ABSTRACT
In this chapter, we consider several ways to highlight the importance of the context in which an assessment occurs. As we have defined it, a context is a sociocultural perspective that is relevant for a particular patient in a particular situation. That is, an assessment takes place at a particular time for both clinician and patient, and at the time of assessment, a patient’s particular background and reason for assessment intersect with the time and place of the assessment. Taken together, these form the context in which the assessment occurs. This definition recognizes that patient (and clinician) identities are in flux, changing, and reactive. For example, a young adult female being evaluated over concerns about having borderline personality disorder might be facing shame around receiving a diagnosis, concern about the stigma of mental illness, and stigma considering young adult social culture. Additionally, she might be facing the loss of freedom should an inpatient stay be necessary, and the future repercussions of the stigma associated with being in inpatient care. What if we were to also fold in the fact that this patient identifies her own mother’s institutionalization as a significant contributor to her father’s substance abuse and his subsequent abandonment of the family? What if the culture of the family was not accepting of Western health care? The lack of sensitivity to cultural differences between clinician (giving the diagnosis) and patient (receiving the diagnosis) might also contribute to the patient’s rejection of said diagnosis originating from a Western dominant ideology. Traditional psychological assessment instruments provide scores for comparison against normative samples, but clinicians invested in being responsive to their patients must also consider the larger contexts at play to bring a deeper meaning to the data (Stiles, Honos-Webb, & Surko, 1998).
