ABSTRACT
This final chapter addresses the most frequently asked questions about the theoretical underpinnings of individualized assessment. Some of the responses have been mentioned earlier in the text, many have been implied, and some appear here for the first time. The chapter is intended to encourage assessors to further articulate their own understandings, by comparing them with the responses presented here. The more explicit we are about our theory, the more likely we are to modify both theory and practice, thereby providing more consistent service to our clients.
It seems to me that this book deals with the existential situations of individuals, but it does not seem to adopt the existential philosophy of despair. Is your approach to individualized assessment in fact existential?
Yes it is, in that it focuses on how individuals experience their worlds and how individuals participate actively even in what happens to them. However, individualized assessment is of course psychological rather than philosophical. As assessors we are interested in individuals, not for the sake of exploring principles of existence, but to assist clients by presenting different perspectives, pointing out consequences of habitual comportment, and suggesting possible options. Existential writings have informed and sometimes inspired human services professionals, but commitment to any specific social or political philosophy does not necessarily follow. Similarly, the insights of existential philosophy do not necessarily lead to pessimism or despair.
Although phenomenology has been interested in the abstract ontology of Being, existentialism has been interested in the ontic problems of existing as a concrete, individual being—for whom everything has meaning, and who inescapably contributes to his or her own future. Existentialism is a philosophy of existence (from the Latin ex-istere, to stand out toward, to emerge, to become). Its developers have been concerned with the individual’s continuous struggle to achieve a creative balance between acknowledging the immutable facts of one’s existence (for example, gender, age, war, vulnerability) and daring to project one’s self-made future. This struggle creates the tension of living both the necessary and the possible, or the tension of living both one’s subjecterfness (objectness) and subjectness. Despite severe limitations to freedom, we nevertheless do participate actively even in the way we live our restrictions. We inevitably and continually play a part in what we make of our lives. This is the meaning of Jean-Paul Sartre’s celebrated statement that “existence precedes essence,” namely, that one must make what one will of one’s own existence. Hence also Sartre’s (1943/1975) seemingly contradictory statement that we are “condemned to freedom.”
Existentialism’s beginnings are not only in the works of the French atheist philosopher Sartre (1905–1980), but also, for example, in those of the Danish Christian theologian Sören Kierkegaard (1813–1855) and the German social critic and philosopher Friedrich Nietzsche (1844–1900). They addressed the times within and against which they wrote from their individual pessimistic and sometimes anguished persuasions. In their various ways they stressed the anxiety and despair that attend an individual’s efforts to make life meaningful in a world with no absolute, pregiven meanings. That is, not only are our daily accomplishments impermanent, but our ultimate progress is toward death, and we are responsible for making our own meaning of that too!
Acknowledgment of this circumstance, however, has not led all existential philosophers into despair. For example, Max Scheler (1928/1962) addressed the nature of sympathy and described human beings’ fundamental mode as that of love. Martin Buber (1923/1958) stressed our possibilities for personal, open, sensitive, spiritual relations with fellow persons. Gabriel Marcel (1951/1978) has stressed the role of hope in transcending our difficulties. European psychiatrists were the first to see in phenomenology and existentialism helpful ways of understanding their patients’ daily struggles, ways that encouraged therapist and patient to look beyond disease and causality models and examine also the patient’s co-authoring of his or her life. From there, patients could be encouraged to take the initiative in revising the course of their lives. Some influential texts were those of Ludwig Binswanger (1967/1975), Medard Boss (1957/1963), Viktor Frankl (1946/1955; 1946/1959), and Jan van den Berg (1955). The American psychologist Rollo May, as chief editor of Existence: A New Dimension in Psychiatry and Psychology (1958), brought a variety of European existential psychiatric formulations to the attention of American clinicians. (See Fischer and Fischer, 1983, for the relation between existentialism and phenomenology, and how these philosophies can serve as a framework for psychotherapy.)
The book strikes me as simply taking a consistent humanistic stance. Why don’t you call your approach humanistic and let it go at that?
The approach is, of course, humanistic in the broad senses of being humane, sharing the humanities’ concern with the role of values in culture and history, acknowledging the power of a person’s experience and will, and taking a holistic, growth-oriented stance. However, as it happened, I encountered existentialism and phenomenology before I discovered humanistic psychology, so in fact 1 developed individualized assessment within the context of those European philosophies. Other people, however, such as Ray Craddick (1972/1975) and Richard Dana (1966) began their correctives to traditional testing within more explicitly humanistic frameworks. Others, like George Kelly (1955), prior to the coalescence of humanistic psychology, had already taken approaches to assessment that were broader than the prevailing natural science paradigm. In short, one can undertake individualized assessment under several aegises, not just that of humanistic psychology.
Another reason for not labeling individualized assessment as basically humanistic is that humanistic psychology has become a partial corrective to traditional psychology rather than an alternative theory or approach. I prefer to ground individualized assessment in a human-science psychology, one that has an explicit philosophy of science, and that encourages research and theoretical integration of the findings of other disciplines. Despite significant efforts at developing and systematizing humanistic psychology (for example, Bugental, 1967; Severin, 1965; Sutich & Vich, 1969), it has remained primarily an attitude. Granted, it is a constructive attitude—a vigorous, helpful, affirmative commitment to human welfare—and it emphasizes possibility rather than limitation or necessity. Still, it has remained an attitude rather than a systematic approach for psychology.
A third reason that individualized assessment is not primarily humanistic is that many people believe that this attitude can be appended to other theories. For example, behaviorists (Avila, 1972) argued that they, too, could be considered humanistic insofar as they apply their system toward humane ends. Thus, characterizing individualized assessment as humanistic may inaccurately imply that it is merely good-hearted and growth-oriented.
Also, because in the early days much of humanistic psychology was largely a reaction against technology, quantification, experimental manipulation, medical models of mental illness, and so on, the term “humanistic” still implies to many people a rejection of traditional psychology. Just ten years ago many psychologists said that humanistic assessment was a contradiction in terms. Many colleagues who saw my work as humanistic could not comprehend that I took testing, diagnostics, psychopharmacology, and psychopathology seriously. But a hopefulness that does not take into account physical reality, limitations, and pain is an artificial hopefulness. Finally, I wish to avoid the unfortunate associations of humanistic psychology with numerous faddish, superficial, would-be therapies.
I will quickly if oversimply characterize the course of humanistic psychology, in order to provide a further sense of its relation to individualized assessment. Its greatest force and impact occurred in the late sixties. It had drawn support from phenomenology and existentialism, from Gestalt perceptual theory, Eastern religions, and from some of the more holistic early-day American psychologists like William James and Stanley Hall. In the 1930s, several leading American psychologists, such as Gordon Allport and Henry Murray, had stressed holism more explicitly and attempted to legitimize experience and ideographic methods, but their work was still primarily within the intrapsychic determinist orientation. It was not until 1955 that Hadley Cantril introduced the term “humanistic psychology.”
By that time the movement had become a distinctly American one, a reaction had set in against what was seen as the elitist, authoritarian, removed concerns of behavioristic, materialistic academic psychology, and against the emphasis of applied psychology on abnormality and deficiency. Clinicians in particular were ready for Carl Rogers’ optimistic “client-centered” approach (1942/1961). Shortly after, Abraham Maslow (1954/1962) bypassed the artificialities and fragmentizing of laboratory and statistical research to favor literature and field interviews. Moreover, his topic was the lives of self-actualizing persons, rather than traits, abilities, or dynamics of pathological or laboratory groups. Despite this radical departure from mainstream psychology, he offered a touchpoint for traditional concerns by specifying that a hierarchy of physical needs must be met before a person can develop toward higher human values and functioning. However, his appeal to students and younger psychologists, who are now teachers and leaders themselves, was his emphasis on human potential, growth, and community. It was probably critical for the movement that Rogers and Maslow in their early work wrote in optimistic, practical, nontechnical language that nevertheless provided explicit alternatives to traditional concepts and practices. When their distinctively theoretical work appeared, both the public and psychologists were more receptive to it.
