A 15-year-old boy was referred by his therapist for a collaborative/therapeutic assessment. She questioned whether there can be any trust or alliance with him; she was feeling very frustrated. She believed this was a client in the process of developing a personality disorder. His parents wanted to know why he lies, steals, manipulates, defies, deliberately annoys, and is generally angry, resentful and dysregulated with them. In the past there were substantial anxiety and panic attacks, now controlled by medication.
One of the main goals of a collaborative assessment is to encourage a patient to develop curiosity about him/herself, to self-reflect, and to help the patient to feel mentalized. These features of C/TA have documented implications for the success of future treatment. In this case, the patient refused to ask any questions about himself, and periodically dismissed and disparaged the assessment, assessor, and therapist.
In spite of this, a key impact of the assessment for the patient was a gain in trust and curiosity about himself, and a feeling of being understood and accepted. This allowed outpatient therapy to proceed. Implications for assessment in general and for work with adolescents developing a personality disorder will be discussed.