Co-Existence or Alliance? Psychological Assessment and Its Effects on Therapeutic Process Using SystemicPsychotherapy as an Example

doi:10.4236/psych.2011.21007

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Psychology

2011. Vol. 2, No. 1, 42-48

Co-Existence or Alliance? Psychological Assessment and Its

Effects on Therapeutic Process Using Systemic

Psychotherapy as an Example

Anna Pittermann1,2, Klaus D. Kubinger2

1Department of Surgery, Medical University of Vienna, Vienna, Austria;

2 Faculty of Psychology, University of Vienna, Vienna, Au s tria.

Email: [email protected]

Received August 5th, 2010; revised December 22nd, 2010; accepte d December 27th, 2010.

Psychotherapists are still uncertain about what positive or negative effect psychological assessment might have

on the process of psychotherapy. The aim of this study was to sum up the effects of psychological assessment on

the therapeutic process in the systemic therapy of couples. The question of whether psychological assessment

techniques enhances therapeutic progress and helps to achieve therapeutic goals, from the point of view of the

clients, was investigated using randomized samples of clients in couples therapy. For this purpose, couples, who

had signed up for systemic psychotherapy, were randomly placed in either a group with psychological assess-

ment or one without. In addition to the continual monitoring of the subjective achievement of therapeutic goals,

the perceived benefits of the results of the psychological assessment by the clients and therapists were also in-

vestigated. The investigation of 42 couples showed that therapeutic success, from the client’s point of view, oc-

curred sooner and was more stable when a psychological assessment was done in advance. In general, psycho-

logical assessment was seen in a more positive light by the couples than by the therapists.

Keywords: Psychological Assessment, Systemic Psychotherapy, Therapeutic Progress

Psychotherapy and Psychological Assessment

Despite the extensive literature on psychological assessment

(Kubinger, 2003; Kubinger, 2006) and its application within

psychotherapy (Cierpka, 2000, 2003; Fiegl & Reznicek, 2000;

Kubinger, 2006; Laireiter, 2000a) there is still great un- cer-

tainty among practicing psychotherapists about the use of psy-

chological assessment within their work. In Austria clinical-

psychological assessment forms only a small part, if at all pre-

sent, of what is taught as part of psychotherapy education (e.g.

Training guidelines - Psychoanalysis; Austrian Psychotherapy

Act; Training guidelines - Systemic Therapy), resulting in little

engagement with this subject for those psychotherapists without

additional clinical psychological or psychological training.

Psychological assessment is, thematically and in terms of ap-

plication, closely linked to psychotherapy. Many questions

addressed by psychological assessment are also relevant to

psychotherapeutic practice and some questions can only be

answered with the aid of psychological assessment (Laireiter,

2005). Despite, or perhaps, because of this close and yet vague

connection, most therapists have a very clear attitude towards

psychological assessment. They have decided to either reject,

endorse or simply ignore the option of employing it, while the

need is not felt for either the gathering of findings about effi-

cacy based on psychological assessment or for existing findings

to be incorporated into therapy (Ludewig, 2005; Stieger, 1995).

This attitude is seldom supported by thoroughly researched

results or experience tested in practice. Most of these attitudes

either stem from personal opinion or life experience, and not

from the scrutiny of the particular theoretical concepts of as-

sessment, or are based on a profound lack of information about

how to employ psychological assessment. Control studies of the

effects of psychological assessment within psychotherapeutic

processes, whether fruitful or disruptive in nature, could not be

found even in extensive research of literature. Assessment, as

an information gathering process, and psychotherapy whether

seen as a fruitful partnership or an enforced and not very har-

monic relationship, are an “integral element of a circular proc-

ess” (Scheib & Wirsching, 1994, p. 169). In everyday practice

the therapist always encounters p sychological ass essment anew;

patients come to the therapist with diagnoses or results, the

therapist creates a hypothesis based on information, evaluates

their own work with the help of assessment techniques (Braun

& Regli, 2000; Laireiter, 2000b) and even sometimes employs

these for therapeutic purposes (especially projective techniques

such as the Enchanted Family (Kos & Biermann, 2002), repre-

sentational tests such as the Family System Test (Gehring,

1998), or circular questioning in the Subjective Family Image

(Mattejat, 1994)), for further information about assessment

tasks in psychotherapy, see (Laireiter, 2000c). Some assess-

ment techniques even come unmistakably from a therapeutic

background (such as Beckmann, Brähler and Richter’s Giessen

Test (Beckmann, Brähler, & Richter, 1983) psychoanalysis or

the Family Board (Ludewig, 2000) systemic family therapy).

