Clinical Significance. A Therapeutic Approach to Psychological Assessment in Treatment Planning

Research Paper (undergraduate), 2014
26 Pages, Grade: A




1 Introduction

2 Purpose

3 Methodology

4 Historical Perspectives

5 Theoretical basis for Clinical significant change in Therapeutic Assessment

6 Initial Theory on Therapeutic Mechanisms of change in Psychological Assessment

7 Conceptual Meaning of Clinically Significant Change in Therapeutic assessment

8 Empirically documenting clinically significant change in Therapeutic Assessment

9 Discussion

10 Conclusion

11 Recommendation and Future direction

12 References


Psychological assessment has long been reported as a key component of clinical psychology. This paper examined and shed light on the complexities surrounding the clinical significance of therapeutic approach to treatment Planning. To achieve this objective, the paper searched and used the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to analysed the underlying themes: 1) a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2) explained the conceptual meaning of clinical significant change in therapeutic assessment, 3) answered some of the questions regarding practicability and the clinical significance of therapeutic approach to treatment plans, particularly during or before treatment, 4) linked therapeutic assessment to change in clients’ clinical impression, functioning and therapeutic needs, 5 ) used initial theory to explain the therapeutic mechanisms of change in clinical practice, 6) analysed the empirically documenting clinically significant change in therapeutic assessment. Finally, the study suggested that though therapeutic assessment is not sufficient for the systematic study of psychotherapy outcome and process, it is still consistent with both the lay-man and professional expectations regarding treatment outcome and also provides a precise method for classifying clients as "changed" or "unchanged" on the basis of clinical significance criteria.

1 Introduction

Psychological assessment is to some degree of a crossroads. Though, research suggested that psychological assessment should move from psychometrics and scale development to a pragmatic assessment (Meyer et al., 2001), however, raising the issue among psychologists reliably reveals robust and conflicting opinions. Although psychological assessment covers a nontrivial part of clinical activities (Norcross, Karpiak, & Santoro, 2005), the drops in graduate training in assessment (e.g., Curry & Hanson, 2010) and changed reimbursement from managed mental health care (e.g., Eisman et al., 2000) consistently influenced its usage in clinical practice. However, despite the challenges, the use of the traditional method for treatment evaluation continues to be a major discourse among researchers and practitioners. The use of traditional assessment for treatment plan was limited in two respects. Firstly, psychological assessments offered no statistical information on the inconsistency in client’s response to treatment, despite the relevance of the information on variability of treatment outcome. Secondly, the effect of psychological assessment is less significant on clinical outcome.

Though, much has been done in the past to promote clinical significant change in therapeutic assessment, their outcomes are yet to be proved and analysed systematically (Finn, Fischer, & Handler, 2012). The clinical significance of therapeutic assessment to treatment refers to its proficiency to attain the values of competence set by clients, clinicians, and scholars. While there was little agreement about the standards, the available research confirmed many propositions on the issue. Some of this include: a high proportion of clients improving; a level of adjustment that is identifiable by peers and significant others (Wolf, 1978); removal of the current problem (Kazdin & Wilson, 1978); normative levels of effectiveness by the end of therapy ( Nietzel& Trull, 1988); or changes that meaningfully lessen the risk from other health problems to mention a few. This shifts in psychological assessment, particularly, as it related to envision and collective oriented therapy blown a new life into the debate on clinical significant change in clients ‘treatment outcome. The measures and models that come from this paradigm shift were categorized as therapeutic assessment (Finn, Fischer, & Handler, 2012) and shared and documented by various scholars (e.g., Meyer et al., 2001) as a concept that prompts therapeutic change in treatment. However, despite this development, clinicians still found it hard to agree on whether a change in clients ‘condition can be attributed to the assessment or not (Jacobson, Follette, & Revenstorf, 1984).

Hollon (1998) provided additional evidence to support this argument by emphasised the difference between effective and specific, effective, and perhaps effective therapies in clinical practice. According to his specification, a treatment is labelled effective, specific and clinically significant when a therapy is ‘significantly superior to a pill or psychological placebo in at least two independent research settings’ (p. 18). For instance, if a psychological assessment is more beneficial than when there was no treatment in at least two settings, it is considered as effective and clinically significant. On the other hand, if the therapeutic efficacy is only supported by single evidence, the assessment is thought-out as possibly efficacious, pending replication. These positions echoed the reflection of the question "What does clinician mean when they talk about change as clinically significant?" However, the answers to this are not, of course, the operational meanings in use but the ideas it designed to signify. That is why till now there were contrary views on what makes an assessment clinically significant.

