Beyond Diagnostic Labels: A Relational & Culturally Responsive Assessment Model

Rethinking Psychological Assessment

For many individuals and communities, psychological assessment has not always felt safe.

Historically, assessments were often conducted in ways that felt extractive. Information gathered. Scores calculated. Conclusions delivered. Sometimes without sufficient attention to context, culture, lived experience, or relational trust. This has been especially true for those whose identities and worldviews fall outside dominant Western frameworks.

Today, there is growing recognition that assessment must evolve. Not away from science, but toward humanness.

A relational and culturally responsive assessment model seeks to hold two commitments at once:

• Scientific rigor and diagnostic clarity

• Respect for story, context, and lived experience

It moves beyond diagnostic labels without abandoning them.

Foundational Influences

My first encounter with this approach came while teaching the Assessment in Counselling Psychology course at City University, where I was introduced to Stephen E. Finn’s Therapeutic Assessment model, a collaborative paradigm originally developed at the Center for Therapeutic Assessment in Austin, Texas.

Unlike traditional evaluation models, which often separate assessment from intervention, Finn’s work frames the assessment itself as a therapeutic encounter.

When conducted collaboratively and respectfully, the process can reduce distress, increase insight, and strengthen self-understanding.

As I explored the model more deeply, I quickly noticed how naturally it aligned with principles I already value in therapy and assessment. Curiosity. Dignity. Relational safety. Mutual meaning-making. What began as an academic introduction gradually became something more personal.

Over time, this framework evolved into a clinical and ethical compass that informs how I walk alongside clients, particularly those who have felt misunderstood, overlooked, or overwhelmed by traditional systems.

Importantly, this approach is not only philosophically compelling. It is also empirically supported.

A Growing Evidence Base

Therapeutic Assessment, as developed by Finn and colleagues, is not solely a philosophical reorientation of psychological testing. It is supported by a growing body of empirical research demonstrating measurable clinical impact.

Early controlled investigations found that individuals who received collaborative test feedback reported significant increases in self-esteem and reductions in distress compared to control groups who did not receive personalized feedback (Finn & Tonsager, 1992). Subsequent replication studies further demonstrated that structured, collaborative feedback can enhance psychological insight and promote symptom improvement (Newman & Greenway, 1997).

Meta-analytic findings provide additional support. In a quantitative review of Therapeutic Assessment outcome studies, Poston and Hanson (2010) found statistically significant positive effects across domains including treatment process variables, symptom reduction, and self-enhancement outcomes.

More recently, Durosini and colleagues (2021) conducted a meta-analysis examining the efficacy of psychological assessment as an intervention and reported overall positive effect sizes, particularly in domains related to self-esteem, self-verification, and therapeutic alliance.

Taken together, these findings suggest that the collaborative and relational features of the model are not incidental. The assessment process itself can function as a meaningful intervention. The therapeutic stance, characterized by shared inquiry, transparency, and active client involvement, appears to contribute directly to improvements in engagement and emotional well-being.

This convergence of humanistic philosophy and measurable clinical benefit provides a strong empirical foundation for relational and culturally responsive assessment models.

Rather than positioning assessment as a neutral act of classification, the evidence supports its potential to become an active site of insight, validation, and psychological growth.

From Evaluation to Collaboration: Defining the Model

A collaborative therapeutic assessment is an approach in which the assessment process is conducted with the client, not on the client.

Instead of a one-directional evaluation, the process includes:

• Shared discussion of the client’s questions and goals at the outset

• Ongoing dialogue about what the testing is exploring and why

• Space to reflect on meaning rather than focusing solely on scores

• Integration of narrative, strengths, and cultural identity

• Feedback delivered as conversation rather than verdict

Standardized tools may still be used. DSM-5 diagnostic criteria may be reviewed. Reports remain structured and clinically sound.

What changes is the stance.

The clinician becomes a guide and collaborator. The person being assessed remains the expert on their own lived experience.

When Diagnosis Is Not Enough

A diagnosis can be helpful. It can streamline access to supports, clarify challenges, or unlock accommodations in school or work settings. It can reduce confusion or internalized shame.

