Chapter 15: Clinical and Forensic

Question 1

Neuropsychological Testing: Neuropsychological test batteries

Answer 1

Fixed neuropsychological test batteries are designed to
comprehensively sample the patient’s neuropsychological
functioning.

Question 2

Neuropsychological Testing: Halstead–Reitan Neuropsychological Battery

Answer 2

Halstead and his student Reitan, developed a battery of tests designed specifically to assess the presence or absence of brain dysfunction.

The aim of the Halstead-Reitan is not simply to diagnose whether there is brain injury, but to determine the severity of such injury, the specific localization of the injury, the degree to which right or left hemisphere functioning is affected, and to provide some estimate of the effectiveness of rehabilitation.

• Purpose – to diagnose a brain injury
• A classic neuropsychological test battery.
• Requires a highly-trained examiner for administering the various subtests and a full workday to complete.
• Scoring yields a number referred to as the Halstead Impairment Index.

Question 3

Neuropsychological Testing: Halstead–Reitan Neuropsychological Battery (three batteries)

Answer 3

• Ages 5 to 8
• Ages 9 – 14
• Adult
  three separate batteries, one for young children (aged 5 to 8), one for older children (aged 9 to 14), and one for adults.

Many other known subtests are included (e.g., Wechsler, MMPI)
Shows validity in differentiating people with impaired brain functioning
versus intact brain functioning

Question 4

Neuropsychological Testing: Criticisms

Answer 4

• Expensive equipment
• Administration
   Long
   Stressful
   Costly
   Not appropriate for all patients
   Scoring is simplistic
   Lack of standardization

Question 5

Projective Techniques: Categories

Answer 5

1. Associative Techniques: the subject responds to a particular stimulus, such as an inkblot or a word, by indicating what the stimulus suggests
2. Construction Techniques: the subject con- structs a response, usually in the form of a story, to a stimulus, usually a picture, TAT
3. Ordering Techniques: involve placing a set of stimuli in a particular order. Typically the stimuli are a set of pictures, like a comic strip that are random and need to be put in order
4. Completion Techniques: the subject responds to a “partial” stimulus. Sentence completion tests are a prime example
5. Expressive Techniques: the subject engages in some “creative” activity, such as drawing, finger painting, acting out certain feelings or situations (as in psychodrama). The Draw-A-Person test is a good example.

Question 6

Projective Techniques: Clinical Usefulness

Answer 6

1. Social responsibility
2. Professional responsibility
3. Teaching responsibility
4. Advancement of knowledge
5. Challenge to research skills

Question 7

Projective Techniques: Basic assumptions

Answer 7

• A response reflects a person’s personality and/or psychodynamic functioning
• Behaviors can be influenced by transitory aspects
  Reliability is difficult to measure because it doesn’t make sense with most methods
  Are we evaluating the reliability of the test or the rater?

The projective viewpoint further assumes that perception is an active and selective process, and thus what is perceived is influenced not only by the person’s current needs and motivation, but by that person’s unique history and the person’s habitual ways of dealing with the world.

Question 8

Projective Techniques: Sentence Completion Tests

Answer 8

A stem is presented to a person and they are asked to provide the first response that comes to mind

Many of these measures lack standardization, reliability, validity, and appropriate norms

Examples: Washington University Sentence Completion Test, Rotter Incomplete Sentence Blank

Value of these measures is that they may be used as a semi-structured interview, which provides a starting point for the clinician to ask questions

Question 9

Projective Techniques: Drawings

Answer 9

Research doesn’t show very good reliability or validity
Examples: Draw-A-Man and the DAP
These may be useful to assess cognitive development in children
Not useful to assess a client’s functioning
Reliability and validity are moderate

Question 10

Projective Techniques: Bender Visual Motor Gestalt Test

Answer 10

Purpose for Adults
* Measure of neuropsychological functioning
* Projective personality test

Purpose for Children
* Test of visual-motor development
* Projective personality test

The test consists of nine geometric designs
Each design is on an individual card and presented one at a time; the subject is asked to copy it on a piece of paper.
Bender (1938) believed that the quality of the reproduction of the designs varied according to the level of motivation of the subject and according to the pathological state of the subject, such a state being “organic” (i.e., the result of damage to the central nervous system) or “functional” (i.e., no actual brain damage but the abnormal behavior serving some psychological purpose).

