Therapeutic assessment refers to personality assessment that aims to have direct therapeutic influence on patients. In therapeutic assessment, the client develops highly personalized questions together with the therapist.

The holistic theory focuses on what is known and what is not yet known. It also focuses on what is understood and what is not yet understood. It pays attention to inconsistencies and recurring themes.

Self-report cannot always be used because some people have introspective limitations (1), are ambivalent about changing (2) or may want to present themselves in a particular manner (3). This makes the multi-method approach useful.

The MMPI-2 measures psychiatric symptoms (1), personality (2) and test attitude (3).It measures what friends can see and may report about the person. The Rorschach measures the level of personality organization (1), level of object relations (2), the capacity and style of affect management (3), the cognitive and affective style (4), the accuracy of perception (5) and self-perception (6). It measures what is ‘under the surface’.

Incremental validity refers to extra knowledge coming from additional instruments.

A treatment plan should be based on the best science available. The clinical hermeneutics error refers to the therapist losing track of the actual degree of pathology due to adopting the patient’s perspective. High-level depth of processing or interpreting and explaining the behaviour leads to a loss of normative judgement.

The Neo-Kraepelinian diagnostic rubrics consist of ascertainment of facts to determine the presence or absence of relatively explicit diagnostic criteria (1), the making of differential and multi-axis diagnoses (2) and the differential selection of treatment guided by differential diagnosis (3).

A high degree of comorbidity may be the result of manifestations of the same few maladaptive personality traits (e.g. negative emotionality) which are interpreted as symptoms. The features a diagnostician focuses on may be consequences of extreme levels of personality traits (1), problematic configurations of trait levels (2) or extreme adaptations to personality traits (3).

Personality traits influence how individuals interpret and construe life events. Trait levels refer to an individual’s specific dispositions. There are three trait dimensions:

1. Extraversion
   This is an aspect of the broader dimension of positive emotionality (PE).
2. Neuroticism
   This is an aspect of the broader dimension of negative emotionality (NE).
3. Constraint
   This is related to reversed psychoticism and reversed sensation-seeking.

Treatment planners should know about four things:

1. Heritability of personality traits
   This is the proportion of variance in a trait that is attributable to genetic influences.
2. Initial findings on the source of personality trait stability
   A lot of stability of personality stems from genetic factors whereas change arises primarily from unshared environmental factors.
3. Gene-environment correlations
   This is the tendency of people to seek and create trait-relevant environments, leading to personality stability.

Individuals with certain genotypes select environment that provides stability for their personality traits. Passive gene-environment correlations result when parents provide both genes and environmental influences that contribute to the development of a characteristic in their children. Active gene-environment correlations occur when other individuals respond to behaviour produced by the individual’s genotype in characteristic ways. The passive gene-environment correlations are substantial early in life and decline shortly thereafter.

The principle of equipotentiality states that there are many potential life adaptations for any level of individual difference. Markedly different life adaptations can reflect the same or similar underlying personality dispositions (e.g. high in conscientiousness can lead to not spending a lot of money or constantly spending money).

Basic tendencies refer to underlying dispositions. Characteristic adaptations refer to concrete habits (1), attitudes (2), roles (3), relationships (4) and goals (5) that result from the interaction of basic tendencies with the shaping forces of the social environment. For any level of basic tendency, there are many potential characteristic adaptations. Adaptation includes coping with external circumstances or adaptation to one’s basic tendencies. People can have similar personality characteristics but express them in different ways (e.g. criminals and firefighters score similarly in sensation-seeking).

There are four benefits of using personality trait assessment in clinical assessment:

1. Knowing where change is possible
   It allows deciding whether problems are intimately linked to a person’s broad personality dispositions or whether they are more circumscribed. It allows the clinician to determine where the problem stands on a simple-complex continuum. It also allows treatment to focus on characteristic adaptations rather than basic tendencies.
2. Realistic expectations
   It can provide the client with realistic expectations about treatment.
3. Matching treatment to personality
   It can match the treatment to the personality of a client.
4. Growing a self
   It can lead to an increase in self-knowledge, providing the client with more resources, options and capacities.

Simple problems involve situationally specific and transitory habits that are primarily the product of current environmental contingencies (e.g. fear of dogs). Complex problems involve cross-situationally pervasive signs and symptoms reflecting long-term patterns of adjustment. Complex problems can be seen as a consequence of enduring personality traits.

Neuroticism influences the intensity of a client’s distress. Extraversion influences the client’s enthusiasm for treatment. Openness to experience influences the client’s reactions to the therapist’s interventions. Agreeableness influences the client’s reactions to the therapist. Conscientiousness influences the client’s willingness to do the work of psychotherapy.

Trait theory helps the therapist understand and anticipate the client’s private experience (1), helps the therapist understand and anticipate the client’s reaction in treatment (2) and helps the therapist formulate a practical treatment plan and opportunities and pitfalls of treatment (3).