PSYC 401 - Midterm 2

Krishnamurthy et al. (2004) - competency in psychological assessment

• overview of issues related to development of assessment competencies

• proposed 8 specific competencies for psychological assessment

8 specific competencies in psychological assessment

1. background in psychometric theory (statistics, test construction)

2. knowledge of scientific, theoretical, empirical, contextual bases of assessment (interpreting scores, confounding variables)

3. knowledge of different psychological theories and their assessment

4. assess outcomes of treatment/intervention

5. ability to evaluate roles, contexts that patients and psychologists function in/reciprocal impact of those roles on assessment

6. establish/maintain collaborative professional relationship

7. understand relationship between assessment and intervention

8. technical skills (problem identification, appropriate assessment, systematic data gathering, integrate info, communicate findings, provision of feedback)

psychological assessment

evaluation of an individual who is experiencing some difficulty so that info gleaned can be useful in dealing with the problem using tools such as tests, interviews, case studies, behavioural observation, specially designed apparatuses

goals of psychological assessment

• problem explication

• formulation

• prognosis

• treatment issues and recommendations

• provision of therapeutic context

• communication of findings

problem explication

establishing a formal diagnosis based on classification systems that exist or a description of diagnostic picture without providing a formal diagnosis

diagnosis

assigning diagnostic category or label

• generated through structured interviews

• uniformity of disorders

• classification into categories

formulation

attempt to explain genesis, maintenance, process related info in a person for treatment

• generated through psychological assessment

• viewed as more important than diagnosis

• each person seen as unique

• involves the patient

• based on theoretical perspective of psychologist

info used in formulation

• intraindividual issues (motivation, learning, cognitive styles)

• interpersonal issues (relationships)

• environmental issues (life events, living situation)

• process-related issues (behaviours during interview)

• content info (what patient provides/says during interview)

prognosis

expected course, degree and speed of recovery - not always clear solely based on diagnostic info

treatment

based on psychologist’s knowledge of treatments and diagnosis/formulation info

• influenced by factors like intelligence and psychological mindedness (ability to observe own internal life, insight)

assessment in research

provide info regarding nature of disorder (severity of symptoms, comorbidity, co-occurrence of other symptoms)

• determine efficacy of treatments for specific disorders

actuarial approach to making clinical decisions

scores on measures are used in statistical formulae in making decisions

• quantitative

clinical judgement approach to making clinical decisions

clinical experience and clinical intuition are used

• qualitative

testing vs. assessment

• testing is administering, scoring, interpreting psychological tests

• assessment uses many data sources to arrive at conclusions regarding psychological problems (broader)

assessment vs. diagnosis

• diagnosis identifies/documents a patient’s symptoms to classify into a category

• assessment collects broad info that interact to determine patient’s subjective experiences

psychodiagnostic assessment

gather clinical data on problem experienced, process info, first clinical exposure for people, initiate and develop therapeutic alliance, context for understanding difficulties

• clinical interview most common

• utilize tests and tools - multimethod approach

data gathered in psychodiagnostic assessment

• demographic

• presenting problem

• history of problem

• medical history

• current and past living situation

• family history

• childhood, early adult history

• previous treatment

most common clinical tests

1. clinical interview

2. Wechsler Adult Intelligence Scale

3. MMPI-2

4. sentence completion

5. thematic apperception test

6. Rorschach inkblot test

7. Bender-Gestalt

8. drawing tests

9. Beck depression inventory

10. Wechsler intelligence scale for children

intellectual/cognitive assessment

determination of intellectual and cognitive functioning/strengths

behavioural assessment

determine antecedents, reinforcement histories, maintenance issues for psychological/behavioural problems

health assessments

determine behaviours, personality structures, environmental features that influence patient’s physical health status

psychophysiological assessments

heart rate, skin temperature, muscle control that are factors in physical/psychological health problems

rehabilitative assessments

determine functional capacity of individuals following psychological/physical injuries

forensic assessments

determine factors that may have contributed to criminal behaviour, likelihood of reoffending, treatment of issues pertaining to criminal behaviour

idiographic approach to assessment

understand an individual, couple, family, and psychological issues that pertain to them (specific, detailed)

• typically done for treatment planning

nomothetic approach to assessment

assessments done on groups in order to understand broader issues/constructs pertaining to types of problems or treatments