By the late sixties, the humanistic movement was solidly established as a psychology of well being—of growth, becoming, potential, pursuit of goals, self-actualization, self-worth, self-fulfillment. It emphasized joy, spontaneity, ecstasy, love, transcendence. Its basic concerns were the inner person and higher human qualities, such as consciousness, creativity, meaningfulness, ethics, aesthetics, dignity, choice, and spirituality. By the beginning of the eighties, these concerns were widely acknowledged as relevant to psychology. Therefore, psychologists no longer found it necessary to specialize in humanistic psychology. At the same time, other schools of psychology had come of age and hence could afford to look for ways to accommodate some of the humanistic themes. In the meantime, most humanistic psychologists had discovered that their movement was not sufficient in itself, and that rapprochement with the new mainstream was possible, even though it remained necessary to re-emphasize humanistic themes from time to time. In short, humanistic psychology has completed much of its work, and it is time now for a scholarly and collegial pursuit of a scientific psychology designed to address human matters on their own ground. This human-science psychology, of course, also includes and perpetuates humanistic psychology’s basic concerns.
Of course, the next question follows directly: just what is human-science psychology?
It is an approach that considers not only the characteristics that humans share with other biological organisms, but also those characteristics that have evolved as uniquely human. Among the particularly human characteristics are consciousness, language, purposiveness, and reflectiveness. Humans comport themselves in accordance with their experience of a situation’s relevance to where they are going. But that experience is complex. At a particular moment, cognition and reflection may dominate, or may be only potential. The relevance, or meaning, of a situation is influenced not only by the subject’s past, but also by his or her ways of moving through it to his or her various goals—which themselves vacillate in their salience, partially in accordance with interruptions from the environment. The methods of the natural sciences are not sufficient for studying these human characteristics, which do not lend themselves to physical measurement, for designing experiments in which conditions are presumed to remain constant, or for explanations in terms of preconceived variables. The term “human-science psychology” is meant as an explicit contrast to North America’s historically dominant approach, which had been one modeled on the classical natural sciences. Textbooks refer to psychology as a “social science,” but they do not say outright that sociology, psychology, and education have been modeled on the physical sciences, presumably the only way to be scientific. The term “human science” is meant in part to call that assumption into question. This questioning of our old allegiance to the natural sciences’ paradigm is not restricted to phenomenological and humanistic circles. Precisely because psychology has come of age—having proven the rigor and efficacy of its method—it is now looking at its limits, and looking for ways to broaden its scope while still remaining scientific.
Human-science psychology, as it has evolved thus far, is scientific in that its qualitative, descriptive methods are designed to explore and share the order, the coherence or consistency, that holds for people in general, as well as for various subgroups of people. Human-science psychology is empirical in that it studies actual events as directly as possible, through subjects’ descriptions and through first-hand observance. Its research methods are presented in detail so that other researchers can conduct similar studies, compare findings, reach consensus, and clarify differences. Through these studies, a coherent body of knowledge is now being developed. Practitioners of human-science psychology not only apply these research findings, but in their own practices are scientific in that they specify both the perspective through which they observed, including their own involvement, and just what they saw that others too could see if they looked in a similar way.
Human-science psychology is not new. In the nineteenth century, when academicians and researchers were formulating psychology as an area of study in its own right apart from philosophy, Franz Brentano (1838–1917) made a case in Germany that psychology should not be conceived strictly as one of the rapidly developing natural sciences. He argued instead that it belonged within the Geistesewissenschaft tradition, and should be pursued as a human science (see, for example, Rancurello, 1968). Later, William James, sometimes cited as the father of American psychology, was similarly inclined, but American psychology took up the major part of his Principles of Psychology (1890/1981), which dealt with laboratory-type psychology, rather than his other reflections. It was not until the 1960s that systematic critiques of our natural-science traditions began to appear among psychologists (for example, Bakan, 1968; Lyons, 1963). Since the mid-1960s, the entire psychology department at Duquesne University, all faculty and graduate students, have worked within a general project of developing psychology as a human science, with an explicit theoretical foundation, research methods, content, and practical applications. In 1970, Amedeo Giorgi published Psychology as a Human Science: A Phenomenologi-cally Based Approach. A representative sample of other writing from Duquesne can be found in the Duquesne Studies in Phenomenological Psychology (Giorgi et al., 1971, 1975, 1979, 1983) and in the Journal of Phenomenological Psychology. Duquesne graduates are now completing their own books, for example, Colaizzi, 1973, and Romanyshyn, 1982. Many other psychologists also are contributing to the development of psychology as a human science (for example, Chein, 1972; de Rivera, 1976, 1981; Polkinghorne, 1983; Pollio, 1982; Rychlak, 1977).
Ideally, human-science psychology will not stand in opposition to its older colleague, natural-science psychology. Rather, psychology at large will broaden its base by incorporating human-science psychology’s developments. Of course, individual psychologists will continue to pursue our subject matter from our favored perspectives, some attuned to individuals’ lived worlds, others to behavior in relation to environment. But we should all be mindful that humans are not adequately described through either perspective alone.
The following points correct some frequent misunderstandings of human-science psychology. (1) It is not traditional psychology, with humane or humanistic intentions added on. (2) It goes beyond philosophical phenomenology by dealing with empirical matters in their own right. It is not just an “armchair” psychology, dealing only in “intuition,” reflection, and so on. (3) Although human-science psychologists are at present concentrating on the uniquely human realm, they acknowledge that environmental and biological realms also guide and limit human possibilities. As our human-science research methods, data, and understandings grow, we can attempt to study just how all three realms participate in experience and action. (4) Human-science psychology is not opposed to laboratory research or to statistical analyses, so long as these methods are regarded as ways of describing human comportment, and so long as research into lived worlds is also acknowledged as a valid and related access to human events.
The preface to this book says that its individualized approach is grounded in a European phenomenological philosophy of science. That sounds like a contradiction. How could phenomenology be a philosophy of science? Besides, the assessments took into account medical and environmental factors, not just the client’s experience. In what sense is individualized assessment phenomenological?
Let me address “phenomenology,” and then say in what senses individualized assessment is consonant with phenomenology. Before that, though, I also want to point out that although my own route to individualized assessment was via phenomenology, the practices and general approach also are consonant with other contemporary post-positivist orientations, such as structuralism and systems analysis.
Etymologically and philosophically, phenomenology refers to the study of (ology) how things appear to us (phenomena), in contrast to how they could be thought of as themselves (noumena). Of the three distinct contemporary meanings of phenomenology, the first two are not foundational for individualizing psychological assessment. First, in medical practice and research, the phenomenology of a disorder refers to a pattern of apparently identical symptoms that may be due to different etiologies. Although attention-deficit disorders may look the same in many children, for example, for some the disorder may be due to a catacholamine imbalance, sensitivity to artificial food preservatives, or a congenital nervous system impairment.
