Memorable Experiences in Therapeutic Assessment: Inviting the Patient's Perspective Following a Pretreatment Randomized Controlled Trial

Abstract

Accumulating evidence documents the efficacy of Therapeutic Assessment (TA) in terms of symptom reduction and other outcomes, but only minimal data speak to the patient's perspective of what is memorable, or potentially important, about this intervention. In line with the humanistic and phenomenological philosophy of TA, we solicited patient input by asking personality disorder (PD) patients who participated in a recent randomized controlled trial (De Saeger et al., 2014 ) about their experiences. We report on 10 PD patients who were administered semistructured interviews designed to assess an in-depth perspective of undergoing TA. Our methodological approach can be described as phenomenological and integrative, approximating guidelines provided by the Consensual Qualitative Research paradigm (Hill, 2012 ). Four core content domains emerged from the transcribed and coded interview protocols: (a) relationship aspects, (b) new insight into personal dynamics, (c) sense of empowerment, and (d) validation of self. Novel experiences were mostly of a relational nature, and pertained to feeling of being treated like an equal and essential partner in a highly individualized venture. Research and clinical implications of these patient reports of TA participation are discussed.

A systematic review of qualitative studies of adults’ experiences of being assessed for psychological therapies

“…Women often tolerated enormous amounts of distress before seeking help . Despite this, some, men and women, questioned the legitimacy of their right to support or attention and felt grateful to receive a service…”

“…Many people had tried different approaches to easing their distress, including traditional psychological and talking therapies, mental health services, alternative therapies and self‐help. People using specialist services (for women or people diagnosed with personality disorder) often reported negative contacts with psychiatry which motivated them to seek a new approach . For some using specialist personality disorder services, the service was considered a “last resort” as all prior attempts to engage with mental health services had been unsuccessful …”

“…Whilst this could be cathartic and validating, sparking new insights, it could also be painful and traumatic, raising difficult and painful issues without sufficient support . A significant determining factor appeared to be the degree of collaboration: explicitly collaborative assessments conducted across multiple sessions were often experienced as empowering, whilst assessments with multiple sessions that were done to a person were more often experienced as traumatic; this was in the context of the latter often being a “last resort” . Positive assessments could inspire hope and be a catalyst for change, providing a foundation and direction for therapy .…”

“…Feeling believed and heard had a validating impact, whilst feeling unheard was at times experienced as a betrayal . For some using women's and “personality disorder” services, feeling validated or pathologized was entwined with previous experiences of psychiatry …”

“…Where this occurred, the person sometimes went on to dislike their therapist or group, often disengaging after a few sessions. Conversely, experiencing kindness could be “heart‐warming”, creating a sense of hope, with the manner of giving feedback either opening or closing opportunities for self‐reflection . Staff could also be experienced as patronizing, or failing to respond to people as individual's, preventing engagement .…”