Essentials of Psychological Assessment Supervision by Wright A. Jordan;

Author:Wright, A. Jordan; [Wright, A. Jordan]
Language: eng
Format: epub
ISBN: 9781119433019
Publisher: John Wiley & Sons, Incorporated
Published: 2019-09-17T16:00:00+00:00

Understanding Problem Context

Much of the research on how well treatments tend to work with individuals is organized around specific diagnoses and occurs under very controlled conditions. Life, for better or worse, is much more complicated than individual factors (like diagnosis) and optimal conditions. The larger context in which individuals function (or have difficulty functioning) often plays a significant role in the etiology, reinforcement, mitigation, or altering of problems. Because of this, some researchers have focused on how contextual factors affect how well treatments tend to work with different individuals.

One area of focus related to the context in which individuals are struggling and the effect of this context on treatment effectiveness is level of social support. While clinical assessments often evaluate (at least informally) level of social support during a clinical interview, it is generally an area that is not formally assessed or discussed in supervision. However, level of social support has been shown to differentially predict what kinds of treatments are likely to be most effective (see Beutler et al., 2000). What is most important for supervisors to understand is how counterintuitive the findings have been for what most supervisees would expect to be the case. That is, individuals with low social support tend to fare better in cognitive-behavioral therapies that are not focused on building relationships, whereas those with a great deal of social support benefit more from treatments aimed at enhancing relationships. Many supervisees implicitly assume that those with low levels of social support need treatments aimed at building more and better relationships. Supervision can address this briefly and even hypothesize or theorize why the counterintuitive finding may make psychological sense, especially within the context of the client being assessed. For example, if an assessment client has a strong and healthy support network, a supervisory discussion may focus on the hypothesis that the client already has strong social skills and the capacity to be close with others, and so treatment should capitalize on and enhance these skills. Primarily, though, as with many of the other contextual and client characteristic factors, the supervisory discussion may be brief and focused on whether this factor (level of social support) somehow contraindicates whatever treatment recommendations emerged from the diagnosis and/or case conceptualization.

While research has not been systematic (for a brief discussion, see chapter 14 of Groth-Marnat & Wright, 2016), supervisors should ensure an explicit consideration of current life circumstances and their potential impact on different types of treatment. It may be too ambitious, for example, for someone who has just recently been diagnosed with a significant illness (mental or physical) to engage in treatment targeted at rapid and major behavior change; supportive psychotherapy may be more appropriate in the developmental perspective of treatment. Major life changes or transitions may similarly impact what kind of treatment makes intuitive sense (or what kinds of treatment may not). Because research in this area is sparse, unsystematic, and thus not generally prescriptive (or helpful), the onus is on the supervisory relationship to discuss and consider whether

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