Practice Innovations, Vol 10(1), Mar 2025, 15-31; doi:10.1037/pri0000241
Therapeutic assessment (TA) is noted for its collaborative, patient-centered nature and ability to create therapeutic benefits through the assessment process itself. TA provides diagnostic clarification and improves readiness for, and engagement in mental health and substance use treatment. Psychotic spectrum disorder (PSD) refers to a collection of symptoms involving significant disturbances or marked alterations in thoughts, perceptions, and behaviors significantly impairing functioning. Psychological assessment, often a first step toward PSD treatment is fraught with challenges including historical and ongoing effects of racism on testing, social stigma, internalized stigma, providers’ parentalistic approach to care, and beliefs that patients with PSD cannot partake in decisions about their care. Noting the alignment of TA with recovery-oriented therapeutic approaches for psychosis, and the need for patient collaboration in treatment, researchers and clinicians have begun to call attention to the potential value of TA in PSD assessment. We present three cases illustrating the utility of TA as a culturally responsive assessment approach for PSD. Case A discusses misdiagnosis in a multicultural context and an abbreviated TA approach. Case B addresses the roles of the TA relationship and a multicultural lens in assessing and communicating a delusional disorder diagnosis. Case C discusses partnership with the patient’s therapist and using a radically collaborative assessment process to make a diagnosis of schizoaffective disorder. We describe common themes across cases—the power of narrative shifts and creating corrective therapeutic experiences through TA. We discuss TA as a culturally responsive approach and the potential value of TA as an antioppressive practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved)