Breaking the Silence: Using Therapeutic Assessment to Give Voice to Shame and Trauma. A Single-Case Repeated-Measures Design

While case studies have demonstrated the effectiveness of Therapeutic Assessment (TA) with clients with unresolved trauma, the precise mechanisms of change remain untested. This study investigates predictions about how TA helps clients resolve trauma. The first part of the article details the TA for Mei, a woman with severe PTSD, C-PTSD and shame. The second part of the article includes a single-case time-series design experiment using Mei's daily self-reports from before the TA through 25 days post-TA, along with pre-, mid-, and post-TA administrations of the Trauma Symptom Inventory - 2 (TSI-2) and Symptom Checklist - 90 - Revised (SCL-90-R). Simulation Modeling Analysis was used to evaluate level-change and the trajectory of change in Mei's daily ratings. A Repeated Measures ANOVA, Reliable Change Index and clinically significant change were used to measure the effectiveness of the TA according to TSI-2 and SCL-90-R data. Results demonstrated clear overall progress, with moments of symptom deterioration related to specific elements of the assessment (e.g., administrations of the Adult Attachment Projective Picture System and Thurston Cradock Test of Shame) and Mei's daily life followed by sharp improvements after the assessor helped Mei process the re-elicited trauma and build self-compassion.