Imagine the following scenario:
You walk into your primary care doctor’s office. You are feeling sick, weak, and unlike yourself. After describing your symptoms to the doctor, she smiles at you and says, “I think I have a general idea of what’s going on. I have about fifteen hypotheses about what is causing your distress. I am going to pick a hypothesis at random and treat it, hoping for the best. If I am wrong, we will try the next one.”
Wait, wait, wait, you may be thinking. Isn’t there a way to narrow this down before we embark on treatment that will be costly, time consuming, and may hurt me if it turns out to be the incorrect treatment.
Of course this does not happen because medical doctors rely on tests to better understand what is going on. Unless they test for bacteria, they may be treating a virus, and your illness may be prolonged. Medical tests narrow down the hypotheses about symptoms in order to find the root cause, which can then be treated more efficiently.
However, the same cannot be said about the counseling profession. Even if a counselor is an astute diagnostician, diagnosis tells very little about the underlying processes that are causing psychological distress. In essence, the first months of therapy are, more often than not, an analogue of the above scenario; the counselor is working through hypotheses about what is really going on in order to figure out the best way to treat a client. Many medical professionals fall into similar patterns, providing potentially dangerous psychotropic medications based on symptoms alone, leading to ineffective treatment. For example, symptoms of ADHD can manifest due to underlying anxiety, depression, trauma, autism, Bipolar Disorder or organic brain dysfunction. Without accurately assessing for all of these, treating for ADHD alone will likely be ineffective.
Just like the medical profession, the mental health profession has tests that can quickly and accurately identify what is going on with a client, thereby fast-forwarding the therapeutic process. Testing includes questionnaires and interactive psychological tasks that determine information about psychological functioning. Most tests are based on decades of research. The process is long, but interactive, interesting, and often fun.
How accurate is psychological assessment? Meyer et. al. (2001) compared psychological testing with medical testing and commonly accepted medical advice and found psychological testing to be on par with, and some times more accurate than medical tests and commonly accepted medical advice.
In their book, How to Fail as a Therapist: 50+ Ways to Lose or Damage Your Patients, Drs. Bernard Schwartz and John Flowers list reasons 8-13 as having to do with underutilizing psychological assessment. Lack of assessment carries with it the same dangers described above – incorrect medications, ineffective therapy, and high client drop out rate because of missing the mark when trying to figure out what is going on.
Here are some real-life case examples of how assessment can help:
1. Trisha was a 19-year-old female residential client who had already been through weeks of intensive therapy with little improvement. One reason is she refused to connect with her therapist. Testing revealed underlying personality dynamics characterized by anxious dependence. Trisha was extremely needy due to difficult early relationships. She would become too dependent on others who would always fail to meet her expectations, leading to retraumatization. When confronted with this, Trisha acknowledged she had refused to connect with her therapist in order to protect herself from this dynamic. This information was incorporated into the treatment, resulting in a positive outcome.
2. Jerome was a 16-year-old traumatized male living with his parents and an older brother with schizophrenia. He had become increasingly withdrawn as of late. Testing revealed extremely high suicidal ideation despite none being reported to his therapist. When this was brought to his attention, Jerome broke down and said he had recently purchased a gun. He had been experiencing strange things and was sure he was psychotic like his brother. Further testing revealed no psychotic processes, but high levels of trauma-based dissociation. This information drastically changed Jerome’s outlook and he re-engaged with therapy.
3. Vanessa was a 45-year-old woman labeled as “Borderline” and Bipolar by many clinicians. She had been hospitalized multiple times in the past decade. Regular treatment for Borderline Personality Disorder led to little results and medications were ineffective. Testing revealed neurological and personality traits similar to those who have high functioning Autism and trauma-based dissociation. Within 6 months, Vanessa was tapered off of unnecessary medications and was provided with an environment that suited her needs. She improved more in those 6 months than in 10 years of previous treatment.
Other reasons for assessment may not be so dramatic. Assessment can help with all of the following:
1. Clarifying diagnosis
2. Differentiating difficult diagnoses where symptoms overlap such as ADHD and Hypomania
3. Identifying intellectual strengths and giftedness
4. Quickly identifying maladaptive interpersonal patterns or coping methods
5. Recognizing underlying issues that perpetuate psychological symptoms
6. Highlighting personality or cognitive strengths to help clients find their best path or career
7. Understanding difficult therapy dynamics leading to “stuck” treatment
8. Obtaining objective results to aid with medication management
9. At the start of therapy, creating a list of goals based on difficulties revealed by testing
10. Obtaining school or home based services
11. Ruling out organic causes of dysfunction
12. Determining the best type of treatment given a client’s personality
Mental health treatment does not necessarily require guesswork or long-term contact to discover deep personality dynamics. A good psychological assessment can vastly improve treatment outcomes, identify yet unknown strengths and weaknesses, and fast-forward the therapeutic process. For more information, please visit: http://psychcentral.com/lib/what-is-psychological-assessment/0005890
Dr. Joel Schwartz is a post doctoral psychological assistant with Poach Consulting and Associates (http://southbaytreatment.com/joel-schwartz-psy-d/). He also provides assessments for Connolly Counseling and Assessment (http://www.connollycounseling.com/). He has particular interest in psychodynamic psychotherapy, trauma treatment, people on the Autism Spectrum, and LGBT issues and pychological evaluations for teens and adults. He may be contacted at firstname.lastname@example.org.