Session Abstract: A case presentation of a lonely, troubled young teenager with intense revenge fantasies- and his worried parents- demonstrates the utility of multi-method collaborative therapeutic assessment to “sign post” results and recommendations, pointing in some directions and away from others. This complex assessment by Dr. Santas took place in the context of skillful therapy and skills training at a Dialectical Behavior Therapy (DBT) Clinic in Oakland, California, and involved close collaboration with the clinical team. The boy’s parents had initiated therapy several years prior to the assessment because of atypical aggressive behavior at home. Dr. Saks, the referring therapist, saw the mother in individual therapy and also worked with both the boy and his mother briefly to help with emotion regulation and to improve the parent-child relationship. At the time of the assessment, the teen had moved into a full DBT program with his own individual therapist, while Dr. Saks continued to consult with his mother.
Parents and multiple therapists together had a great deal of understanding of this young teen before the assessment took place, but progress was slow, there was confusion about who was right about what, what was most important, and intense fears that made it difficult to bring the diagnostic picture and next steps into clear focus. The assessment was very helpful in clarifying the many narratives, diagnostic questions and case formulations swirling around this teenager, including his own stories about himself and identity issues. By bringing order and clarity to the concerns, as well as pointing them in the right direction and prioritizing interventions, the assessment results and collaboration between assessor (Dr. Santas) and one of the therapists (Dr. Saks) served the purpose of creating “sign posts” in the road map. These sign posts provided much needed guidance, reduced anxiety, answered questions for the assessment, and reduced parents’ polarization. The teenager himself was a very verbal, engaged, collaborative and lively participant in the process; he had multiple questions about himself and was relieved by results.
Chair Information: Diane Santas, PhD | Independent Practice- California and UC Berkley
Discussant Information: Jocelin Saks, PhD | Clearwater Counseling & Assessment Services and Sharon Witkin, PhD | Clearwater Counseling & Assessment Services
Presentation 1 Title: Multi-Method Collaborative Assessment and its Utility in a DBT Clinic with a Young Teenager
Presentation Abstract: This complex case demonstrated both the utility of a collaborative assessment in the context of intensive DBT treatment, but also the importance of multi-method assessment and integration of findings. Diagnostic questions (and confusion) ranged from Autism Spectrum to Antisocial Personality, and it was a complex picture including chronic pain, past social trauma (bullying), suicidal gestures and longstanding family conflict. Parents had some strong empathy and insights- but were also polarized, confused and fearful. Clinicians were wondering if the teenager needed a more intensive setting, such as therapeutic boarding school. While some progress had been made, everyone was worried and this teen was at high risk for self-harm, disordered eating and school refusal. His mixed race heritage and identity added another layer of complexity to the picture.
While the focus of this evaluation was social-emotional assessment, I also did some cognitive testing to see how the teen handled brief, structured and more emotionally neutral tasks as well as to answer his own questions and fears: “What if I have a bad IQ?!”. In addition, I did a personality inventory, performance measures such as a Rorschach and the Thurston Cradock Test of Shame, as well as drawings and the Early Memories Procedure. Parents and the teenager filled out behavioral checklists and Autism screenings, and I consulted with other clinicians and reviewed records. Lastly, I did extended inquiry with the teenager about his very lively, insightful and revealing stories and I trickled in feedback to address his questions about himself and his “dark thoughts.” Integrating test data and observations with history and information from treating clinicians was critical to being able to clarify the big picture and “sign post” results for this family when everyone involved already had a good understanding of some critical pieces of the puzzle.
Dr. Saks, who was the referring clinician and knew the family over many years, will briefly discuss her work with one of the parents as well as a brief therapy intervention she did several years prior to the assessment. Dr. Witkin, co-founder and former Clinical Director of the DBT program at Clearwater Clinic, will be the discussant for the case presentation.
Jocelin Saks, PhD | Clearwater Counseling & Assessment Services
Sharon Witkin, PhD | Clearwater Counseling & Assessment Services