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The Erik H. Erikson Institute of the Austen Riggs Center, Stockbridge, Massachusetts
2
Psychology Department, University of Tennessee at Knoxville
3
Connecticut Valley Hospital, Whiting, Forensic Division, Middletown, Connecticut
In this case study, we explore the effectiveness of Therapeutic Assessment with a severely disturbed 25-year-old man, referred by his therapist,
following Finns (2007; Finn & Tonsager, 1992, 1997) model. This patienttherapist pair had been working together for approximately 2 months,
but the therapy had ceased to progress. The therapist requested a clearer picture of his patients affective functioning, interpersonal functioning, and
self-functioning that might facilitate more effective treatment. Through a collaborative assessment process informed by the principles of Kohutian
self psychology, the evaluator and patient slowly formed a working alliance that proved useful for the eventual communication to the patient of his
psychologically tenuous reality. This case illustrates the utility of a collaborative, multimethod Therapeutic Assessment with a severely ill patient
and the use of Therapeutic Assessment by a less experienced clinician.
Fowler (1998) offered a sensitive portrayal of the challenges encountered by clinicians in training who are attempting to master
the complexities of psychological assessment. Fowler advised
trainees and their supervisors alike to pay close attention to
subtle interpersonal and intrapsychic dynamics that often mobilize defenses in the clinician, which, in turn, may threaten the
integrity of the process and outcome. Fowler urged thoughtful
use of the assessors own personality resources in developing a
deeper understanding of patients experiences. Berant proposes
a perspective similar to that of psychotherapy and favor a
dual process within which the traditional goals of psychological assessment coincide with a sophisticated analysis of
the complex relationship between assessor and patient (Berant,
Saroff, Reicher-Atir, & Zim, 2005, p. 207). Fortunately, with the
advent of collaboratively based, therapeutically oriented assessment principles (Finn, 1996a, 1996b, 2007; Finn & Tonsager,
1992, 1997; Fischer, 1994), the field of personality assessment
has opened new possibilities for the integration of psychotherapy with assessment.
The case presented here represents E. J. Peters (hereafter
I, me, and my) first attempt at a therapeutically oriented
evaluation. During this assessment, I attended a semester-long
class taught by the second author (L. Handler), which focused
on the theory and practice of a variety of therapeutic assessment
models guided by the principles and techniques developed by
Finn and colleagues (Finn, 1996a, 1996b, 2007; Finn & Tonsager, 1992, 1997), as well as the works of other contributors
to collaboratively based assessment (Fischer, 1994; Handler &
Hilsenroth, 1998). Additionally, I attended a 2-day seminar led
Received June 6, 2007; Revised August 27, 2007.
Address correspondence to Eric J. Peters, The Erik H. Erikson Institute
of the Austen Riggs Center, 25 Main Street, Stockbridge, MA 01262; Email:
epeters4@utk.edu
by Stephen Finn during which the theory and practice of Therapeutic Assessment (TA) was presented.
OVERVIEW OF TA
TA is a clinical technique in which the assessment process
itself is considered to be a therapy-like intervention that is transformative for the patient. That is, the TA process provides experiences that allow patients to alter their self-view. In a sense,
TA is a treatment experience in microcosm, one that enhances
self-awareness and often leads to life changes (Finn, 2007; Finn
& Tonsager, 1992, 1997; Handler, 2007, 2008).
In a landmark article, Finn and Tonsager (1997) contrasted TA
with traditional information-gathering assessment. The goa of
traditional assessment is primarily to diagnose, plan treatment,
evaluate treatment, understand a patient better, or to monitor the
progress of treatment. The focus is on communication about the
patient. The major goal of a TA, according to Finn and Tonsager
(1997)
is for patients to leave their assessments having had new experiences
or gained new information about themselves that subsequently helps
them make changes in their lives. The assessors primary task is to
be sensitive, attentive, and responsive to patients needs and to foster
opportunities for self-discovery and growth throughout the assessment
process. (p. 378)
Finn and Tonsager (1997) noted that in the traditional assessment approach, tests are usually seen as methods used to
provide standardized scores that are useful for describing patient behavior to a third party. These scores are used to make
nomothetic comparisons that reflect or predict behavior outside
of the assessment setting. In TA, a test is considered useful if
it also provides an opportunity for the patient and the assessor to have a dialogue concerning characteristic ways of responding to usual problem situations and tools for enhancing
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assessors empathy about [patients] subjective experiences
(Finn & Tonsager, 1997, p. 378). Notice that the emphasis here
is on mutual learning by the assessor and patient.