Second, in North America, when clinical psychologists and psychiatrists refer to phenomenology, they generally point to experience in its own right, apart from its causes or from “reality.” “The phenomenology of schizophrenia,” for example, refers to the experiential world of schizophrenics, regardless of one’s theory of schizophrenia. Psychologists such as Rogers (1964) and Snygg and Coombs (1949) were influential in establishing a legitimate place in psychology for this phenomenal world. Until recently, however, mainstream American psychology has been primarily interested in explaining the natural scientific causes of experience and perception rather than exploring the nature of human experience in its own right. This meaning of phenomenology is relevant for individualizing psychological assessment, but it is the third meaning that offers theoretical foundations.
This version of phenomenology is a philosophy most directly associated with the German thinkers, Husserl (1913/1969; 1954/1970) and Heidegger (1927/1962). Their critiques of the philosophies of the natural sciences pointed out that scientists have defined their task as the discovery of the laws that govern nature, as though these were knowable by humans and yet independent of human ways of knowing. Instead, sciences ought to take into account the structure and functioning of human ways of knowing—which are not separate from humanly known phenomena. Philosophical phenomenology is the methodical study of how things appear through consciousness, and hence also of the nature of consciousness. The epistemology and research methodology implicit in this position are a radical alternative to logical positivism in particular and to empiricism in general, which in one way or another have claimed to bypass human participation in science, and instead have attempted to explain all events exclusively in terms of classification and quantification.
Phenomenological psychology, being an empirical rather than philosophical discipline, does not pursue phenomenology’s further interest in ontology. Phenomenological psychology instead has been interested in the “consciousness” of actual embodied beings—that is, a “consciousness” that is not necessarily cognitive or self-aware but always part of an individual’s particular situation. Consciousness, body, and environment are distinguishable but inseparable aspects of a unitary phenomenon: the person’s relations with his or her world—the world as he or she lives it, perceptually/affectively/behaviorally, and so on.
Those inevitable hyphens in phenomenological literature (for example “being-in-the-world”) are intended to evoke a sense of a particular world with which a person is already in relation. At least in terms of what is knowable to that person, there is no independent, true world in itself. Likewise, the person does not exist apart from the world as he or she lives it. The term intentionality, as it appears in phenomenological literature, refers to this condition, namely that a person is always “intending”—referring to, being oriented toward. This being oriented-toward includes one’s explicit and implicit purposes. Another frequent term in phenomenological writing, structure, refers to the mutual relationship of a person and that person’s world in any particular situation. That relational, structural whole is the unit of study for a phenomenologically based psychology. The writings of the French philosopher-psychologist Merleau-Ponty (1942/1963; 1945/1962) have encouraged recognition of the coherence of such structures.
Of course the physical and biological realms are also real, and human-science psychology, being interested in actual lives rather than in philosophy per se, takes into account the medical, environmental, historical, and other aspects of a person’s situation. These constituents predispose and limit; focusing on them helps us both to understand more fully and to find points of intervention. But as phenomenologically oriented psychologists, we are mindful that to understand how such constituents participate in a person’s life, we must also look at how those predispositions and constraints are taken up by individuals as they continue their lives, pursuing projects in accordance with their perceptions and perceiving in accordance with their projects.
Individualized assessment, then, is phenomenological in the following major senses. (1) Its practitioners take into account that all knowledge is human knowledge; that is, that even our sciences are formed in accordance with human questions, ways of thinking, concerns, and so on. We do not simply discover data; we inevitably prefigure it through our interests and perspectives. (2) Individualized assessment respects the structural, unitary character of what we break apart for analytic purposes: experience, action, body, and environment. Von Eckartsberg’s (1971) term experiaction evokes a holistic sense of the experiencing person traveling through environments. Biological and physical predispositions and constraints are not regarded as totally deterministic; instead they are seen as participating in the person’s lived body and lived environments. (3) Individualized assessment takes into account the necessarily perspectival character of all perception and knowledge, whether those of scientist, assessor, or client. Perspective refers to cultural and historical context, methods of observation, personal history, present concerns, and so on. (4) Individualized assessment is phenomenological in that it addresses the individual as a particular individual in order to explore and describe that person’s lived world. Rather than describing the person in terms of pre-established kinds of measurements and categories, the assessor tries, in the parlance of our times, to reach clients “where they are.” “Where they are” includes clients’ ways of taking up biological, environmental, and developmental givens, in terms of where they are trying to go. “Where they are” also includes what things look like from the clients’ present stages in their travels. (5) Individualized assessment is phenomenological in that it attends to how assessees’ approaches to situations preform what they can see and do. (6) Finally, given the above orientation, individualized assessment is phenomenological in that its practitioners are open to the development of methods of research and service that take into account humans’ structural ways of co-determining their worlds.
If knowledge is always perspectival, what becomes of objectivity? Does this mean that all our assessments are subjective?
Yes, all our assessments are subjective, in that the client is inevitably seen and understood in terms of particular decisional concerns, the assessor’s training and personal history, our social-cultural context, and so on. Subjective here implies recognition that humans (including scientists and assessors) are more than passive mechanisms; they engage the world actively, relating to it in terms of where they are going, of what they are up to. But subjectivity is not necessarily distortion; rather it is the starting point for accrued, consensual knowledge. It is only through particular perceptions that we discern shared meaning—themes known through variation.
“What becomes of objectivity,” then, is that physicalistic methods of study are no longer seen as guaranteeing truth, nor even as more objective. Instead, we acknowledge the ambiguous, unfinished, always-in-transition nature of what is known. Being objective now involves two efforts: (1) respecting and being faithful to the richness of any subject matter, and being open to alternative perspectives on it—whether potential ones or those already taken by others; and (2) while still within that openness, trying in a disciplined, systematic manner to specify one’s own access and perception and their relation to what others have reported. Other investigators, too, then can see how to make direct comparisons with their observations.
Although it also makes good use of measurements, this objectivity does not limit knowledge to prespecified, external criteria (such as cut-off points for diagnosing brain-damage). On the other hand, a merely personal viewpoint, such as a “feeling” that someone is masking depression, is regarded as only personal until the viewer specifies what was perceived and what his or her professional and personal points of access were. The subjectivity of our assessments, when properly disciplined, is also objective.
Discussions of the subjectivity within objectivity may be found in the following sources: Boelen, 1968 (“Objective knowledge can never be understood in terms of the external object alone”); Koestenbaum, 1971 (“Objectivity means objective to a subject”); and Strasser, 1963 (“Nothing is objective for us without us”).
Doesn’t the collaborative aspect of individualized assessment assume that people have free will? If so, how can psychological assessment be predictive?
Human comportment can be understood and anticipated because our freedom is limited, and because it follows known constraints. We certainly cannot simply “will” things to be one way or another. Even our capricious moments arise in particular, “predictable” circumstances.
We are free to the extent that we are not entirely determined by things and forces. It is for this reason that natural science methods are not sufficient for the study of human comportment. Effective study must take into account that people behave in accordance with their sense of the situation in which they find themselves. That “sense” develops in terms of their evolving goals. But goals are not projected out of nowhere; people’s destinations are continuations of where they have been, with variations occasioned by obstacles and invitations. Through collaboration with clients, assessors refine their understandings and predict more effectively because their collaboration takes into account both (1) clients’ sense of their circumstances; and (2) how clients take up those circumstances. The collaborative aspect of individualized assessment also increases clients’ latitude—their options—by inviting them to explore viable variations of their past goals and paths.
We are free in that we each take up our situation in our own way, and with opportunity and reflection, we can change both the taking-up and the situation. But the other side of this freedom is that we have no choice but to take up our circumstances in our own ways, in accordance with who we are and where we are going. Although individualized assessment does not attempt artificially precise prediction, it does anticipate productively by being mindful of both sides of our freedom.
