Clinical Psych Exam 1

Pages 50-69

·         An Outline of the Assessment Process

o   Clinical Assessment Process

§  1. Receive and clarify referral question

§  2. Plan data collection procedures

§  3. Collect assessment data

§  4. Process data and form conclusions

§  5. Communicate assessment results

o   1. Receiving and Clarifying the Referral Question

§  Clinicians must ask themselves: what do I want to know, and how best can I find out about it?

§  Referral source = the person or agency requesting the psychological assessment

§  Referral question = the question or issue to be addressed

·         Shapes how clinician assesses a client and how they interpret and communicate results to the client

o   2. Planning data collection procedures

§  Important to gather detailed info in domains MOST relevant to the client and the goal of the assessment (you can never know everything about a client)

§  Selecting assessment instruments

·         Should consider reliability, validity, and utility, as well as relevance to the referral question

o   3. Collecting Assessment Data

§  The Value of Multiple Sources of Assessment Data

·         Interviews, observations, tests, and historical records

·         Informants (clients and individuals with intimate knowledge of the clients’ characteristics and problems) may provide helpful info

·         Clinicians combine info from multiple assessment sources to help form a more precise image of their clients

o   4. Processing Data and Forming Conclusions

§  Data converted from raw form to interpretations and conclusions that address one or more referral questions

o   5. Communicating Assessment Results

§  Create an organized presentation of results called an assessment report

§  Must be clearly written and clearly related to the goal that prompted the assessment in the first place

·         The Goals of Clinical Assessment

o   Classification and Diagnosis

§  Accurate diagnosis is important because:

·         Proper treatment decisions depend on knowing what is wrong with a client

·         Research on the causes of psychological disorders requires that each of them can be accurately identified and differentiated from other disorders

·         Accurate diagnosis allows clinicians to efficiently communicate with one another and with key stakeholders like insurance companies about disorders

§  Brief History of the DSM

·         1952 = DSM I

o   Uniform terminology to describe and diagnose abnormal behaviors, but no clear rules to guide diagnostic decisions

·         1968 = DSM II (made DSM more similar to WHO’s classification system)

o   Uniform terminology to describe and diagnose abnormal behaviors, but no clear rules to guide diagnostic decisions

o   ~ 106 diagnoses

·         1980 = DSM III

o   Explicit diagnostic criteria and algorithms for combining criteria into a diagnosis

o   First one with diagnostic criteria

·         1987 = DSM III R

o   More criteria and more specific

·         1994 = DSM IV

o   More criteria and more specific

·         2000 = DSM IV TR

o   More criteria and more specific

·         2013 = DSM 5

o   New chapter organization

o   Some diagnostic categories changed

o   Some diagnoses changed

o   ~ 350 diagnoses

§  Evaluation of the DSM

·         All-or-nothing categorization imposed by the DSM is kind of problematic as most psychological disorders present in varying degrees

·         No info about how diagnostic decisions should be adjusted based on clients’ socioeconomic status, cultural traditions, etc

§  Alternate Classification Systems

·         Suggestion of dimensional approaches à clinicians shouldn’t assign diagnoses based on whether clients display an arbitrary number of systems, but rather on the measurement of client characteristics on a set of dimensions that are relevant to each disorder

·         Psychodynamic Diagnostic Manuel (2006) – thought to help generate more complex pictures of clients

o   Description

§  Descriptive assessment useful for pretreatment measures, guiding treatment planning, and evaluating changes in behavior after treatment

§  May also improve measurement in clinical research

o   Planning and Evaluating Treatment

§  Plans have to be pretty specific to the client and consider their background

§  Clinical assessment can determine the effectiveness of a treatment

o   Prediction

§  Goal of clinical assessment is to make a prediction about human behavior

·         Prognosis

·         Future performance

·         Dangerousness

§  Prognosis = prediction about the outcome of treatment, also related to predictions about changes in symptoms without treatment or under certain circumstances

·         Clinicians can use the DSM to build on the accuracy of prognosis

·         Prognosis can be influenced by assessment of client factors

·         Hard to provide accurate prognosis

§  Predicting performance

·         Ex: WWII, clinician Henry Murray used specialized tests to evaluate potential soldiers for who would be the most successful operatives

