Collaborative / Therapeutic Assessment E-Book

Stephen E. Finn

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 734

Veröffentlichungsjahr: 2012

Beschreibung

A guide to conducting Collaborative/Therapeutic Assessment to promote client growth Mental health professionals are increasingly enthusiastic about and ready to use psychological test data, research, and theory in life-relevant ways to improve diagnosis, client care, and treatment outcomes. With Collaborative/Therapeutic Assessment (C/TA), clients participate actively with the assessor in exploring how their test scores and patterns reflect who they are in their daily lives and how they can learn to help themselves cope with life's challenges. Using a case study approach to demonstrate how to apply C/TA in practice, Collaborative/Therapeutic Assessment provides practitioners with a variety of flexible and adaptable case examples featuring adults, children, adolescents, couples, and families from different backgrounds in need of treatment for assorted concerns. Designed for both experienced and novice clinicians, the book begins with a brief history of C/TA, and provides clear definitions of the distinctions among many common approaches. It uniquely presents: * Eighteen diverse C/TA assessments covering: depression, multiple suicide attempts, severe abuse, dissociation, an adolescent psychiatric ward, custody evaluation, a couple in crisis, and collaborative neuropsychology * Guidance on how both client and clinician can agree on the best course of action through joint exploration of assessment procedures, results, and implications * Closely related approaches to psychological testing, including Individualized Assessment, Collaborative Assessment, Therapeutic Model of Assessment, Collaborative/Therapeutic Neuropsychological Assessment, and Rorschach-based psychotherapy * Clearly labeled Teaching Points in each chapter Collaborative/Therapeutic Assessment provides psychologists in all areas of assessment, and at all levels of experience, with powerful C/TA examples that can dramatically illuminate and improve clients' lives.

Leseprobe

Contents

Preface

About the Contributors

Chapter 1: Collaborative/Therapeutic Assessment: Basic Concepts, History, and Research

What is The History of Collaborative/Therapeutic Assessment?

What Are The Common Features of Collaborative/Therapeutic Assessment?

What Does Research Show About Collaborative/Therapeutic Assessment?

Conclusion

Part I: Assessments of Individual Adults

Chapter 2: Therapeutic Assessment of a Dissociating Client: Learning Internal Navigation

Clarissa’s Decline

My Thoughts As I Approach Clarissa

Our Collaborative Relationship Begins: Safety and Control First

Dipping Into The Dissociative Whirlpool With Structured and Semistructured Performance Tests

Open-Ended Performance Measures: Nearsight, Farsight, and Insight

Feedback Session: Slowing Down Near The Suicide Barrier

Follow-Up: Clarissa’s Gift

Chapter 3: Therapeutic Assessment of Depression: Love’s Labors Lost?

Context of Referral

Chapter 4: Collaboration in Neuropsychological Assessment: Metaphor as Intervention With a Suicidal Adult

Referral and Context

Assessment Process

Summarizing With The Client

Conclusion

Chapter 5: Collaboration Throughout the Assessment: A Young Man in Transition

Jim Mankins

First Session

Second Session

Chapter 6: Therapeutic Assessment for a Treatment in Crisis Following Multiple Suicide Attempts

Therapist’s Request For Consultation

First Session With Anne

Comportment During Testing Sessions

Formal Findings

Feedback to Dr. X

Feedback Session With Anne

Follow-Up

Chapter 7: Using Therapeutic Assessment to Explore Emotional Constriction: A Creative Professional in Crisis

Context of Referral

Collaborative Generation of Questions and Their Personal Context

Impressions and Hypotheses

Standardized Testing

Reflections and Hypotheses

The Assessment Intervention Session: Idiographic Use of Assessment Instruments

Summary/Discussion Session

Written Feedback For Arnold

Follow-Up

Personal Impact

Chapter 8: Therapeutic Assessment Involving Multiple Life Issues: Coming to Terms With Problems of Health, Culture, and Learning

Laying The Foundation

Unplanned Avenues

Bridges Into New Ways of Being

Chapter 9: Collaborative Assessment for Psychotherapy: Witnessing A Woman’s Reawakening

Anna’s Assessment and Psychotherapy

Summary and Conclusion

Chapter 10: Therapeutic Assessment of Severe Abuse: A Woman Living With Her Past

Client’s Background

Previous Assessment

Current Therapeutic Assessment

The WAIS-R as A Therapeutic Intervention

The Rorschach as A Therapeutic Intervention

Moving Past The Abuse

Part II: Assessments of Children, Adolescents, and Young Adults

Chapter 11: Therapeutic Assessment of an Adolescent: An Adopted Teenager Comes to Feel Understood

Initial Session

Mary’s Story as Told By Her Mother

Mary’s Story

Mary’s Early Memories

Family Session

Midassessment Meeting With Ms. Smith

Summary/Discussion Session

Creating A Coherent Narrative

Chapter 12: Collaborative Storytelling With Children: An Unruly Six-Year-Old Boy

Collaborative Storytelling

Billy’s Story

Discussion

Chapter 13: Rorschach-Based Psychotherapy: Collaboration With a Suicidal Young Woman

East Meets West

Presenting Issues

Client’s Background

Assessment

Results of Mariko’s Initial Assessment

Feedback

Changes During Ongoing Therapy

First Retest

Second Retest

Results of Client Feedback Questionnaires

Conclusion

Chapter 14: Collaborative Assessment of a Child in Foster Care: New Understanding of Bad Behavior

The Case of Tanisha

Chapter 15: Therapeutic Assessment With a 10-Year-Old Boy and His Parents: The Pain Under the Disrespect

Background and Assessment Questions

Child Testing Sessions and Parents’ Observation/Processing

Establishing Relationships With The Family Members

Family Intervention Session

Summary/Discussion Session and Parent Feedback Letter

Feedback Session With David, Karen, and Carlos

Research Findings

Summary

Chapter 16: Collaborative Assessment on an Adolescent Psychiatric Ward: A Psychotic Teenage Girl

Fantasy Animal Drawings With Adolescents

The Case of Tea

Summary

Part III: Special Applications

Chapter 17: Therapeutic Assessment Alternative to Custody Evaluation: An Adolescent Whose Parents Could Not Stop Fighting

Ta in CC/PPE

Case Study

Chapter 18: Therapeutic Assessment With a Couple in Crisis: Undoing Problematic Projective Identification via the Consensus Rorschach

Referral

First Impressions

Initial Session

Individual Sessions

Couples’ Assessment Intervention Session

Summary/Discussion Session

Follow-Up Session

Long-Term Follow-Up

Summary

Chapter 19: Case Studies in Collaborative Neuropsychology: A Man With Brain Injury and a Child With Learning Problems

Collaborative Therapeutic Neuropsychological Assessment (CTNA)

The Case of Walter

CTNA With A Child: The Case of Ilyssa

Summary

Afterword: Forward!