Are tests necessary for assessing individuals as individuals? Aren’t field observations and interviews more direct, and therefore more relevant; indeed, more valid?
Tests are not essential to individualized assessment, but they certainly can be helpful. Testing is a more efficient way of getting to know a person than following him or her through assorted environments and circumstances. Beyond providing systematic samples of a person’s comportment, tests help the assessor to focus, to avoid environmental distractions. Rather than everything seeming new to the assessor, only the client is new, against the backdrop of familiar tests. For the client, the tests are an opportunity to rediscover oneself. Normative profiles provide both assessor and client with additional perspectives, with surprises and slants to consider. From the client’s side, test data present aspects of one’s life usually taken for granted, but now thematic. The testing situation also affords the client time out from the full complexity of daily demands. It is an occasion for the client to contemplate, pull things together, consider alternatives. The testing session is a special situation but not an artificial one.
Table 3.1 reviewed many of the functions of tests in individualized assessment. In various ways the table pointed out that we have direct access to the client’s life when we regard test scores as derived or secondary data, but as also being tools to help us explore the client’s ongoing life. Moreover, comportment within the assessment session(s) provides a direct sample of the client’s life. Within the context of shared assessment work and shared referents, client and assessor explore the relevance to the client’s concerns of what they observe together. Regarding everyday life as the point of departure into tests, for the purpose of returning to that actual life with jointly revised understandings, renders tests as relevant as field observation. In addition, testing affords the advantages of normative comparisons, and when the assessment is collaborative, it affords focused experience and interventional opportunities, all of which are not as readily available in field settings, even when followed with discussion. Individualized use of tests is expressly calculated to increase relevance and validity of conclusions.
I can see how test comportment, in the sense of directly observed behavior, can be regarded as an instance of how the client behaves within certain kinds of situations. But how can an assessor integrate research data on traits and factors with observations of an individual’s comportment? I can write reports either in terms of my personal observations and discussions with the client, or in terms of scores on tests of abilities and personality traits, but not both at once. These seem like different levels of knowledge that don’t go together.
The way out of this common dilemma is to regard the life events that led to the referral, as well as comportments during the assessment, as the primary data. Statistical norms, lists of subtest factors, tables of traits, and so on, are ways of presenting performance outcomes from groups of people. These indeed are a different realm of data. To use them effectively in an individualized assessment, the assessor must be mindful of the assumptions and procedures through which statistically based information was gathered, and must ask to what degree it is pertinent to the client’s present situation. The assessor must remember that a person’s place within group-derived data is one type of information to reflect upon; it is not more basic, relevant, or valid than direct observation. Scores are not the “results” to be reported; they are sources for reflection and should result in new understandings of actual comportment. These new understandings of the ways a person is going about his or her life are the results; scores may be reported as secondary data that were useful in developing these understandings.
For example, Mr. Lipton’s corporation wanted to know whether he was ready for promotion to a higher level of management. On the WAIS-R, he earned an IQ of 103; his critical thinking skills as measured by the Watson-Glaser were above average for the general population, but low for management norms. These scores placed Mr. Lipton well below average for persons in his present position, and way out of the running for higher positions. But I did not report this information until I understood its relation to how he had earned these scores and the relevance of that process to his current job success and future positions. It turned out that his success on the job, which was greater than would have been predicted by the intelligence tests, was related to the clarity of performance standards at work. There, he could readily tell when he had reached the designated standard. But on the WAIS-R, he was left on his own to decide when an answer was adequate; in that situation he earned many one-point credits where two were possible. Similarly, there was notable intra-subtest scatter—that is, he often received credit for items more difficult for most people than those he had just missed.
The subsequent “results” reported to the corporation were neither just direct observations during testing nor just scores and interpretations based on tables. Rather, I said that Mr. Lipton has performed creditably when clear criteria were provided for him, but that despite this prior success, he was likely to encounter more difficulty than his peers when his job required abstract thinking about goals, and when it required him to decide when a job was done well enough. I added that with opportunity for practice and help to understand why various criteria have been set, Mr. Lipton could develop a more independent, reflective, and hence consistent approach to the less structured assignments that are part of higher levels of responsibility.
I did not report that Mr. Lipton’s “general fund of knowledge is lower than his comprehension of social relations.” That kind of statement is taken directly from “cookbooks,” tables, manuals, and handouts. It misleads readers to believe that the Wechsler tests were constructed to sample such “abilities” as “comprehension of social relations” systematically. Although the statement seems reasonable, the reader cannot use it to help Mr. Lipton since daily life referents are missing. Such reporting is unfinished business. The assessor has reported what he or she should reflect upon, rather than the results of that reflection. Interpretive tables—whether numerical, psychodynamic, trait, factored abilities, or whatever—should be taken seriously but not literally. In short, normative data are integrated into a report to illustrate the client’s ways of going about his or her life. Simultaneously, such data serve as documentation of how the assessor’s understandings were developed. Further documentation may be presented in schematic form as a technical appendix to the report.
I can see how you use the Bender and the Wechsler tests in an individualized way. But how can you use the traditional Rorschach within an individualized approach?
The Rorschach is a task similar to many others in a person’s daily life. A person “walks through” the cards placed in his or her path, continuing along his or her way, coping with obstacles and opportunities in habitual manners. I do not look for underlying causes, traits, drives, and so on; these are only names that we have applied to patterns of observed behavior. Rather than describe a person in terms of these generalities, which risk “explaining away” actual comportments, I prefer to describe how, where, and when the person encounters situations like those presented by the inkblots. For example, I noted that Mr. Lipton looked for a meaning to an entire blot (W) but when nothing immediate—like a bat or butterfly—occurred to him, he addressed a segment of the card (D), and moved from there to find related meanings in other sections. In this additive way he generally accounted for most of a card, but the relationships among the parts were often tenuous or forced, such as: “Well, make this part be a lamp behind them, but I don’t know what it’s doing in a jungle.”
Similarly, he had answered WAIS-R items in a fact-by-fact way that did not always add up to maximal credit. To describe the similarity between an axe and a saw, he said, “They cut. Both made of steel. They’re sharp.” Mr. Lipton did not abstract from these features the more essential commonality, that both are tools. Later discussion revealed that at work he likewise has earned a reputation for sticking with a project, segment by segment, until everything is done. He is respected for finishing assignments in a thorough manner. But now we could see how he had experienced difficulty in developing a training program to teach others his job. He just was not accustomed to looking for an overview, for basic principles, or for relationships.
Mr. Lipton’s Rorschach included several m responses (inanimate movement). Above average m has been found empirically to correlate with feelings that things are situationally out of one’s control, that one must await fate, like surgery patients just before their operations (Exner, 1978). Mr. Lipton had blithely told me at first that despite his difficulties in establishing a training program, and despite uncertainty about if and when he would be promoted, things were moving along just fine. This strong presence of m indicated to me that Mr. Lipton was after all appraising his situation more realistically than he had admitted. Now when I asked, he readily agreed that indeed his current situation was much like being in an airplane maintaining a holding pattern— that he was eager to move on, that there was nothing at the moment he could do about it, and that what happened next depended on circumstances and other people. The various blends, calculations, and ratios are signs of how the person progressed through the cards, that is, instances of his or her current ways of going through other, similar situations. Rorschach comportment is not similar to all situations, and reflection and discussion are necessary to reveal the differences. Discussion and reflection also help to clarify whether the person’s present attunements are more situational than habitual.
