Feasibility of the IMTAP to assess social emotional functioning

Participants felt also that the video is essential to do the IMTAP assessment: all problems were not able to see just based on questions in scoring forms.

5.3 Feasibility of the IMTAP to assess social emotional functioning

The client in the video recorded therapy sessions was a 9 years old boy, diagnosed with ADHD (F90.0) and phobic anxiety disorder of the childhood (F.93.1). Therapy goals were set in social emotional area.

Participant’s answers to the IMTAP domains scoring about the functioning of the client were mainly quite parallel with each other’s answers; in general they were not completely different or opposed results in some domain scorings. The IMTAP rating scale is the following: Never= 0%, Rarely =under 50%, Inconsistent= 50 -79% and Consistent 80-100%.

Answers in all the sub-domains in emotional, social or fundamentals of musicality were in range of 50 -100 %. However 50 % was mentioned only once in Social domain in turn taking. Apart of this one exception, all of the other answers were in range of 71 - 100% for the client´s total functioning.

This means that the function of the client is all the time in the areas "Inconsistent 50 -79 %" or

"Consistent 80 - 100%".

Big difference in social domain´s turn-taking question might be possible to explain with the fact that it was not always easy to answer directly to all questions because the assessment situation was not planned to fit especially to the IMTAP questions. In this case the assessment situation did not include certain tasks to observe a turn taking. Answers can include changeable interpretations about the situations and how to apply the certain question.

When the answers from tables 6, 7 and 8 are analysed more it is possible to see that the answers in the "Inconsistent 50 -79 %" area are more few and far between than the answers in the "Consistent 80 -100%" area. Ratio of Consistent to Inconsistent are in emotional domain 18/2: in social domain 26/4: and in musicality domain 3/2.

This is quite surprising from the perspective that the domains to this research were chosen related to supposed problem areas of the client who has an ADHD and phobic anxiety disorder of childhood.

Problems of the client did not come up clearly by this assessment tool: he seems to manage quite well in his problem areas.

Most often the answers about the managing of the client ranged from 71% to 100% in the sub-domain answers. In some case maximum difference was 29% between the highest and the lowest results in the same area and minimum difference only 9 %. A 29 % difference in the answers is quite notable but as the IMTAP rating scale only has 4 categories with a scale from 0% to 100%

(Never= 0%, Rarely =under 50%, Inconsistent= 50 -79%, Consistent 80-100%) it is not so notable.

One step of scaling can include broad variations of the percentage values.

Phobic anxiety disorder of childhood (F 93.1) means, that the client has strong fears relating to some issues. This kind of information was not revealed with the IMTAP emotional domain questions. Also other problem area, disturbance of activity and attention (F90.0) did not come up during initial assessment sessions and the IMTAP social domain questions. Based on domain scoring it would seem that the client has not particular problems in these areas.

To be able to be aware of client´s problems the therapist should have preliminary knowledge from the parents and other health care professionals who have worked with the child. Also the point, that this particular client functions very well in daily life because of a supportive guardian and ADHD medicine, is meaningful.

Effect of the ADHD medication was possibly the one explanatory factor that the IMTAP social functioning domain did not reveal the problems in a social functioning. Medication works well with this client and the problems in interaction come up at home at evening time when the level of medication in client’s brain system is low. Other place where problems usually could be seen is a peer group. A calm therapy situation in private with the therapist does not produce the same kind of social challenges to the client. However the relationships with other people and how the client manages different feelings in social situations would be important to clarify in psychotherapeutic assessment some how (Enckell, 2005).

Based on the preliminary knowledge, the client´s fears were straddled special at the nighttime and the client was very shamed about them and tried to hide them in the daily functioning and speaking.

If the therapist wants to work with his fears the client has to really trust the therapist and the therapy process has to be longer before the client is able to bring them up. An initial assessment situation was at a very early face of the therapy and at that point it was not yet possible to handle this kind of mental challenges.

In this research frame the participants did not know the diagnosis of the client, they just knew that the client is in a music therapy because of mental reasons. The meaning of this "blind test" was to see if the IMTAP would produce the information about the social emotional problem areas without preliminary knowledge of the client. This starting point was very different from a normal initial assessment situation where the therapist has quite a lot of background information about the client.

Information gathering beforehand is a normal part of psychotherapy assessment (Enckell, 2005).

An interesting finding was that the participants were able to see part of the client’s problems by observing the video but not by the IMTAP assessment tool. This supports a participant’s comment that it would be beneficial to use the IMTAP assessment together with the video. Even though the therapist is involved in the real therapy situation by her/himself it is possible that he/she would not be able to observe everything at the moment of action, but afterwards the video would bring out important things. The possibility to enter own comments was also requested and this is a natural reaction when the participants felt that they see important things outside of the assessment tool question.

One aspect of the IMTAP assessment domain in the social emotional areas is that the assessment tool brought up maybe more strong areas than problems of the client. Focus group interview participants also mentioned this point. One solution would be to have more categories in the rating scale, and with a finer scale one could come up with more detailed information about the abilities of the client. The IMTAP rating scale was considered to be too rough.

5.4 Applicability of the IMTAP to the Finnish psychodynamic initial assessment