Author Index

Subject Index

Copyright © 2012 by John Wiley & Sons, Inc. All rights reserved.

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Library of Congress Cataloging-in-Publication Data:

Collaborative/therapeutic assessment / edited by Stephen E. Finn, Constance T. Fischer, and Leonard Handler.

p.; cm.

Includes bibliographical references and indexes.

ISBN 978–0–470–55135–6 (pbk. : alk. paper)

ISBN 978–1–118–16866–0 (ebk)

ISBN 978–1–118–16864–6 (ebk)

ISBN 978–1–118–16865–3 (ebk)

I. Finn, Stephen E., 1956– II. Fischer, Constance T., 1938– III. Handler, Leonard, 1936–

[DNLM: 1. Psychological Tests. 2. Personality Assessment. 3. Psychotherapy—methods. WM 145]

LC classification not assigned

616.89’075—dc23

2011029119

Preface

Collaborative/Therapeutic Assessment (C/TA) is the term we use in this book to refer to multiple closely related approaches to psychological testing that are variously called individualized assessment, Collaborative Assessment, therapeutic assessment (lowercase), Therapeutic Assessment (uppercase), Therapeutic Model of Assessment, Collaborative Therapeutic Neuropsychological Assessment, Rorschach-based psychotherapy, projective counseling, and dynamic assessment. We will define and draw distinctions among many of these approaches in Chapter 1 and give a brief history of the field. We will also review research about these methods, which continues to accrue at a rapid pace. The remainder of the book consists of 18 case examples of C/TA from practitioners (including us) in four different countries. The chapters are divided into three sections: Part I concerns C/TA with adult individual clients; cases in Part II illustrate C/TA with children, adolescents, and young adults; and Part III contains cases illustrating special topics in C/TA, such as Collaborative Therapeutic Neuropsychological Assessment (CTNA), therapeutic assessment in a child-custody situation, and Therapeutic Assessment of couples. Within each section, the chapters are arranged alphabetically by the first author’s last name. In a final chapter we discuss commonalities among the cases and make concluding comments.

The clients written about in this book include adults, children, adolescents, couples, and families with many different types of backgrounds and concerns. All clients’ names and identifying information have been greatly altered to protect their privacy. The authors/practitioners include longstanding colleagues and young professionals, some of whom were former students of ours. All assessors necessarily adapted the basic concepts and practices of C/TA to their different settings, clients, and theoretical backgrounds. Readers will readily see that there is no single way to undertake C/TA, and that they already engage in various of these practices, and can easily tailor others for their own use.

This case study project was designed as a teaching text, and every chapter contains clearly labeled Teaching Points throughout its pages. Different authors have located these teaching points in different ways. We believe these points will be useful to graduate students and seasoned professionals alike. As we edited one another’s and our contributors’ work, we found ourselves continuing to learn about the ways in which creative, respectful, and well-trained professionals can use psychological tests to help clients and important people in their lives achieve new ways of thinking and being in the world.

Although the terminology used varies, all of the approaches represented in this book share the notion that psychological assessment is a serious enterprise, involving a special kind of professional relationship, and that it has the power to illuminate and affect people’s lives. As we read through these chapters, we found ourselves moved and inspired, and we experienced a range of emotions: awe, sadness, excitement, hope, envy, and gratitude. Our hope is that you will find these accounts equally moving, and that if you do, you will help spread the word about the potential therapeutic power of psychological assessment.

OUR PERSONAL CONTEXTS FOR THIS BOOK

We strongly believe that all behavior occurs within specific meaningful contexts. Therefore, we decided it would be responsible and most likely meaningful to readers to give information at the beginning of this book about our personal contexts and how they shaped us. We now share three first-person accounts of our involvement with Collaborative/Therapeutic Assessment.

Connie Fischer

Prelude to entering graduate school in psychology

I majored in political science and minored in philosophy at the University of Oklahoma, where I also took a social psychology course from Muzafer Sherif, whose research took place in everyday life settings. His discussions did not involve explaining findings in terms of causes and constructs, but rather addressed the actual interactions of observed people (e.g., the Robbers Cave experiment with kids at summer camp). Unsurprisingly, I was also impressed with Kurt Lewin’s experiments, which involved people in their usual settings responding to various conditions (e.g., grade-school youngsters being taught by teachers told to be authoritarian, democratic, or laissez-faire).

While at OU, I earned a secondary schools teaching certificate in social studies and did my student teaching in Oklahoma City. While teaching an honors senior world history course, a student asked who had set up the French class structure of bourgeoisie, aristocracy, journalists, and so on. I said that I was sure that no one designed that system. A student asked me if I had noticed mud huts on a road on the way into Oklahoma City from Norman. When I nodded, she said that the corner hut with chickens pecking in the dirt for corn seed belonged to her grandfather. She told us that her father was the president of a First National Bank in town, and she said that she thought that her own family showed that although we have a certain kind of class system, it is not like the permanent caste system of India.

Knowing that in this large school, many of the students did not know one another’s families, I did a class experiment in which I pointed to one student at a time in the first row and asked for a show of hands regarding which salad dressing probably was favored in that student’s home, then for another row of students I asked how many cars were owned by the family, and so on. Then I pointed to each student in a row and asked whether that student would go to college (all were academically qualified). We agreed both that no one had set up this structure and that many students would break out of it. Two days later I was told to report to the Superintendent of Schools, who informed me that my job was to teach facts, not to teach students to think, which was dangerous for them.

Graduate school

So I decided to apply to graduate schools in psychology, with the goal of earning a Master’s degree. I thought that I would be terrifically mature by then and would have found my answer as to whether I might be dangerous to students. And if I determined that encouraging students to reflect was not dangerous, I would have the authority of a graduate degree (which was true then). I chose the University of Kentucky, which listed lots of courses about “learning.” Of course they turned out to be about rats, not people, but I became fascinated about psychology, especially social psychology. I eventually changed my concentration to clinical psychology, with the thought that I might find a way to work with communities in what I thought of as “preventative mental health.” Besides, there were no jobs except as professors for social psychologists, and I certainly did not want to be a professor! Clinical psychology at the time was practiced almost exclusively in child guidance centers and hospitals, and I didn’t want to do that either. So here I am, with a 45-year history of being a professor and clinical psychologist!

