Psychological Testing and Treatment Implications: We Can Say More

Abstract

Psychologists invest considerable time and labor in psychological testing and report writing. Patients and families expose vulnerabilities and make a significant financial and time investment in the hope that testing will make a difference in treatment. Frequently, though, handling of treatment implications in reports is generic, which might not justify the time, expense, and emotional investment involved in the evaluation. As diagnosticians, we have the responsibility and potential to contribute more meaningfully to the work of our referring colleagues and the treatment of the patients we assess. I review the psychotherapy research literature to highlight evidence-based findings that can serve as guideposts in formulating treatment implications. Subsequently, I illustrate how we can use test data to make nuanced inferences about therapeutic alliance, potential resistances, likely transferences and countertransferences, and conceptualizing treatment on the supportive–expressive continuum.

Acknowledgments

I thank Dr. Linda Helmig Bram and Dr. Alice Bartlett for their assistance in preparation of the article.

Notes

The clinician-report Countertransference Questionnaire (Zittel & Westen, 2003) used in Betan and Westen's (2009) research can be applied in testing practice to lend discipline and structure to this process.

I would argue that the emphasis on manualized therapies for DSM–IV disorders has far overshadowed the evidence-based research presented earlier.

This vignette involved deviation from standard test administration. After expiration of the item's time limit, the examiner decided to deviate in this way because he viewed this as a prime opportunity to test hypotheses related to the referral question, which he prioritized over any potentially negative impact on subsequent Block Design items, subtest or IQ scores, or the validity of possible future readministrations. Such deviations should be made sparingly and judiciously. Optimally, examiners apply such testing-the-limits/extended inquiry intervention after the standard administration of the subtest (see Bram & Peebles, in press).