Assessment and Treatment Principles

Question 1

What are the key reasons for including a diagnosis in an assessment?

Answer 1

Diagnosis may be used to:

1. Determine if psychopathology is present and its type
2. Help characterise or formulate an understanding of the problem.
3. Inform treatment planning/priorities
4. Establish a baseline for monitoring change
5. Create a shared language for progress

Question 2

Why might a diagnosis be “required” in an assessment?

Answer 2

It may be required due to contextual factors, such as gaining access to the healthcare system.

Question 3

What are the pros and cons of receiving a diagnosis for individuals?

Answer 3

Pros: It can provide clarity and benefit individuals.

Cons: it can be reductionist, minimising, and stigmatising.

Question 4

How should we approach the diagnosis process in psychopathology?

think about the general reasoning for a diagnosis.

Answer 4

The process must carefully consider who benefits and how to obtain a diagnosis with the greatest care.

Question 5

Why are symptoms in psychopathology rarely pathognomonic?

meaning: “a sign or symptom specifically characteristic or indicative of a particular disease or condition”

Answer 5

It’s because the same features might be common across several conditions. Meaning, principles must guide the assessment process.

Question 6

How do we make informed diagnoses in psychopathology?

Answer 6

We must combine information from various types and sources and ensure the process is grounded in reliability and validity principles.

Question 7

What are some of psychologies strengths in assessing psychopathology? think about measures

Answer 7

We can measure human behaviour and cognitive processes with a focus on how information is obtained and combined. We don’t look at one thing in isolation (usually) it is the aggregation of data.

Question 8

What should be considered when evaluating diagnostic entities?

Answer 8

1. The reliability and validity of the diagnostic entities themselves
2. Consideration should be given to underpinning information (if this is reliable and valid: the information source and how it was obtained)

3.How the data are combined (i.e. are they consistent or plausible given the know facts)

4. The order of questions and presentation of points

Question 9

What is diagnostic reasoing?

Answer 9

A dynamic thinking process that leads to the identification of a hypothesis that best explains the clinical evidence.

Question 10

What is the hypothetico-deductive reasoning method?

Answer 10

A model that asks experts to test whether there is sufficient evidence for a hypothesised diagnosis, while also looking for disconfirmatory evidence.

Question 11

How does the HDR method help with diagnosis?

Answer 11

It controls for biases and shortcuts by looking for patterns rather than focusing on a single piece of information, systematising and structuring the diagnostic process.

Question 12

What is the aim of systematic and structured diagnostic reasoning?

Answer 12

To provide the most robust and accurate diagnosis for the client by inhibiting premature conclusions and structuring the information effectively.

Question 13

What are psychometric considerations in assessment?

Answer 13

They include reliability, validity, and method of combining information used in assessments (e.g., test categories and inputs)

Question 14

What scientific concepts are important in assessment?

Answer 14

Forming testable hypotheses, repeatability of methods/standardisation, and searching for disconfirmatory evidence.

Question 15

Why is it important to check for cognitive biases in assessments?

Answer 15

To guard against errors in reasoning and ensure that assumptions are questioned through systematic approach.

Question 16

What is reliability in psychometric considerations?

Answer 16

Measurement consistency, including diagnostic decisions (e.g., inter-rater reliability/agreement, and kappa statistic)

Question 17

What is validity in psychometric considerations?

Answer 17

The degree to which a test/system measures what it is intended to measure (e.g., convergent validity, predictive validity)

Question 18

What is standardisation in assessments?

Answer 18

A fixed procedure for applying methods to increase measurement consistency, affecting test administration, scoring, and data reporting.

Question 19

What types of evidence are considered in psychometric evaluations?

Answer 19

Evidence can be qualitative vs. quantitative, sourced from interviews, behavioural observations, or tests, and obtained through structured or unstructured methods.

Question 20

What is the role of the clinical interview in assessment?

Answer 20

It is a primary source of information for some professionals, based on direct observation of client behaviour, speech, emotional reactivity, and their capacity to engage.

Question 21

How does the clinical interview help with diagnosis?