My UK program was heavily experimental and psychoanalytic (and a strong program that has served me well). But it was my four-year traineeship at the Lexington Veterans Administration neuropsychiatric hospital that allowed me to add what today I call “collaborative” explorations with patients both in therapy and testing. Also I was able to observe and interact with the patients in hallways, the canteen, and on their wards and on outside walkways. These experiences grounded my attending to contexts of comportment. Many of my supervisors had come to this hospital because the German emigrant phenomenological psychiatrist, Erwin Straus, was in residence. In my last year of classes, despite earning A’s in all practica and clinical courses, my faculty assigned me a grade of C in my last diagnostic testing course because they noted from the two-way mirror that: (1) I was inefficient in test administration (I put my pencil down on the left side of my body, requiring that I cross my body to pick it up); (2) when I saw that the just-admitted 19-year-old, who had suffered a first psychotic break, was frightened by the giggling and talking seeming to come from the mirror, I explained that the mirror was indeed a window through which my teachers were watching to see if I was giving the tests correctly. I had been told not to talk with the patient, just to test. Criticisms three through six were similar, and convinced me that I would never practice in the way I had been taught, which I believed undermined patients’ sense of agency and confidence.

Career

Anyway, with my new PhD, I wound up at Duquesne University, whose psychology department was bringing in members who would work together to develop philosophical foundations and clinical and research methods that were explicitly appropriate to humans’ aspects that exceeded physiological and learning history (the dominant paradigm at the time). We now call our approach “human-science psychology” (in comparison to its companion natural science psychology). Our early philosophical sources were European existentialism and phenomenology (e.g., Heidegger). I was assigned to teach the “testing course,” which no one else wanted to teach but was necessary if our students were to be eligible for licensure and to land jobs. This unwelcome assignment turned out to be a blessing. Together, over years, besides learning standardized administration, testing research, and so on, the students explored ways to carry out individualized assessments and report writing. My book Individualizing Psychological Assessment (1985) was based on my lecture notes and my ongoing list of suggestions to students about their reports. We did some testing in clients’ homes, we learned to write without constructs, to describe in terms of observed action and clients’ discussions with us. Clients read and wrote comments on our reports.

My early journal manuscripts, about writing reports to be read by clients and their helpers, were quickly and emphatically rejected, variously as unethical (patients would be injured by hearing about their pathology) and unprofessional, and even as dangerous to our profession (without our jargon, we would seem to be ordinary). One editor instructed me never to submit to his journal again. I suspect that no one read the full papers, where I provided excerpts that did not tell clients that they had underlying homosexual or aggressive drives, and so on. Reviewers could not imagine writing in ways that clients could understand and that would not be overwhelming.

Eventually, I found my way to the Society for Personality Assessment, whose members are engaged multiply in developing and researching tests, teaching assessment, and in the practice of therapy and assessment. I think that SPA members’ openness to my presentations was largely due to their multiple involvements in assessment. Some years after publication of Individualizing Psychological Assessment, which both Steve Finn and Len Handler had read, we introduced ourselves to each other and then often organized symposia, learning from each other. For example, I borrowed Steve’s practice of asking referred clients what they might want to learn for themselves from the assessment, and I borrowed Len’s Rorschach postinquiry question, “And if this mushroom could talk, what would it say?” and much more; ours has been a mutually profitable journey.

Steve Finn

My interest in personality began while I was an undergraduate at Haverford College. My advisor and mentor, Douglas A. Davis, taught a course on Harry Stack Sullivan, and I found it fascinating. But it was later, as a graduate student at the University of Minnesota, that the power of personality assessment grabbed me. In 1979, my first year there, we students took basic courses in personality assessment and clinical psychology from some of the great personality psychologists of our times, such as Auke Tellegen, Paul Meehl, and James Butcher. The summer of my first year, I did a practicum in the adult psychiatric unit of Hennepin County Medical Center (HCMC), and during my very first assessment, a client underwent a huge transformation following a feedback session I gave about his Rorschach. (I have written about this case in my book, In Our Clients’ Shoes, 2007). I was moved, awestruck, and curious.

I remember speaking to my professors at the university about what I had witnessed. They commented that they had heard about clients’ appearing to get better as a result of an assessment. “Has anyone studied this or written about this phenomenon?” I asked. “Not that we know of,” they replied. And so I decided that I wanted to be the person who figured all this out! I had many more impressive experiences during my internship and fellowship at HCMC, under the supervision of three extremely wise and capable clinical psychologists, Ada Hegion, Kenneth Hampton, and Ziegrieds Stelmachers. All three helped me begin to think through the underlying therapeutic mechanisms of psychological assessment.

After I received my PhD, I was hired as a faculty member in Clinical Psychology at the University of Texas at Austin, in part because I agreed to teach the “testing course.” I remember spending weeks preparing my first lecture for this course, which I titled “An Interpersonal Model of Psychological Assessment” in a deliberate nod to Sullivan. Over the next nine years, I continued to read, do research, and experiment with how to make psychological assessment therapeutic for clients. A student of mine, Mary Tonsager, collaborated on a study for her Master’s thesis of the therapeutic effects of a specific method of giving MMPI-2 feedback to clients (Finn & Tonsager, 1992). This was the first published controlled study showing that psychological assessment could lead to significant changes in clients’ symptomatology and self-esteem.

A very important event during this period was my discovery of Connie Fischer’s book, Individualizing Psychological Assessment (1985/1994). A friend had recommended the book to me, and I remember staying up all night reading it the night I checked it out of the library. I was astonished, inspired, and excited that someone had so fully developed an assessment model that spoke to me. I read and re-read Connie’s book and all of her articles that I could get my hands on. I studied transcripts of her interactions with clients, and I began to incorporate many of her ways of involving clients as active collaborators. I found that Connie’s methods greatly increased the therapeutic power of the assessments I was doing in my small private practice.

In 1993, I was hungry for time to fully test out my emerging model of psychological assessment, which I named Therapeutic Assessment. After much consideration, I resigned my full-time position at the University of Texas to open the Center for Therapeutic Assessment in Austin, Texas. I remember being scared about whether I could earn enough money to support myself, so I did one of the only things I could think of for marketing. I went to three of the most successful psychotherapists in town, took them out to lunch, and volunteered to do an assessment for free with one of their most difficult therapy clients. All accepted my offer, and within months, word had spread, and I had more referrals than I could possibly handle. Initially, I had one part-time employee (Mary Tonsager). Nine months later there were seven full-time psychologists working at the Center, and we had a nine-month waiting list for assessments.