Finn and Tonsager (1997) also discussed what defines success
in TA as compared with traditional assessment. In the traditional
approach, success is determined by how cooperative a patient is
in following instructions and generating responses to the tests in
an uneventful manner. Emphasis is placed on whether the diagnoses and recommendations are clearly supported by nomothetic findings and on assuring that the referring agent is satisfied
and puts the report to good use. Success in TA is defined by
whether the assessor understands the patient and whether the
patient has had experiences in the assessment process that are
transformative. In other words, a successful assessment in TA
is determined by whether the patient felt that he or she was understood, valued, and respected by the assessor and whether the
answers to the patients questions produced some meaningful
change for the better. Success is also determined by whether the
patient feels more empowered and capable of maintaining the
positive changes in the future.
Finn (2003) published the first comprehensive TA case study
of an assessment involving a referral from a therapistpatient
dyad whose therapy had recently lost a clear focus and had begun
to stagnate. Finn (2003) described his use of TA in the service
of getting the therapy back-on-track by obtaining diagnostic clarification and helping his patient develop new personal
insights. Finn (2003) also emphasized the in vivo empathic responsiveness experienced over the course of the assessment as
a helpful tool for facilitating greater understanding.
This case, also a referral from a therapistpatient dyad, differs in two important respects. First, the level of symptomatic,
intrapsychic, and interpersonal distress of the patient to be presented far exceeds that of Finns (2003) patient. The second
defining feature of this case study is our explicit discussion of
self psychology theory and technique when applied during a
TA.
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CASE STUDY
Referral
A 5th-year, doctoral-level, psychodynamically oriented therapist (J. D. Winkel) referred his 25-year-old patient, Mr. G, to a
community-based, university clinic for a psychological assessment. The therapist had been working with Mr. G for approximately 2 months at a nearby community mental health center.
The therapist was increasingly concerned about factors contributing to Mr. Gs aggression and his propensity to experience
intense and fluctuating mood states within and between sessions. The therapist had discerned Mr. Gs narcissistic character
defenses but was uncertain as to the severity of an underlying
mood or thought disorder, his level of self-cohesion, or his ability to discern how others function psychologically. The therapist
expressed specific interest in ruling out a psychotic disorder so
that he might be assisted in appropriately balancing his use of
supportive/expressive therapeutic interventions. According to
the therapist, Mr. G was open to participating in the evaluation
but was not optimistic that it would be of any use, considering
that he had a prior negative assessment experience.
Intake session. As part of clinic policy, Mr. G was interviewed to collect information about his reasons for seeking
an evaluation; treatment history; and social, occupational, and
developmental history. He also completed the Minnesota Multiphasic Personality Inventory2 (MMPI2; Butcher, Dahlstrom,
Graham, Tellegen, & Kaemmer, 1989) and the Symptom
Checklist90Revised (SCL90R; Derogatis, 1994). The intake was completed by a 3rd-year, doctoral-level student and
not the 2nd-year, doctoral-level student ultimately assigned to
complete the assessment (E. J. Peters).
Mr. Gs MMPI2 and SCL90R indicated significant
distress in multiple areas of functioning. In regard to his
MMPI2 clinical scores (Figure 1), Mr. Gs distress was so
all-encompassing that his profile defied nuanced interpretation
of particular areas of concern. The F (110) and F-back (116)
Validity scores suggested the need for a cautious interpretive
approach, especially in regard to Content scales, which were
likely invalid. In contrast, his TRIN (50) and VRIN (68) suggested a generally honest attempt at responding in a consistent
manner. Thus, validity indexes do not indicate beyond a doubt
that this protocol was invalid. Based on these initial measures,
E. J. Peters tentatively began to view Mr. G as a young man
with a potentially psychotic-level character who was experiencing a level of distress so subjectively overwhelming and
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about 30 seconds of silence, perhaps having assumed enough
submission, he employed a sarcastic and grandiose tone and
began to question the validity and effectiveness of psychological
testing in general. He said he would be able to see through the
tests and that they would be unable to help him.
