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Article Excerpt
An experiment was conducted to test the effects of assessment feedback on rapport and self-enhancement. After adult participants (N = 83) completed the Millon Index of Personality Stylers, the experimental group was given personalized assessment feedback; the control group received only general information about the inventory. After the session, all rapport-related scores (positive evaluations of examiner and session) and most of the self-enhancement-related scores (accurate mirroring, self-esteem, self-competence, and self-understanding) were significantly higher in the group that received assessment feedback. These results suggest that both processes are mechanisms by which the provision of assessment feedback produces positive change. Implications for mental health counselors are drawn.
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Assessments are used as starting points for several psychotherapeutic approaches, including cognitive-behavioral (e.g., Silverman & Kurtines, 1996), motivational (e.g., Miller & Rollnick, 1991), and personality-based approaches (e.g., Butcher & Keller, 1988). Traditionally, pre-treatment assessments have been regarded as having primarily diagnostic utility, conducted in order to gather accurate information about the client, conceptualize and diagnose the client's problems, and develop a treatment plan (Tallent, 1992). Recently, however, a shift in views of the purposes of assessments has occurred, with some scholars arguing that assessments can have significant therapeutic, in addition to diagnostic, utility when clients are provided with feedback about assessment results (Finn & Tonsager, 1992, 1997; Newman & Greenway, 1997).
Drawing upon clinical experience, many writers have noted various client benefits following a feedback session (for a review, see Finn, 1996). Indeed, current ethical guidelines state that clients should be given feedback about the assessments they have been given (e.g., Principle 4 D.7, American Mental Health Counseling Association, 2000). However, little research has been done to evaluate the impact of assessment or the provision of assessment feedback upon clients (Finn & Tonsager, 1997). As the popularity of treatment models using assessment and the provision of assessment feedback as initial motivating strategies have grown (Dunn, Deroo, & Rivara, 2001), so has the need for mental health professionals to understand the specific effects of assessment feedback, particularly as it impacts processes thought to increase clients' engagement in treatment and their motivation to change. The purpose of this study was to investigate two such processes: rapport-building and self-enhancement.
The few studies that have been conducted on the effects of feedback offer evidence of its potential. For example, one established brief therapeutic modality, Motivational Enhancement Therapy (MET: Miller & Rollnick, 1991; Miller, 1997), integrates the use of feedback with substance abuse clients in order to enhance motivation to change behavior. MET proponents provide feedback to clients on their Substance Abuse Subtle Screening Inventory (SASSI; Miller) profiles in order to increase awareness and reduce the defensive denial that often characterizes substance-abusing clients. Studies of the effects of SASSI feedback indicate that it positively affects both client motivation for treatment and treatment outcome (DiClemente, Bellino, & Neavins, 1999). However, studies such as these do not illuminate why or how feedback can have these effects.
In the first systematic investigation of a therapeutic model of assessment, Finn and Tonsager (1992) began isolating the mechanisms by which feedback has an impact on therapeutic outcomes. Specifically, they endeavored to investigate whether either assessment feedback itself or attention from the examiner had an impact by having half of an undergraduate sample recruited from a university-based outpatient clinic waitlist complete the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and receive feedback about assessment results (attention + assessment/feedback). Control group participants received attention from the examiner equal in time but did not complete the MMPI-2 or receive feedback (attention, no assessment/feedback). Participants who received feedback on the assessment reported, across a 2-week period, significant decreases in symptomatology, significant increases in self-esteem, and greater hopefulness about the future than control group participants. However, because only the experimental group completed the MMPI-2, the impact of feedback was confounded in this study with the effects of taking (or not taking) the assessment.
Newman and Greenway (1997) replicated and extended this first study, investigating basic questions left unanswered regarding the potential beneficial effects of assessment feedback, their duration, and the sources of these benefits. Both a control group and an assessment group in a university counseling center completed the MMPI-2. Those in the experimental condition received feedback before completing measures of self-esteem and symptomatology, whereas those in the control condition completed the outcome measures without the benefit of feedback (but subsequently received it). Participants in the feedback condition reported significant increases in self-esteem and decreased symptomatology compared to the control group at a 2-week follow-up. This finding replicated Finn and Tonsager's (1992) results but experimentally controlled for the effects of completing the MMPI-2. Newman and Greenway also confirmed that the benefits to the assessment feedback group were specifically due to their receiving feedback, not to completing the MMPI-2 or receiving examiner attention. Despite this design innovation, what is responsible for the effects is still unknown, and Finn and Tonsager's question, "Which aspects of the feedback session were responsible for the changes?" (p. 279) remains unanswered.
In the clinical literature, two processes can be identified that likely underlie the impact of assessment feedback on various therapeutic outcomes. First, assessment feedback has been described as providing an opportunity for rapport building early in the therapist-client relationship. Consistent with this rapport-building hypothesis, some have suggested that sharing specific and relevant feedback reduces client defensiveness and instills client confidence in the helping process, thus contributing to a collaborative working relationship (e.g., Rozensky, Sweet, & Tovian, 1997). Others have also noted the relationship-building function of feedback, particularly when it is delivered in an accurate and empathic manner (Baucom & Epstein, 1990; Finn, 1996). Thus, it is reasonable to hypothesize that assessment feedback enhances and accelerates the rapport-building process.
Second, assessment: feedback has been described as an intervention that enhances self-related processes such as self-understanding, self-verification, positive self-regard, and self-awareness (e.g., Arkowitz, 1992; Finn, 1996). Consistent with the self-enhancement hypothesis, Escovar (1997) and Finn and Tonsager (1997) argued that concrete and accurate assessment information addresses basic human motivations of self-verification and insight, self-esteem, self-discovery, and self-efficacy. Many clinicians believe that the early enhancement of client self-awareness facilitates the collaborative identification of treatment goals and the motivation to work toward them (e.g., Baucom & Epstein, 1990; Millon, 1999). Thus, it is reasonable to hypothesize that assessment feedback enhances therapeutic outcomes through self-enhancement processes (e.g., accelerating client self-awareness and increasing self-efficacy and self-esteem). Alternatively, and most likely, feedback has both rapport-building and self-enhancing effects.
THE PRESENT STUDY
The primary aim of the present study was to extend what is known about the impact of assessment feedback by identifying processes that may promote therapeutic outcomes. To do so, we designed an experimental study in which participants were randomly assigned to an experimental...
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