There are, especially among the main systemic family therapy

clientele, namely couples and families (in the widest definition

of those words), a large number of techniques which concen-

trate on this target group and the most common problems that

they bring to psychotherapy. These techniques include Couples

Diagnosis with the Giessen test (Brähler & Brähler, 1997), the

Family Relations Indicator (Howells & Lickorish, 1989), the

A. PITTERMANN ET AL. 43

Family Assessment Measure (Cierpka & Frevert, 1994), the

Family System Test (Gehring, 1998) and the Family Identifica-

tion Test (Remschmidt & Mattejat, 1999) (see also Ludewig,

2000; Brähler & Brähler, 1997; Benninghoven, Cierpka and

Thomas, 2003; Thomas, 2003). Despite this wide range of test

instruments many therapists would rather rely on their own

diagnostic aptitude than an assessment procedure or gathering

more information. The aim of this study is to investigate whe-

ther the therapeutic process in systemic family therapy is posi-

tively or negatively influenced by psychological assessment. A

positive influence could be a focusing of the therapy process

based on the results of an assessment done prior to therapy.

Psychological assessment could in this way simplify thera-

peutic work for the therapist, accelerate the achievement of

therapeutic goals or lead to greater client satisfaction. However,

it is also conceivable that this type of assessment has no influ-

ence, or even has a disruptive influence on the therapeutic

process because it requires resources such as time and energy

without providing any advantage to the therapeutic process.

Furthermore, it might be subjectively experienced by the client

as unhelpful or labeling.

Trial Plan and Methods

The study of the effects of psychological assessment on sys-

temic couples therapy was carried out at the Institut für Ehe-

und Familientherapie (IEF; Family Therapy Institute), Vienna.

The IEF is a Vienna Social Services institute which currently

employs nine systemic psychotherapists. The Family Therapy

Institute provides systemic psychotherapy for couples, families

and individuals. Psychological assessment is not routinely car-

ried out there. The management team, therapeutic team and

administrative team have all already kindly agreed to take part

in the study, and to support the research project.

The plan for the study was to include couples who contacted

the institute with “partnership problems” (as opposed to dif-

ficulties relating to other members of the family group). The

randomization of couples was carried out by using the date that

they joined the study. The couples were alternately placed in

the “therapy without psychological assessment (PA)” (control

group, CG) and the “therapy with psychological assessment”

(trial group, TG). The trial group couples underwent psycho-

logical assessment lasting approximately one hour before the

first session with the therapist (see Figure 1). In accordance

with Orlinsky (2008) no attention was paid to the therapeutic

variables (gender, age, number of years at IEF etc.) as it is in

any case unclear as to how these effect the therapeutic proc-

ess.

