Assessment

Testing the Treatment Utility of Therapeutic Assessment in Patients with Severe Personality Pathology
Hilde de Saeger, Roel Verheul and Jan Henk Kamphuis

Therapeutic Assessment (TA) refers to a collaborative, semi-structured approach to individualized clinical assessment. A distinguishing feature of TA is that the primary assessment questions are formulated in collaboration with the client. Referring clinicians are also encouraged to formulate questions provided they are shared with the client. Hence, from the outset, the client is not merely a source of information, but first and foremost an active participant in the assessment procedure. Test selection is guided by the client’s and referring clinician’s questions, while subsequent administration and scoring are conducted according to standardized techniques. Individualized feedback is another key element of the TA procedure. In TA, feedback is again characterized by its question-driven, individualized, and collaborative nature. For more detailed descriptions of TA, please visit the website http://www.therapeuticassessment.com

More than ever, clinical assessment needs to demonstrate treatment utility, to serve the economic aims of optimal allocation of scarce resources. The presumed paucity of research documenting the treatment utility of clinical assessment has even led some to advocate a reduction of its use in clinical practice. This study will put the treatment utility of TA to the test following a manipulated assessment design.

Treatment selection
Janine van Manen and Roel Verheul

Health care would be ideal if it were to be patient-focused (demand-driven), evidence-based and cost-effective. All too often, however, the reality is different. Within care institutes, the type of therapy is determined not infrequently by the institute’s own range of treatments. In the absence of consensus on matched care, the decisive factor is often the individual preference of the intaker or patient. This project aims to develop a tool to support treatment selection for personality disorders. The envisaged tool consists of decision-making trees or decision-making rules that provide pointers to answer to the following questions:

• Is psychotherapy possible with this patient?
• What should the primary targets and goals of treatment be?
• What is the optimum dose for this patient in terms of setting, duration/frequency and theoretical frame of reference?

The innovative nature of this development process lies in the systematic and step-by-step integration of clinical, empirical and experiential knowledge. An initial prototype is being modelled based on best clinical expertise in conjunction with existing scientific knowledge. The next step will be to perform retrospective and prospective case analyses to examine to what extent the prototype reflects existing practice. The model will then be checked against empirical data from SCEPTRE. Finally, model-consistent and model-inconsistent indications will be compared in terms of their effectiveness and efficiency.

As far as we know, this project is the first attempt to rationalise treatment selection for personality disorders. With a view to the possibility of its implementation, we have consciously adopted an approach in which clinical expertise is the point of departure. This was done because a literature study revealed a lack of success of other strategies like computerised expert systems and evidence-based guidelines built exclusively on empirical evidence. The four institutes participating in this project have already given an undertaking to implement the instrument if it is found to be usable.