ADDICTION & RECOVERY Category in Blog

Knowledge is Power: a Q&A with Edward Steen, PhD, Freedom Institute’s Consultant for Psychological Assessments

Clinical Psychologist, Edward Steen, PhD has joined Freedom Institute as a consultant to provide psychological assessments for our clients.  These assessments not only provide clinical information to inform treatment but also act as a motivational and therapeutic intervention to help clients jump-start and get traction in their recovery.  

How did you develop an interest in psychological assessments?
I did my doctoral training at NYU.  A lot of important assessment psychologists had worked there over the decades, so as students we always saw assessment as a critical part of our training, which was rigorous.  For example, to help us really dig into the test material, our professors would challenge us to think about how to estimate intelligence using personality tests and how to think about personality dynamics using IQ tests.  I also studied neuropsych testing at the Manhattan VA for a year and a half and ran the testing and assessment service at Jacobi Medical Center when I worked there.  I have a full-time private therapy practice with a focus on addictions. I found that using my training in psychological assessment proved helpful to my clients to clarify issues related to their addictions issues that were difficult to explore in standard talk therapy.

How does psychological assessment work?
The assessment services that we are going to start at Freedom Institute are a concise, focal battery of just two tests, the Rorschach Inkblot Test and the Personality Assessment Inventory, a well-validated self-report measure.  The idea is to use the combination of these two measures to help identify personality variables that have posed obstacles to treatment with certain clients.  For example, when a client has had multiple detoxes or rehabs and doesn’t know why those experiences aren’t “taking,” it can be very helpful to look for perhaps hidden or less clear psychological or personality variables that are impeding therapy progress. For example, clients may be experiencing underlying mood and anxiety states, difficulty with affect regulation, problems with social and interpersonal functioning, issues stemming from trauma and shame, and so on.

And how does the information from these tests help clients?
We are using a newer approach to assessment, meaning it is still not widespread and well-known, which has a particular focus on the importance of new ways of sharing the testing feedback with the clients. The approach is called Therapeutic Assessment and was created by Dr. Steven Finn, who is based in Austin. First of all, there is a lot of flexibility to test selection, rather than a strict, traditional test battery.

Secondly, we ask the client to come up with his or her own test referral questions.  We ask what they would like to learn about themselves, or what they have been confused about and would like clarity on. Then I do my best to answer those questions.  Third, this approach dramatically changes the way in which feedback is delivered and draws heavily on therapeutic methods such as Motivational Enhancement.  In this approach, the tester, the client, and the client’s therapist all contribute to crafting the feedback.  Importantly, I try to shape the presentation of the test data around the client’s own test referral questions.  Beginning with the empirical test data, the tester, client and therapist create a narrative around the client’s questions that incorporates the test data in a way that is meaningful and has some emotional impact for the client.  That narrative can serve as an important touchstone at different—perhaps tricky—points in the therapy moving forward.

Rorschach Inkblot tests, really?
Concerns about the Rorschach are completely understandable since most people are familiar with them through perhaps not-so-serious scenes in movies and TV.  However, the Rorschach as it is administered today is indeed an empirically-based assessment tool.  Unfortunately, the field of psychology has not done a super job of clarifying how these psychological tests work and how we use them.

Some psychologists have tried to step up the game on this front more recently.  A big issue is that of what we mean by “projective tests.”  What that suggests to a lot of people is that there is an ambiguous stimulus, the client “projects” something on to that stimulus, and then the tester somehow interprets the projections, usually in a sort of parody of 1950’s Freudian analysis.  Unfortunately, there actually are some tests that work more or less in this fashion.  Three in particular are the Thematic Apperception Test (TAT), the Bender Gestalt, and Figure Drawing tests.  The TAT has line drawings of different images—lonely kid on a porch, looming old guy in a room—and clients are instructed to tell a story about the picture, and then the tester “interprets” the themes and the meanings of the story.  In the Bender, the placement of different abstract shapes is interpreted in terms of psychodynamics—for example, dependency needs when figures touch or overlap.  In Figure Drawings, the tester is asked to draw people, a house, and a tree, and then interpretations are made about the client’s personality dynamics.  These are three examples of exactly the kind of work that I do not do, and in my opinion, the criticisms levied against them do have some validity.  While they can be helpful, there has not been enough emphasis placed on studying and standardizing methods of interpretation, and submitting these methods to rigorous study.

However, with Rorschach, there have been numerous evolutions of scoring and interpretive strategies, and in the end, if the analysis of a particular interpretive finding cannot be repeatedly supported by empirical research, then that interpretation gets discarded. There have been many hundreds of validation studies performed for the inkblots and the Society for Personality Assessment has approved and detailed the empirical basis of the Rorschach methodology.

Can you provide a quick case study or example of how feedback from an assessment has helped a client in recovery?
I did an assessment with a client recently who didn’t understand why she had so much difficulty with relationships—romantic, close friends, even business colleagues—many of whom often remarked that she seemed “closed off.”  She was attuned to her goals and ambitions in the world, but was having difficulty creating a meaningful lifestyle for herself.  She came across as successful, smart, worldly and curious, and very likable, and seemed eager for help, but there was something that didn’t feel right in the therapy interactions.

After a Psychological Assessment, we learned that she had a tremendous amount of anger and aggression to levels that surprised both of us when we went over her scores together.  We were able to relate this to some early experiences: her father had died suddenly when she was young, around 9 or so, and although her mother bounced back and rebuilt their lives, and remarried, her stepfather then died when she was a teenager.  Her mother, understandably, never fully recovered from this second loss.  What seemed to emerge from these losses was a sense of rage against the unfairness of life, which she kept well hidden.  She had a reluctance to get too attached to people since they could (and for her, did) disappear.  She was entirely focused on controlling her destiny even when and where it just could not be controlled.

All these adaptations are completely understandable given her early traumas, however they worked against her goals in adult life.  Because of her almost desperate desire to control her life circumstances, she had significant difficulty empathizing with the people in her life and seeing things from others’ perspectives.  The testing allowed her to recognize this and helped her refocus her therapy efforts on looking inward on her own longings and fears, and developing a sense of self-compassion for her early coping efforts (she was very gritty in that early emotional landscape) instead of trying to control what was “out there in her world.”  The results and feedback from the testing allowed her to understand her issue and focus on working to change it.  She understood she had to work on being comfortable in relationships without trying to control the outcomes.  This was difficult for her to do, but critical for her to achieve the life goals she had set for herself.  It would have taken a very long time to get to this point of self-awareness without the testing.

How long does the assessment take? And how long before feedback is presented?
We are trying to make it very concise at this point.  About an hour with a self-report questionnaire and about an hour interacting with the tester with with inkblots.  Ideally, we want a quick turnaround with the feedback, just a week later, so we can get the findings woven into the client’s group and individual therapy experiences as quickly as possible.  As we experiment with the assessment procedure, we hope we can adapt and modify how we do this to best serve the Freedom Institute community.