During the first four sessions, the clients from both groups

were continually monitored by gathering information about

their experience of the therapeutic progress. The number of

sessions chosen for observation was based on the experience of

the Family Therapy Institute, which showed that most thera-

peutic change happened within the first four sessions and that it

was very possible to form an opinion on the success of the

therapy at this point. Moreover, due to the numerous short

courses of therapy that are carried out at the Family Therapy

Institute, and for comparison and cost reasons, it seemed most

logical to document the first four sessions. The documentation

carried out by the therapist at the end of each session included

the therapist’s subjective appraisal of the degree of achievement

of goals on a scale of 1 to 10 (1 = no achievement; 10 = maxi-

mum achievement of therapeutic goals), the documenting of the

therapeutic process (routine electronic documentation of con-

tent of the session) and, if necessary, the documenting of any

early termination or other therapeutic change. At the end of the

session the couples were asked to separately mark their evalua-

tion of the therapeutic progress on a scale of 1 to 10 (1 = no

progress; 10 = maximum progress). Additionally, after the

fourth session the clients of the “with psychological assess-

ment” group were asked for their feelings about psychological

assessment and whether they would judge the instruments used

to be helpful or interesting, or not. After the fourth session the

therapists with clients of the “with assessment” group also re-

ceived a questionnaire about how they, in retrospect, would

evaluate the information obtained by psychological assessment.

At the end of the four sessions of the study all the clients and

therapists completed a final questionnaire regarding the achieve-

ment of the therapeutic goals.

Test Condition “With Psychologic al A ss essment”

After initial contact with the Family Therapy Institute the

subjects under the test condition “with psychological assess-

ment” completed an assessment session lasting approximately

one hour, during which they were presented with two relation-

ship assessment questionnaires to work through. Every couple

was separated so that each partner worked alone on the couples

assessment with the Giessen Test (Brähler & Brähler, 1997)

and the questionnaire about supply and demand in partnerships

([Fragebogen zu Angebot und Nachfrage] FAN (Pfundner,

Test Group

“with assessment” Control Gro u p

“without assessment”

Telephone contact by the couple Telephone contact by the couple

Assessment Appointment

Couples diagnosis with the Gies-

sen test

Questionnaire about supply and

demand in partnershi ps

1st session

Discussion of results

Evaluation of therapeutic progress

M/W/T

1st session

Evaluation of therapeutic pro-

gress M/W/T

2nd session

Evaluation of therapeutic progress

M/W/T

2nd session

Evaluation of therapeutic pro-

gress M/W/T

3rd session

Evaluation of therapeutic progress

M/W/T

3rd session

Evaluation of therapeutic pro-

gress M/W/T

4th session

Evaluation of therapeutic progress

M/W/T

Therapeutic goals reached

questionnaire M /W/T

Questionnaire about psychological

assessment M /W/T

4th session

Evaluation of therapeutic pro-

gress M/W/T

Therapeutic goals reached ques-

tionnaire M/W /T

Figure 1.

Table representing the planned study (M/W/T = conducted by Man/

Woman /Therapist).

A. PITTERMANN ET AL.

1997; Simader-Hunek, 2004; Kubinger, 2007).

Couples Assessment with the Giessen Test

Couples assessment with the Giessen test comprises of two

questionnaires for each partner. Using the 40 items of the Gies-

sen test, each partner first evaluates himself (self evaluation)

and then his/her partner (external evaluation). The analysis is

carried out on the scales “social response”, “dominance”, “con-

trol”, “underlying mood” and “permeability”.

The method used adult, heterosexual couples as a standard

and enabled the description of individual characteristics, the

comparison of these descriptions for both partners, and the

comparison of interactions (degree of symmetry, degree of

complementarity, degree of validation, the contradictions un-

covered in the self and external evaluations, and the degree of

identification). Couple types have not been allocated due to

their controversial status (Kubinger et al., 2003).

The Partnership Supply and Demand Questionnaire

In the partnership supply and demand questionnaire each

partner is able to use the Q-sort method to state which aspects

of living together in the partnership, which they receive from

the other partner, are particularly important to them, and which

aspects they are willing to give. By using the Q-sort technique,

in which individual answers must be ordered in a graded series

of categories of subjective importance, the grading of every

answer as “very important” is avoided and an individual rank-

ing of priorities becomes necessary. The analysis is carried out

descriptively in an overview of the interindividual and intrain-

dividual differences between supply and demand.

In order to avoid gathering redundant information with the

psychological assessment and the first interview, special atten-

tion was paid to choosing instruments to use in the study which

provide information that went beyond a medical history. The

purpose of the methods used was to elicit more information

than the first and second interviews normally yielded, and to

deliver relevant results for the assessment of the relationship.

