“Am I Going Crazy, Doc?”: A Self Psychology Approach to Therapeutic Assessment

Abstract

In this case study, we explore the effectiveness of Therapeutic Assessment with a severely disturbed 25-year-old man, referred by his therapist, following Finn's (2007; Finn & Tonsager, 1992, 1997) model. This patient–therapist pair had been working together for approximately 2 months, but the therapy had ceased to progress. The therapist requested a clearer picture of his patient's 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.

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.