When asked about the origin of these concerns, Mr. G spoke of
a prior assessment experience during which he felt the examiner
was condescending and dismissive of his perspective. He stated,
Im disturbed by the notion that someone cant be emotionally
unwell and also know he is sick. He felt the prior assessment
didnt help at all and that he was left with the sense that he
was too complex and therefore need[ed] Freud if there was to
be any hope of figuring out his problems. I responded
I can understand why youd be guarded about the prospects of this
evaluation. Part of you feels itll be worthless and you wouldnt want
to get your hopes up, but part of you wants to take a chance with this
because youre here. Until this point no ones been able to help you
understand what might be going on. To make it worse, you were left
out of your last evaluation, as if your perspective didnt matter, because
youre supposedly sick and incapable.
Standardized Testing
Session 3. Although most patient experiences and behaviors during the administration of the Wechsler Adult Intelligence
ScaleIII (WAISIII; Psychological Corporation, 1997) are uneventful, this was not the case for Mr. G, as his insecurities and
narcissistic defenses manifested themselves clearly. For example, during the WAISIII Picture Arrangement subtest, he stated,
Im sexually aroused by this story. His level of anxiety filled
the room, despite his better than average performance (Verbal
IQ = 131, Performance IQ = 97, Full Scale IQ = 116). His petulant behavior, although unsettling due to its intensity, was quite
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supervision. Beyond his manifest aggressive and controlling
behaviors, my supervisor (K. G. White) helped me understand
how emotionally disorienting and uncomfortable it is when a
patient needs you to provide a selfobject function rather than
being seen as a whole, complex person in your own right. In
fact, Kohut (1968) hinted at the potential for the clinicians
edgy experience due to being used to fulfill something urgently needed within an idealizing or mirroring transference
when he wrote, These objects are not loved for their attributes,
and their actions are only dimly recognized; they are needed in
order to replace the functions of a segment of the mental apparatus that had not been established in childhood (p. 481). Based
on the patients traumatic familial and subsequent interpersonal
history, in-session fluctuations of barely manageable affect, and
my own strong internal responses, my supervisor began to suspect a deeper level of psychopathology than simply a narcissistic
character disorder. My supervisor advised that my postsession
reactions might be useful and felt that we should wait and see,
with the Rorschach and other tests, what else might lie beneath
Mr. Gs manifest narcissistic defenses. My supervisors positive
contextualization of my internal responses provided me with a
stabilizing and calming selfobject experience that undoubtedly
allowed me to function more empathically as the evaluation
progressed.
Session 4. In our next meeting, we continued the assessment with relatively unstructured tests (the Draw-a-Person test
[DAP]; Handler, 1996) and Bender Visual-Motor Gestalt Test;
Bender, 1938). This phase of the evaluation was defined by a
clear increase in Mr. Gs use of exhibitionistic, arrogant, and
aggressive behaviors as observed during our interactions and in
the test data. A few notable experiences are worth discussion.
Mr. Gs DAP drawing was meant to represent me (E. J.
Peters). He did not take his eyes off me as he sketched my
whole upper body in detail. When asked to tell a story about
the man in his picture, he began, This is a big university hot
shot. . . . I was acutely aware of a tension creeping into my
body as he was now assessing me. I felt frozen in place; there
was aggression in the air.
The parallel process in this moment was striking in that as the
video camera recorded our interaction, Mr. G and I would both
be evaluated and exposed in supervision. I remember distinctly
feeling subpar and inarticulate. It slowly began to occur to me
that this experience might be akin to Mr. Gs experience in a
potentially important way. After all, we both rely heavily on
our intellect, and when it is not available to us, we are both
less armed for dealing with whatever life throws at us. In this
particular moment, my intellectual resources were eluding me,
and my level of anxiety shot up accordingly. I knew it was
important not to let our mutual anxieties collapse the space
between us that needed to remain open if we were to mutually
explore what was occurring in the room.
To rediscover a sense of calm, I mobilized a selfobject function of my own by summoning Kohuts (1984) theoretical
premise that it is essential for the integrity of the clinical process
that the therapist remains steady and not react with thinly veiled
aggression, withdrawal, or submission to the patients experiences. As I grew calmer, I was able to reflect on how disorienting
it could be to be evaluated and intuited that Mr. G might be angrily responding to feeling like a guinea pig and feeling the
threat of exposure of supposed weaknesses. I also realized that
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TABLE 1.Mr. Gs Rorschach responses.
Card
Response
II
III
IV
VI
VII
VIII
Inquiry
Well its monochromatic, black, so it lends not much life to this blot. It lends itself to a kind of
sinister interpretation and its just . . . horns kinda put demonic into it, eyes, mouth. Reason I
say demonic apparition is because you see the mouth open here and you can see the back of
the apparitions skull. [Laughing?] Yes, the mouth is here, its turned up and his eyes seem,
as I understand it, slanted in a sinister way. After I saw the face I saw a second one which is
better I think.