Besides direct observation and discussion with the client, I often consult norms for the traditionally scored Rorschach. Thereby I have available about 60 years of Rorschach experience on the part of hundreds of clinicians and researchers. I find it particularly helpful to reflect on Exner’s empirical research on the life circumstances during which people change their ways of going through inkblots. He has reported that attunement to achromatic areas (C) goes up during a state of emotional constraint, such as occurs during Marine boot camp and divorce procedings. Hence in recent years I have usually administered a standard Rorschach, and when it was at all complex, I have scored it and drawn up a summary sheet. Exner’s (1974) administration and inquiry procedures are efficient, and do not alienate the client. Hence I can complete a standardized Rorschach, and still have time to collaborate and to try out interventions with the client. The formal inquiry instructions not only facilitate scoring, but yield a personal sense of the client’s experience of the cards (“I want you to help me see it as you did”).
In short, to use the Rorschach for individualized assessment, I do not have to read a crystal ball, make symbolic interpretations, nor deal in intrapsychic structures as such. When a report says things like “this is a person who has rich inner resources and organizational skills, and whose preferred response tendency is for actional delay,” the author is reporting unfinished business. That author has not yet found out what he or she is talking about, aside from what manuals say about interpreting the Summary Sheet entries M:EC, Z, and perhaps a:p. The purpose of a test is not to find out how a person performs on that test, but how that person performs in similar situations in ordinary life. This view is consistent with recent positions taken by Rorschach theorists, such as Exner (1980) and Weiner (1977). In addition, within individualized assessment’s human-science psychology framework, test scores are regarded as providing another perspective and an occasion for questioning prior perceptions. Test data are not regarded as indicators of presumably underlying generative conditions or entities.
I understand the use you make of projective materials, but what is your general theory of projective techniques? In particular, how can an essentially perceptual task, like inkblots and TAT pictures, reveal personality and predict behavior?
Projective techniques are tasks for which assessees are given only general instructions and for which there is no right or wrong answer. As assessees we undertake the task in accordance with our understanding of the assessment’s personal relevance, and within that framework bring to bear our knowledge, past experience, ways of approaching unfamiliar situations, and ways of continuing our progress through life. That is, since there are no right answers, as test-takers we respond in terms of where we have been and where we are going, in short, in terms of who we are (“personality”). Projective materials reveal our projects—what we are up to as we travel through life, shaping and being shaped by what we attend to. We avoid facing certain possibilities, become immersed in others, notice but do not speak of some, simply do not see others, and so on. Our choice of responses is guided by our attunement to features that are familiar parts of our lives, to possibilities for expansion, and to dangers to be avoided. The depth of who we are, of our personality, can be said to be horizontal—existing in our journeys, in our evolving relationships with people and things. Our future behavior, at least in similar circumstances, is foreshadowed as a continuation of our travel through the projective cards. Thus, although a human-science theory of projective techniques deals with the complexity and tensions of personality, it does not require constructs like “inner dynamics,” “unconscious determinants,” or “defense mechanisms.”
To understand how a see-and-associate task can inform assessors about a person’s “personality and behavior,” we need only to recall that perception and behavior are abstractions from the unitary process of living our lives. For example, we perceive in light of what we are up to; that is, we know the world in terms of our actional past and projected movement. And just as we see in terms of our projects, so we comport ourselves in terms of what we see. No mechanisms are required to account for the relations among perception, personality, and behavior.
But what about inner dynamics? These are real, although they are not always visible in a person’s daily life. Aren’t you missing dynamics when you insist on bringing test data down to terms of observable life events?
Inner dynamics are indeed real, in two senses. First, we have all felt torn between two desires, both of which may be personal and not known to observers. Second, we all have observed someone else stuck between warring desires, perhaps resolving the struggle through self-defeating, otherwise inexplicable behavior.
However, there is a danger in accepting these impressions of dynamics as being totally “inner.” The danger is that they become regarded as unconscious mechanisms, with lives of their own. “They” are then seen as causing or explaining action. For example, a student’s demanding but then missing an appointment with me might be explained as a consequence of inner conflict. In turn, we assume that she would require therapy or other external direction to change her ways. Psychological assessment then would be aimed at evaluating the “inner dynamic” rather than the person’s ongoing life.
Reflection on the initial impressions of the innerness of the struggle shows us that besides being personal and not necessarily directly visible, the struggle also involves things, people, and events with which the person is actionally related. That is, the desires are desires to do something, in order to get somewhere, have something, be someone. I can imagine that the student’s desires might be to receive attention, warmth, praise, reassurance from someone important, while also being someone important, someone who does not need others. The action is relatively passive; but receiving and being are actional. The struggle was between a present, in which the past is still relevant, and a future.
“Inner dynamics” are seen as exclusively inner only when we fail to look at the full situations in which they occur. This failure is encouraged by the coherence, the repetitive pattern, of the struggle across situations; it is indeed possible to recognize the same struggle despite differences in its context and content. However, we are not being true to the actual state of affairs if we then say that the context and the content (the people, things, events that are the immediate objects of the struggle) were not essential constituents of that struggle. Recognition of the repetitive strain is important for effective assessment; but the work is unfinished if the actual life contexts and objects are not acknowledged as essential aspects of the struggle.
Thorough approach to assessment requires a theory of unconscious motivation, defenses, and emotion. What has become of those in your individualized approach to assessment?
We are continually and multiply motivated. That is, we are always up to several things at once, always trying to be many things, and always on our way to more than one place. But we usually are not conscious of all of our motives. I think of unconscious as a term that points to the broad range of “up to’s” that we are not aware of at a particular moment. The following are examples of comportment being purposeful without the person having consciously decided on that purpose. (1) A man shifts positions in his chair, seeking bodily comfort, even before realizing that his legs are becoming stiff. (2) A woman chooses yellow wallpaper for her bedroom, without knowing that as an infant she came to associate yellow surroundings with the nursery that was quiet, warm, and responsive to her cries. (3) A professor is unfairly critical of the content of a poorly typed and unproofed term paper, not realizing that through prior experience he has come to associate this kind of presentation with careless thinking. (4) A receptionist scares off young sales representatives with the gruff manner that she assumed years ago to dissuade people from taking advantage of her; today she is no longer afraid of being exploited and does not realize that she is still being gruff.
Of greater relevance to the above question, of course, is behavior that reveals purposes a person prefers not to acknowledge. An example is the woman who went to a behavior modifier with the complaint that her marriage was in trouble because of her frigidity. Therapy progressed nicely through use of systematic desensitization, wherein the woman, relaxed in a prone position, was asked to picture scenes that were increasingly anxiety-provoking as they advanced along a hierarchy from nonsexuality to intercourse. The woman managed to remain relaxed until the intercourse scene was suggested, at which point she sat up and proclaimed, “I’ll be darned if I’ll give him [the husband] the satisfaction!” Here we see that what has been called “the dynamic unconscious” is not some sort of mechanism, but the conflict of a person unwittingly undertaking incompatible projects. In the example, the woman wanted to be a good wife—including being a lover—but she did not want to provide sexual satisfaction to her husband. As is usually the case, her way of defending herself from seeing the whole situation, being frigid, served its purpose but was self-defeating because it restricted her life.
Defenses are ways in which we manage not to acknowledge that some of our goals are in conflict. The more rigidly we adhere to our defenses, the more we restrict our lives. Among the best known patterns of defensive restriction are those we used to call neuroses. Of course self-deceptions are also part of our everyday lives.