Over the next 7 to 10 years, my colleagues and I collaborated in developing the methods of Therapeutic Assessment for adult clients, child and adolescent clients, and couples. We did hundreds of assessments with clients who had many different types of life difficulties, and we became known for consultative assessments, in which we worked with clients and psychotherapists who felt they were stuck in their work together. This was an exciting and rich time, and I was also fed by my involvement with the Society for Personality Assessment (SPA). There I finally met Connie Fischer, whom I had long admired, and found her to be open, approachable, and encouraging of my work. I also heard papers by Len Handler and Caroline Purves and recognized them as kindred souls. I organized symposia and workshops at SPA, APA, and the meetings of the International Society for Rorschach and Projective Methods to bring us all together and help us learn from each other. International meetings helped me find colleagues in many other countries who thought about psychological assessment in similar ways, and gradually an international community has evolved.

My last 10 years have been devoted to a mixture of clinical practice, writing, research, and training others in Therapeutic Assessment. My colleague at the University of Texas, Deborah Tharinger, spearheaded a research project on Therapeutic Assessment with children and adolescents that has been extremely productive and that helped refine the methods of TA with these populations. In 2007, I published In Our Clients’ Shoes: Theory and Techniques of Therapeutic Assessment, and this has led to more invitations to present around the world. I established a website on Collaborative/Therapeutic Assessment (www.therapeuticassessment.com), a training institute (the Therapeutic Assessment Institute), and I cofounded the European Center for Therapeutic Assessment at Catholic University in Milan, Italy. These days I am concentrating on how to train clinicians in the methods written about in this book. I am still disheartened by many poorly written traditional psychological assessment reports that I come across in my clinical practice, but the tide seems to be turning. Recently, it seems the world is increasingly ready for Collaborative and Therapeutic Assessment.

Len Handler

I’ve told this story many times, but each telling varies as to the time it took place. Let’s just say that I met Connie Fischer and Steve Finn about 15 years ago, at an annual meeting of the Society for Personality Assessment. They were sitting at a hotel restaurant table, sharing a bottle of good wine. Steve asked whether I would like to join them, and I did so, eagerly. Soon our conversation led to my assessment approach, after which, to my surprise, both Steve and Connie remarked that what I was really doing was therapeutic or collaborative assessment. I felt welcomed and pleased that there was a place for me in the assessment world—one that now made my approach legitimate. I no longer felt that I had unsystematically diverted from the only “correct” scientific assessment approach, based on standardized assessment procedures.

We agreed that the wine was good and that adherence to a standardized approach was often not helpful to the client and might even be harmful. I shared with them the problems patients often had when I conducted assessments at two Veterans Administration hospitals, and the ways in which I tried to make the assessment process less painful. In my previous assessment experiences, I had been asked not to deviate from standardized methods, but I continued to make changes nevertheless.

It was important, I recognized, to provide support, direction, and sequential feedback to the patients. For example, I asked one inpatient the first item of the Similarities subtest, “How are an orange and a banana alike?” He looked at me, obviously troubled, and said, “They’re not alike.” According to the directions for the Similarities subtest of the 1955 Wechsler Adult Intelligence Scale (WAIS), the examiner was to tell the patient how the two fruits were similar, if the patient did not give a correct answer. No hints were to be given after that. The patient continued to say the subsequent items were not alike, and would have failed the subtest if we had continued in this fashion. I told the patient that there were no tricks in these questions; there really was a way in which the two items were alike. Given this reassurance, we went back over the items and the patient achieved an excellent score.

When I used this example in assessment class many years later, I was chastised by some students for varying from standardized procedure who believed that the patient should be given a score of zero for that subtest. The class discussed my approach, which was to continue to assure the patient that there was “no trick here,” and that there really was a way in which these pairs of items were alike. I asked him if we could go back over the items, and he agreed to do so. We no longer had any problems with suspicion. The patient was able to lay aside his suspicion after only mild reassurance and would probably be able to function outside the hospital, with just a little bit of support and assurance. In retrospect, the patient’s initial suspicious reaction was a natural reaction, because he was a newcomer to the hospital ward and his history included situations in which he had been “hurt” by friends and family members. He shared these events with me later in our relationship. At that point I was learning how to be “as” the patient, so I could learn to know what he was experiencing. I was delighted by the results of “knowing” the persons I was testing, and in most situations the patients seemed like they enjoyed “knowing” me.

To mention a metaphor that many of us have adopted (thanks to Steve Finn), from In Our Clients’ Shoes, the “shoes” metaphor has been very helpful for me and others to experience what it’s like to feel, think, and have other aspects of inner experiences. I am not talking about empathy, which is an external stance, experienced by a person about another person. According to Webster’s Dictionary (1953), empathy is defined as “Imaginative projection of one’s own consciousness into another being.” Rather, I mean “intimate contact with the internal life that makes the [assessor] the same as his [her] patients” (Bouchard & Guérette, 1991, p. 388). Perhaps that is why Jan Kamphuis, in his chapter (in this volume), stated that he simply does not forget his TA clients. There is usually some personality aspect or a life situation expressed by a client that is or was also mine at some time, as well as theirs. I remember most of the veterans I tested at the two Veterans Administration hospitals, so long ago, and have still kept their reports in my files.

Becoming aware of the client’s experience of his or her daily work and family relationships helps me to be better connected with the client. All the while I am learning from him or her, for example, what it was like to be a mailman, and sometimes imagining that I am a mailman. I remember that patient, whom I tested almost 50 years ago, and the initially unexpected (to me) stresses he faced, sorting or delivering the mail. For him the post office was a minefield, filled with associates who were dangerous if he interacted with them. Yet, he trusted me; I began to feel it was, indeed, a minefield and we were both cautious in our discussion—until “he-me” found the other employees were less and less harmful and eventually were even safe.

In another area, I have always been fascinated with various aspects of narrative therapy and the importance of stories in a child’s (and in my own) life. I also spent many years studying children’s play. I made up stories for my children, especially on long trips. The more unusual the stories were, the more the kids liked them. Even today, Greenberg, the flying pig, is with us in our home. So it seemed natural that we should draw and tell each other stories. Yet, in doing therapy with children, many of the stories did not seem to have dynamic meaning. One frightened child was unresponsive until I asked her to draw—not a person or a tree or a family, but to my amazement I suddenly chose “a make-believe animal.” I found that stories generated with that approach were rich with emotions, be they positive or negative, and helped me understand the fantasy world of a child.