Projective methods were avoided because of the possible ob-

structive effects on a clear delineation between intervention and

assessment. The Giessen Test and The Partnership Supply and

Demand Questionnaire were chosen, on the one hand, because

they were specially designed for use with couples (as opposed

to many other methods which provide more insight into rela-

tionships between more than two people), and also because t h ey

offer many opportunities for couples therapy feedback. They

could positively influence the therapy process by providing

both more information to the therapist and more clarity to the

client, and they therefore have the potential to focus the thera-

peutic process and steer it onto the right tracks.

The results of the questionnaire were compiled by the person

in charge of the study and retained in one closed envelope for

the therapist and another for the client. During the first session

that the client and therapist had together the envelopes were

opened and the results were read. The other trial group sessions

of the study took place in a similar manner to those of the con-

trol group (again see Figure 1).

Gathering of Da ta

The gathering of data at the Institut für Ehe-und Familien-

therapie ran from April 2006 (first applications) to August 2007

(last results from the couples in the study).

The Participants

The couples who took part in the study consisted of 42 men

and 42 women. At the time of initial contact 23 couples (54.8%)

were married and 19 (45.2%) were living together. 73.8% of

the clients stated that they lived with their partner and one or

more children, 14.3% lived with their partner, 9.5% lived alone

and 2.4% lived alone with their child. It was not possible to

collect information about the current professions of 12 of the 84

people in the study. Of the remaining 72 people, 40 were em-

ployees (55.6%), 10 stayed at home (13.9%), 6 were unem-

ployed (8.3%), 5 were students, 4 (5.6%) were self employed

and 3 (4.2%) were skilled workers. 3 people were retired. The

couples who contacted the Institut für Ehe-und Familienthera-

pie for therapy all came from the greater Vienna area.

Application

25 couples (59.5%) made contact seeking therapy of their

own initiative, the other 17 couples (40.5%) were referred (for

example by counseling centres, psychiatric institutions, etc.). In

66.7% of cases, contact was made by the woman.

17 couples (40.5%) gave a possible separation as their reason

for the application, 23 couples (54.8%) indicated conflict within

the relationship, and for two couples (4.8%) violence was the

reason for starting therapy.

The Setting

13 couples had a male therapist, 21 couples a female thera-

pist, 2 couples had a male/female co-therapist team, and 2 cou-

ples a female/female co-therapist team. 4 couples, who had had

an assessment appointment, did not start therapy at the IEF.

Procedure

There was room in the study for 42 couples, i.e. 84 individu-

als. There were 26 couples (61.9%) in the trial group and 16

(38.1%) in the control group. The clients included in the study

contacted the IEF about couple therapy by phone and had a

50:50 chance of being assigned either to the trial or control

group. When the clients made contact by phone a list immedi-

ately identified if they were to be in groups with or without

Psychological Assessment. The clients with psychological as-

sessment were immediately invited to the first assessment ap-

pointment. Every client, regardless of whether they were as-

signed to the trial group or control group was informed that

there would be a waiting period before the first interview. The

waiting period at the Family Therapy Institute is, several weeks

to months due to the high demand, and this means that by the

time a first interview session becomes available the client may

possibly have lost interest in therapy or have solved their own

problems themselves.

It is notable that considerably more clients from the trial

group actually appeared for their first interview, although they

had exactly the same length of time to wait for the first inter-

view. This explains the difference in percentage of clients in the

trial group and control group after distribution.

A. PITTERMANN ET AL. 45

Results

Therapy Status

In August 2007, 21 couples (50.0%) were in ongoing therapy

according to study conditions, 17 (40.5%) had ended therapy, 3

were no longer interested and one couple remained on the

waiting list. 56.0% of the couples for whom therapy had al-

ready ended belonged to the group without assessment (control

group) and 44.0% to the group with assessment (trial group)

(see Table 1). As regards the completion or continuation of

therapy, there was no significant difference (chi-square test: p =

0.444) between the couples with and the couples without psy-

chological assessment.

