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.
This week’s blog was contributed by Maegan Sady, PhD, ABPP-CN. Maegan is a project director in PAR’s research and development department in addition to being a licensed psychologist and board-certified neuropsychologist. She worked as a pediatric neuropsychologist for nearly a decade before joining PAR.
As we emerge from the pandemic, the need for flexibility in assessment is here to stay. The only way to begin to combat socioeconomic and technological disparities is to offer more options, but how do we do it? Several themes on flexible assessment have emerged from what we learned during the pandemic, and PAR is ready to help.
Many psychologists have adopted a hybrid, in-person/telehealth assessment model, necessitating careful deliberation over personal and professional implications. Which tests can be given remotely, and what evidence is needed to make that decision? Which clients are a good fit for teleassessment? Which tests can be given while wearing personal protective equipment (PPE)? If we sit six feet away from our client, how do we indicate where to start on the response page? How do we assess patients who cannot travel and do not have high-speed internet? In essence, how can we answer every referral question without compromising our ethical obligations to our tests, our patients, and each other?
Thankfully, timely guidelines emerged from the American Psychological Association; the Inter Organizational Practice Committee, which focuses on neuropsychology; and a new book, Essentials of Psychological Tele-Assessment. More recently, journal articles are beginning to present viable models for teleassessment and hybrid practice, both generally and for special populations (e.g., older adults, pediatric medical patients, historically underserved populations). Evidence is building that testing remotely or with PPE can be valid for many tests and within many populations. A few articles even address the impact of teleassessment on trainees, with recommendations for supervisors.
Digital tools are more flexible
Whether you’re testing someone face-to-face, from the next room, or fully remotely, electronic materials make life easier. Digital versions of more than 150 test manuals allow you to access administration and normative information from your home office and clinic any day of the week. Digital stimulus books, available for some of PAR’s most popular tests, allow you to cut back on the number of items you’re transporting and cleaning. They also make it easier to switch to a new test in the moment. To provide full remote administration options, we modified or specially designed eight performance-based tests for remote administration, and indirect evidence supports the remote utility of multiple others.
To use these tools most effectively, you can find white papers and video demonstrations for digital and remote administration on our website. Our digital materials do not confine you to a single device type, and our E-stimulus books do not require Wi-Fi or Bluetooth.
Screening as a model of care
With longer waitlists, pressure to assess more patients in less time, and more complex presenting problems, screening approaches are becoming more valuable. Screening can assist with triage, and doing so within a telehealth format has been shown to reduce wait times, increase satisfaction, and lead to more timely intervention and referral. Questionnaire-only assessment can be an efficient way to make treatment recommendations for patients with primarily emotional or behavioral concerns. More than 60 rating scales are available on PARiConnect as well as in print, meaning this evaluation approach can save time whether it’s executed remotely or in-person.
Screening in the context of a full evaluation allows you to cover more domains in less time. With 15 screeners/short forms of rating scales available on PARiConnect and several more in print, you can quickly add a measure of suicide risk, substance abuse, trauma, or depression to your battery. You can also use one of our performance-based screening tests to efficiently determine whether mental status, intellectual ability, or academic performance requires a closer look.
New presenting problems
In addition to new formats, testing is also changing in terms of content. Psychologists know all too well that the past two years have magnified or introduced multiple forms of stress and trauma, including anxiety, grief, effects of systemic racism, and food and housing insecurity. As a result, experiences of PTSD, depression, substance abuse, and parenting stress have increased. Adding a few extra measures to your test library is a good way to ensure you’re able to assess for a wide range of presenting issues.
With new procedures come new potential threats to validity. Practitioners must consider the integrity of testing remotely, in PPE, and under the general stress of a pandemic, in addition to more traditional considerations around effort and applicability of tests. There are creative ways to mitigate these threats, and we must document our efforts in our reports, citing limitations in interpretation where necessary.
Poised for success
In spite of challenges, psychologists have persisted. Testing settings are fluid, clinical conclusions have more caveats, and the list of areas for future research is longer than ever—but patients continue to depend on you. We have our work cut out for us, but together we can make psychological assessment more accessible, meaningful, and innovative.
Learn more about our digital assessment options.
May is when Americans recognize the service and sacrifice members of the military and their families have made—and continue to make—for their country.
Introduced by Senator John McCain and designated by Congress in 1999, Military Appreciation Month provides opportunities for Americans to honor and remember those who serve and have served—and recognize and thank those who support them.
2022 observations include:
May 1: Loyalty Day is a time to reflect on American heritage
May 6: Military Spouse Appreciation Day pays tribute to the partners who support service members
May 13: Children of Fallen Patriots Day raises awareness of the struggles facing children of fallen service members
May 21: Armed Forces Day honors those in all branches who are currently serving
May 30: Memorial Day provides a time to pause and remember the service members who sacrificed their futures to ensure ours
May is also Month of the Military Caregiver, which recognizes the people who care for more than two million veterans.
During the month of May, many organizations give back to those who are active military or have previously served. Here is a list of businesses that are offering Military Appreciation Month discounts.
Families, caregivers, active servicemembers, veterans, and retirees face unique circumstances that may require your assistance, and PAR has developed a range of products to help you meet these needs, including the DAPS, the PSS, and the TSI-2 (to assess symptoms of PTSD); the PAS, the PAS-O, and PAI (to evaluate for a broad range of symptoms, including anxiety and depression); and the SDS (to assist veterans with postmilitary careers).
According to Mental Health America, 60.3% of youth in the U.S. with major depression do not receive any mental health treatment. In the 2022 report, Nevada, Idaho and Arizona had the highest prevalence of mental illness and lowest rates of access to care. Curious how your state ranks in comparison? You can access the youth data chart here.
As a PAR customer, you know the crucial role mental health plays in the development of children. It’s in that spirit that we recognize National Children’s Mental Health Awareness Day on Saturday, May 7.
Started by the Substance Abuse and Mental Health Services Administration (SAMHSA) more than a decade ago, the purpose of the event is to highlight the importance of the mental health needs of children and reinforce the concept that mental health is a key element in a child’s development.
How is this accomplished? Nationwide, more than 1,100 communities and 170 organizations get involved by taking part in community and virtual events, health fairs, youth-oriented educational programs, and social media interactions.
Children will always need help with various challenges, including behavioral, mental, social–emotional, interpersonal, adjustment, and learning difficulties. Visit the PAR school resources page to learn more about our most popular assessments and tools.