Therapeutic Assessment (TA) is a collaborative approach to psychological assessment developed by Stephen Finn that aims to facilitate positive change in clients. Key aspects of TA include reducing power differentials between clients and assessors, involving clients in all stages of assessment, and providing feedback to promote self-understanding. Research shows TA improves client outcomes more than traditional assessment. A case study example describes using a personalized fable to give a boy named Caleb feedback on his assessment in a supportive way. Guidelines for constructing effective fables include crafting details the child relates to and modeling constructive solutions.

1. Jackie Henry, MA University of St. Thomas Finn’s Therapeutic Assessment with Children

2. Outline Intro: What is Therapeutic Assessment (TA)? Basic Tenets Session Structure Research Case Study: Fable Feedback Tips for Fables References

3. Introduction: What is Therapeutic Assessment (TA)? Term first coined 1993 by Stephen Finn, Ph.D. Finn: Ph.D. U of MN, Interned at HCMC, now at Center for Therapeutic Assessment in Austin, Texas Based off of Constance Fischer and Leonard Handler (collaborative psychotherapy work) Based in humanistic and human-science psychology Differs from traditional psychological assessment, whose main goal is to diagnose disorders, plan treatments, and evaluate the effectiveness of interventions TA Main goal: to facilitate positive changes in clients through the assessment process

4. Introduction: What is Therapeutic Assessment (TA)? Reduce the power differential between the client and assessor as much as possible Clients and assessors work together to understand clients’ life problems and explore new ways of thinking and being Clients are involved in all parts of an assessment Determining its goals Discussing the possible meanings of test results Preparing written summaries TA can be used with many types of clients: inpatients, outpatients, adult individuals, couples, young children, adolescents, families, and business or work groups Generally most suited for clients being assessed voluntarily

5. How Does TA Promote Positive Change? Finn and Tonsager (1997) theorized that Therapeutic Assessment helps clients by: 1) Confirming certain views they have of themselves 2) Giving them new information about themselves and a greater sense of self-efficacy 3) Helping clients feel understood and accepted

6. Basic Tenets of TA Collaboration Mental health professionals, family members, the client, other resources Respect Clients are seen as “experts on themselves” Humility Assessors using TA are trained to “find their own versions” of the struggles experienced by their clients Compassion As compassion increases, shame decreases Openness and Curiosity Clients will teach us about how to improve TA methods and evolve concepts (adapted from www.therapeuticassessment.com)

7. TA with Children and Families Collaborative: Invites parents to observe some or all of their child’s testing sessions This is thought to affect the process and outcome of the therapeutic assessment in significant ways (Tharinger et al., 2007): Fosters curiosity about their child Engages parents as active participants Demystifiespsychologicalassessment Educates them about psychological tests and the assessment process

8. Child-Focused TA Session Structure Usually 10 sessions: initial interviews, testing sessions, a family intervention session, and parent and child feedback sessions Initial Interview: 2 Sessions 1st: Parents/caregivers present their concerns and background info collected 2nd: Child invited to present concerns, relationship-building unstructured play Assessment Intervention Sessions: 3-6 Sessions Individualized based on their specific assessment questions Additional assessment questions can be generated in these sessions Cognitive and academic testing, self-report, and personality testing Free play to assess the child’s play and to allow the child to destress Helps to see how ready the parents are for feedback

9. Child-Focused TA Session Structure Discussion Sessions: 2 Sessions of collaborative feedback First session: parent meeting only Provide a summary of the assessment results Make connections between what was learned and the parents’ original questions Ask for reactions and questions Review recommendations Make plan for presenting feedback to the child Second session: parents and child Written Feedback: presented in the form of a fable, song, or poem Child’s assessment questions are addressed Comprehensive letter to the parents is sent to the family as a lasting record of the TA experience (Tharinger, Finn, Hersh, et al., 2008) Follow-up Sessions Often do family therapy: the opportunity to practice and solidify what had been learned from the assessment

10. Research Research to date suggests: TA impacts clients more positively than traditional psychological assessment TA is a promising brief intervention TA is effective with both adult and child clients Finn & Tonager (1992): first controlled study of TA College students in two groups: supportive non-directive counseling vs. TA (initial session, MMPI-2 test administration, and summary/discussion session) Immediate positive feelings, and at 2 week follow-up Tharinger & Finn, et al. (2009) 14 children (age 12 and under) and their mothers: 8-session TA Both children and mothers reported less symptoms, more positive family environment, and mothers felt more positive about their children Both children and mothers were highly satisfied with the experience of Therapeutic Assessment

11. Case Study: Constructing a Feedback Fable Caleb: 9-year-old Caucasian boy referred by a local child guidance center for a psychological assessment His mother and father had never been married but had co-parented throughout Caleb’s life and currently were experiencing significant conflict about how to raise him. In addition, Caleb’s father had recently married and had a 1-year-old daughter Caleb’s mother was single, and Caleb’s primary residence had always been with her