These are his hands. The way he has his wings and hands, hes kinda supplicating to God
maybe [patient motions hands upwards] a higher power. I say angelic because he has a high
collar, it appears to be some sort of official uniform, also a belt. Do you see what I see?
[Yes, I see it]. The student has become the master [patient motions with hands wildly above
his head].
What makes this a vagina is the discharge down here, the red down here. The red towards the
bottom looks like discharge, coupled with inflamed ovaries, and their position makes it
look like ovaries. [Inflamed?]. Color, and the fact that I know, well you asked me how it
looked, I know inflamed because discharge is happening. Theyre starkly red compared to
the kidneys which have a diminished color compared to reproductive organs. [Kidney?]
Looks like kidneys because of their position in relation to what I recognize as sexual
organs. [Patient appears upset as he is holding his head with a strained expression on his
face.] They do not in fact look like kidneys, maybe this person should see a doctor because
they may have some kidney problems.
Reminds me of a Dali painting in which, because these heads, these broad shoulders are
disproportionate to the heads which is why I say titans, almost in that Raphaelesque look,
like a painting back in the days when they made the men look super huge and with tiny
heads. Arm, hip bones. These are two, theyre conjoined twins. Theyre facing each other,
but theyre tearing, you know pulling away [with hands makes a tearing motion]. These two
heads looking askew and these are the two people. This is this guys left shoulder, this
guys right shoulder [points to the card and his own body numerous times]. Two arms
coming down and this is the heart. I guess I couldve said heart; thats what I meant by vital
essence. It could be a heart, maybe not, but they obviously share something which is being
rended as they pull apart from each other [pulled apart, rended?] Theyre obviously an
entity, obviously theyre intimate, but the lines, theyre faint lines, their position looks like
pulling apart, but their lines give perspective, motion to their lower halves as if theyve been
split half-way up [patient is becoming increasingly distressed as he is anxiously looking
around the room with sudden movements].
Again, a large forest creature because its black, dark so thats where that evil intent comes
from. I kinda pulled that one out of my ass. These are the undersides of his feet as if were
looking at him from under a glass. These are his legs. I say creature because really his face
is unidentifiable from anyone I know, let alone one that would be attacking me in the
woods. [Caught me?] He is in a very high position. Im in a very low position. Hes very
tall and Im very close to him as I see it in my minds eye. [Do you see another person?]
No, its narrative. [Tree/Dick?] Theres something the overwhelming sense is, dont write
this down, Im working through this. [Transcribed after session from videotape]: This does
not fit so I cant make it a part of the blot. Since Im a funny guy I postulated a few theories.
These are wings. We are looking at it from top-down, as if it were lying on its belly on a table.
These are antennae. Im not intimately familiar with the biology of butterflies, but looks
like some sort of appendage. Funny enough color didnt factor otherwise Id see it as
demonic like the other ones. Well I do see it demonically, theres a little face but I didnt
want to see a demon in every one.
This is obvious. I doubt this is an inkblot. I think this is an actual skinned cat because this was
the easiest one for me. It looks exactly like a pelt! [Pelt?] Because its been prepared as if a
hunter or tracker has stretched the skin. It reminds me of, like if you go to a lodge and see
hides of buffalo. Its stretched out. Im not sure what the practicality is of that, I dont know
why they stretch out the skins, probably to dry it. But, it looks like a dried out, intentionally
prepared pelt because of its symmetry and uhh because it looks like a pelt thats why!
Its just the, well because it looks like pictures Ive seen in medical books of female
reproductive organs. Its got some plumbing, two objects that look like ovaries, more
plumbing down here, this is a vagina, a vaginal cavity. There are so many body parts, why
am I seeing body parts? Because they look like that!
Looks like an artists rendering because heres the two wolves. These are hands climbing up
rock or some sort of summit and its stylized because real world physics wouldnt allow for
this. This seems to be rocky. They almost symbolically . . . what seems to be some sort of
forest. Are you familiar with Viking mythology [recites stories about mythology and
warriors for approximately 3 min]. Its like theyre passing a symbolic forest or a tree.
Theyre gonna pass through all this [points to center of card]. Looks like some sort of skull
sitting atop a tree so hes, he looks powerful, all-knowing, not even looking at the wolves.
Knelt on tree, not even looking at them. Hes passing something to them, transmitting
something.