The work of W. Fischer (1982; 1984) strikes me as the most promising approach to emotions, especially as it relates to defenses. He describes how we try to be certain kinds of people while the world both facilitates and resists our efforts. We find ourselves affected by these promotions and impediments to our progress. Our bodily exhilaration, weakness, and tension are the immediate, lived realm of affect. Especially when our progress is disrupted, we may attend to how we are bodily affected. Fischer reserves the word feeling for what we then focus on as we try to name or describe our state. He reserves the term being emotional to refer to the stance we take toward finding ourselves affected.
Consider my reaction when I find myself stuck in a parkway traffic snarl on the way to the airport. My fingers drumming on the steering wheel, my breath becoming shorter, and my abdomen tightening as though ready to push on ahead, all announce that I have been affected, that I want very much to be on my way, and that I am becoming frustrated in that endeavor. When I realize that I will miss the plane, I become angry and castigate the road system, the dumb drivers, and other scapegoats. Gradually, I recognize that my emotional castigating is a defensive maneuver that protects me from facing the fact that even while getting myself to the airport, I had been acting as though I did not have to take special measures like listening for traffic reports or leaving home early enough to allow for congestion. Being angry also lets me put off full recognition that indeed I have missed the flight, and that I must now decide “what to do about it.”
If my motives were not incompatible in the first place (trying to be both a competent person going to important meetings and a person who does not have to take reality into account), I might have bypassed being angry. In that instance, following the initial frustration, I might simply have noted what a shame it was to have lost all that time, and started planning how to route myself back home and what to do about the missed meeting.
Being emotional is not always a negative stance. If I had been aware that I was not eager to catch that plane to go to a boring meeting, I might have found my body relaxing, and then I might have celebrated with a joyful exclamation that “Hah! I don’t have to go after all!” In either case, the emotional stance can be both a defense against seeing my involvement in what “happened,” and later a source for reflection about my assorted, previously unconscious, motives.
Individualized assessment practices are consonant with this theory of “unconscious motivation, defenses, and emotion.” In individualized reports they appear primarily in the form of the re-presentational descriptions of comportment, insofar as those descriptions show the client being on the way toward multiple, oftentimes conflicitng, goals.
You take a thoroughly holistic attitude toward personality, affect, and so on, and yet you also use intelligence tests. What is intelligence from a human-science perspective?
I think of intelligence in its older, prepsychometric sense, as when we speak of “an athlete’s intelligence” or “a statesman’s intelligence.” This usage is closely related to what we mean when we speak of personality in that it brings into focus what stands out for the athlete or statesman as he or she analyzes and maneuvers through situations. The term intelligence points also to the impact of the person’s consciousness and actions. The “more intelligent” quarterback, for example, has read the defense more perspicaciously and passed for greater yardage than other quarterbacks.
Although most of our standardized intelligence tests were constructed originally with the intention of measuring an underlying capacity, they nevertheless lend themselves to exploration of intelligence in the holistic sense. To facilitate this holistic usage, and to avoid reification of IQ, I developed the following definition of what intelligence tests address (see Fischer 1969; 1973c; 1974).
Tested intelligence is the sampled effectiveness, expressed statistically in relation to age peers, of one’s approaches to situations in which competence is highly regarded by our culture. Today our culture values competence that deals with facts and logic.
Each phrase of the definition helps to prevent slippage into thinking of intelligence as an actual thing that presumably causes, drives, directs, or allows intelligent conduct. Intelligence is only a generalization from comportment that we characterize as effective. In the definition, the word sampled reminds us that the test items are a small sample of situations, and that the particular occasion during which one was tested was not representative of all such occasions. Being mindful of sampling encourages assessors to reflect about the relevance or nonrelevance of the test items to the client’s life situation, and about the testing circumstances and interactions and how they might be relevant.
The phrase effectiveness of approaches alerts us to look not just at the outcome (right or wrong answers, total points), but also at the process through which the person arrived there. Approaches attunes us to the individual as a person coming to the test items proactively, but also out of a history. Approaches also reminds us of the dialectics of testing: The person approaches something in particular (the assessment project, specific items) with his or her own understandings, shaping and being shaped simultaneously, as well as sequentially. When we are interested in influencing the person’s kinds or levels of effectiveness, we will be most successful by attending to and stepping into that dialectical process that involves both approach and specific situation. The word situation evokes a sense of the client’s lived world; it disrupts any notion of the test items as stimuli for responses mediated by “intelligence.”
The reference to effectiveness “expressed statistically in relation to age peers” reminds us of how IQs come about. Determining the IQ is like curving grades for a spelling test. The middle scores are assigned C’s, the top and bottom spellers are assigned A’s and F’s, and so on. Neither IQs nor spelling grades measure inherent capacities or other entities. Intelligence tests, like spelling tests, are tests of achievement. Both are generally effective predictors of what can be accomplished next, and in this sense they are also tests of aptitude.
Finally, the definition points out that the socially valued competence sampled by intelligence tests is largely that of learning facts and dealing with them in a logical manner. Precisely because of the importance of this kind of competence in our culture, intelligence tests are helpful in sampling a person’s problem-solving approaches. However, we should remain mindful that through our test construction and use, we perpetuate or revise what is thought of as “intelligent.”
Do you distinguish among intelligence, ability, aptitude, and achievement?
Yes, certainly these distinctions are useful in their everyday senses. I think of ability as pertaining to demonstrated accomplishment in a very specific area, whereas intelligence (on the IQ test) refers to how one “reads” more or less cognizable situations and maneuvers effectively through them. Thus we might speak of someone as an intelligent sales manager, but also as one whose mathematical ability is underdeveloped. It is through observed accomplishment that we predict future achievement. What one has already done (achievement) one can do again (ability); we say that one is therefore ready (aptitude) to learn more advanced forms of the particular activity.
There is a technical distinction between achievement and aptitude, however, that should be honored. Within the testing tradition, especially in educational contexts, an achievement test is used to test individuals’ mastery of course material after an entire class has been exposed to the same instruction. Aptitude tests make no assumptions about prior experience, and simply assess present readiness to go on to the next step of learning.
Few assessment professionals conceive of intelligence, ability, or aptitude as some sort of physical capacity inside a person. Nevertheless, in the absence of an explicit theory of accomplishment, such as that above, we often talk and act as if we do. For example, we ask whether someone “has enough” intelligence to do something, or we speak of someone “lacking” an ability (“He lacks social skills”). This shorthand way of speaking works well enough when we are making decisions about whether a person is ready to handle a task. But this languaging with nouns can undercut efforts to help a person develop. From an individualized assessment perspective, we would look beyond present levels of tested ability, to ask what else the person already has accomplished and under what circumstances. We would explore where we might step into his or her approaches to those tasks, to promote further accomplishment. Verbs, adjectives, and adverbs are the appropriate language for working with action, context, and process.
I gather that you see your human-science approach to individualized assessment as being suitable for both normal people and for people who are pathological. Do you view pathology, then, as on a continuum with normality?
All patterns of existence, whether disordered or not, are variations of our human situation. But I do not see what we call normal and pathological as necessarily being points on one or more baselines. One of our major difficulties in distinguishing normality and pathology is that we have defined normality as the absence of symptoms, rather than in its own right. I would prefer that we go ahead and follow our inclination to think in terms of categories, but that we broaden them: (1) ordinary existence—the norm; (2) extraordinary existence—ideal development; and (3) disordered existence—variations from the ordinary that are problematic for the individual or for his or her community. I would like to do away with both words in the term “mental health,” because disorder is not primarily either mental or medical. Even though we are coming to see “health” as an umbrella term for both psychology and medicine, we readily revert to speaking of nonhealth as “disease,” and look too quickly for medical explanations and treatment at the expense of attending to the person’s world, choices, and life circumstances.