§  Predicting dangerousness

·         Largely anecdotal evidence

·         Clinicians not very good at accurately predicting dangerous behavior

·         Factors Influencing the Choice of Assessment Instruments

o   Reliability = consistency with which a test measures some target variable

§  Measured using repeated measurements à if results of the same test with same clients are similar, that test has high test-retest reliability

§  Measured by internal consistency à comparing results from two parts of a test and checking how highly they correlate (if strong correlation, high internal consistency)

·         Split half reliability = splitting the test in half, like all the odd questions and all the even questions

§  Measured with interrater reliability à comparing conclusions drawn by different clinicians using same assessment system to diagnose, rate, or observe the SAME clients

·         Higher when same criteria used

·         Lower when clinicians base judgments on subjective criteria (projective tests, unstructured interviews)

o   Validity = the degree to which a test measures what it is supposed to measure

§  Construct validity = the overarching term for validity

·         CV high, when results are systematically related to the construct or attribute the test, is supposed to be measuring (do the results make sense in light of this theory?)

·         Content validity = how well a test captures all relevant dimensions of its target construct (ex: a depression screening that just asks about feeling sad and none of the other symptoms of depression)

·         Criterion validity = how strongly the results of a test method correlate with some important outcome/criterion

o   Predictive validity = measured by evaluating how well results of an assessment method forecast events

o   Concurrent validity = degree to which results of a test method are similar to those of other methods that are designed to measure the same construct

o   Discriminant validity = extent to which results from measurements of one construct are unrelated to theoretically irrelevant constructs

§  An assessment device cannot be VALID without first being RELIABLE

§  Test validity can be assessed only when tests are used for their intended purposes

o   Standardization = scores were analyzed after being given to a large, representative sample

o   Bandwidth vs Fidelity

§  bandwidth = the breadth of an assessment method

§  fidelity = the depth or detail of the info it yields

§  bandwidth fidelity dilemma = there is a tradeoff between the amount of information obtained and its depth

o   Other Factors Affecting Assessment Choices

§  Clinician experience and Theoretical Orientation

§  Assessment context (like in a private practice vs in court)

§  Cultural factors

Pages 109-126

·         Testing in Clinical Psychology

o   What do tests measure? Literally everything

§  Tests for every disorder, every age group, every social demographic

·         Basic Concepts in Psychological Testing

o   What is a psychological test?

§  Psychological test = systematic procedure for observing and describing a person’s behavior in a standard situation

§  Planned stimuli, client must respond, clinician scores/interprets results, incorporate results into assessment report

§  Important features of psychological tests = objectivity and standardization

§  Tests differ from other clinical assessment techniques in three ways:

·         Test responses can be quantitatively compared with norms, which serve as a baseline

·         Tests can be taken privately, without a clinician present

·         Tests can be administered in groups or individually

o   How are tests constructed?

§  Analytical approach (/rational approach) = tests constructed by asking what qualities we want to measure, and how we define them

·         Analytically constructed tests of the same concept will differ significantly depending on the testers’ definition of that concept, what about it they find most important, and how they think it is to be measured

§  Empirical approach = data-based approach to test construction, where testers let data guide their content choices

·         Can include questions with low face validity – that is, questions that are seemingly irrelevant to the trait – which can be helpful because clients cannot manipulate their answers to what they think researchers want to see

§  Analytic approach can be faster and less expensive and can test for any trait in the book, even if there’s not a lot of data-based research on that trait

§  More likely to use an empirical approach when making specific predictions about people

§  Sequential system approach = construction that combines aspects of both analytical and empirical techniques

·         Analytical approach to make the test, empirical approach to refine it

·         Some test items are selected from existing tests, and some are written because the test designer thinks they should be evaluated

·         Then researchers try out the test on a group and look at the results to determine which items were answered differently by people who are already known to differ on the trait of interest

·         Scales = groups of correlated measures, which are often considered during test construction to measure a certain dimension

o   Standardization and Score Interpretation

§  Standardization samples = samples that establish the norms of a specific population on a particular test

§  Re-standardization happens appx every ten years, but it is complex and expensive

§  Scores can also be interpreted based on a specific criterion that the researcher specifies