Answer 21

It allows the clinician to observe mismatches between verbal and non-verbal cues, which may have diagnostic significance.

1. Enables the collection of a variety of information i.e. subjective distress, the clients view of the problem, and potential symptoms.
2. Enables the collection of different types of information i.e clinical observations, signs, behavioural assessments, and may cover family history, and protective factors/resources.

Question 22

How can psychometric testing aid in the diagnostic process?

*There are two main points to this question

Answer 22

1. Psychometric tests have a high amount of internal control about how data is gathered and maintained whilst also being reliable measures of cognitive, and behavioural experiences.
2. Because they are standardised measures, we can assess deviations from the ‘standard’ and see if they have significance in diagnosis.

Question 23

Apart from assessing deviations in data, why else can standardisation be helpful as an assessment tool in the diagnostic process?

Answer 23

Because psychologists don’t have bodily data like other medical disciplines, standardisation can help in the validity and reliability of measures.

Question 24

Why might a psychologist refer a client or patient for a medical assessment as a part of the diagnostic process?

Answer 24

1. Because a lot of psychological problems have a physical component meaning there could be causal, correlation, or indirect comorbid conditions.
2. It is considered good practice and the results would be taken into consideration when assessing the evidence for the diagnostic criterion.

Question 25

What overarching factors affect the assessment process?

Answer 25

Human cognitive biases, personal biases, procedural aspects (e.g., time, space, client willingness), and awareness of these issues to avoid distorting the assessment process.

Question 26

Why is accurately measuring “normal” behaviour challenging?

Answer 26

It involves assumptions about behaviour consistency. Judgement is needed to integrate conflicting data and offset factors like premature evaluation.

Question 27

What does “polythetic” mean in the context of the DSM-5 diagnoses?

Answer 27

It means there are multiple diagnostic criteria (e.g., 13 criteria where 8 are needed for diagnosis). Individuals can have different sets of symptoms, making diagnoses flexible but challenging.

Question 28

How can challenges of the assessment process be offset?

Answer 28

By considering clinician biases, understanding the reliability and validity of data, and using a reflexive approach with a provisional diagnosis, allowing for flexibility and ongoing reassessment.

Question 29

What is the definition of treatment in psychopathology?

Note. treatment is a word borrowed form the medical model of health. The use of this word associated with changes in an individuals psychology may have adverse effects.

Answer 29

The application of techniques to relieve symptoms and improve adaptive functioning.

However, in conditions like personality disorders or dementia, the traditional notion of “treatment” may not be appropriate, as some seek environmental or social changes instead.

Question 30

What are the difference approaches to treatment?

Answer 30

1. Biological (medical and non-medical)
2. Psychological approaches (psychodynamic, behavioural, humanistic/experiential, and cognitive)
3. Couples/family therapy.

Research of treatment su cess often lacks agreement on definitions and overlooks the client’s perspective.

Question 31

What issues arise with treatment and causal inference?

Answer 31

Some treatments are accidental discoveries, and the improvement in symptoms doesn’t necessarily indicate the cause of the disorder. For example, antidepressants may reduce symptoms, but this doesn’t prove serotonin was the cause.

Question 32

Why is caution needed when interpreting treatment outcomes?

Answer 32

Just because a treatment works doesn’t mean it reveals the underlying cause. Many conditions are multifactorial, and strong, robust research is needed to avoid drawing faulty conclusions based on serendipitous changes.

Question 33

What are the paradigmatic approaches to therapy?

Answer 33

Different therapy paradigms assume different views of human nature, which affect treatment approaches. Biological approaches are often outside a psychologist’s scope, while family and couples therapy is less commonly used for severe psychopathology, which tends to focus on individuals.

Question 34

What dimensions should be considered when comparing treatments?

Answer 34

Clients may consider the therapy’s goal, method, treatment length, therapist role, and other relevant dimensions when comparing treatments from different paradigms.

Question 35

What are the characteristics of psychodynamic, biological, humanistic, and cognitive therapies?