Of the 17 couples who were no longer in therapy, 8 (41.1%)

had broken off the therapy, 9 (52.9%) had ended the therapy in

mutual agreement with the therapist or therapists. Also in this

case, there was no significant difference regarding the reasons

for ending therapy between the two groups (chi-square test: p =

0.819, see Table 2 ) .

Duration of the Therapy

The number of clients in therapy over the four observed ses-

sions can be found in Figure 2. Of 26 (100%) clients starting

therapy with psychological assessment, 22 (84.6%) appeared

for the first therapy session. The same number of clients with

psychological assessment came to the second session. 20

(76.9%) continued with the third session, and there was a total

of 19 present at the fourth session (73.1%). The distribution of

clients without psychological assessment looked a little different.

In this case, 16 couples appeared for the first session (the

100% mentioned in the table should not disguise the fact that

considerably more couples made contact and underwent a first

interview appointment. However, as they were part of the group

without assessment they were not considered to have not ap-

peared for their first session - a situation that will be explored at

more length in the discussion). 87.5% (14 couples) were at the

second session, 68.8% at the third and only 50.0% (8 couples)

remained for the fourth session. The difference in number of

sessions attended between the couples with and without psy-

chological assessment was not significant (chi-square test: p =

0.075).

Table 1.

Therapy status.

Ongoing Therapy Ended Therapy

With Psychological

Assessment 14 (56.0%) 11 (44.0%)

Without Psycholog i c al

Assessment 7 (43.8%) 9 (56.3%)

Table 2.

Reasons for ending therapy.

Couple Drop Out Mutually Agreed

Cessation

With Psychological

Assessment 4 (50.0%) 4 (50.0%)

Without Psycholog i c al

Assessment 4 (44.4%) 5 (55.6%)

The time between application and first session was different

between the two groups: 69 days (range: 21-138) versus 52

days (6-187), for the trial group and control group respectively.

Whereas the time period within the trial group between application

and testing was about 30 days (12-62). As regards the time

period between the individual sessions, there was no significant

difference between the control group and trial group couples

(GLM: p = 0.418).

Therapeutic Progress Made Over the Course of the

Sessions

Self Evaluation by the Clients

The self evaluation of therapeutic success of the clients with

and without psychological assessment is recorded in Table 3.

The evaluation of the therapeutic progress of clients in the

group with psychological assessment shows a significant dif-

ference between the different points in time in the therapy

(Friedman test, p = 0.002). The self evaluation increased con-

stantly over time. The group without psychological assessment

also displayed a significant difference between points in time

(Friedman test, p = 0.005). After an initial increase in self

evaluation, by the 3rd session this had fallen below the value

for the first session, only to increase significantly again in the

fourth session. For clients with psychological assessment sig-

nificantly better values, in comparison to the first session, were

already apparent by the third session, for clients without as-

sessment this improvement was not apparent until the fourth

session.

If the difference in self evaluation between the sessions in the

categories, improvement (“+”), no improvement (“0”) and de-

terioration (“–”) is considered, it becomes apparent that be-

tween the 2nd and 3rd sessions significant frequent improve-

ments appear in the group with psychological assessment, while

significant frequent improvements only become clearly appar-

ent in the group without psychological assessment between the

3rd and 4th sessions (Table 4). When observed in detail the im-

provements both at the time point of session 3 and 4 are sig-

nificantly higher for the group with psychological assessment.

A breakdown of the results according to gender shows that

there is no difference in self evaluation for men over time be-

tween the groups with and without psychological assessment

(Friedman test; p = 0.069). Only in the third session was a sig-

nificant difference to be seen (U test; p = 0.047), in that male

Figure 2.

Number of clients in therapy. (PA = Psychological Assessment)

A. PITTERMANN ET AL.

Table 3.

Evaluation of therapeutic goals with and without psychological as-

sessment.

With Psychological

Assessment Without Psycholog i c al

Assessment

Self Evalua ti on n Md (range) n Md (range)

1st session 40 4 (0-10) 30 5 (1-10)

2nd session 39 5 (0-10) 24 6.5 (2-10)

3rd session 36 6.5 (3-10) 17 5 (0-10)

4th session 28 6.5 (3-10) 11 8 (4-10)

Table 4.

