's approach appears to be applicable with instruments or batteries of instruments that provide multidimensional information relevant to the concerns of patients seeking answers to questions related to their mental health status. The approach espoused by Finn will thus be presented here as a model for deriving direct therapeutic benefits from the psychological assessment experience.

What Is Therapeutic Assessment?

In discussing the use of the MMPI-2 as a therapeutic intervention, Finn (1996b) describes an assessment procedure whose goal is to "gather accurate information about clients . . . and then use this information to help clients understand themselves and make positive changes in their lives" (p. 3). Simply stated, therapeutic assessment may be considered an approach to the assessment of mental health patients in which the patient is not only the primary provider of information needed to answer questions but also actively involved in formulating the questions that are to be answered by the assessment. Feedback regarding the results of the assessment is provided to the patient and is considered a primary, if not the primary, element of the assessment process. Thus, the patient becomes a partner in the assessment process; as a result, therapeutic and other benefits accrue.

The Therapeutic Assessment Process

Finn (1996b) has outlined a three-step procedure for therapeutic assessment using the MMPI-2 in those situations in which the patient is seen only for assessment. It should work equally well with other multidimensional instruments and with patients the clinician later treats.

Step 1: The Initial Interview

According to Finn (1996b), the initial interview with the patient serves multiple purposes. It provides an opportunity to build rapport, or to increase rapport if a patient-therapist relationship already exists. The assessment task is presented as a collaborative one. The therapist gathers background information, addresses concerns, and gives the patient the opportunity to identify questions that he or she would like answered using the assessment data. Step 1 is completed as the instrumentation and its administration are clearly defined and the particulars (e.g., time of testing) are agreed upon.

Step 2: Preparing for the Feedback Session

Upon the completion of the administration and scoring of the instrumentation used during the assessment, the clinician first outlines all results obtained from the assessment, including those not directly related to the patient's previously stated questions. This is followed by a determination of how to present the results to the patient (Finn, 1996b). The clinician must also determine the best way to present the information to the patient so that he or she can accept and integrate it while maintaining his or her sense of identity and self-esteem.

Step 3: The Feedback Session

As Finn (1996b) states, "The overriding goal of feedback sessions is to have a therapeutic interaction with clients" (p. 44). This begins with the setting of the stage for this type of encounter before the clinician answers the questions posed by the patient during Step 1. Beginning with a positive finding from the assessment, the clinician proceeds first to address those questions whose answers the patient is most likely to accept. He or she then carefully moves to the findings that are more likely to be anxiety-arousing for the patient or challenge his or her self-concept. A key element to this step is to have the patient verify the accuracy of each finding and provide a reallife example of the interpretation that is offered. Alternately, the clinician asks the patient to modify the interpretation to make it more in line with how the patient sees him- or herself and the situation. Throughout the session, the clinician maintains a supportive stance with regard to any affective reactions to the findings.

Additional Steps

Finn and Martin (1997) indicate two additional steps that may be added to the therapeutic assessment process. The purpose of the first additional step, referred to as an assessment intervention session, is essentially to clarify initial test findings through the administration of additional instruments. The other additional step discussed by Finn and Martin (1997) is the provision of a written report of the findings to the patient.

Empirical Support for Therapeutic Assessment

Noting the lack of direct empirical support for the therapeutic effects of sharing test results with patients, Finn and Tonsager (1992) investigated the benefits of providing feedback to university counseling center clients regarding their MMPI-2 results. Thirty-two participants underwent therapeutic assessment and feedback procedures similar to those described above while on the counseling center's waiting list. Another 28 participants were recruited from the same waiting list to serve as a control group. Instead of receiving feedback, Finn and Tonsager's (1992) control group received nontherapeutic attention from the examiner. However, they were administered the same dependent measures as the feedback group at the same time that the experimental group received feedback. They were also administered the same dependent measures as the experimental group two weeks later (i.e., two weeks after the experimental group received the feedback) in order to determine if there were differences between the two groups on those dependent measures. These measures included a self-esteem questionnaire, a symptom checklist (the SCL-90-R), a measure of private and public self-consciousness, and a questionnaire assessing the subjects' subjective impressions of the feedback session.

The results of Finn and Tonsager's (1992) study indicated that compared to the control group, the feedback group demonstrated significantly less distress at the two-week postfeedback follow-up and significantly higher levels of self-esteem and hope at both the time of feedback and the two-week postfeedback follow-up. In other findings, feelings about the feedback sessions were positively and significantly correlated with changes in self-esteem from testing to feedback, both from feedback to follow-up and from testing to follow-up among those who were administered the MMPI-2. In addition, change in level of distress from feedback to follow-up correlated significantly with private self-consciousness (i.e., the tendency to focus on the internal aspects of oneself) but not with public self-consciousness.

M. L. Newman and Greenway (1997) provided support for Finn and Tonsager's findings in their study of 60 Australian college students. Clients given MMPI-2 feedback reported an increase in self-esteem and a decrease in psychological distress that could not be accounted for by their merely completing the MMPI-2. At the same time, changes in self-esteem or symptomatology were not found to be related to either the level or type of symptomatology at the time of the first assessment. Also, the clients' attitudes toward mental health professionals (as measured by the MMPI-2 TRT scale) were not found to be related to level of distress or self-esteem. Their results differed from those of Finn and Tonsager in that general satisfaction scores were not associated with change in self-esteem or change in symptomatology, nor was private self-consciousness found to be related to changes in symptomatology. Recognizing the limitations of their study, Newman and Greenway's recommendations for future research in this area included examination of the components of therapeutic assessment separately and the use of different patient populations and different means of assessing therapeutic change (i.e., use of both patient and therapist/third party report).

Overall, the research on the benefits of therapeutic assessment is limited but promising. The work of Finn and others should be extended to include other patient populations with more severe forms of psychological disturbance and to reassess study participants over longer periods of follow-up. Moreover, the value of the technique when used with instrumentation other than the MMPI-2 warrants investigation.

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