Answer 35

Psychodynamic; increases awareness of unconscious motives through free association (therapist is passive)

Behavioural; treats physical or brain disease processes that underpin a disorder through surgeries and medications (therapist is diagnostician and active)

Humanistic; Increases emotional awareness through empathy and support (therapist as teacher)

Cognitive; change contingencies and teach more adaptive cognitions and skills through guided learning and behavioural rehearsal (therapist is active and non-judgemental)

Question 36

What are the potential harms of therapy?

Answer 36

1. The side effects (e.g., medication, ECT increased focus on weight)
2. Breach of trust (e.g., confidentiality, boundary violations)
3. Loss of liberties (e.g., treatment against one’s will)
4. Harmful psychological therapies, such as CISD, which may increase PTSD and depression if offered prematurely or inappropriately

Question 37

What is combined therapy?

Answer 37

Integrates biological and psychological treatments (e.g., medication and psychotherapy) following a biopsychosocial approach. Ensuring success requires research and collaboration between medical and psychological professionals.

Question 38

What is Eclectic Therapy?

Answer 38

Draws from multiple psychological paradigms to create a client-centric approach, ignoring traditional boundaries. Evaluation of effectiveness can be challenging due to its individualised nature.

Question 39

What trend is observed in Australian Medicare-subsidised mental health services over time?

Answer 39

There is an increase in usage, likely due to more psychopathology being recognised and a reduction in stigma around seeking help. However, this data may not capture the full extent of demand since it often excludes psychological services.

Question 40

Who primarily prescribes antidepressant medications in Australia?

Answer 40

General Practitioners

Question 41

What are some limitations of meta-analyses in psychotherapy effectiveness.

Answer 41

1. the “file drawer” problem may overlook unpublished studies with negative or no effects.
2. Pooled results may include adverse therapies, which could distort the overall effect size.
3. Individual patient outcomes cannot be predicted solely from meta-analysis data.

Question 42

What does the landmark 1977 meta-analysis reveal about psychopathology?

Answer 42

It supports the effectiveness of psychotherapy, showing an effect size of .85 SD units, indicating the those who received psychotherapy were significantly better off than those who did not.

Question 43

How much psychotherapy is typically needed for beneficial outcomes?

Answer 43

They can occur after a few sessions, suggesting brief psychotherapies can be very effective.

Question 44

What additional factors should be considered when evaluating therapy trends?

Answer 44

Specific disorder trends, chronicity, patient and therapist characteristics, and demographic representation in the sample must all be evaluated to understand outcomes better.

Question 45

Why is the selection of trial participants important in therapy studies?

Answer 45

The representativeness of trial participants, especially regarding comorbidities (e.g., depression and anxiety), affects the applicability of study results to the broader population.

Question 46

What distinguishes efficacy from effectiveness in therapy studies?

Answer 46

Efficacy studies are tightly controlled and have high internal validity, while effectiveness studies are more correlational and provide descriptive information without establishing cause and effect.

Question 47

What role do beliefs and expectations play in treatment efficacy?

Answer 47

Patient beliefs about treatment efficacy can contribute significantly to treatment gains, leading to the possibility of placebo effects influencing outcomes.

Question 48

What are ‘common factors’ in psychotherapy?

Answer 48

Aspects of treatment that predict positive responses, regardless of the specific therapeutic approach, such as therapeutic alliance, empathy, and timely treatment.

Question 49

What characteristics are associated with better therapy outcomes?

Answer 49

1. quick establishment of a therapeutic alliance.
2. Therapist attributes like warmth and empathy
3. Encouragement of emotional expression.
4. Use of a flexible approach to therapeutic techniques
5. Specific, limited therapy goalsH

Question 50

How can understanding unhelpful factors improve therapy?

Answer 50

Identifying unhelpful factors, such as rigidity and cultural arrogance, can help therapists refine their approaches to enhance client outcomes.

Question 51

What is the WHO’s stance on mental illness prevention?

Answer 51

Addressing mental health requires not only treatment but also prevention strategies, as psychopathology is too widespread to rely solely on therapeutic outcomes.