Evaluation of therapeutic goals with and without psychological as-

sessment, including di fferences in self evaluati on between sessions.

With Psychological

Assessment Without Psychologi c al

Assessment

Self Evaluatio n n Md (range)/% n Md (range)/%

1st session 40 4 (0-10) 30 5 (1-10)

Difference

1st-2nd session

–

21 (56.8%)

6 (16.2%)

10 (27.0%)

–

12 (50.0%)

6 (25.0%)

2nd session 39 5 (0-10) 24 6.5 (2-10)

Difference

2nd-3rd session

–

22 (66.7%)

4 (12.1%)

7 (21.2%)

–

4 (26.7%)

3 (20.0%)

8 (53.3%)

3rd session 36 6.5 (3-10) 17 5 0-10)

Difference

3rd-4th

session

–

10 (35.7%)

7 (25.0%)

11 (39.3%)

–

8 (88.9%)

1 (11.1%)

0 (0.0%)

4th session 28 6.5 (3-10) 11 8 (4-10)

(+. improvement, 0. no change, -. decrease)

clients with psychological assessment evaluated their therapeu-

tic progress as being better (Med = 6.5) than men without as-

sessment (Med = 4.5). In the case of the women a significant

difference over time (Friedman test: p = 0.039) was observed in

the group with assessment which was not present in the group

without psychological assessment (Friedman test, p = 0.115).

Women with assessment improved continually over time in

their self evaluations (Med. 1st session = 4.5; 2nd session = 5;

3rd session = 6.5; 4th session = 7). Women without assessment

displayed a non significant decline after the third session (Med.

for the 4th sessio n s : 5, 6, 5, 8).

External Evaluation by the Therapist

Clients from the group with psychological assessment always

gave themselves a higher value than the therapist did. By the

3rd session this difference had become significant (Wilcoxon

test, p < 0.001) (Table 5). The clients without psychological

assessment evaluate their therapeutic progress higher than their

therapists do. In this group the difference becomes significant

in the 1st session (Wilcoxon test, p = 0.003) and 2nd session

(Wilcoxon test, p = 0.002) (Table 5). There was no significant

difference in the therapist’s evaluations between clients wi-

th/without psychological assessment (U test, p > 0.05).

Subjective Evaluation of Psychologi ca l A ssessment

By the Clients: 66.7% of clients stated that the examination

prompted them to think things through and 33.3% felt the psy-

chological test helped them to deal with their difficulties. By

the Therapists: In only 10.8% of cases did the therapists experi-

ence psychological assessment as being supportive of the thera-

peutic process. In at least 24.3% of cases the results were con-

sidered a relevant source of additional information. In their

evaluation of the benefits of the assessment for the clients, the

therapists indicated that they believed psychological assessment

had prompted the client to think things through in only 25.7%

of cases, and it was accepted that assessment helped clients to

deal with their difficulties in only 8.6% of cases.

Discussion

The results of this study relating to the effects of psycho-

logical assessment on the therapeutic process show that psy-

chological assessment doesn’t have a negative effect on any of

the parameters investigated by us. The values of the self evalua-

tion of therapeutic success increase over time for clients with

and without assessment - a fact that indicates that therapy is

experienced by clients as helpful and relevant irrespective of

the provision of psychological assessment or its absence. It is

noticeable, however, that for clients with psychological as-

sessment the therapeutic benefits subjectively experienced seem

to occur sooner and may be more permanent. An earlier sig-

nificant improvement is experienced by the clients in this study,

i.e. after the completion of testing, and this improvement is

more stable. A clear difference between the genders regarding

benefit from psychological assessment could not be established.