• typically done in research

tools of psychological assessment

• tests

• techniques

techniques

tools that provide relevant clinical info that does not necessarily involve patient reporting on his own behaviour, often compared to norms - help with hypothesis generation

• semi/unstructured interviews

• projective techniques

• behavioural observations

• less reliable/valid than tests

purposes of clinical interviews

1. gathering clinical data on difficulties

2. info about process-related variables (like how comfortable they are with the therapist)

3. provides first clinical exposure for many

4. opportunity to initiate/develop therapeutic relationship

5. context for understanding nature of difficulties

interview skills

• develop rapport

• primary active listening (open ended questions, paraphrasing, clarifications, summarizing, minimal leading)

• secondary active listening (normalizing, structuring, probing)

• nonjudgemental

• awareness of nonverbal behaviour/subtle changes

• ability to connect disparate kinds of info

psychic determinism

everything has some goal, meaning, purpose, and cause - clinician needs to pay attention to all behaviour that patient exhibits

mental status exam

focuses on patient’s

• appearance

• behaviour

• orientation to time, place, person

• memory

• sensorium

• psychomotor activity

• states of consciousness

• affect

• mood

• personality

• thought content and process

• intellect

• judgement of insight

during treatment

non-structured interviews

not trying to diagnose or formal formulation, create a positive interpersonal experience and beneficial internal development for patients

• help person feel better main goal

• Freudian approaches includes initial unstructured interview

semi-structured interviews

• flexibility of interaction between patient and clinician

• can talk about whatever issues come up and clinician can probe

• clinician does have some info tries to obtain to develop diagnostic and formulation info

pros of semi-structured interviews

• rapport

• flexibility

• modifiable

• not limited to certain tools or norms

• useful and commonly used

cons of semi-structured interviews

• reliability and validity from clinician to clinician (?)

• lacks reliability

• may be susceptible to clinical biases

• not good for research

structured interviews

• based on very specific diagnostic criteria from current nomenclature

• very highly structured in terms of info sought

• purpose is to provide clear diagnosis and really interested in other domains

pros of structured interviews

• reliable

• good research tool

• modules for specific disorders

cons of structured interviews

• content constrained by diagnosis

• time consuming

• no other pertinent info gathered

• not as conductive to establish rapport with patient

• process info not focused on, just content

major sources of error by clinical psychologists

1. base rate issue (how common behaviour is)

2. barnum effect (common statements worded to sound rare)

3. illusory correlation

4. preconceived ideas/confirmatory bias (look for evidence that supports ideas)

5. inappropriate use of heuristics (cognitive shortcuts)

objective tests

tests where items are presented the same to all and options for responding are the same - measures characteristics that the responder is aware of (surface level)

• IQ tests, self-report tests, items describing some behaviour

pros of objective tests

• economical

• administration and scoring is easy

• objective

• quite reliable

cons of objective testing

• surface or behavioural in nature only

• single summary score not representative

• transparency in meaning

response sets

patients answering in ways that present a false picture of themselves to the clinician

• underreporting or over-reporting of psychopathology

• acquiescence or non-aquiescence

• carelessness or inconsistency

• self-deception

clinical objective test

• Minnesota Multiphasic Personality Inventory

• Personality Assessment Inventory

• Millon Clinical Multiaxial Inventory

construct validation test construction

• review lit and case studies to understand qualities of test variable

• train item writers to write questions that capture different aspects of the variable

• use statistical reliability approaches to pare items down

empirical criterion keying test construction

• administer a bunch of questions to two different groups and find a question that discriminate the two groups

• determine if the questions are able to generate differences

Minnesota Multiphasic Personality Inventory (MMPI)

• one of the most frequently used tests

• used criterion keying approach

• measures personality and psychopathology

• 13 scales: 3 validity and 10 clinical

• use: initial screening for psychopathology, personnel selection, marital therapy, treatment outcome studies

MMPI scales

1. hypochondriasis (germs/bodily concerns)

2. depression

3. hysteria (self-centred, reactive)

4. psychopathic deviate (asocial/antisocial)

5. masculinity-femininity (aesthetic interests, confidence)

6. paranoia

7. psychasthenia (anxious, obsessive)

8. schizophrenia

9. hypomania (excessive activity, lacks direction)