2 Purpose

This article brings together several empirical findings that support the clinical significance of therapeutic assessment in treatment planning. It also aimed at answering some of the questions regarding the clinical significant change during or before treatment. The paper linked therapeutic assessment to intervention process that identified, described, and managed clients’ functioning, clinical impression, and therapeutic needs. To achieve these objectives, the paper empirically outlined the following; 1) a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2) examined the conceptual meaning of clinical significant change in therapeutic assessment, 3) used initial theory to explain the therapeutic mechanisms of change in psychological assessment, and analysed the common deficiency identified in treatment validity, and lastly, 4) gathered empirical evidence to supports the clinical significant change in therapeutic assessment in clinical practice.

3 Methodology

This paper analysed and reviewed empirical literature that highlights the clinical significant of therapeutic approach to treatment planning. It also addressed the complexities, practicability and acceptability of therapeutic approach to psychological assessment. The study collated and reviewed relevant articles, books, journals, and meta-analysis on clinical significant of therapeutic approach to psychological assessment. Both the ERIC and PSYCHLIT databases were searched using the following key words: therapeutic approach, clinical significant change, treatment outcome, treatment planning and psychological assessment. This procedure initially reported about 1650 articles, journals, technical reports, paper presentation, case studies and book chapters covering more than 28 year period. Based on the abstracts retrieved from this initial 1650 plus articles and publications, the search was lessened to a relatively few hundred of studies that are pertinent, current and relevant to the theme of this paper. The contents of the remaining several hundred of articles cum journals were further scrutinised and only those that reported empirical findings were kept aside and used, while others were left out of further consideration. The process shows that only a few studies documented empirical findings on clinical significance of therapeutic approach to psychological assessment in clinical practice. To verify references, manual searches of relevant journals and articles related to the paper are performed.

4 Historical Perspectives

Therapeutic assessment is a short-term highly organized hypothetically and scientifically grounded method of psychological assessment. This method though arguable, was established by Stephen Finn and his professional colleagues and was significantly swayed by the humanistic school and self-psychology. Historically, therapeutic intervention was linked to the work of the humanistic crusade of the 1950s and 1960s. Though, many humanistic oriented clinicians (Rogers, 1951) were strongly against the use of psychological assessment, its experimental utility continues to grow over the years and was crucial for effective treatment plan in clinical practice.

The periods between the 1960s and1970s also saw scholars such as Goldman (1972) described assessment and treatment as “a failure marriage” (p. 213). Besides, some of these scholars also had a long-held conviction that professional involvement of clients in assessment was injurious and unhealthy (e. g., Eisman et al., 2000). Of most interest among this view is the way they put a diverse twist on psychological assessment and is response method. For instance, some psychologist looked at psychological assessment as a therapeutic interpersonal knowledge rather than a clean reductionist practice (Riddle, Byers, & Grimesey, 2002). Yet, despite the avalanche of criticism, therapeutic assessment continue to spread and covers important and specific areas such as (a) assisting service users to develop questions they need to solved through the assessment and testing, (b) gathering contextual evidence associated to their problems, (c) using previous assessment (d) engaging clients in partnership and making logic of the results, and last but not the least, provide immediate response to clients’ early questions (Finn, 2007). Yet, the question remains, thus this approach really therapeutic enough to bring appropriate change in client ‘condition. So far, this continues to face empirical test and till now, no agreement was made on the issue.

Furthermore, the lack of uniformity in the ethical guiding principle in the 1990s limits professionals from sharing the outcome of the assessment with clients (e.g., forensic evaluations; American Psychological Association, 2002; Curry & Hanson, in press; Smith, Wiggins, & Gorske, 2007). This set up a major change paradigm-wise in the assessment-related behaviour and research foci and ushered in different types of therapeutic models that continue to influence the treatment of mental health disorders ( Finn, 2007; Gorske & Smith, 2008; Riddle et al., 2002; Tharinger, Finn, Wilkinson, & Schaber, 2007; Wygant & Fleming, 2008)