It was notable that the therapeutic progress experienced by the

clients was always greater than that of their therapists’ evalua-

tions. The therapists did, however, see a continual improvement

in their clients, but indicated obvious therapeutic progress only

at a later stage than the clients did. The earlier and more stable

therapeutic success for clients with psychological assessment

was related, as also stated by the clients who were questioned

about the subjective evaluation of the assessment carried out, to

the examination with psychological testing of the couples being

useful in helping the couples to deal with the problems that had

led them to therapy in the first place. They could therefore

make earlier constructive use of the therapy. The initial conclu-

sion to be drawn is that, despite the clearly very limited context

Table 5.

Evaluation of therapeutic success by the therapist (treatment and con-

trol group).

With Psychological

Assessment Without Psychol og i c al

Assessment

Self Evalua ti on n Md (range) n Md (r ange)

1st session 41 4 (0-7) 28 3 (1-7)

2nd session 39 4 (0.8) 22 3 (1-6)

3rd session 36 4 (1- 9) 15 4 (0-7)

4th session 19 6 (2-9) 9 6 (4-8)

A. PITTERMANN ET AL. 47

of only two instruments being used in the psychological test

examination within the unique circumstance of couples therapy

within the framework of a systemic therapy institute, psycho-

logical assessment can indeed have a very positive influence on

the therapeutic process. A further positive aspect of psycho-

logical assessment is apparent in that an assessment done be-

fore the first session can lead to a couple appearing for therapy

despite a long waiting period. It must be noted that there is no

data about how many couples without assessment dropped out

during the waiting period, as it is exclusively the couples who

appeared for their first interview appointment in the group

without assessment who appear in the statistics. At this point

therefore it can only be observed, without being supported by

figures, that the number of couples that did not appear for their

first interview after assessment was carried out was an order of

magnitude smaller than that of the couples in the group without

an assessment appointment. It seems possible that either this

difference can be explained by the couples having already “in-

vested” in the assessment and wanting to justify having gone to

this trouble and they therefore appear for their first interview to

find out the results of the assessment, or it could be that the

assessment carried out during the waiting period conveyed the

impression to the couples that real interest was being shown in

their problems and in this way a stable commitment to the

therapy institute was established. The fact that there is no dif-

ference between the groups in the breaking off or ending of

therapy indicates that the couples who appeared for therapy,

irrespective of whether testing has previously been carried out

or not, were genuinely interested in undertaking therapy.

In order to answer the question of what use psychological as-

sessment has for clients and therapists at the end of the day, the

subjective evaluation of the relevance of psychological assess-

ment was investigated from a clients’ and therapists’ point of

view. The final evaluation questionnaire filled out by the trial

group included the opportunity to give an open answer to the

question, “I found the questionnaire examination to be help-

ful/not helpful, because:” While the clients were sparing with

their criticism, and only in one or two cases said that the test

results were not of enough significance or already known, the

therapists took issue with numerous difficulties with psycho-

logical assessment. The criticism included the statements that

psychological assessment was too superficial, irrelevant to the

therapeutic process, would cement hypotheses, and that the

results were in stark contrast to the problems claimed. Not one

therapist gave a positive evaluation of psychological assess-

ment. The clients, on the other hand, presented a great many

arguments in support of psychological testing. The clients indi-

cated that they found the questionnaire examination to be help-

ful since it gave them an overview of the necessity of formulat-

ing their difficulties and general problems, concretized the “ini-

tial conditions” of the problems, provoked contemplation of

and engagement with their image of themselves and how others

saw them, and in this way allowed the development of a new

understanding of the problem. The clients noted that in addition

to this they had gained new perspectives on their problems, but

also the things they had in common had become clearer and

avenues to discussion between the partners had opened up. It is

certainly necessary and desirable that further investigation,

using various different control studies and different test tech-

niques, is carried out in order to identify the optimal ways of

implementing psychological assessment within the therapeutic

process for the future. This first study regarding the possibility,

not simply of the coexistence, but the actual alliance of psy-

chological assessment and psychotherapy has clearly shown

that this course of action is worth pursuing.

Acknowledgements

The authors would like to thank the head of the Institute für

Ehe-und Familientherapie, Dr. Joachim Hinsch, and his team

who made this study possible.

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