10. social-introversion

• +3 validity scales

MMPI pros

• strong empirical basis

• body of research

• good reliability/validity

• well-known/respected

• lots of clinical info

• ease of administration

• objective/comprehensive

MMPI cons

• excessive length

• standardization sample

• not sure if MMPI research can be generalized to new revisions

• labels antiquated

• normative sample not representative

• interpretative process complicated

MMPI validity checks/response biases

1. L: questions to measure if someone is lying (lie scale)

2. I: questions to measure if someone isn’t paying attention/exaggerating (unusual/severe psychopathology)

3. K: questions to measure defensiveness/assertiveness

MMPI clinical scales

• Neurotic spectrum: 1,2,3,7

• Psychotic spectrum: 6,8,9

• Psychopathic: 4

MMPI interpretation

validity (proper conditions for testing established) → pattern interpretation → incorporate with other scales

• not simply evaluation equaling diagnosis

MMPI-A

MMPI/MMPI-2 version for adolescents - dropped some items, reworded some items

MCMI

measure of personality and psychopathology

• 28 subscales

• directly accords with DSM criteria

pros of MCMI

1. developed from comprehensive theory

2. reflects current DSM and is useful with personality disorders

3. takes into account base rates

4. strong test construction approach

5. easy to administer

6. shorter to administer

cons of MCMI

1. imbalance of T/F questions

2. test is weak in assessing subclinical levels of psychopathology

3. validity problems

PAI

344-item measure with 22 subscales measuring clinical syndromes and and personality variables - measures symptoms of disorder from mild to severe and underlying pathology

projective tests

use ambiguous stimuli instead of objective - subject has to impose their interpretation (reveal part of themselves)

• can have standardized administration, but possible responses not pre-determined

• behaviour assessed at deeper level

• measures psychological states, personality, underlying psychological makeup (defences, coping)

response determination

a response is not an accident, but a function of subject’s psychological attributes

types of projective tests

• association (what visual/auditory stimulus is associated with) - RIT

• construction (drawing) - TAT

• completion (sentence completion)

• choice/ordering (picture arrangement)

• expressive (role play)

rorschach test

interpretation of ambiguous inkblots

• Mirror image score

• Free association stage → inquiry stage → interpretation stage

• clinically/research validated from Exner’s comprehensive system

rorschach criticisms

• poor psychometrics

• non-empirical basis for scoring/interpretation

• methodological

• lack of standardization procedures

rorschach inquiry stage

code

• location

• determinants

• form level (ability to form pictures)

• content

• popularity of responses

• organizational activity

rorschach interpretation stage

assess

• info processing

• cognitive mediation

• ideation

• capacity for control/tolerance for stress

• affect

• self-perception

• interpersonal perceptions/relations

rorschach pros

• easy to administer

• standardized administration, scoring, interpretation

• large normative sample

• acceptable reliability/validity

• taps info not tapped by objective tests

• may be resistant to faking

rorschach cons

• not developed for purpose currently used for

• early research created confusion/bias

• lack of research for minorities

• additional reliability/validity needed

• complex scoring/interpretation

thematic apperception test (TAT)

measures motivational, interpersonal, social-cognitive aspects of functioning - asks participants to interpret photo cards

• thought to reflect underlying processes

TAT scoring

not really scored, more themes determined based on a variety of domains (drives, relationships, conflicts, defences, ego strength) - find common themes

social cognitions and object relations scale

measures complexity of object relations, affect tone, capacity for emotional investment in relationships, understanding social causality

social cognitions and object relations scale pros

• potentially valuable to assess deeper aspects of personality

• focuses on global aspects of person’s interpersonal and motivational world

• aids in development of rapport

• adequate reliability and validity of some scoring and interpretive schemes

social cognitions and object relations scale cons

• no standardized administration or normative data

• general reliability and validity are difficult to establish

• subjectivity in scoring and interpretation

drawing tasks

access parts of personality not accessible with objective tests or bypass defences - interpret personality, assess interpersonal relationships

• given a paper and asked to draw certain objects, places, people

psychodynamic perspective of therapy

trying to uncover relational features of problems person is experiencing - relations over instincts

• need to take info about the person in to diagnose them properly

scientific approach to clinical work

• based on info available, develop a model/theory of human behaviour that guides behaviour in attempt to understand

• develop hypotheses to test based on the model/design, appropriate means to asses model

