The Benefits of Psychological Assessments and When to Use Them

PSYCHOLOGICAL ASSESSMENT

A Psychological Assessment involves the planned use of interviews (generally semi-structured) and specific psychometric assessments (tests) to answer questions highlighted in a referral. I find that questions are typically around teasing out complex diagnoses, helping clarify symptoms/coping style/personality, or, specifying the types of therapy and therapist most likely to assist the patient.
The components all play a specific role. The interview helps define the current situation/problems and important elements of personal history. It also engages the patient with the assessment process. The tests themselves act as both lens and lever: getting a unique perspective on relevant issues while also highlighting where and how therapy probably needs to be focused.
When it comes to tests, there are many psychological tests assessing almost any variable you could imagine. Categories of test more relevant to clinical assessment include:

• Tests of intelligence and neuropsychological functioning (such as tests of executive function, memory, attention, reasoning et cetera);
• Brief face-valid symptom measures (such as the Beck Depression Inventory or the K10);
• Omnibus measures such as the Rorschach, the MMPI – 2 or the PAI-2 (which combine personality, coping style and psychopathology assessments), and;
• ‘Pure’ personality measures such as the Hogan Personality Inventory, the NEO or the IPIP-120 which do not assess psychopathology.

The type of measure chosen depends on the question you want to answer as well as the time demands and financial cost of the test under consideration. Each type has strengths and weaknesses. In my opinion, the omnibus measures such as the MMPI-2 and Rorschach are the most complex, the most interesting and the most broadly useful for clinicians and patients.

IMPACT

What are the benefits for psychiatrists? There are many. You get to check and challenge your own diagnoses, specify treatment-related patient factors and get a different perspective cast over complex patients. The tests help clarify what intensity of intervention is required – it helps you not miss those patients who present very well but are just good at ‘holding it together’ on interview while really requiring far more clinical intervention. The insights from these assessments help you build a collaborative formulation and treatment plan with patients, improving the likelihood of treatment compliance and treatment outcome. It’s an interdisciplinary & collaborative form of work – working with a clinical psychologist – and it helps overcome the isolation common in private practice. Finally, it is enjoyable – it helps you to honestly engage with people about distressing, difficult or complex issues.

Benefits for the patient are also significant. The interview and test process engages and empowers; it communicates a genuine respect for the patient and has them as an integral part of the process rather than just the ‘subject’ of an assessment. Testing lends legitimacy to an assessment process. Apart from objectivity, it also fosters rapport-building with patients in the form of a joint understanding and decisions on interventions or treatments. Again, perhaps the most important element is that therapeutic assessments have a clinical impact about the equivalent to a similar period of therapy or counselling. (Poston and Hanson, 2010)

REFERRAL TRIGGERS

When should you refer a patient for a psychological assessment? Whilst it’s easy to say “with every patient”, I think there are a few points when psychological assessment is particularly worthwhile. These include:

• Pre-treatment evaluations, particularly if you know a patient has been referred to you because of limited success in previous treatment or the patient has complex problems/presentation;
• When treatment has stalled and psychological assessment can be used to identify the factors limiting progress, and;
• Questions of fitness where decisions are being made about patients based on their psychological functioning (i.e., return to work). Psychological assessments give you relatively objective evidence to be used in decision-making processes.

SUMMARY

My professional experience of using therapeutic psychological assessments is extremely positive. I find they bring an insight, clarity of focus and opportunity to engage with patients in an open and powerful way that I have not found in any other way or method of working. When working this way with Psychiatrists, it has helped us ‘divvy up’ the therapeutic tasks, keep a common language and common set of goals with patients. We are able to keep a clear focus on what we are working on and why. Similarly, when I’ve discussed the impact of assessments with patients, the feedback I get is resoundingly positive.
Now I’ve laid out the administrative process and clinical argument for them, I’m looking forward to sharing some case examples of the kinds of insights and impact this type of work can have for you as professionals and for the patient under your care.

QUIZ