Yet a diagnosis alone rarely tells the whole story.

Two individuals may meet criteria for the same condition such as ADHD, PTSD, or Autism, yet their lived contexts, histories, strengths, and cultural identities may shape how those experiences appear in daily life. A purely label-driven approach can miss this nuance.

A relational assessment model asks:

• What patterns are meaningful within this person’s life story?

• How have environments, communities, and cultures shaped these patterns?

• Where do strengths and capacities emerge alongside challenges?

This approach expands the purpose of assessment from classification to understanding.

Cultural Responsiveness in Practice

Cultural responsiveness is not a checklist. It is an orientation and an ongoing commitment.

In practice, this means:

• Exploring cultural identity and worldview as part of assessment

• Recognizing the impact of history, community, and systemic inequities

• Interpreting standardized scores with contextual humility

• Avoiding assumptions about norms or deficits

• Engaging in respectful dialogue about meaning and cultural frameworks

For Indigenous clients and communities, assessment may need to account for collective identity, land-based connection, extended kinship systems, healing traditions, and systemic inequities that influence educational or occupational pathways.

A relational model acknowledges that Western diagnostic systems are one lens, not the entirety of understanding.

Blending Science with Humanity and Care

Cultural and relational responsiveness does not mean abandoning evidence-based practice.

In this model:

• Standardized testing is administered and scored according to professional guidelines

• Diagnostic criteria are reviewed carefully when appropriate

• Strengths, needs, and profiles are interpreted within normative frameworks

• Reports remain structured, detailed, and defensible

The difference lies in how interpretation is reached. It unfolds through conversation, context, and shared exploration rather than through detached deduction.

This balance is essential for individuals seeking formal diagnoses, accommodations, or medico-legal clarity while also wanting the process to feel humane, respectful, and co-created.

Who May Benefit from a Collaborative Assessment Model

This approach may be especially helpful for individuals who have:

• Felt misunderstood or invalidated by previous assessments

• Experienced stress or shame in traditional clinical settings

• Strong cultural identities that feel sidelined in mainstream models

• Long histories of masking or self-doubt, including high-masking ADHD adults

• Intersecting identities that challenge one-size-fits-all frameworks

• A desire for insight, not just classification

It invites people into a process that honours both factual clarity and personal meaning. A model rooted in care and informed by evidence.

Closing Reflection

Psychological assessment has the potential to clarify, validate, and guide. It also carries responsibility.

A relational and culturally responsive model recognizes that assessment is not simply a technical procedure. It is an encounter between two human beings situated within broader social and cultural systems.

When approached thoughtfully, assessment can become a space for understanding rather than reduction.

If you are seeking an evaluation that integrates scientific rigor with relational care, cultural awareness, and meaningful dialogue, a collaborative therapeutic model may offer a more grounded and authentic experience.

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Written by Heidi Keefe, Registered Psychologist & Founder of Constellation Mental Health Services

Heidi provides integrative psychological assessment designed not only to identify diagnoses, but to help people understand the patterns behind their experiences and how to move forward with clarity.

Learn more about our assessment services → Assessments

References

Durosini, I., Aschieri, F., Smith, J. D., & Hilsenroth, M. J. (2021). Therapeutic assessment efficacy: A meta-analysis. Psychological Assessment, 33(10), 962–972. https://doi.org/10.1037/pas0001036

Finn, S. E., & Tonsager, M. E. (1992). Therapeutic effects of providing MMPI-2 test feedback to college students awaiting therapy. Psychological Assessment, 4(3), 278–287. https://doi.org/10.1037/1040-3590.4.3.278

Newman, M. L., & Greenway, P. (1997). Therapeutic effects of providing MMPI-2 feedback to clients at a university counseling service: A collaborative approach. Psychological Assessment, 9(2), 122–131. https://doi.org/10.1037/1040-3590.9.2.122

Poston, J. M., & Hanson, W. E. (2010). Meta-analysis of psychological assessment as a therapeutic intervention. Psychological Assessment, 22(2), 203–212. https://doi.org/10.1037/a0018679