Therapeutic assessment promotes treatment readiness but does not affect symptom change in patients with personality disorders: Findings from a randomized clinical trial.

Abstract

The field of clinical personality assessment is lacking in published empirical evidence regarding its treatment and clinical utility. This article reports on a randomized controlled clinical trial (N = 74) allocating patients awaiting treatment in a specialized clinic for personality disorders to either 4 sessions of (a) therapeutic assessment (TA) or (b) a structured goal-focused pretreatment intervention (GFPTI). In terms of short-term outcome, TA demonstrated superior ability to raise outcome expectancies and patient perceptions of progress toward treatment (Cohen's d = 0.65 and 0.56, respectively) and yielded higher satisfaction (d = 0.68). Moreover, patients reported marginally stronger alliance to the TA clinicians than to GFPT clinicians (d = 0.46), even though therapists perceived the alliance as equally positive in both groups. No differences in symptomatic ratings were observed. Results are discussed with reference to treatment utility in this particular patient group.

Trainee and Client Experiences of Therapeutic Assessment in a Required Graduate Course: A Qualitative Analysis

“…These results suggest that the collaborative stance of the assessor, along with the other core values of TA, likely elicited the clients’ positive responses. This interpretation of the results is augmented by empirical studies concerning the assessor-client relationship, which is fostered by the structure and techniques of the TA model (e.g., De Saeger et al, 2014; Hilsenroth et al, 2004). Further, client reports of experiencing positive accurate mirroring, indicating that the assessor made the client feel understood and validated, reflect a key component of the theory of change in TA: During the summary and discussion of findings, clients are first presented with information that is congruent with their self-view; in other words, they experience positive accurate mirroring.…”

“…In multiple studies comparing TA to traditional assessment (e.g., Ackerman et al, 2000; Hilsenroth et al, 2004) or other brief intervention (De Saeger et al, 2014), clients in the TA condition reported acceptability or satisfaction as high or higher than the comparison condition.…”

“…Our results unequivocally indicated that trainees saw the value and clinical utility of TA/PA. Additionally, the growing body of research on TA supports its utility for a variety of clinically meaningful outcomes from symptom improvement (e.g., Finn & Tonsager, 1992; Smith et al, 2010) to engagement in indicated services (e.g., Ougrin et al, 2008) and preparation for treatment (e.g., De Saeger et al, 2014; Smith et al, 2015). TA could serve as a bridge between antiquated views concerning the usefulness of assessment as well as achieve acceptability among trainees and practicing psychologists, in turn increasing its use and improving training.…”

“…This brief version of the TA model did not include the assessment intervention session, which Finn (2007) considers to be the most advanced step in the model and further notes that it is not always indicated. For this reason, some controlled empirical studies of TA have elected not to include them (e.g., De Saeger et al, 2014). …”

“…In brief, practitioners using a collaborative/therapeutic approach conduct psychological assessment with the explicit aim of directly improving client distress, symptomatology, and functioning. Empirical research supports the effectiveness for these aims (e.g., Finn & Tonsager, 1992; Newman & Greenway, 1997; Smith, Handler, & Nash, 2010) as well as enhancing clinically meaningful therapeutic processes (e.g., Ackerman, Hilsenroth, Baity, & Blagys, 2000; De Saeger et al, 2014; Hilsenroth, Peters, & Ackerman, 2004; Ougrin, Ng, & Low, 2008; Smith, Eichler, Norman, & Smith, 2015). The core values of the TA reflect the therapeutic aims of the model: humility, respect, compassion, collaboration, and openness and curiosity (Finn, 2009).…”