§  Ipsative measurement = comparing someone’s scores to their own previous scores

o   Avoiding Distortion in Test Scores

§  People present in the room, even the type of tester (male/female, dressed casually/formally, younger/older, singular/multiple) can distort scores

§  Response set/response style/response bias = the tendency for some clients to respond in certain ways to most or all items, regardless of item content

§  Malingering = clients give untruthful responses to intentionally create false impressions

§  Ways to minimize distortion:

·         Develop clear and simple instructions to guide examiners and test-takers

·         Conducting extensive trials to identify response tendencies on specific items

·         Seeking advice from test bias experts to flag potential problems

·         Incorporate items that can detect response bias or deliberate distortion

·         Tests of Intellectual Functioning

o   Theories of Intelligence

§  Intelligence includes three characteristics

·         Abstract thinking/reasoning abilities

·         Problem-solving abilities that are adaptive for survival

·         Capacity to acquire new knowledge

§  Information-processing approach to intelligence testing would be identifying the mental processes that are involved in intelligent behavior

§  Psychometric = mental measurement (focus on scores, performance, etc)

§  Main psychometric approaches to intelligence = general intelligence, multiple intelligences, hierarchical and factor-analytic

§  General Intelligence model

·         Intelligence is a global, general ability. If you do well on one cognitive test, you are likely to do well on all cognitive tests

§  Multiple Specific Intelligences Models

·         General intelligence is made up of a collection of relatively separate, more specific abilities

·         Sternberg says there are three basic kinds of intelligence

o   Analytical = the kind of intelligence measured by traditional tests, essentially book smarts

o   Creative = the kind of intelligence you would use to compose music

o   Practical = essentially street smarts

§  Hierarchical and Factor-Analytic Models

·         Combination of the other two models where scientists recognize the positive correlation among various tests of cognitive ability while also recognizing that the g factor can be measured by many different groups of cognitive tests

·         Cognitive abilities are organized in a hierarchy of layers

o   The Binet Scales

§  Binet-Simon scale in 1908 = one of the first intelligence tests for children that tested specific skills that got more advanced as the test progressed. If your mental age as determined by the test was equal to your actual age, you were considered to be of regular intelligence

§  1916 the Stanford-Binet Intelligence Scale came out, which also measured adults

·         Used intelligence quotient (IQ) instead of mental age

§  SB5 2003 measures 293 items and is based on a hierarchical model of intelligence

·         Can calculate a full-scale IQ score or ten sets of subtests, half verbal and half nonverbal

·         Subtests meant to measure five abilities that are thought to be at the middle level of the intelligence hierarchy: fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing, and working memory

·         High levels of reliability, good validity

o   The Wechsler Scales

§  David Wechsler developed the Wechsler-Bellevue (W-B) Intelligence Scale, an intelligence test specifically for adults

·         Contained verbal and nonverbal subtests

§  The revised version of the W-B was the Wechsler Adult Intelligence Scale (WAIS) invented in 1955

§  1981 was WAIS II

§  1997 was WAIS III

§  2008 was WAIS-IV

·         Items presented with increasing difficulty within subtests. When you answer a couple incorrectly, the tester moves on to the next subtest

·         Contains 15 subtests, but 5 are optional

·         Four index scores: verbal comprehension, perceptual reasoning, working memory, and processing speed

·         Combining the four index scores gives you a General Ability Index Score

§  Wechsler Intelligence Scale for Children (WISC) and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI)

·         Tests for children aged 6-17 and 2.6-7.7 years, respectively

§  High reliability of Wechsler scale assessments

§  Clinical Interpretation of Intelligence Test Scores

·         In addition to IQ, the Wechsler tests show a person’s cognitive strengths and weaknesses

o   Other Intelligence Tests

§  Kaufman Assessment Battery for Children

§  Peabody Picture Vocabulary Test-Revised

§  Leiter International Performance Scale

§  Raven’s Progressive Matrices

o   Aptitude and Achievement Tests

§  Aptitude = the capacity to acquire knowledge or skill       

·         Aptitude tests predict success in an occupation or program (SAT, for one)