5 Theoretical basis for Clinical significant change in Therapeutic Assessment

The use of the traditional evaluation for treatment plan has been long criticized. In fact, the process comes with some limitation particularly, on measuring change in clients. Both in applied research and clinical practice, assessing the change that clients experience as a result of the treatment they undergo is a common practice. However, to quantify change in order to evaluate correctly the significance of the treatment to change in clients ‘condition is cumbersome, to say the least challenging. Though, the Null hypothesis significance testing provides professionals with valuable information during treatment, however, it failed to highlight the significance of the estimated effect because it partly relies on sample size (Thompson, 2002). Though, the measures of outcome size has been used to cover this constraint, nonetheless, the more the observed outcome is, the more likely it relate to a clinically meaningful change. While it was reported that these types of measures hinge on the variability of the analyzed scores, it was also agreed that a large outcome does not ineludibly link with an important effect (Jacobson, Roberts, Berns, & McGlinchey, 1999; Kazdin, 2001). Though, the null hypothesis significance testing and the measures of outcome size are used to analyse the difference between group averages, they failed to detect the individual change in treatment outcome. Moreover, the process also failed to stipulate whether or not there is a particular change in clients ‘condition and at what percentage (Jacobson & Truax, 1991). Therefore, the limitations of statistical tools in assessing intervention outcome prompted the change from statistical to clinical significance (see Kendall, 1999; Ogles, Lunnen, & Bonesteel, 2001).

6 Initial Theory on Therapeutic Mechanisms of change in Psychological Assessment

Research on treatment outcome has long probed why psychological assessment is theoretically therapeutic and clinically significant. Most of these studies sought for a particular assessment a tool that brings about therapeutic change in treatment. However, this thought prompted two caveats in the treatment of mental health disorders. Firstly, it was found that the mechanisms for change are not functioning in all the psychological assessments. That is, the mechanism for change was only appropriate for a collective approach in psychological assessment (Finn & Tonsager, 2002) and the other professionals (Purves, 2002). Although parts of this theory are yet to be tested empirically; it was a resultant of wide clinical experience. The theory found that basic human intentions are resolved by personality assessment and by other effective psychotherapies. Besides, this theory also sees clients’ self-verification as an important tool for clinical significant change in therapeutic assessment. Besides, the theory postulated that clients who are ready and willing to partake in treatment are expected feedbacks and proof that sees their opinion about self and that of the people around them as approved by others. This motive is refers to as a self-verification. According to this theory, it is severe when clients had an experience that tested their schemas or that of people around them particularly when the therapist gave clients a feedback that was extremely opposite of their self-thought. This if happened may affect the treatment outcome.

Secondly, the theory established that human aspiration should be respected and admired by others and that it is good to consider one-self as decent. This is refers to as self-enhancement. This motive was highlighted by object-relation psychotherapy (Winnicott, 1975) and poignantly cleared in applied psychological assessment. Surprisingly, a significant number of clients assessing psychotherapy had negative self-concepts which often revealed during the start of the assessment. For instance, a client might ask why he/she is lazy or loser in a relationship through feedback, clients’ assessment scores can be positively used to change this negative assumptions. A client who sees himself as "lazy" because he characteristically achieves little success in life might be advised after the use the MMPI-2 test that he/she is clinically unhappy. Additionally, clients might be advised that been depressed have an emotional impact on their energy level, or that depression affects people ability to complete their basic daily chores. Such explanations helped clients to develop positive change and view about their behaviour. It also helped clients to improve the negative ways they interpret things, thus, increased their self-esteem and promotes positive change (Newman & Greenway, 1997).

Thirdly, the ego psychologist (e.g., Freud, 1936) emphasised the human necessity for exploration, mastery, and control, i.e., self-efficacy/self-discovery. This assumption lately formed the foundation of Bandura's (1994) theory of self-efficacy. Base on this, assessment must design in a way that would tackle such desires and offered clients with fresh facts about their personality. Also, a therapy must be efficient to organize evidence on clients’ life experience. This action created an exhilarating "aha" experience for clients and upsurge their self-efficacy and knowledge. This kind of therapeutic process is called naming clients' experiences and it promotes clinical significant change in treatment. This was obvious in the work conducted by Corsini (1984) where he reported that through new information clients mix and made common sense from a number of apparently dissimilar incidences, i.e., to create new answers to their problems (e.g., "taking my antidepressant medication makes me feel better and productive."), and fashioned a perfect likelihoods future (e.g., "If this problem is over, I perhaps might complete my college degree)


Excerpt out of 26 pages


Clinical Significance. A Therapeutic Approach to Psychological Assessment in Treatment Planning
Atlantic International University  (School of Social and Human Studies)
Personality Assessment
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ISBN (Book)
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clinical, significance, therapeutic, approach, psychological, assessment, treatment, planning
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Olusegun Emmanuel Afolabi (Author), 2014, Clinical Significance. A Therapeutic Approach to Psychological Assessment in Treatment Planning, Munich, GRIN Verlag,


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