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Card
Response
IX
Inquiry
Its not an alienjust a joke. Armor because this looks like plate-metal. Two shoulder plates.
This is an alien looking at us. These are the breast plates. Shoulder plates are rounded, red
makes it look shiny, the red and theres light glinting, thats what makes me think of armor.
Thats the first part I put together. [plasma?] I cant fit the plasma because it looks chaotic,
free-forming, billowing. [Billowing?] Flowing. Dont see much face because of plasma.
Green evoked thoughts of little green men. There are his two eyes right there looking at us
from behind whatever this crap is. I couldnt assimilate it to my satisfaction.
I like this one because it didnt look, its not obvious. I could get something out of it. First
thing I noticed were the animals. Hes holding crabs. This looks like a big pincher because
a lot of crab species have one long and differently colored pincher. Red looks like some sort
of animal, dyed animal pelt. When I say shaman I guess that has to do with that fact that I
see robes and skins, but then theres not much behind it, like in a modern scene someone
wouldnt be wearing one garment, hes got this slung over his shoulders and hes like naked
underneath, so Im seeing the vestiges of the first clothing. These are pelts flung over his
shoulders, this is his face. Hes got some sort of mask made from animal parts, bone or
leather mask with a horn. Arms outstretched with crabs in hands. The rest of blot, painting,
is the other part where I got shaman because hes got animals, hes praying, and all these
strange colored magical parts like a spell is being woven.
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a vagina, a vaginal cavity. There are so many body parts, why am I
seeing body parts?
AI response to Card VII: Two women looking at each other. . . .
Theyre older women with fancy hats on, churchgoing hats.
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Case Conceptualization
Mr. Gs above average intellect helps him contain an embattled inner life that is burdened by considerable uncertainty
about his own identity and capacity to relate to others. Yet, his
intellect is not available to be used effectively in vocational or
academic pursuits because it is almost wholly enveloped by his
overwhelming need to shield himself from a world that he perceives as hostile, alien, and unreachable. Due in large part
to his abusive past, Mr. G has had to employ an inordinate
degree of his intellectual resources for the sake of navigating
a world that has offered him little in the way of security or
joy.
Mr. G is often internally pressured to put on what he refers
to as his stronger, more confident alter ego. Rorschach responses filled with powerful semihuman responses, in addition
to provocative behavior toward the assessor, clearly attest to his
fear of being shamed and exposed as impotent. After all, he
learned from a very young age that any sign of weakness would
be met with brutality. Thus, he often overcompensates, and his
defensiveness becomes interpersonally vitriolic and ultimately
an impediment to deep relationships. His use of narcissistic defenses such as grandiosity, rageful devaluation, and undiscriminating idealization of radical cult-like leaders all serve to keep
him at a distance from reciprocal, intimate relationships. It is as
if he feels continuously under siege, and with preemptive verbal
barrages, he attempts to ward off potential threats. His pressured
need to create a dramatic and impressive but also bizarre and
off-putting self-image when he senses himself to be under the
scrutiny of other people can be seen in his interactions with the
assessor as well as his approach to a variety of tests, including his
extreme MMPI2 and his aggressive and exhibitionistic DAP,
Rorschach, and Bender. As a consequence of these defensive
maneuvers, he does not get close enough to others to experience
the more benign ebbs and flows of interpersonal closeness. Because relationships are necessary for developing and sustaining
a stable sense of self, Mr. Gs interpersonal conflicts seem to
maintain and exacerbate his identity confusion. However, as can
be seen from the AI phase of the Rorschach, appropriate attunement to his need for soothing, idealizing, selfobject functions
goes a long way in diminishing his narcissistic defenses as well
as his dysphoric and anxiety symptoms.
Mr. G is distressingly uncertain of who he is (e.g., The
worlds very existence, and that of my own is what lies at the
bottom of my puzzlement.) and is deeply torn in two contradictory directions. On one hand, he experiences himself as one
of the rare few individuals who sees things the way they truly
are. In this mode, he holds firmly to radical neo-fascistic political beliefs, intellectual grandiosity, and a pose of total lack
of dependence on others. Clearly illuminated by the content
and his approach to the Rorschach, Mr. G holds himself to the
prophetic ideal of being emperor-like and, as he stated, special.
