We noted that assessments (when effective and influential) are guiding narratives for a program – whether they are formative or summative in nature. It is not enough for an assessment report to contain numbers and charts. This report must tell a coherent and compelling story—often by engaging a metaphor that yields insights or at least important questions regarding the program or organization being reviewed. In the case of assessments regarding programs intended to treat emotional and mental disturbances, the metaphors being used are often quite powerful and highly influential.
We have attempted to identify and reflect on several of these metaphors in the previous essays in this series. Are the disturbances a result of spiritual deviations (the devil’s evil work), blockage in the flow of energy (one of the five elements), social deviations (“madness”) or mental illness. The story told about a patient’s “Illness” helps to guide strategy for treatment. Images of a patient ’s “psyche” produces theories and whole textbooks on personality that impact the formation and maintenance of various schools of psychotherapy. And, most importantly (for this essay), metaphors are inherent in the classification being employed in DSM.
Here is the fundamental challenge to be faced in the use of any compelling assessment. The metaphor can, appropriately and effectively, be used to guide the tactics and strategies being used in a program (including a clinical treatment program); however, the metaphor can be changed as the program (treatment) progresses. This is where an ongoing formative assessment process becomes so important. The metaphor is essential—but should not be taken as the “truth.” Action-learning and meta-reflective processes help to ensure that the metaphor being used is helpful but not restrictive regarding the capacity to challenge underlying assumptions and modify what is being done to serve the intended client population.
One final point regarding assessment. It is critical that data do not come from just one source or be produced through the deployment of just one method. Even two sources and two methods are not enough—for what do you do when each of these sources or methods produces quite different results? If there are three sources and three methods, then it is likely that two of the sources and methods will yield similar results—and the “outlier” source or method provides an important alternative perspective. This fundamental multi-source/multi-method tenant of effective assessment is called Triangulation. In anticipation of the application of our analysis of assessment processes to our critical analysis of diagnostic processes (and DSM in particular), we can apply Triangulation to a clinical setting.
