Critical Moments-Capitalizing on Therapeutic Opportunities during Collaborative Assessment (1.5 CEs)

BACKGROUND & PURPOSE: The effort to bring about meaningful positive change is one of the more complex, and at times elusive goals of collaborative assessment. Planned Assessment Interventions serve this purpose in a more structured Therapeutic Assessment. However, we have found that such material can also be explored in an unplanned way during collaborative assessments when important affect, thoughts, or behaviors emerge spontaneously. Often these opportunities allow the evaluator to address core problems and questions with the client that are at the heart of an assessment and to experience the problem “in vivo” in a way that deepens understanding. However, capitalizing on these moments sometimes results in detouring or even derailing the test plans and procedures, and we have begun to think more systematically about when it is appropriate to diverge from the formal line of inquiry. It is our intent in these papers to delineate some of the indicators for therapeutic detours and derailments from testing procedures, and to provide examples of how this has been effective in our own practices of collaborative assessment. For example, important considerations in deciding to take a detour include when to do it, under what conditions, with what test material, and when is it most likely to work.

CASE DESCRIPTIONS & EVALUATION OUTCOMES: Dr. Santas will present case material related to relatively brief therapeutic interventions during different phases of collaborative assessments with an adult and a teenager. These interventions happened when testing the limits, during the extended inquiry, addressing an interaction within the relationship, or in response to questions. In both cases, the interventions were critical in deepening understanding for the client (and assessor), clarifying diagnostic questions, and impacting the client’s story about themselves. In contrast, the conditions under which one might leave a projective test incompletely administered in order to explore a therapeutic opportunity seem to us much more constrained, and thus much more rare, than when choosing to take a detour. To illustrate the decision to depart from the planned procedure, Dr. Witkin will present a case of a 17 year old girl whose assessment was derailed when the evaluator decided to challenge and explore her behavior mid-test, rather than continue to document what the therapist already knew. The conversation that ensued was enough to complete the collaborative assessment, answer all questions, make family recommendations, and ultimately set the client and her parents onto a more productive therapeutic path.

CONCLUSIONS: These case studies attempt to make more explicit something that we already do as assessors who are also therapists, most likely along with others in the CTA community. We hope to stimulate further discussion as we try to elucidate the conditions and boundaries for such spontaneous therapeutic interventions and how they fit into the more formal Therapeutic Assessment model (such as when this type of intervention makes a planned Assessment Intervention redundant, and when a more planned intervention is still needed). The conditions for spontaneous interventions and for disrupting a test include but are not limited to the purpose of the evaluation, the nature of the test and its importance in a battery, the relationship of the intervention to the central question for the
assessment, the trust in the relationship, and the therapeutic experience of the assessor.

Chair

Diane Santas | Private Practice

Discussant

Discussant comments of the late Bruce Smith, PhD as read by Diane Santas

Goals & Objectives

1. Describe two types of unplanned therapeutic interventions during collaborative assessments. 
2. Describe when and under what conditions spontaneous interventions or "detours" from the testing plan might benefit the client. 
3. List criteria for the rare occasions when one might discontinue a test or "derail" the testing plan.