This ideal, as one could imagine, is quite difficult to realize day
in and day out and often leaves him gravely vulnerable to affective slides if his grandiosity is not aptly mirrored. When chinks
in the armor begin to appear, he spirals into deep depressions,
experiences himself as falling apart, and thus becomes unable to
maintain his sense of invulnerability. At these points, he looks at
his interpersonal decisions and radical beliefs and feels wholly
different, or, in his words, alien, pathetic, and ashamed.
These experiences, laden with intense anxiety, are so radically
dissociated from his alternative sense of grandiosity that he feels
Feedback Session
In line with the case conceptualization and his questions developed at the beginning of the assessment, the feedback session
was aimed at providing Mr. G with insight to help him better
understand his aggressive and devaluing behaviors, the impact
of his childhood on his capacity to manage his emotions, and
a sense that understanding of his difficulties is possible. Due
to his potential for disorganized thinking, it was conceptualized that his narcissistic defenses, for now at least, were his
best defense against psychosis. The feedback was designed to
empathize with the need for these protective defenses without
colluding with them.
The question was how to share these insights with Mr. G.
I was concerned that informing a patient that he was precariously close to a psychotic break would increase his fears and
make the situation worse. Both my supervisor (K. G. White)
and mentor (L. Handler) explained that conveying accurate understanding would likely impact him positively because it was
likely that he already had a sense that his thinking was, at times,
disordered. They indicated that avoiding such essential feedback was akin to not seeing and not understanding Mr. G
and therefore potentially invalidating the assessment process
in his eyes. Instead, by honestly attuning to his increasingly
frightening experiences of cognitive confusion, narcissistic behaviors, and poorly integrated childhood memories, his fear that
nobody could understand him other than Sigmund Freud might
be ameliorated. Further, empathically and mutually discussing
the findings of the assessment process might provide him with
a sense that human relations based on compassion and understanding, rather than shame and misunderstanding, are indeed
possible. To alleviate my own fears about flooding Mr. G, it was
helpful to role-play with my mentor (L. Handler) to practice
sharing, as empathically as possible, difficult issues illuminated
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I was surprised to watch Mr. G make this deep connection
with his past. Wanting to give him an example of how hes not
an asshole, I responded:
EJP: Thats wonderful, you being able to do this, to sit here with such
difficult thoughts and feelings and stay open without getting stagnant
or puffing out your chest with me. This is why I think psychotherapy
will be so helpful for you over time.
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indeed capable of responding more clearly and with a greater
degree of reality testing.
EJP: Right, I agree. You do need to sit with these things and work them
through. And, youre right that it would be good to have someone to
help keep you on track. It was like when I asked you after the Rorschach
was over to just tell me what everybody else sees. I sensed the emotions
in you were getting too hot and I wanted to take some pressure off.
Conclusion
The results of this assessment indicate that TA can be mastered by less experienced clinicians with little to no experience with traditional information-gathering procedures. A few
months after the evaluation, Mr. Gs therapist reported an increase in rapport as well as commitment to therapy. In particular,
the therapist expressed gratitude for highlighting the usefulness
of empathy as a way of tempering Mr. Gs stormy and vacillating self-experiences. The following was reported by the therapist
following the assessment process:
Just prior to the evaluation, Mr. G screamed at the top of his lungs
in a tearful rage, Nobody understands me! Nobody knows what I go
through! After the testing was completed, Mr. G stated that the results
were very representative of his struggles. He engaged therapy with more
vigor and a greater sense of hopefulness. He declared specifically that
he wanted to show his mother the report so she might better understand
him. Mr. G did show his mother the assessment report and reported
afterwards how he became enraged when she attempted to explain her
view of portions of the social history. Unfortunately, Mr. G interpreted
this as an indication that his mother was too ignorant and egocentric to
understand his pain and his problems. At least initially, Mr. Gs wish to
be better understood by his mother was dashed. However, using some
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emotional responsiveness in a therapeutically oriented assessment. As this difficult case makes clear, there is potential
for significant benefit for patient and clinician alike when
the internal worlds of both are considered essential resources,
rather than impediments, for a deeper understanding of human
personality.
Finally, because one of the core motivations of self psychology is to help a patient feel heard, seen, and understood, it is particularly amenable to TA. The optimal attunement experienced
by a patient in a well-organized, self psychology-informed TA
might make it more likely that he or she will proactively consider
treatment recommendations, as did Mr. G.
ACKNOWLEDGMENTS
A brief version of this manuscript was presented as a paper at
the 2006 Society for Personality Assessment Annual Meeting in
San Diego, CA. We thank the two reviewers for their thoughtful
and constructive reviews that greatly enhanced this manuscript.
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