• alter, accept, refute model

formulation approach to clinical work

• develop hypothesis model of unique person seeking help, alter details of model for each person

• model guides behaviour of therapist in attempting to understand individual and effecting change

psychodynamic formulation

• aim is to increase treatment efficacy

• understanding idiosyncratic way individual organizes knowledge, emotions, sensations, experiences, behaviour allows therapist to have more choice

triangle of adaptation

cycle of person’s attachment needs, associated affective states when attachment needs are not satisfied, and the defences/coping mechanisms to cope with lack of satisfaction

triangle of object relations

cycle of relationships a patient goes through while in therapy

• current relationships (including self) → past relationships → therapist

foundational assumptions of case formulation

• understanding of personality and interpersonal patterns essential to therapeutic work

• one’s wishes/needs underlie interpersonal patterns (often unmet with problematic behaviour)

psychodynamic underpinnings of therapy concepts

• attachment needs are often unconscious

• anxiety/affect are often generated by frustrated/unfulfilled attachment needs

• defences are means of coping with unwanted anxiety/affect

• concepts of self is related to triangle of adaptation which subsequently shapes relationships in triangle of object relations

defences

• manifest themselves as behaviours and can define interpersonal transactions

• activated in effort to maintain ego integrity and psychological homeostasis

• well-adjusted individuals possess repertoire of defences appropriate to context in which they are applied

use of triangles in treatment

• explore past and current relationships

• watch for examples of development of perfectionistic behaviour in treatment

• explore interpersonal precursors or motivators/fears for perfectionistic behaviour

• look for how relationship with therapist is similar to past/current relationships

• work towards other ways of attaining interpersonal needs

CBT case formulation

marry unique experience of client with skills, theory, knowledge of therapists to understand/alleviate client’s presenting issues

• developed from cognitive model (how we view selves, world, future determines emotions/behaviours)

• develop disorders when people have unhelpful patterns on interpretations and behaviours

• effective treatment - modifying unrealistic thinking through promoting client strengths/resilience affects emotional wellbeing

• contains all of patient’s symptoms, disorders, problems and the mechanisms/precipitants behind them

• collaboration between therapist/client is key

developing formulation for problems

• list all problems, symptoms, etc - data from multiple sources including clinical interview, structured diagnostic interviews, self-report scales, self-monitoring data provided by patient, observations of patient’s behaviours, reports from family + other

• mechanism hypothesis (what maintain symptoms)

developing formulation for mechanisms

• heart of formulation

• mechanisms/processes/symptoms maintaining disorder - include biological mechanisms, but emphasize and focus on psychological mechanisms

developing formulation for precipitants

• determine events, situations that give rise to problems, symptoms, disorders throughout treatment

• look for earlier events that might reflect origins

levels of formulation

• case

• disorder or problem

• symptom

5 ps of case conceptualization

• presenting

• precipitating

• perpetuating

• predisposing

• protective

presenting

• present patient problems in terms of emotions, thoughts, behaviours

• goes beyond diagnosis and tries to define current problems

• define short, medium, long term goals

• clarify problems, establish therapeutic connection

precipitating

• proximal (close to manifestation of problem) external and internal triggers

• introduce cognitive model

• initial focus on cognitions

perpetuating

• internal and external factors that maintain the problem

• focus on interrupting the cycle

• quality over quantity

predisposing

• distal (contributors to problem occurring at any time) internal and external vulnerability factors

• longitudinal understanding of problems

protective

• person’s resiliency and strengths

• attempts to build on these for treatment

key characteristic of 5 Ps of case conceptualization

• based on cognitive model

• involves concepts like schemas, assumptions, rules, maintenance cycles of thoughts, emotions, behaviours

• formulation in levels from presenting issues to predisposing factors

• complementary to diagnoses

when do formal assessment originate?

began in early 1900s - Alfred Binet’s intelligence testing among children, WWII military personnel sorting

where else can you find assessment?

• education

• neuropsychology

• medicine

• industrial and forensic psychology

contemporary theories of personality

• trait-based (stable behavioural dispositions)

• dynamic (unconscious, psychological processes and structures, mental representations)

5 principles of personality tests

1. core features of personality are relatively stable over time

2. expression of traits and dynamics varies across gender, culture, age

3. assessment of traits/dynamic often requires different approaches

4. traits are dynamic, dynamics are trait like

5. personality assessment is inextricably interpersonal