I am pleased to offer reflections on the valuable and important insights from Respect for the Journey: A survivor-led investigation of undergoing psychotherapy assessment. The researchers’ personal experiences of undergoing assessment allow them to take a reflective engagement with the data and to better understand the impact of the process. My commentary will take a step back to reflect on taking a trauma-informed approach in both research and assessment, considering terminology and voice, reflect on how literature on disclosures could enhance and provide additional depth to this work, and consider where next.

I recommend that future research on assessments include a further exploration of the literature on trauma-informed practices [1, 2]. Taking a trauma-informed lens to assessments will add depth to the analysis, and aid in and supplement the interpretation by researchers. The findings from this research highlight the need to shift from a mindset of ‘what is wrong with you’ to ‘what has happened to you’, a key principle of trauma-informed approaches.

The researchers explore the negative impacts of process, describing the emotional weight of the assessment for the individual. Individuals may feel they are being judged as ‘good’ enough to receive a service to help them. Or they may feel that they need to be judged as ‘bad’ enough in their suffering to need the service. The researchers highlight the potential for an individual to feel that they are ‘wanting or unworthy of therapy’. An assessment process that is rigid and tool based might also, unintentionally or intentionally, impact on how those undergoing an assessment feel they can tell their story.

Language, terminology and voice are important. It is critical to consider the definitions for some of the terms used in the research and the process, and how that will frame an individual’s understanding.

I believe researchers with lived experience should consider if the term ‘survivor’ accurately describes them in the context of their research. For research into assessments, this implies they have had to survive some ordeal, whether it be the assessment process or the subsequent therapy. Reframing researchers as having experience of the process sets a different tone, voice and perception of their engagement with the process and the data.

The Oxford English Dictionary (OED) defines assessment as ‘the evaluation or estimation the nature, ability, or quality of someone or something’. Understanding the impact of framing this process as an assessment requires an examination of ‘who’ and ‘what’ is being assessed. An assessment might be used in a general sense to help identify what types of support are needed—so the ‘need’ is being assessed. In other cases, it might be that the assessment is used to determine if the service or intervention is right for the person/s being assessed.

An ‘assessor’ is ‘a person who evaluates the quality of a person or thing’ (OED). Does calling the person conducting the assessment an ‘assessor’ contribute to this perception of being judged? A process that is conducted by an assessor and is, consciously or unconsciously, framed as a judgement seems to invite negative and complex emotions. Research into assessments should consider and report on how the terminology used impacts on an individual’s experience of the process.

The researchers suggest there is a need to make the assessor human. One starting point would be to refer to those conducting this task (assessment) as who they are, for example: professionals, practitioners, therapists, etc. Then a reframing of the assessment to be a more holistic process that includes listening and respecting the journey of those seeking to access a service. This reframing does not diminish the need to gather information, but allows for it to happen in a sensitive and trauma-informed manner.

The researchers conceptualise the process of the assessment as a journey. They recommend that this process take into account the experiences of trauma that individuals have experienced, which may be abuse experienced in childhood or early adulthood. I recommend, that in addition to the trauma-informed practices, an examination of the research on disclosures of childhood abuse could add more depth and weight to this analysis.

Researchers who explore disclosures of childhood abuse also conceptualise this process as a journey, with many parallels to the findings in this research. Disclosure of childhood abuse is described as a process that takes time and is influenced by the relationship that exists at each interaction. The majority of the research in this area has focused on child sexual abuse and has found the process can be traumatic and can itself have both short-term and long-term impacts [3].

There are common factors identified that inhibit and enable disclosure of childhood abuse within the assessment process. This is not surprising considering that some of these individuals will have experienced childhood abuse and may be disclosing their abuse during the assessment.

Children and young people report that feelings of shame and embarrassment may stop them from reporting or fully reporting their abuse [4]. Even as an adult, those feelings will not automatically go away. Therefore, having to recount, even in a very limited manner for an assessment, traumatic experiences such child sexual abuse, can exasperate these feelings of shame and embarrassment. This may be particularly true for boys and young adult males [5].

Similar to the assessment process, worry about being judged is a common theme for many children and young people when disclosing their abuse, particularly those that experience child sexual abuse. Although some of this worry is the result of the young person being manipulated by the perpetrator into thinking they are responsible for their abuse, there are wider systemic issues at play. Societal norms and victim blaming narratives, particularly views about how children should behave, assumptions around masculinity and femininity, adultification bias, and systemic racism intersect to create feelings of judgement when speaking about child abuse [6, 7]. These systemic issues will also contribute to those who are undergoing an assessment feeling worried about being judged.

Knowing what is going to happen, what cannot happen, and options for next steps is key for those on this assessment journey. Open and honest communication was also valued by children and young adults disclosing abuse. Young people felt it was important to know if no action could be taken or if action would be delayed, rather than a vague or unclear answer with no clear next steps. Young people were even comfortable with vague, ‘I don’t know’ responses that included ‘but I will tell you by < specific time/day > what the next steps are.’ [3, 4, 8].

The researchers found that belief is a key component of what could make the assessment process better. The concept of ‘belief’ is also raised in literature examining disclosures of child abuse as something that enables disclosure. But, for some professionals, this need to show belief and warmth may be in direct opposition to their professional tasks or their ways in which they cope with the hearing of traumatic events. Professionals may be given rigid tools and specific instructions on how to respond to disclosures raised during assessments. This may include attempting to remain neutral or maintain a specific demeanor required by their organization. Research on disclosures found that some professionals focused more on ensuring they were following proscribed actions and behaviours rather than engaging with the person in front of them [8]. This response could make the professional appear ‘less human’ and more robotic.

Trauma-informed approaches would highlight the potential impact of secondary trauma for these professionals because hearing and dealing with these traumatic events on a prolonged basis can have a negative impact on their emotional welling [9]. It may be that professionals, intentionally or unintentionally, adopt a less emotional response to cope. Literature into how professionals should respond when hearing disclosures of abuse emphasize instead a need for professionals to strive to be non-judgmental and empathetic, practice using positive body language and good listening skills and ensure that they are considering their own biases when listening to disclosures [3].

The researchers raise a point about assessments that may lead nowhere that highlights ethical issues about identifying needs without providing support. There should be consideration about what that means for those who are undergoing the assessment, and the impact on those who conduct assessments that lead to no support from that particular organisation. Further exploration of how to sensitively, honestly and appropriately communicate this to those undergoing an assessment, particularly if the issue is related to payment or limited capacity of the organization is needed.

I recommend that research into assessments looks to build upon this critical work. The value of the researchers who have experiences of being assessed is critical. I recommend that researchers also consider how to examine the views of those who conduct assessments alongside those who experience the assessments. There may be areas where these two groups may have common areas which can easily be addressed, but it is also critical to understand where views diverge and explore how those can be bridged. Assessment is a process, that is a journey, and the journey must be undertaken together.