Question 11

Projective Techniques
Bender Visual Motor Gestalt Test
Widely used and very popular
Why use it?

Answer 11

1. Brief and easy to administer
2. Two purposes
3. Useful for a screening device
4. Clinician can obtain valuable information from observing a client’s
   behavior
   Not sure if it is useful to differentiate groups

Question 12

Some Clinical Issues and Syndromes: Clinical versus Statistical Prediction

Answer 12

Research has found that statistical or mechanical prediction is as good as clinical prediction or better most of the time

Clinical methods involves looking at GPA, GRE, and LOR and predicting success
Statistical prediction would be putting said info in a regression equation

Question 13

Some Clinical Issues and Syndromes: The Effective Therapist

Answer 13

White- horn and Betz (1960) identified effective therapists by comparing SVIB (strong) responses of therapists who were successful with schizophrenic patients and therapists whose improvement rates with their patients were low.

Looked at effective and less effective therapists and their responses
on the Strong (SVIB)
Some specific patterns were found
Maybe interactions? Some good with schizophrenics and others good
with neurotics

Question 14

Some Clinical Issues and Syndromes: Alcoholism
what is the test used for?

Answer 14

Test results may be used for:
* Individualized treatment – assessing needs, coping skills, strengths,
risk factors
* Better match of client and treatment options
* Monitor therapeutic progress

(1) The test information can result in individualized treatment to meet the patient’s needs, coping skills, psychodynamic strengths, risk factors, and so on
(2) The test information can allow a better match between client and available treatment options
(3) The test results can serve to monitor the course of therapeutic progress or lack of it

Question 15

Some Clinical Issues and Syndromes: Alcoholism
Assessment instruments may be used for:

Answer 15

1. Screening Tests
2. Diagnostic Tests
3. Triage Tests
   (triage being a medical term referring to the assignments of patients to specific treatments)
   whose results might be used to determine the appropriate setting, such as hospitalization vs. out-patient treatment, and the intensity of the treatment.
4. Treatment
5. Monitoring
6. Program Evaluation
7. Family and Marital Functioning
8. General Psychology Tests
   Such as the MMPI, to assess general emotional adjustment, neuropsychological functioning, degree of psychopathology present, and so on
9. In-Process Measures
   measures used to assess specific aspects of the treatment program and the client’s progress in that program, for example, the degree of acceptance that one has a drinking problem

Question 16

Some Clinical Issues and Syndromes: Two testing strategies:

Answer 16

• Indirect scale
   Items with no obvious relationship to drinking
   Empirical approach
• Direct scale
   Items directly related to drinking
   Has more face validity

indirect scale strategy
involves the administration of a large pool of items, such as the MMPI, items which have little or no obvious relationship to drinking behavior.
The responses of alcoholic and control samples are then statistically analyzed and a scale compiled of items whose responses are statistically different in the two groups

direct scale strategy
where the pool of items is directly relevant to drinking and related behaviors i.e., items have face validity

Question 17

Eating Disorders
Eating Disorder Inventory-2 (EDI-2)

Answer 17

• 91 items
• Self-report to assess symptoms, behaviors, feelings related to anorexia and bulimia
• Assess patient symptoms
• Plan treatment
• Evaluate effectiveness of interventions
• Criterion-related, concurrent, and construct validity all explored

Question 18

Health Psychology: primary focus

Answer 18

How behavioral factors affect physical health and illness
Related area – Occupational Health Psychology
Study of the process by which behavior is linked to physical disease, physiological effects of stressors that can influence susceptibility to disease

