Chapter 4 Flashcards
Characteristics of Clinical Assessment
Standardization: There is a standardization among clinical assessment tools. The intelligence test is one of the most standardized clinical assessment tools.
Reliability: needs to measure things reliably. There is interrelated reliability
Validity: it needs to measure what it’s supposed to measure. Face validity is it looks like what it is. Predictive validity can be predict something about the individual (behavior, disorder, etc.). Concurrent validity is when the tests relate to other standardized tests measuring the same thing.
Clinical Interviews
Strengths:
Face-to-face encounters (the diagnostic exercise)
Gathers the background data with specific theoretical focus
Unstructured: open-ended
Structured: Primarily specific (ex. Mental status exam - what they say vs. what they show)
Limitations:
if there’s not validity or accuracy (person may be misleading)
the interviewer may have bias or mistakes in judgement
there’s a lack of reliability
Some people believe that interviewing should be discarded as a tool of clinical assessment
interviewer and interviewee interaction (lack of empathy or trust between the two)
Clinical Tests
used to gather info about psychological functioning to infer broader functioning
There are more than 1000 tests out there and there are six categories:
Projective tests: belief that subject will project their personality into their response ex. ink-blot test, Rorschach test (standardized ink-blot test, more trustworthy), thematic apperception test (series of card w/ different pictures patient describes them), sentence-completion test, and drawings.
Strengths:
Most commonly used until 1950s
Now used to gain supplementary information (used in conjunction w/ other things)
Limitations:
Reliability and validity not consistently shown in clinical tests
May be biased against minority, racial, and ethnic groups
Personality Inventories
designed to measure broad personality characteristics, focused on behaviors, beliefs, and feelings, usually based on self-reported responses,
the most widely used one is the Minnesota Multiphasic Personality Inventory (MMPI original, MMPI-2 revised, MMPI-A adolescents)
Scores range from 0 to 120 w/ ten clinical scales:
Hypochondriasis: abnormal bodily concerns
Depression: pessimism, hoplessness
Conversion Hysteria: uses issues as a scope out of doing things
Psychopathic Deviate: anti-social, not w/ the norms
Masculinity-Femininity: just says what is more male or female
Paranoia: abnormal suspicion
Psychasthenia: guilt and obsessiveness (OCD)
Schizophrenia: bizarre unusual behavior
Hypomania: overly emotional
Social Introversion: shyness
Strengths:
easier, cheaper, faster than projective tests
objectively scored and standardized
appear to have greater validity than projective tests
Limitations:
cannot be considered highly valid
Measured traits cannot be directly examined (you don’t directly observe behavior)
does not account for cultural differences
Response Inventories
based on self-reports
focus on specific area of function (Beck Depression Inventory)
Categories:
Affective Inventories
Social Skills Inventories
Cognitive Inventories
Strengths & Weaknesses:
strong face validity (you know exactly what they’re testing for)
not all have been subject to standardization, reliability, or validity
Psychophysiological Tests
measure physiological response as an indication of psychological problems (heart rate, blood pressure, body temperature, etc.)
think polygraph
Strengths & Weaknesses:
plays key role in assessment of psychological assessments
require expensive equipment
can be inaccurate and unreliable
other things are better than the polygraph; MRI studies are more accurate. Concurrent validity helps
Neuroimaging and Neurophysiological Tests
Neurological - intended to directly assess brain abnormalities by assessing brain structure and brain function (ie . EEG, PET scans, CT scans, MRI, fMRI).
Neurophysiological - indirectly assess brain function by measuring cognitive, perceptual, and motor functioning on certain tasks, such as the Bender Visual-Motor Gestalt Test.
Intelligence Tests
designed to indirectly measure intellectual ability
typically consist of a series of different verbal and nonverbal skills
General score in an intelligence quotient (IQ) which is mental age divided by chronological age
Strengths:
one of the most carefully produced clinical tests
highly standardized on large groups of subjects
high reliability and validity
Weaknesses:
Performance can be influence by nonintelligence (motivation, interest)
cultural biases in language or tasks are present
minority groups may be less comfortable which influences the results
Clinical Observations
Naturalistic observations occur in everyday environments
Analogue are used and conducted in artificial settings
Merits of Natural and Analogue:
There is concern about reliability and validity because people can act different if they know they’re being observed, and what the researcher documents could be biased. Also, could lack generalizability. These still provide us with a lot of information.
There is an idea of self-monitoring where people observe themselves by recognizing the frequency of certain behaviors and thoughts, but validity is an issue.
Classification Systems
using all available information, clinicians attempts to paint a cluster of symptoms and make a diagnosis
based on an existing classification system (DSM in the United States ICD in other nations)
DSM-5 and DSM-5-TR:
most common in US
lists of categories, disorders and symptom descriptions w/ guidelines for assessment
Provides categorical (name of disorder and criteria) and dimensional (severity of disorder) information ex. categorical is specific anxiety or depression disorders and the specific criteria, dimensional is how bad those disorders are
there is a degree of predictive validity with the DSM-5 and concurrent validity, yet validity is still a concern
Reliability is also questioned
some concerns are the validity of certain disorders, gender and cultural differences, and sometimes everyday behaviors are pathologized (grief)
ICD is used in other countries
Effects of Diagnosis
Diagnosis and Labeling can lead to harm
Misdiagnosis and reliance on clinical judgment are concerns
Labeling may lead to stigma and self-fulfilling prophecy
Treatment Decisions
Clinicians use a combination of idiographic and nomothetic information.
Other factors important for determining a treatment plan:
Therapist theoretical orientation
Current research
General state of clinical knowledge—currently focusing on empirically supported, evidence-based treatment
Effectiveness of Therapy
how is success defined?
how is improvement measured?
how does variety and complexity of treatments influence effective evaluation?
We know people differ from one another, so success varies from people to people as well
Therapy outcome studies show that therapy in general is better than no treatment at all or a placebo. The average person who receives treatment is better than 75% of those who weren’t treated.
Therapy can be harmful 3 to 15 percent of clients get worse during treatment
Most studies focus on therapy as a whole not specific models of therapy, so we don’t know which ones work the best. We do know some specific therapies work better for some specific abnormal disorders