§  Achievement = the knowledge or skill that a person has acquired

·         Achievement tests measure proficiency at certain tasks

·         Tests of Attitudes, Interests, Preferences, and Values

o   Self-Directed Search (SDS)

o   Strong Interest Inventory (SII)

o   Campbell Interest and Skill Survey (CISS)

o   Kuder Occupational Interest Survey (KOIS)

o   Study of Values (SoV) and Rokeach Value Survey (RVS) both measure values or generalized life orientations

Pages 127-133

·         Tests of Psychopathology and Personality

o   Personality = the relatively stable pattern of behavioral and psychological characteristics by which a person can be compared with others

§  Two ways to test dimensions and disordered aspects of personality

·         Objective tests = structured, relatively clear and specific stimuli to which the subject answers directly, can be scored arithmetically

·         Projective tests = unstructured, more ambiguous stimuli, researcher must score and interpret

·         Objective Tests of Psychopathology

o   The first objective test was the Psychoneurotic Inventory (renamed the Personal Data Sheet in WWI to identify psychological problems in army recruits)

o   Minnesota Multiphasic Personality Inventory (MMPI)

§  Most widely used instrument for assessment of personality and clinical symptoms in adults

§  clinical scales = patterns of responses that were similar for people with a certain disorder to differentiate people who displayed the disorder from people who did not, MMPI found 8 of these

§  MMPI 3 has

·         335 items

·         8 clinical scales (demoralization, somatic complaints, low positive emotions, antisocial behavior, ideas of persecution, dysfunctional negative emotions, aberrant experiences, hypomanic activation)

·         4 somatic/cognitive scales

·         10 internalizing scales

·         7 externalizing scales

·         5 interpersonal scales

·         5 personality/psychopathology scales

·         3 higher order scales

·         11 validity indicators

o   Personality Assessment Inventory (PAI)

§  PAI = clients rate statements from 1 to 4 by how much they agree with each, meant to test a broad range of clinical symptoms

·         344 statements

·         4 validity scales to detect problematic response styles

·         11 clinical scales

·         Numerous subscales

·         Supplemental indexes

o   Millon Clinical Multiaxial Inventory (MCMI IV)

§  195 T/F items

§  5 validity scales

§  15 scales devoted to personality patterns/disorders

§  10 clinical syndrome scales

o   Personality Inventory for the DSM-5 (PID-5)

§  220 items

o   Tests Measuring Specific Aspects of Psychopathology

§  Beck Depression Inventory (BDI-II)

·         21 items

§  Hamilton Depression Symptom Questionnaire

§  Profile of Mood States

§  Fear Survey Schedule (FSS)

·         50-122 items

§  Panic Disorder Severity Scale

·         Objective tests of Personality

o   Eysenck Personality Questionnaire – personality traits tend to cluster into three main dimensions

§  Introversion-Extraversion

§  Neuroticism-Stability

§  Psychoticism

o   Multidimensional Personality Questionnaire – 3 broader dimensions

§  Positive Emotionality

§  Negative Emotionality

§  Constraint

o   NEO-Personality Inventory

§  Originally designed using analytic methods as a measure of 3 dimensions:

·         Neuroticism

·         Extraversion

·         Openness

§  Added two more dimensions later

·         Agreeableness

·         Conscientiousness

§  Helpful in assessing psychological disorders, predicting progress in psychotherapy, and selecting optimal forms of treatment for some clients

o   California Psychological Inventory (CPI)

§  Developed to assess personality in the normal population using empirical methods

§  434 T/F questions

§  29 scales

§  3 validity scales

o   Other Objective Personality Tests

§  16 Personality Factors Questionnaire

§  Myers Briggs Type Indicator (MBTI)

133-141 & 69-76

·         Projective personality tests

o   Projective = unstructured

o   Freud à people project certain aspects of their own personalities to others

o   Projective hypothesis = each person’s personality will have a significant effect on how they interpret/respond to ambiguous/unstructured stimuli

o   Rorschach Inkblot Test

§  10 inkblots, some in color some black and white

§  Initially denounced as faulty

§  Samuel Beck published first English manual of how to give/score the test

§  Code for location, determinants, content, popularity, and form quality

·         W = whole blot

·         F = form was the main determinant

·         C = color

·         A = animal

·         P = popular response

·         + = form described corresponds well to the actual form of the blot

§  Scoring ambiguity reduced interrater reliability

·         Exner Comprehensive System for Scoring Rorschach Test provided specific guidelines for response coding

o   Thematic Apperception Test (TAT)