Primary focus
* How to keep people healthy
* Role of personality factors and coping styles in the development of illness
* The role of stress
* Benefits of social support

Question 19

Health Psychology: Hardiness

Answer 19

Personal Orientation Inventory was based on Maslow’s ideas
Hardiness Test – developed by Suzanne Kobasa
* Some people are less vulnerable to illness
* Says that those who are more resistant is due to hardiness (a constellation of personality characteristics)
1. a hardy person is committed to his or her work and activities (i.e., has a sense of belief in himself or herself and the community)
2. A hardy person has a sense of control (i.e., the belief that he or she can influence the course of events)
3. A hardy person sees life as a challenge (that changes are an opportunity to grow rather than a threat to security)
Hardiness mediates or acts a buffer of stressful life events, or perhaps alters the way in which stressful life events are perceived

Question 20

Health Psychology: Stress

Answer 20

The energy used to cope with life stressors is assumed to rob the body of resistance to disease, and thereby increase the probability of physical illness and interpersonal dysfunction.

1. Stimulus-oriented theories view stress as being in selected aspects of the environment. (experiences such as divorce)
2. Response-oriented theories define or focus on stress as the response of the individual. (mood and coping patterns)
3. A third group of theories might be labeled as “interactionists.”

They see the person as being the major mediating link between the characteristics of the environment and the responses made. The approach here is that not only does the environment have an impact on the individual, but the individual can have an impact on the environment.

Question 21

Health Psychology: Health Belief Model

Answer 21

Developed in the 1950s and 60s
Tried to assess why people were not using procedures to detect serious illnesses

Subjective beliefs about:
* Susceptibility to the disease
* Severity of the consequences
* Benefits of taking action
* Barriers related to action

Question 22

Health Psychology: Schedule of Recent Experiences (SRE)

Answer 22

If a person experiences a significant life event, the readjustment required increases their risk of physical illness
Schedule of Recent Experiences (SRE)
* 43 items
* Designed to measure the occurrence of life events
Research has shown that the correlation is r = .12
Issues:
* Perception of the event is important
* Weighting of items – unitary or weighted scores
* Dimensionality – unidimensional or multidimensional

Question 23

Health Psychology: Stability over time
and Criticisms

Answer 23

Stability over time
Research found that weights stayed stable in normal populations, but
wasn’t true for psychiatric patients

Criticisms
* Too few categories of life
* Focus too many categories around marriage
* Vague items
* Illness may cause the event

Question 24

Health Psychology
Checklists have been developed as alternative method
key issues

Answer 24

Key issues with checklists
1. How does one define and select life events to be included?
2. Does it matter if the change is positive or negative?
3. Is the item an indicator or symptom of illness?
4. Internal reliability of the items which tend to be independent
5. Related problems may be related to one’s role
6. Is one year enough time for an illness to appear?
7. May need to assess time duration as well as occurrence of events
8. How to weight items?
9. Reliability should be considered at item level and not score level

Question 25

Health Psychology
Work of Lazarus

Answer 25

Hassles and uplifts – focus on the minor stresses and pleasures of
everyday life
Present respondent with list of hassles
* Rate if hassle has occurred in the last month
* Rate the severity of the hassle
Present respondent with list of uplifts
* Rate if uplift has occurred in the last month
* Rate the intensity of the uplift

Another approach is represented by the work of Lazarus

focus on the relatively minor stresses and pleasures of everyday life – what they call the hassles and uplifts

Respondents are asked to rate each item first on whether the hassle occurred during the past month, and second, using a 3-point scale on the severity of the hassle

The uplifts scale consists of a list of 135 uplifts, ranging from “daydreaming” to “looking forward to retirement.” Items on this list are also circled if they occurred in the past month, and also rated on intensity

reported that hassles are better predictors of health status than major life-change events

