Evaluations

The purpose of the comprehensive evaluation protocols we have developed at the Center is to make a precise determination of what kind of help a patient needs. These evaluations do not necessarily conclude with a recommendation for psychotherapy. Cognitive or behavioral remediation, neurological evaluation and treatment, medication, occupational counseling, or educational consultation are some of the many alternatives. The comprehensive evaluation may itself serve as a focused treatement intervention. If psychotherapy is recommended, appropriate professionals for referral are selected based upon the patient’s personal requirements and therapeutic needs.

The evaluations we describe range in length and complexity from brief, where the therapist and patient meet a few times, to comprehensive, which may take several months. Over a series of meetings the therapist and patient review the patient's history and pertinent records to make sense out of the patient's personal dilemma. The clinical evaluation follows, accompanied, as needed, by contacts with family members and other professionals who have been involved in the patient's care. The third member of the team, a psychologist-assessor, becomes involved at some point during this process. At the conclusion of his or her formal neuropsychological or psychological assessment, he or she shares clinical and test-based findings with the patient and therapist. While including psychological or neuropsychological testing and adding a third professional to the therapy team, may initially add to the cost of the evaluation and treatment, we believe that it ultimately makes the entire process more economical and distinctly more reliable. Therapist and patient have direction from the beginning of their work, and far less time and money are likely to be spent unproductively.

According to our model, a comprehensive evaluation consists of multiple meetings with the patient, or in the case of a child, the patient and his or her parents. Added may be telephone contacts or meetings with one or more family members and involved professionals, including physicians and teachers. Meetings to establish a diagnosis and formulate a treatment strategy ideally also have the partial function of initiating and testing the value of the evolving treatment recommendations. For example, if it seems that couples therapy is indicated for the patient or parents of the patient, the evaluator meets with the couple several times in both an investigative and initial therapeutic role.

The objective of a comprehensive evaluation is to develop a reliable picture of the patient's difficulties, and to propose a plan for their resolution. The protocol includes an appraisal of the patient's personal strengths, as well as the social and financial resources available to support his or her treatment. All but the briefest evaluations include a psychologist-assessor who does his or her own clinical evaluation and administers a selected battery of psychological or neuropsychological tests. The psychologist-assessor provides an independent perspective balancing the subjectivity of the therapist's and patient's clinical impressions. Other consultants may be called upon to provide specialized input, for example, about the patient's medical, vocational, or educational needs.

We ask the patient, and in the case of a child or adolescent, the family to fill out a series of forms to help the therapist and psychologist-assessor gather background information. As noted above, the evaluator may also talk or meet with people in the patient's life who can add pertinent information to the evaluation. It would not be uncommon for him or her to request permission to make home or school visits to gain first-hand information.

At the end of the evaluation the information it provides is summarized and recommendations are made by the therapist.

Note that the same psychologist-assessor should ideally continue to be available to monitor progress during the course of the treatment. When the treatment is over, follow-up sessions should occur intermittently to determine whether the gains of treatment have been sustained. According to this model, the psychologist-assessor, if available, is included in the followup and remains accessible to the patient and therapist for post-treatment monitoring.

All the evaluative and therapeutic work we recommend is intended to be conducted according to the principles of collaborative psychology and psychiatry. According to this treatment model, the therapist, psychologist-assessor, and patient continually exchange impressions and opinions, arriving at ever more accurate views about the nature of the patient's difficulties and how these can be resolved. The principles of the Collaborative Treatment approach we recommend are elaborated in Frankel's four books and his other publications, as well as in Engelman's and Frankel's published article, The three person field: Collaborative consultation to psychotherapy. Psychotherapy conducted according to the principles of collaborative treatment represents a distinct modification of traditional psychotherapy technique, with emphasis on the exchange of information between the patient, the psychologist-assessor, and the therapist. Particular attention is paid to the patient's observations, opinions, and input about his or her developing needs.

The use of a psychologist-assessor, to whom patient and therapist can repeatedly submit inquiries about the treatment process, is an extension of our collaborative treatment model. Also, to facilitate an authentic collaborative process, we believe the therapist needs to be relatively transparent, revealing enough information about him or herself for the patient to have a good sense of the person with whom he or she is interacting.

Please contact us, if you would like more information about The Center.

Abbreviated List of References

• Engelman, D. and Frankel, S. (2002) The three-person field: Collaborative consultation to psychotherapy. The Humanistic Psychologist, 30, 49-62.
  
  
• Exner, J.E., & Erdberg, P. (2005) The Rorschach: A Comprehensive System (Third Edition). New York: John Wiley & Sons.
  
  
• Finn, S. (2007) In Your Client's Shoes, Mahwah, NJ: Erlbaum.
  
  
• Finn, S. (March 1999). Giving feedback to clients about "defensive" test protocols: Guidelines from therapeutic assessment. Paper presented at the Midwinter Meeting of the Society for Personality Assessment, New Orleans, LA.
  
  
• Finn, S., & Fischer, C. (1997). Therapeutic psychological assessment: illustration and analysis of philosophical assumptions. Presented at annual meeting of the American Psychological Association, August 8, 1997.
  
  
• Fischer, C. (1994). Individualizing psychological assessment. Mahwah, NJ: Erlbaum.
  
  
• Frankel, S. (2008) Evidence from Within: A New Paradigm for Clinical Practice.
  
  
• Frankel, S. (2007) Making Psychotherapy Work: Collaborating Effectively with Your Patient, Madison, CT: Psychosocial Press [An imprint of International Universities Press].
  
  
• Frankel, S. (2006) The clinical uses of therapeutic disjunctions, Psychoanalytic Psychology, 23: 56-71.
  
  
• Frankel, S. (1995 and 2004) Intricate engagements: The collaborative basis of therapeutic change, Jason Aronson [An imprint of Rowman and Littlefield], Lanham, MD.
  
  
• Frankel, S. (2000) Hidden faults: Identifying and resolving therapeutic disjunctions Madison: CT: Psychosocial Press [An offprint of International Universities Press].