What we now refer to as “healthy” could be defined as optimum well being or readiness to fulfill optimum human potential. Our current loose use of healthy allows us to give a person a “clean bill of health” (absence of any categorized disorder) even if that person is unhappy, destructive, or rut-stuck. We should be as alert to possibilities for helping ordinary persons to grow as we are to identifying disordered persons. The inclusion of ideal forms of personality reminds us that normality and disorder are not simply natural states that we can name. They are inescapably formed by social/political/economic/religious values. We should be more explicit about these values, question them from time to time, and purposely plan our communities to enhance ideal personality and to impede disordered existence.
My own criteria for ordinary functioning include readiness to cooperate with other individuals and with society at large, in addition to readiness to understand and maneuver within one’s community well enough to hold one’s own. This readiness is based on exposure to, and respect for, differences. My notion of ordinariness is strongly influenced by American democratic ideals, including the assumption that the ordinary is socially viable. Of course there are many ways of being ordinary. I hope psychology will increasingly study the structure of these ways, rather than continuing to concentrate on statistical norms (IQs, divorce rates, MMPI norms). For example, some researchers are concerned with everyday affective states and emotional stances, such as being pleased with oneself (Mruk, 1981) or being jealous or envious (Titelman, 1977). These human-science studies include analysis of how people get into these states or stances, and of what becomes possible for them at these junctures. After we study the structures of these ordinary phenomena, then we can research how they sometimes become prevailing life styles rather than transitory moments. Whether these styles are lived in an ordinary or in a disordered way, we can understand the individual in terms of process. And we would recognize that person’s possible pivot points into other states and stances.
Disordered existence is just that: life that is ordered, structured, so differently from the ordinary, the usual, that the person does not cooperate with others, or does not hold his or her own as a member of the community. This person may exaggerate or minimize some aspects of ordinary life (the continuum issue), or maintain a radically different pattern of existence. Disordered existence is always restricted existence—the person, for whatever reasons, is not as open to life’s range of possibilities as most people are. To understand disorder, we should study the person’s life holistically—structurally—rather than focus on symptoms. We could then discover if and when a person functions as most of us do, and whether those moments could and should serve as a point of expansion into more ordinary or extraordinary existence. Again, we would have to examine our values closely, to avoid promoting conformity at the cost of diversity and challenge.
We should be more keenly aware of the implicit criteria we currently follow in identifying people as pathological. In actuality, we identify as pathological those people whose differences from us are problematic to themselves or to us, especially if those differences occur in a recognized pattern. As our increasingly complex society requires even more cooperation and flexibility from its members, we are increasingly noticing, diagnosing, and studying patterns we call “personality disorders.” People diagnosed in this way do not necessarily experience themselves as troubled, but they certainly trouble us through their drug and alcohol abuse, criminality, withdrawal, or erratic conduct. Studies of disordered lives from a more holistic perspective than we usually take would attend to the person’s lived world, and to the when-nots as well as the whens of problematic conduct. Yochelson and Samenow in just such an attempt have provided a rich glimpse into The Criminal Personality (1976).
Extraordinary, or ideal, existence extends ordinary viability into greater depth and breadth of experience, openness, wonder, appreciation of others’ circumstances, and a sense of connection with nature, with history, and with the future. Extraordinary persons take responsibility for their actions, while pushing the limits of constraints as they pursue the possible. I also think of the ideal mature adult as combining Maslow’s self-actualizing person (1954) and Erikson’s eighth stage of development (1959). Qualitative, descriptive research into patterns of disordered existence (Murphy & Fischer, 1983) and into ordinary affective and emotional phenomena (de Rivera, 1981) will test and develop these conceptions, as well as provide knowledge for individualized assessment practice.
If “psychopathology” is in fact restricted or disordered existence, and if judgment of pathology necessarily involves social values, does that mean we should not use scientific diagnostic systems, like DSM III?
No, it doesn’t. But of course we must use any diagnostic system in a circumspect manner if it is to serve our clients well. We must remain mindful that the diagnostic system is a way of organizing our observations. Because the system is more or less scientific, we tend to see the categories (such as “unsocialized aggressive conduct disorder”) as real in themselves. Then, instead of using the accumulated experience available through the system to alert ourselves to a possible pattern, we look for the “proper” label: “Is this patient actually a schizoid personality or a schizophrenic in remission?” Similarly, when we are not circumspect, we slip into circular reasoning, categorizing symptoms with a diagnosis, and then explaining the symptoms as a function of the category: “Of course he refuses to mingle; after all, he’s an avoidant disorder.” As Szasz (1970; 1974) has vividly argued, this attitude leads professional and client alike into underplaying the client’s responsibility for his or her life.
There is a related danger of forgetting that a diagnostic system is supposed to be a tool rather than an end. We sometimes restrict ourselves to looking for, and noticing, only those features that are listed in the diagnostic manual. Not only is this a limiting attitude, it also emphasizes negative features. The “bottom line” of clinical records becomes a summary of evidence in favor of the chosen diagnosis. That evidence is expressed in terms of the manual’s criteria (for example, “blunted, flat, and inappropriate affect were displayed”) rather than in terms of actual events. Clinical records in particular, and diagnostic conferences to a lesser extent, too easily become places where professionals talk among themselves, solving the puzzles presented to them by their diagnostic system rather than exploring the client’s world, self-direction, interests, and so on.
These negative functions of a diagnostic system can be avoided when we bear in mind that the system is something we constructed to help us observe, communicate, and reflect. The diagnostic system also serves positive functions. It is a means of sharing the accumulated experience of generations of clinicians and researchers. The difficulties of using the system with particular clients alert us to false assumptions, or simply to gaps in our knowledge. These experiences then lead to research and revision of the system. Robert Spitzer, chairperson of the Task Force that produced the third edition of the Diagnostic and Statistical Manual of Mental Disorders, has said, “A major purpose of DSM III is to serve as the forerunner of DSM IV.”
A systematization of what we know about so-called mental disorders allows the clinician to scan that knowledge to see if he or she has prematurely understood a client in terms of only one pattern. Schematization of present knowledge also helps professionals to consider what past and present thinkers have had to say about similar groups of troubled persons. We humans live our limitations and further restrict our existences in very complex ways; thorough consideration of this complexity is facilitated by a system of classified knowledge. That system is necessarily somewhat arbitrary and cannot provide a complete “fit” for any client. Most clients do not match criteria “classically,” and all lives exceed the categories. That is, lives are fuller than just their disordered aspects. A diagnostic system is like a tour guide—highlighting familiar routes to frequently visited places, but not attempting to map the entire area.
A major positive function of a diagnostic system is that it facilitates communication among professionals. Because the terms have consensual meaning, they are shortcuts to more detailed discussion. This orienting function of diagnosis helps professionals and clients alike to see that a troubled or troubling pattern is not idiosyncratically chaotic, but has happened before to others. This knowledge assists both client and professional to realize that neither is helpless; both can cope with the difficulties. Indeed, formal classification schemes are intended as a preliminary phase of treatment—of doing something about the identified trouble. Finally, professionals are more readily held accountable for their interventions when others can ask questions in terms of a shared system of knowledge.
