USE OF STANDARDIZED ASSESSMENT INSTRUMENTS IN COUPLE THERAPY: THE ROLE OF ATTITUDES AND PROFESSIONAL FACTORS

Journal of Marital and Family Therapy, Apr 2006 by Lavee, Yoav, Avisar, Yitzhak

The study examined therapeutic approach, professional affiliation, training, seniority, and work setting as predictors of attitudes toward standardized instruments and their use in couple therapy. Data were gathered from 163 certified marriage and family therapists in Israel. Results showed that 27.6% of marital therapists used standardized instruments for assessment. More positive attitudes toward standardized instruments were associated with the extent of training in their use and with a structural-strategic approach. Logistic regression analysis indicated that positive attitudes, training, and work setting best predict the application of standardized assessment instruments. Reasons for the relative lack of use of standardized assessment instruments are discussed. It is recommended that more training in assessment instruments be included in marriage and family therapy training.

During the last two decades increasing importance has been attached to valid and reliable assessment in family and couple therapy. In parallel, there has been significant growth in the development of assessment tools for this purpose. A large body of literature has been devoted to reviewing the quantitative and qualitative assessment tools used in couple and family therapy (Fredman & Sherman, 1987; Grotevant & Carlson, 1989; Jacob & Tennenbaum, 1988; Jordan & Franklin, 2003; Sperry, 2004; Touliatos, Perlmutter, & Straus, 1990) and their effectiveness in clinical practice (Bagarozzi, 1989; Bradbury, 1995; Duffy & Chenail, 2004; Floyd, Weinand, & Cimmarusti, 1989). Despite evidence of the utility of such instruments in therapy, clinicians tend to rely on their impressions, intuitions, and data they collect in interviews, rather than on tools whose validity and reliability has been proven by research (Boughner, Hayes, Bubenzer, & West, 1994; Bray, 1995; Fraenkel, 1997; Reichertz & Frankel, 1993).

This study focuses on standardized quantitative assessment instruments. It extends previous research on the use of standardized assessment tools in clinical practice by examining (a) the use of such instruments for couple assessment in therapy, (b) therapist attitudes toward using such measures, and (c) factors that predict therapist attitudes toward standardized measures in couple assessment and their use of it.

COUPLE ASSESSMENT IN COUPLE THERAPY

Clinical assessment is an essential part of any treatment, both physical and mental. In couple therapy, the assessment provides information about the couple's problems and strengths, enables an evaluation of the individual, interpersonal, and environmental factors that may exacerbate problems or hinder the couple's recuperation, and helps to identify internal and external forces that may affect intervention outcomes (Floyd, Haynes, & Kelly, 1997). The assessment enables the therapist to establish therapeutic goals and to plan modes of intervention.

Skills in clinical assessment and diagnosis are considered to be among the core competencies of marriage and family therapists (MFTs; American Association for Marriage and Family Therapy, 2004). The assessment skills refer to the comprehension of individual, couple, and family assessment instruments, including their strengths and limitations, their reliability and validity, and their relevance to therapeutic decision making, as well as the ability to administer the instruments and interpret their results.

Several assessment methods are used in couple and family therapy, including interviews, qualitative assessment methods, behavioral observations, clinical rating scales, and self-report instruments. The various methods may differ in the types of data they use and in the ways in which the data are collected. They may also be characterized by the extent to which the data collected are subjective (based on the therapist's or the clients' perception of the relationship) or objective (based on observable data), and the degree to which it represents an internal or external view of the relationship (Cromwell, Olson, & Fournier, 1976; Deacon & Piercy, 2001; Olson & Cromwell, 1975). No single method provides a complete picture; a more comprehensive assessment of the relationship may be obtained by a multidimensional assessment that involves each partner's perception together with the therapist's view (Bray, 1995; Cromwell et al., 1976; Cromwell & Peterson, 1983; Olson, 2000).

Standardized assessment instruments are believed to provide efficient, valid, and reliable measures of various aspects of the couple relationship, which can serve as an adjunct to the therapist's subjective judgment. Existing instruments include personality assessment tools developed for the assessment of individuals but also used in relationship assessment, instruments that were developed specifically for couple assessment, and family assessment instruments used for couple assessment or adapted for this purpose.

Personality Assessment Instruments

Personality assessment instruments were not used in couple therapy until the late 1980s, when therapeutic and assessment approaches integrating intrapersonal and interpersonal-systemic components were introduced under the assumption that personality assessment tools may be useful for understanding couple processes. Use of these instruments still encounters some objection in the field of family therapy (Bagarozzi, 1989; Nurse, 1999), but research on family therapists' use of standardized assessment instruments (Boughner et al., 1994) has shown that clinicians are more likely to use personality measures than instruments developed specifically to assess the marital system.