I decided to collaborate with the child and to respond with my own story, one that touches the soul of the child and mine as well. Children have shoes to be in, just like adults do. So I listen to the child’s make-believe story and I respond with my story, one that gives the child a message that says, “I understand.” In some cases my story is affiliative for the child, and for some, the message is one of strength or protection. My choice of a story that answers a child’s need can often be seen as the child begins to participate in what has now become “our” story.

I’m happy that I stopped, those many years ago, for a glass of good wine, with Connie and Steve. Our relationship has been fulfilling.

REFERENCES

Bouchard, M., & Guérette, L. (1991). Psychotherapy as a hermeneutical experience. Psychotherapy, 28, 385–394.

Finn, S. E. (2007). In our clients’ shoes: Theory and techniques of Therapeutic Assessment. Mahwah, NJ: Erlbaum.

Finn, S. E., & Tonsager, M. E. (1992). Therapeutic effects of providing MMPI-2 test feedback to college students awaiting therapy. Psychological Assessment, 4, 278–287.

Fischer, C. T. (1985/1994). Individualizing psychological assessment. Mahwah, NJ: Erlbaum. (Originally published by Brooks/Cole.)

Webster’s new collegiate dictionary. (1953). Springfield, MA: G. & C. Merriam.

Wechsler, D. (1955). Weschlser Adult Intelligence Scale (WAIS) manual. New York, NY: The Psychological Corporation.

About the Contributors

J. B. Allyn, MBA, specializes in creative and technical writing and editing in the field of psychology. For many years, she has collaborated with Diane Engelman in writing therapeutic stories for assessment clients. She also wrote the forthcoming book Writing to Clients and Referring Professionals About Psychological Assessment Results: A Handbook of Style and Grammar (in press). She is affiliated with the Center for Collaborative Psychology, Psychiatry, and Medicine in Northern California.

Judith Armstrong, PhD, is a Clinical Associate Professor of Psychology at the University of Southern California and in private consulting practice. Her research on the assessment of trauma based on disorders and traumatic dissociation includes developing the Rorschach Trauma Content Index and the Adolescent Dissociation Experiences Scale. She is chair of the APA Trauma Division Task Force that created the first clinical guidelines for trauma assessment.

Thomas D. Cromer, PhD, is a staff psychologist at North Shore University Hospital Long Island Jewish Medical Center in Manhasset, NY. He has presented and published research regarding early psychotherapy processes and therapeutic alliance, as well as patient personality characteristics and their relationships to psychotherapy outcomes.

Hilde de Saeger, MA, is a clinical psychologist who works at the Viersprong, a psychotherapeutic center for people with personality disorders, in the Netherlands. She is currently working on a doctoral dissertation about the effects of Therapeutic Assessment on people with severe personality disorders. She is a member of the Therapeutic Assessment Institute.

Marc J. Diener, PhD, is an Assistant Professor in the Clinical Psychology Program at the American School of Professional Psychology, Argosy University, Washington, DC. His research program focuses on personality assessment as well as psychotherapy process and outcome. He has presented and published research in the following areas: attachment, psychotherapy technique, psychotherapy outcome, application of meta-analytic methodology, self-report and performance-based measures of personality, and clinician training. He also maintains a part-time independent practice.

Diane H. Engelman, PhD, cofounded and codirects the Center for Collaborative Psychology, Psychiatry, and Medicine in Northern California. She is a neuropsychologist in private practice, specializing in collaborative, individualized therapeutic assessment and assessment-informed psychotherapy. Other areas of focus include the psychological aspects of medical illness and patient empowerment. She has cowritten dozens of therapeutic stories used as intervention with assessment clients and the article “The Three Person Field: Collaborative Consultation to Psychotherapy” (2002).

F. Barton Evans, PhD, is a clinical and forensic psychologist and Therapeutic Assessment practitioner. He lives in Asheville, NC, where he works at the Asheville Veterans Administration Hospital and is Clinical Professor of Psychiatry at the George Washington University School of Medicine, Washington, DC. He is the author of Harry Stack Sullivan: Interpersonal Theory and Psychotherapy (1997) and coeditor of the Handbook of Forensic Rorschach Assessment (2008).

Stephen E. Finn, PhD, is the founder of the Center for Therapeutic Assessment in Austin, TX, a Clinical Associate Professor of Psychology at the University of Texas at Austin, and Director of Training at the European Center for Therapeutic Assessment in Milan, Italy. He is the author of A Manual for Using the MMPI-2 as a Therapeutic Intervention (1996) and of In Our Clients’ Shoes: Theory and Techniques of Therapeutic Assessment (2007).

Constance T. Fischer, PhD, ABPP, is Professor of Psychology at Duquesne University, Pittsburgh, PA, and is in part-time independent practice. She authored Individualizing Psychological Assessment (1st edition 1985/1994; 2nd edition in press), coedited Client Participation in Human Services (1978), and edited Qualitative Research Methods for Psychologists (2006). She has published widely on collaborative assessment and on psychology as human science—a companion to psychology as a natural science. She is a past President of APA’s Divisions 24 and 32.

Melissa E. Fisher, PhD, received her doctorate in School Psychology from the University of Texas at Austin. She is currently completing a postdoctoral fellowship at the Texas Child Study Center in Austin, TX in cognitive-behavioral therapy and neuropsychological assessment. Her research interests include the prevention and treatment of depressive and anxiety disorders in youth.

J. Christopher Fowler, PhD, is a senior psychologist and Associate Director of Research at The Menninger Clinic, Baylor College of Medicine, Galveston, TX. His clinical and research interests include complex treatment-resistant psychiatric disorders, borderline personality disorder, psychological assessment, and suicide.

Marita Frackowiak, PhD, is a licensed psychologist in private practice at the Center for Therapeutic Assessment in Austin, TX. She is a founding member of the Therapeutic Assessment Institute and a Lecturer at the University of Texas at Austin. Dr. Frackowiak is certified in Therapeutic Assessment with adults, children, adolescents, couples, and families. She lectures internationally on Therapeutic Assessment and offers consultation to clinicians wanting to learn Therapeutic Assessment.

Bradley Gerber, PhD, received his doctorate in School Psychology from The University of Texas at Austin. He is currently completing a postdoctoral fellowship at Children’s Hospital Boston and Harvard Medical School in pediatric psychology. His areas of research interest include evidence-based interventions, psychosocial treatment for children with medical illnesses, and the role of therapeutic alliance in treatment.