12. Case Study: Caleb Caleb’s father was emotionally constricted in his interactions with Caleb: obviously uncomfortable with any discussions of emotions Caleb’s mother was emotionally demanding and extremely intrusive in her interactions with him It also became apparent that his mother was moderately depressed and substantially unresolved about her relationship with Caleb’s father

13. Case Study: Caleb Parents had disagreements about whether Caleb had an attention deficit hyperactivity disorder The integration of assessments strongly suggested that Caleb did not have a neurologically based attention deficit disorder Behavioral difficulties were mainly accounted for by intrapsychic and interpersonal factors His becoming agitated or distracted when discussing his family

14. Case Study: Caleb “Cameron the Camel”: one-of-a-kind five-humped camel who always wore running shoes, based on Caleb’s drawing Lived in the desert all alone and was always running Humps were used to depict Caleb’s being flooded with feelings, but the symbolism for being overwhelmed was changed from extra humps to “big, heavy” humps that were overly full of emotions In the fable, all camels used their humps as a place to store their light and happy feelings as well as their heavy feelings Cameron the Camel would become uncomfortable when his humps became full and heavy, leading him to fidget and move around excessively

15. Tips for Constructing a Fable Create the individualized storyboard Use details the child will recognize and be drawn to (similar name, cultural specifics) Introduce the challenge Goal: model a successful step or steps toward constructive change Maximize effectiveness through awareness and collaboration Parent input helps the child not feel alone in the solution to his or her challenges Stay within the constraints of the real context and possibilities Reflect the child’s reality, engender hope, and provide direction

16. Tips for Presenting the Fable Thank the child for participating and summarize their strengths Introduce the fable and emphasize how special it is Tell the child the fable was written particularly for them Invite them to choose who will read the fable: the assessor, a parent, or the child The choice of reader often is significant As the fable is read, monitor parent and child reactions The child may react negatively or become overwhelmed: take a break from the fable, explore the reaction, enlist help in calming the child before proceeding After the fable has been read and reactions expressed, invite the child to modify it if he or she wishes Gives the child an active role with the fable and a chance to impart his or her own sense of what is needed

17. Fable Example: Tharinger & Finn (2008) NATE: How can we help Nate so his ups and downs aren’t so extreme? Should we take his threats of suicide seriously? Why is he so despairing? What is going on when he is defiant about going to his medical exams? Nate has been traumatized by some of the invasive medical procedures used to treat his cancer. He easily gets flooded by emotion and retraumatized. Nick’s parents are uncomfortable with his feelings because of their own associated trauma. FABLE: Nick and the Magic Saucer Nick’s mother presents him with a magic cup, into which he can pour his frustration, anger, and strong feelings. When he voices his concern about the cup not being large enough for all of his feelings, his parents let him in on their secret: a magic expanding saucer (their support), designed to hold any feelings that overflow out of the cup (to contain Nick’s emotions).

18. Fable Example: Tharinger & Finn (2008) ALLEN: Why is Allen having anger outbursts? How can we diffuse them and ward off his impulsive thoughts? Allen is emotionally constricted and his poor coping skills lead to impulsivity. His eruptions of anger spread to the whole family, which then overwhelms him more. FABLE: Alex the Angry Shark Alex furiously storms into his room after being teased by bully sharks on his walk home from school. By responding to his anger with understanding and a game of sharkball, Alex’s parents are able to avoid an escalation of heated feelings throughout the household and provide the support Alex needs to manage future teasing.

19. References Hamilton, A. M., Fowler, J. L., Hersh, B., Hall, C., Finn, S. E., Tharinger, D. J., Parton, V., Stahl, K., & Arora, P. (2009). “Why won’t my parents help me?”: Therapeutic Assessment of a child and family. Journal of Personality Assessment, 91, 108-102. Tharinger, D. J., Finn, S. E., Wilkinson, A. D., & Schaber, P. M. (2007). Therapeutic Assessment with a child as a family intervention: Clinical protocol and a research case study. Psychology in the Schools, 44, 293-309. Tharinger, D.J., Finn, S.E., Hersh, B., Wilkinson, A., Chistopher, G., & Tran, A. (2008). Assessment feedback with parents and children: A collaborative approach. Professional Psychology: Research and Practice, 39, 600-609. Tharinger, D. J., Finn, S. E., Wilkinson, A. D., DeHay, T., Parton, V., Bailey, E., & Tran, A. (2008). Providing psychological assessment feedback with children through individualized fables. Professional Psychology: Research and Practice, 39, 610-618. Tharinger, D.J., Finn, S.E., Gentry, L., Hamilton, A., Fowler, J., Matson, M., Krumholz, L., & Walkowiak, J. (2009). Therapeutic Assessment with children: A pilot study of treatment acceptability and outcome. Journal of Personality Assessment. Glasser, J. M. (2007). Comprehensive Therapeutic Assessment.The Maryland Psychologist, 52, 24-25. Finn, S. E. (2005). How psychological assessment taught me compassion and firmness. Journal of Personality Assessment, 84, 27-30. Reprinted in Finn, S. E. (2007). In our clients’ shoes: Theory and techniques of Therapeutic Assessment (pp. 253-260). Mahwah, NJ: Erlbaum. www.therapeuticassessment.com