In summary, diagnostic systems are not counter to a human-science psychology or to individualized assessment, so long as we use such systems in pursuit of diagnosis in its larger sense of in-depth understanding. Etymology can be a helpful reminder in this regard: dia means “through” and gnosis means “knowledge.” Circumspect use of a diagnostic system also requires that we remain mindful that its categories reflect our attempt to organize our observations and understandings. They are not natural entities existing independently of our concerns, values, and questions.
This book has emphasized comportment as experiaction: the ways people live their worlds. You have said that physiology and environment limit and shape comportment. Just how do bioneurology, physical environment, and experience interact?
Questions about how mind and body “act” on each other arise only if we have imposed a separation on what is first apparent to us as a unitary life. Of course human life does lend itself to distinguishing physical, biological, and psychological realms; they do function differently, but not independently. Thines (1977), for example, has described the common subject matter of phenomenology and biology, namely direct observations of organisms as they constitute and adapt to their worlds. Merleau-Ponty (1942/1963) referred to the differentiable realms of the physical, vital (living), and human orders. He described the evolution of the vital from the ground of the physical, and of the human from the vital. But he also reminded us that what we might call the “roots” of each evolved order remain embedded in their ground, transforming that ground with their own growth and change, even while continuing to depend on and be limited by the ground. An example illustrates the point: Surgeons recognize that the biological heart of the man whose wife has just died is not the same as the heart of the man whose daughter is soon to be married. Here we see that interpersonal relations (human order) are also lived out biologically (vital order), that the biological state will be lived in the patient’s mood and plans, and that both will participate in the man’s psychological, biological, and physical survival or death.
My own major reason for emphasizing the holistic, structural unity of these realms is a practical one. Otherwise, when confronted with a problem, we turn to our analytic mode of dividing that problem into parts, and of then looking for cause-and-effect relations. Again, when problem solving, we are inclined to look for a past or underlying cause or source, and we regard the lowest order of biology or physics as most real or explanatory. For example, we too readily assume that the explanation for and treatment of major depression and schizophrenia will be at the level of molecular structures and metabolism. I, too, am eager to learn what happens at these levels, and I believe that such understandings could greatly benefit disordered persons. The drawback is that when we think reductively (looking to the lowest order for explanation), we fail to take into account the participation of the human order in the lower orders. Hence we also fail to appeal to the individual’s own resources and responsibility. Specifically, we should investigate how the particular individual takes up the injury, disease, or problem into his or her continuing life. The man who is determined to return to his prior level of physical labor following an injury, for example, may indeed recover more fully than another man with the same injury. Or, his determination may keep the injured area under such stress that he remains disabled longer than a less determined patient.
The lower orders both limit and predispose events at higher orders, but they are neither unilaterally causal nor totally deterministic. Thorough remediation of a disordered life is achieved partly by attending directly to the realm in which the disorder originated, but also by bringing the other realms to bear as resources. Physicians treat Judith’s epilepsy with Dilantin, for example, but we also help her to understand that epileptic neurological firing is most likely when a person becomes tense. We explore (psychologically) with Judith when and how she becomes tense, and help her, perhaps with the assistance of biofeedback, to develop ways of relaxing herself in potentially stressful situations. We also can influence the psychological level via the bodily level. The threatened dissolution of Richard’s marriage is showing up bodily as headaches, sleeplessness, and so on, and behaviorally as poor performance at work. The most thorough resolution of his disordered life would occur through his facing his responsibilities for the marriage’s difficulties, and either saving the marriage, or going on with his life, sadder but wiser. In the meantime, during the acute phase of his efforts to adjust, a mild tranquilizer could calm him adequately so that he could both function better at work, and face the marriage problems more effectively. In short, I accept the mutuality of the physical, vital, and human orders rather than viewing them as interacting or viewing higher levels as being unilaterally caused by lower levels. Hence a search for mechanisms to account for interaction or causes is unnecessary. Rather, it seems to me that as each order takes up the characteristics of the lower order, those characteristics are transformed. Certainly we can and sometimes must study the physical, biological, and psychological orders one at a time, each in its own right. But our research will be most relevant to human existence when we also remain mindful of the “bigger picture,” in which there is a mutuality among the physical, biological, and psychological.
You have emphasized that individualized assessment requires that context be addressed. “Context” has meant not only physically visible environment and biological status, but also the momentary projects and perspectives of client, assessor, and other participants. You have also reminded us that projects and perspectives occur within an historical/cultural context. Do you have a theory of the relations between society and the individual?
No, at least not at a stage that I could write about. But I agree that an explicit understanding of those relationships would benefit our assessments and interventions. Such an understanding is also essential for a thoroughgoing human-science psychology. The following writings on this matter are provocative for readers within a human-science orientation. Foucault (1970; 1973) looks historically at the ways we have constructed reality. Van den Berg’s metabletics (1974) looks historically at how changes in consciousness have given rise to synchronous scientific discoveries and social theories. Sartre (1960/1968) has looked at more recent history in his development of what might be called an existential-dialectical theory of social change. Habermas (1968/1971) has been a leader of the critical emancipatory movement, which examines the assumptions underlying social belief systems in order to free ourselves for other options. Schutz’s phenomenological social philosophy (1962; 1964) looked directly at the individual’s relations with different levels of community. Phe-nomenologically oriented sociologists such as Garfinkel (1967) and Psathas (1973; 1979) are developing ethnomethodology, which looks, through direct observation, for the implicit social rules through which we comport ourselves and build our social systems. Sociologists Berger and Luckmann (1966) also discuss The Social Construction of Reality, and Berger and Kellner (1973) explore the relations of the contemporary citizen to our present world. Von Eckartsberg (1979), a phenomenological social psychologist, has developed methods of exploring the “eco-psychology of personal culture-building.”
Does individualized assessment require a different model of clinical training than the one we currently follow?
Our scientist-practitioner model, broadly conceived, seems sound. Within it, graduate students are first oriented as scientists, learning to conduct as well as to evaluate research. Graduates enter their professional practice not only knowledgeable about clinically relevant research findings, but objective in their observations and disciplined in their pursuit of explanation and change. But the psychologist should be trained not only in natural science, but also in human science. I would like to see the science of psychology construed less narrowly. As it is, we too often slip into a technological attitude, unmindful of our participation in shaping our findings through the questions we do and do not ask.
Professionals can incorporate many aspects of individualized assessment into their practices, regardless of their theoretical training. However, it seems to me that consistent, thorough-going respect for and service to the individual require that the scientist-professional be schooled in what we might call radical (at root) reflection (bending back; see Fischer, 1976). The reflective psychologist is one who is aware that humans are the source of human knowing and acting. I would like to see our programs balance technological training with promotion of a reflective attitude: (1) promoting interest in the everyday world as our primary data, (2) exposing our graduate students more systematically to the arts and to philosophy as collegial and congruent efforts to comprehend the human order, (3) sensitizing assessors as well as therapists to themselves as their basic access to clients, (4) recognizing perspectivity and situation as essential to understanding perception and action, and (5) promoting inquiry into the body as simultaneously psychological and biological.
This reflective stance precludes certainty and final answers. It disallows practice based only on derived data and constructs. It requires acknowledgement that one’s answers are always only partial and always subject to revision. It requires owning one’s perspectives as one’s own. This reflective psychologist version of our scientist-practitioner model admittedly is demanding. There are, of course, advantages to its disciplined circumspection. It enables assessors to address individuals in their particularity—within their own lives. I hope that this introductory book on individualizing assessment has shown concretely that this approach is not only feasible but rewarding to client and assessor alike.