Tad T. Gorske, PhD, is Director of Outpatient Neuropsychology in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh School of Medicine. He is the first author of Collaborative Therapeutic Neuropsychological Assessment (2008), which describes a client-centered method of providing feedback from neuropsychological test results based on Collaborative/Therapeutic Assessment and Motivational Interviewing.

Leonard Handler, PhD, ABAP, is Professor Emeritus at the University of Tennessee, where he served, periodically, as Director of the Psychological Clinic and as Associate Director of the Clinical Training Program. He is a past President of the Society for Personality Assessment (SPA). He was given the Martin Mayman and Bruno Klopfer awards from SPA. He is a coeditor of two texts, Teaching and Learning Personality Assessment (1998) and The Clinical Assessment of Children and Adolescents: A Practitioner’s Handbook (2006).

Mark J. Hilsenroth, PhD, ABAP, is a Professor of Psychology at the Derner Institute of Advanced Psychological Studies at Adelphi University, Garden City, NY. Dr. Hilsenroth is the primary investigator of the Adelphi University Psychotherapy Project and devotes his energy to teaching, one-to-one mentoring in psychotherapy supervision and research, as well as his own clinical practice. His areas of research interest are personality assessment, training/supervision, psychotherapy process, and treatment outcomes. He is currently the Editor of the journal Psychotherapy.

Erin Jacklin, PsyD, is the clinical director and founder of The Catalyst Center, a collaborative assessment and psychotherapy practice located in Denver, CO. She was also cofounder of the Colorado Assessment Society in 2006. Dr. Jacklin specializes in utilizing psychological assessment as a therapeutic tool in her practice.

Jan H. Kamphuis, PhD, is Professor of Psychology at the University of Amsterdam, The Netherlands, and a licensed clinical psychologist. Supported by a Fulbright scholarship, he completed the clinical psychology program of the University of Texas at Austin (1991–1997) and trained at the Center for Therapeutic Assessment. He is Fellow of the Society for Personality Assessment and was recently officially certified in Therapeutic Assessment. He has published extensively on clinical assessment and on personality pathology.

Hale Martin, PhD, is a Clinical Associate Professor in the Graduate School of Professional Psychology at the University of Denver, CO, where he teaches and supervises psychological assessment, emphasizing Therapeutic Assessment. He is also the director of the Colorado Center for Therapeutic Assessment and a member of the Therapeutic Assessment Institute. Dr. Martin cofounded the Colorado Assessment Society in 2006. He is coauthor with Stephen E. Finn of Masculinity-Femininity and the MMPI-2 and MMPI-A (2010).

Patrick J. McElfresh, PhD, is program coordinator and a postdoctoral fellow in the Childhood Depression Treatment Study at the University of Pittsburgh’s Western Psychiatric Institute and Clinic. He is also Adjunct Professor in Psychology at Chatham University, Pittsburgh, PA, where he teaches introductory and personality assessment. A mentee of Constance Fischer, Dr. McElfresh aims to continue practicing and researching Collaborative Assessment in private practice. He is also currently investigating qualitative research approaches for the Rorschach.

Noriko Nakamura, MA, is codirector of the Nakamura Psychotherapy Institute in Tokyo, Japan, founded in 1998, and a former Professor of Clinical Psychology at Soka Graduate University in Tokyo. She is a founding member of the Japanese Rorschach Society for the Comprehensive System (JRSC) and currently serves as its president. She has been involved in the International Society for the Rorschach and Projective Methods (ISR) since 1988 and has been serving as vice president since 2008.

Carol Groves Overton, PhD, received her doctorate from Temple University in 1990. She is the former director of the partial hospital program of Hahnemann University Hospital in Philadelphia, PA. In 2001, Dr. Overton received the Martin Mayman Award from the Society for Personality Assessment for distinguished contribution to the literature in personality assessment. She is currently in private practice in Washington Crossing, PA.

Frank P. Pesale, PhD, is a recent graduate from the clinical psychology program at Adelphi University, Garden City, NY. His research interests are in psychotherapy process and outcome. He has presented and published research in the following areas: psychotherapy technique and process, psychotherapy outcome, personality assessment, and research training.

Caroline Purves, PhD, has completed assessments in Canada, England, and the United States. She developed some nontraditional ideas about the form on her own, only to discover later the more formal collaborative/therapeutic assessment models, which she embraced with enthusiasm. As well as private practice, she supervises assessment and therapy at WestCoast Children’s Clinic in Oakland, CA.

Jenelle Slavin-Mulford, PhD, received her doctorate in Clinical Psychology from the Derner Institute of Advanced Psychological Studies at Adelphi University, Garden City, NY. She is currently completing a postdoctoral fellowship at the Massachusetts General Hospital and Harvard Medical School, Boston, MA, in psychological/neuropsychological assessment. Her areas of research interest include personality assessment, training/supervision, and psychotherapy process and outcome.

Steve R. Smith, PhD, is an Associate Professor and Director of Clinical Training in the Department of Counseling, Clinical, and School Psychology and consulting psychologist to the Department of Intercollegiate Athletics at the University of California, Santa Barbara. He conducts research on therapeutic neuropsychological and personality assessment, diversity issues in assessment, and performance enhancement training with athletes.

Deborah J. Tharinger, PhD, is a Professor in the Department of Educational Psychology at the University of Texas at Austin, a Licensed Psychologist, and Director of the Therapeutic Assessment Project (TAP). Along with Stephen Finn and a group of graduate students, she is studying the efficacy of TA with children, adolescents, and their parents. She has published and presented extensively in this area. Dr. Tharinger is also a founding member of the Institute of Therapeutic Assessment.

Heikki Toivakka, PsL, is a licensed psychologist in the Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland, where he conducts collaborative assessments and family therapy with adolescents and their families. Mr. Toivakka is the President of the Finnish Rorschach Association for the Comprehensive System, and he also teaches family therapy. He has presented around the world on his work with collaborative assessment.

CHAPTER 1

Collaborative/Therapeutic Assessment: Basic Concepts, History, and Research

Stephen E. Finn, Constance T. Fischer, and Leonard Handler

WHAT IS THE HISTORY OF COLLABORATIVE/THERAPEUTIC ASSESSMENT?