Question 26

Health Psychology
Health Status

Answer 26

Focus on the absence of ill health rather than the presence of good health
The Short-form General Health Survey (SF-36)
* Multidimensional
* Measure the full range of health states
* Compared patients with minor chronic medical conditions, patients with serious chronic medical conditions, patients with psychiatric conditions, and patients with both serious medical and psychiatric conditions
* Was able to distinguish between degree of medical condition and different between psychiatric and medical conditions

Question 27

Health Psychology
The Sickness Impact Profile (SIP)

Answer 27

• Used with the elderly
• Measure the changes in behavior associated with sickness
• Assesses wide range of functioning
• 12 subscales measuring three dimensions
• May be better at measuring the decline of health, than the
  improvement

Question 28

Health Psychology
McGill Pain Questionnaire (McGill PQ)

Answer 28

Evaluate the effectiveness of different pain therapies
Also used as a diagnostic tool
Three dimensions:
1. Sensory-discriminative dimension – how long the pain lasts
2. Motivational-affective dimension – the fear associated with pain
3. Cognitive-evaluative dimension – how intense the pain is

Question 29

Health Psychology
Jenkins Activity Survey (JAS)

Answer 29

Measures Type A behavior which is characterized by extreme competitiveness, striving for achievement, aggressiveness,
impatience, restlessness, and feelings of being challenged by responsibility and under the pressure of time

Three components:
* Speed and impatience factor
* Job-involvement factor
* Hard-driving and competitive factor

Question 30

Forensic Psychology

Answer 30

“Application of psychological principles, techniques, and procedures to the understanding of the law, to legal proceedings and legislative processes, and the application of psychology to any ongoing legal proceeding such as a trial , administrative law hearing, and legal arbitration and mediation.” (Reynolds & Livingston, 2012, p.446)

Occurs in both criminal and civil matters
On the next slide are differences between a clinical assessment and a forensic assessment
The purpose of a forensic assessment is provide information to the court which is objective and unbiased

Question 31

Forensic Psychology
Not Guilty by Reason of Insanity

Answer 31

Forensic psychologists make determinations about whether a person can use the defense of not guilty by reason of insanity or is
competent to stand trial.

Not Guilty by Reason of Insanity

The general public overestimates how often this defense is used and how often it is successful.
Data show it is used in 1% of felony criminal cases
Of those cases, it is successful 25% of the time
This means that less than 3 out of 1000 felony cases have this verdict

Question 32

Forensic Psychology
Competency to Stand Trial

Answer 32

Tests are used to determine the answer to this question
A person must understand the charges and the proceedings against them and be able to assist their attorney in the defense

Question 33

More on Forensic Pych

Answer 33

Just because someone is an expert in a case doesn’t mean that the person will be allowed to testify.
The Daubert v. Merrill Dow is the case that most have adopted as the standard to determine if an expert is allowed to testify.
Admissibility of testimony is not the same as credibility.
The standards are described in the following slide.
Testimony must be grounded on valid scientific principles.

Question 34

Forensic Psychology
Daubert v. Merrell Dow Pharmaceuticals (1993)

Answer 34

1. Is the scientific hypothesis testable?
2. Has the proposition been tested?
3. Is there a known error rate?
4. Has the hypothesis and/or technique been subjected to peer review and publication?
5. Is the theory upon which the hypotheses and/or technique is based generally accepted in the appropriate scientific community?
6. Are there non-judicial issues which have been made of the theory or technique?

Question 35

Legal Standards
Legal Cases

Answer 35

• Title VII of the Civil Rights Act of 1964
• Myart v. Motorola (1966)
• Griggs v. Duke Power Company (1971)
• Albemarle Paper Company v. Moody (1975)
• Connecticut v. Teal (1982)
• Watson v. Forth Worth Bank and Trust (1982)
• Daubert v. Merrell Dow Pharmaceuticals (1993)

Question 36

Legal Standards
Test in Educational Settings

Answer 36

• DeFunis v. Odegaard (1971)
• Debra P. v. Turlington (1981)
• Truth-in-testing legislation