§  Set of 31 cards, 30 show people, objects, and landscapes, and 1 is blank

·         Clients are shown ten or fewer cards (one at a time) and asked to develop a story about each one, including the setup and the conflict and how the characters are feeling

·         Blank card = participant asked to imagine a drawing, describe it, and make a story about it

§  1935 – Christiana Morgan and Henry Murray

§  Projective hypothesis that in telling a story, the client’s needs and conflicts will be reflected in at least one of the story’s characters

§  Scoring focuses on content and structure of story

·         Content = what client describes

·         Structure = how clients tell their stories

·         More than one scoring system

o   Other Projective Tests

§  Rosenzweig Picture-Frustration Study – like TAT but measures aggression

§  Children’s Apperception Test

§  Roberts Apperception Test for Children

§  Rotter Incomplete Sentences Blank

§  Washington University Sentence Completion Test

§  Draw-a-Person

§  House-Tree-Person

§  The Bender Visual Motor Gestalt Test

·         The Current Status of Psychological Testing

o   Reliability and Validity of psychological tests

§  Most intelligence tests are better at measuring the speed and effectiveness of info processing than measuring the capacity to think rationally

§  Objective tests of personality and psychopathology show acceptable levels of reliability and validity, projective tests less so

·         Mixed reliability shown for scores generated by projective tests

·         Validity also seems very mixed for projective tests like Rorschach and TAT

§  What makes a test good enough to justify its use?

·         PAWG meta-analysis found that many widely used psychological tests produce results that are about as valid as medical tests

o   Psychological Testing with Diverse Clients

§  Culturally specialized versions of psychological tests are rare, and understanding cultural background is useful in interpreting results

§  Wechsler test is available in Japanese and Spanish

§  Beck Depression Inventory available in Spanish, South Indian, and native South African

§  MMPI exists in 25 languages

o   Ethical Use of Psychological Tests

§  Ethical documents ensure that psychological tests are being developed and administered with ethical considerations in mind

o   New Roles and Goals for Psychological Tests

§  Clinical utility = could the results of a psychological test be used to help them select or adjust treatment methods or evaluate the effects of those methods

·         Even tests that are high in validity might be low in clinical utility

·         Clinical Judgement and Decision Making

o   Clinical Intuition

§  Heuristics = mental shortcuts can lead to error in information processing

·         Availability heuristic = recent or remarkable experiences are easier to recall (ex: lottery ads make people think you win the lottery more than you do)

o   May lead psychologists to overestimate the likelihood of psychological problems that they see often, thus overly diagnosing some problems

§  Illusory correlation = tendency to see an association between variables when there is none

·         Can cause clinicians to draw false inferences from assessment data

§  Anchoring bias = clinging to a first impression

·         May lead clinicians to let info from some sources outweigh info from other sources

·         Confirmation bias = tendency to seek out and interpret new info that aligns with existing beliefs

§  More assessment info isn’t always better – sometimes it decreases the accuracy of clinical inferences

§  Therapists may also misremember info or fail to collect all the data they need

§  Clinical and Statistical Prediction

·         Statistical(/actuarial) prediction = inferences based on probability data and formal procedures for combining info that are all derived from research

·         Clinical prediction = inferences based on practitioner's intuitions, informal observations, assumptions, and professional experiences

·         1954 Paul Meehl – in 19 out of 20 cases, accuracy of statistical approach equaled or surpassed accuracy of clinical approach

·         Meta-analyses = quantitative techniques that standardize the outcomes of a large number of studies to compare or combine them

o   136 studies in one meta analysis – still found that statistical prediction outperformed clinical prediction

o   Improving clinical judgement

§  Slight positive correlation between years of experience and accuracy in clinical judgment

·         Communicating Assessment Results

o   Report clarity

§  Without clarity, relevance and usefulness cannot be evaluated

§  Misinterpretation can lead to misguided decisions

o   Relevance to Goals

o   Usefulness of Reports

§  Incremental validity = ability to add something important to what we already know about the client

§  Some reports that may be clear and relevant may appear useful but actually have little value