Until relatively recently, psychological testing has been thought of exclusively by most mental health professionals as a way to diagnose psychological disorders and plan treatment interventions. Finn and Tonsager (1997) described the goals of this traditional “information gathering model” of assessment as

a way to facilitate communication between professionals and to help make decisions about clients. By describing clients in terms of already existing categories and dimensions (e.g., schizophrenic, IQ of 100, 2g–7 code type on the MMPI-2), assessors hope to convey a great deal of information about clients in an efficient manner. Also, such descriptions are the basis for important decisions, such as whether clients are mentally competent or dangerous, whether they should receive one treatment or another, be granted custody of a child, hired for a certain job, or be given publicly funded special education services. Given the inherent uncertainty involved in such weighty decisions, clinicians and researchers have long emphasized the statistical reliability and validity of their assessment instruments; these characteristics allow one to make nomothetic comparisons (i.e., generalizable across persons and situations and used by a number of clinicians) between a particular client and similar clients who have been treated in the past or studied in research. (p. 378)

However, as early as the middle of the 20th century, some American psychologists were experimenting with ways of using psychological assessment to promote therapeutic change, by engaging clients in discussing their responses to psychological tests. For example, Harrower (1956) devised a method she called “projective counseling,” in which clients discussed their own Rorschach percepts and projective drawings with their assessor/therapists to help them “come to grips, sometimes surprisingly quickly, with some of [their] problems” (p. 86). Similarly, Jacques (1945), Bettelheim (1947), Bellak, Pasquarelli, and Braverman (1949), and Luborsky (1953) all advocated having clients self-interpret their stories to the Thematic Apperception Test (TAT; Murray, 1943) as a way to bypass “resistance” and promote insight.

In recent years, these early efforts have been superseded by various highly developed models of psychological assessment, which we are broadly calling Collaborative/Therapeutic Assessment. Let us trace some of the major models encompassed by this term.

Fischer’s Collaborative, Individualized Assessment

Constance Fischer began in the 1970s (e.g., 1970, 1971, 1972, 1979) articulating a coherent model of psychological assessment grounded in phenomenological psychology, which she at times called collaborative psychological assessment (1978), individualized psychological assessment (1979, 1985/1994), or collaborative, individualized psychological assessment (2000). At that time, Fischer regarded collaborating with clients as a major means of individualizing the assessment process, so the descriptions and suggestions were about this person in his or her life context. She regarded collaboration as therapeutic in process; she also regarded much of standardized testing practice as objectifying the test taker.

Fischer (2000) defined the major principles of her approach as:

1. Collaborate: The assessor and client “co-labor to reach useful understandings” (p. 3) throughout the assessment, which are constantly revised in a hermeneutic, interpersonal process. “The client is engaged as an active agent” (p. 3) in discussing the purposes of the assessment, the meanings of her or his own test responses, useful next steps, and the written feedback that results at the end of the assessment.

2. Contextualize: Clients are not seen as “an assemblage of traits or even as set patterns of dynamics” (p. 4), but rather as persons “in lively flux” (p. 4). Their problems are explored in the context of their lived worlds, “from which they extend, grow, and change” (p. 4).

3. Intervene: The goal is “not just to describe or classify the person’s present state but to identify personally viable options to problematic comportment” (p. 5). Although Fischer clearly differentiated between assessment and psychotherapy in her early writings, she always was clear that a goal of assessment was to assist clients in discovering new ways of thinking and being.

4. Describe: From the beginning, Fischer eschewed the use of “constructs” such as traits or defenses to explain clients’ behavior and advocated the use of thick descriptions in written reports, using clients’ own words whenever possible, to help assessors and the readers find their way “into clients’ worlds” (p. 6).

5. Respect complexity, holism, and ambiguity: Assessors should “respect the complex interrelations of our lives; they do not reduce lives to a variable or to any system of explanation. The goal is understanding rather than explanation” (p. 6).

Fischer hoped that readers of her assessment reports would recognize the clients as described, but would come to see them in new ways. She hoped to capture the many contradictions that each one of us embodies, rather than oversimplifying our complex ways of being.

Fischer’s work was important in providing an eloquent and coherent exposition of a new paradigm of psychological assessment. In addition, she also pioneered many innovative practices that are now widely used within the Collaborative/Therapeutic Assessment (C/TA) community. Finn (2007) and others mined Fischer’s writings and adopted such techniques as (1) writing psychological assessment reports in first person, in language that is easily understood, and then sharing them with clients; (2) asking clients for comments at the end of an assessment, which are then routinely shared with readers of the assessment report; (3) writing fables for children at the end of an assessment, which capture in metaphor the results and suggestions resulting from the assessment; and (4) engaging clients in “mini-experiments” during psychological assessment sessions (e.g., retelling stories to picture story cards to help clients discover new ways of approaching typical problem situations).

Fischer continues to teach, advise, and write about her approach to assessment, as well as the overlap between C/TA and qualitative research. Fischer published an early, now classic, empirical phenomenological study (Fischer & Wertz, 1979). She published qualitative studies she undertook because of their relation to C/TA, for example, Toward the Structure of Privacy (1971) and Intimacy in Psychological Assessment (1982).

Fischer’s method and philosophy are illustrated in this volume in her case example (Chapter 5) and also in the case written by McElfresh (Chapter 9), who is one of Fischer’s former students.

Finn’s Therapeutic Assessment

Finn (2007) defined Therapeutic Assessment (TA; capital “T” and “A”) as a semistructured form of collaborative assessment originally developed by him and his colleagues at the Center for Therapeutic Assessment in Austin, Texas, and later refined on the basis of ongoing research and practice. From the outset, Finn wanted to explore psychological assessment as a brief therapeutic intervention. He initially focused on how to make feedback from psychological assessments therapeutic, and based his techniques and theory on results from a series of studies (e.g., Schroeder, Hahn, Finn, & Swann, 1993) with his colleague at the University of Texas, William Swann, Jr., the developer of self-verification theory (Cf. Swann, 1997). This research led to the distinction made in TA between what is called “Level 1, 2, and 3” information resulting from an assessment. That is, Finn and colleagues discovered that clients found assessment feedback most impactful and therapeutic when they were first presented with information that was close to their current self-schemas, then with information that was mildly discrepant from these schemas, and finally with information that was highly discrepant from the ways they already thought about themselves (Cf. Finn, 1996, 2007, for further exposition of this principle).

As explained in a later book (Finn, 2007), Finn then began to focus on the role of other steps in the assessment process in helping clients change, and he deliberately incorporated many of Fischer’s techniques and underlying principles after he encountered her work and the two of them began collaborating. Basically, Finn discovered that if you wanted to make psychological assessment therapeutic, it helped greatly to engage clients as collaborators. This fit with Swann’s self-verification theory, which posited that clients’ self-schemas would be more amenable to change if clients were actively involved in revising the ways in which they viewed themselves.

Finn was also interested in teaching collaborative assessment to his graduate students at the University of Texas and in doing controlled research on this topic. Thus, he began to standardize many of the techniques developed by Fischer (and later, Handler) into series of steps that could be taught in an orderly fashion. These steps included (1) gathering “assessment questions” from clients at the beginning of an assessment about what they hoped to learn about themselves; (2) involving clients in “extended inquiries” of standardized tests, after a standard administration had been completed; (3) “assessment intervention sessions,” in which assessors planned assessment “encounters” near the end of an assessment during which clients would discover information that was emerging from the standardized sessions; (4) closing “summary/discussion sessions,” in which clients’ assessment questions were addressed according to the Level 1, 2, 3 schema mentioned earlier; (5) sending clients letters instead of reports at the end of an assessment; and (6) holding follow-up sessions several months after the close of a psychological assessment, during which clients and assessors continued to discuss and process the experience of the psychological assessment. This structure is not seen as fixed or absolute, however. Finn has repeatedly emphasized that it can and should be altered to fit each client and setting, and that the well-being of the client always takes priority. The study by Finn and Tonsager (1992) was the first to test this method as a therapeutic intervention, with positive results (more below).

After he left the University of Texas to found the Center for Therapeutic Assessment, Finn was largely free to travel and present his semistructured model of collaborative assessment around the world. Many psychologists first heard about collaborative assessment and about Fischer’s seminal work through Finn’s presentations. This happened about the time that managed care providers started greatly restricting psychological services and particularly, psychological assessment services, to clients in the United States. All of these factors led to a surge in interest in the therapeutic potential of psychological assessment, and many new applications and much new research ensued. We will review this research shortly.

In recent years, Finn’s work and thinking has centered on connecting TA to other important therapeutic models, such as attachment theory (Finn, 2011d), Control Mastery Theory (Finn, 2007), and intersubjectivity theory (Finn, 2007). He also is attempting to integrate theories of Therapeutic Assessment with recent research on infant development and neurobiology (Finn, 2011a, 2011b). Finn’s theory and model are illustrated in his own case example (Chapter 18) on Therapeutic Assessment with couples, and in the chapters by Kamphuis and de Saeger (Chapter 7) and Martin and Jacklin (Chapter 8); Kamphuis and Martin are former students of Finn.

Therapeutic Assessment With Children (TA-C) and Therapeutic Assessment With Adolescents (TA-A)

Finn and his colleagues at the Center for Therapeutic Assessment conducted TA with children, adolescents, and their families from the start. TA with children and adolescents was viewed as a family systems intervention, and involving parents/caregivers as collaborators in the assessment was always seen as essential (Finn, 1997). It was not until 2003, however, that these methods were formally studied. Around this time, Finn paired with Deborah Tharinger to form the Therapeutic Assessment Project (TAP) at the University of Texas at Austin. This collaboration has resulted in a series of articles describing steps in the semistructured model of TA-C, including engaging parents in their children’s assessment (Tharinger, Finn, Wilkinson, & Schaber, 2007), having parents observe their children’s assessment sessions (Tharinger, Finn, et al., in press), using family sessions as part of child psychological assessment (Tharinger, Finn, Austin, et al., 2008), giving feedback to parents at the end of a child assessment (Tharinger, Finn, Hersh, et al., 2008), and writing fables for children at the end of an assessment (Tharinger, Finn, Wilkinson, et al., 2008). TAP also published a pilot study of TA-C (Tharinger, Finn, et al., 2009). Recently, Tharinger has begun to publish articles from their study of Therapeutic Assessment of adolescents and families (Tharinger, Finn, Gentry, & Matson, 2007).

The cases by Frackowiak (Chapter 11) and by Tharinger, Fisher, and Gerber (Chapter 15) utilize Finn’s and Tharinger’s model of Therapeutic Assessment with children and adolescents. Frackowiak trained with Finn after receiving her PhD and was one of the early supervisors on the TAP project.

therapeutic assessment

Finn (2007) has suggested that the term “therapeutic assessment” (lowercase) be used for the work of those psychologists who aim to positively impact clients and important others around them via psychological assessment, but who do not use the semistructured model developed by Finn and colleagues, and may or may not use collaborative methods beyond that of giving feedback to clients. In a much-cited article, Finn and Tonsager (1997) contrasted therapeutic assessment with the traditional “information-gathering” assessment model on multiple dimensions, including their (1) goals, (2) process, (3) view of tests, (4) focus of attention, (5) view of the assessor’s role, and (6) what they considered to be an assessment failure. This article is still relevant today.

The work of Armstrong (Chapter 2), Fowler (Chapter 6), and Overton (Chapter 10) are good examples of therapeutic assessment. Fowler is a former student of Leonard Handler.

Handler’s Therapeutic Assessment With Children

Another person who uses the term “therapeutic assessment” to describe his work is Leonard Handler. Although Handler has written and presented about his collaborative assessments of adults (1996, 1997, 1999), he is best known for his innovative work using collaborative assessment methods with children. For example, Handler developed a set of creative probes to be used with children (and some adults) during extended inquiries of the Rorschach, such as “If this mushroom could talk, what would it say?” Handler also refined collaborative storytelling methods with children (e.g., Mutchnik & Handler, 2002), and invented a now widely used method called the Fantasy Animal Drawing Game. In this method, the assessor first asks the child to draw a “make-believe animal that no one has ever seen” and then to tell a story about the animal. The assessor listens for the message the child gives in his or her story, and then sends a message back by telling a subsequent portion of the story. Handler summarized this and other child collaborative assessment methods in an influential chapter in 2006. He and his students have also published many important case studies and research studies on uppercase Therapeutic Assessment (Peters, Handler, White, & Winkel, 2008) and Therapeutic Assessment With Children (Smith & Handler, 2009; Smith, Handler, & Nash, 2010; Smith, Nicholas, Handler, & Nash, 2011; Smith, Wolf, Handler, & Nash, 2009). Handler has also traveled the world in recent years, presenting workshops on his innovative methods.

Handler’s therapeutic assessment with children is illustrated in Chapter 12, including an extended example of the Fantasy Animal Drawing Game. Toivakka (Chapter 16) also writes about using this method with a hospitalized psychotic adolescent.

Hilsenroth’s Therapeutic Model of Assessment