Chapter 4-Assessment, Diagnosis, Treatment Flashcards
Psychodiagnosis
Categorizing individuals based on behaviors or symptoms
Disorders
Clusters of behaviors that seem to reliably go together in a given culture
*highly subjective
Clinical assessment
Determine whether/how/why a person is behaving abnormally & how to help them
Personality assessment
Assess personality and probe for unconscious conflicts
Behavioral assessment
Observe & record the frequency & duration of target behavior
Direct overt behavior observation
Advantages to classification
- Can potentially PREDICT future behaviors
- Means of COMMUNICATION amongst clinicians
- Provides categories for RESEARCH
- Provides basis for epidemiological RECORDS to increase understanding
Disadvantages to classification
- Puts a label on people
- Can produce social stigma
- can result in self fulfilling prophecy (increase severity of symptoms) - Categories are not perfect and may overlap across disorders
- Diagnoses may not be reliable
- different clinicians come to different conclusions
- variations in client behavior over time - Subjectivity of diagnostic categories
Multi-axial approach (DSM 3-4)
Axis 1: primary diagnosis
Axis 2: personality disorders, mental retardation
Axis 3: relevant physical disorders or medical conditions
Axis 4: psychosocial and environmental stressors
Axis 5: global assessment of functioning
Changed to DSM 5
- Moved from categorical (like 3 symptoms of these, 2 of these, etc) to dimensional scales (none, slight, mild, moderate, severe)
Purpose: to increase reliability & validity
- Eliminated multiaxial system-collapsed first 3 axes (diagnosed, severity, additional info)
- Added “causal specifiers (biol/genetic, environmental, developmental, cultural, social, behavioral)
- Cultural sections include how they vary across cultures, genders, age groups
Criticisms to changes of DSM 5
Might decrease reliability & validity
Does it pathologize previously normal behavior?
Reliability
Consistency
- Is the diagnosis of the client consistent with other clinicians?
- Is the diagnosis consistent across time?
Validity
Accuracy
- Does it group people together whose symptoms have the same cause
- Does it group people together for whom the same treatments are effective?
Culture and assessment issues
- Constructs may not be equivalent cross-culturally
Ex. “Intelligence”, collectivism vs individualism - Scores on some measures may not be comparable to the same scores obtained on a different cultural sample
Rhee et al self esteem study
Ex of how scores may not be equivalent cross culturally
Various Chinese individual (those who have always lived in china, been abroad, recent immigrants to US, etc)
Found self esteem scores went up the longer they had been in western culture
Culture & diagnosis
Behaviors associated with a disorder in one culture may not be abnormal in another culture
Therapeutic interview
Includes both assessment and therapy
Assessment interview
Obtain overall picture of the person
Includes assessment of both verbal and non-verbal behaviors
Structured interviews
Standardized both in terms of items and administration
Pre-established questions & format
Requires single word or numerical answers (close ended)
Intelligence tests
Measure intellectual functioning & speed of cognitive functioning
- verbal & spatial reasoning/functioning
- highly standardized in administration/scoring
- subtest scores “scatter” (I.e. Verbal comprehension, working memory, processing speed etc)
Objective personality assessment
Yields an objective score
Ex: MMPI-500+ T/F numbers, yields a visual profile of traits
Projective personality assessment
Psychodynamic orientation, more subjective
Assumes: given an ambiguous stimulus, and individual will project unconscious elements of their personality onto the stimulus
Ex: Rorschach inkblot test-how long they look, what orientation, unusual emotions expressed
Thematic Apperception Test- ask person to weave story around picture
Children’s Apperceptions Test-child weaves story around picture
Cognitive assessment
Measure thoughts, beliefs, attitudes, etc
through questionnaires, interviews, self monitors, etc
Relational assessment
Emphasis on CONTEXT of behavior
Bodily assessment
Measure of physiological functioning (often arousal states)
e.g. Skin conductance, BP, etc.
Test-retest reliability
Scores obtained at one time are consistent with scores obtained at different time
Internal consistency
Consistency within your measure
Feel confident that all items in measure yield similar results (rule out rogue items)
Interrater reliability
Consistency in results obtained when different people administer the test
Construct validity
Is measure accurately depicting the COMPLEX PHENOMENON I set out to measure
Predictive validity
Do scores obtained accurately predict the behavior that is supposedly being measured?
Ex: SAT, GRE
Content validity
Does it cover all the important aspects of what is being measured?
Face validity
Does the measure appear to measure what is is supposed to?
Concurrent validity
Degree measured from one tool agrees with other tools
Personality inventory
Wide range of questions about behavior, beliefs, feelings
Response inventories
Asked to provide detailed information, but focus on one specific area of functioning
Affective: severity of emotions
Social skills: indicate how they would react in certain social situations
Psychological tests
Measure physiological responses as possible indications of psychological problems
Neurological tests
Measure brain structure/activity directly
Ex: EEG, neuroimaging
Reactivity
Effect of observation on behavior
People will change if known they are being observed
Evidence based treatments
Treatments supported by empirical study
Scientist-practitioner gap
Some studies highly supported by research, but practitioners have experience in the field
*may depend on specific client
Effectiveness of treatment
- People receiving treatment have better outcomes than 75% of those not receiving treatment
- No particular therapy more effective than others
- Certain therapies better for certain problems
Important therapist characteristics
- Give feedback to clients
- Help client to focus on thoughts/behaviors
- Pays close attention to therapist/client interactions
- Promotes self master in clients
Best therapy for phobias/some anxiety disorders
Behavior therapies
Best therapy for psychotic disorders
Meds, CBT, ACT
Best therapy for depression
CBT, meds* for sever depression
Telehealth programs
Online therapy
Some success in serious mental illnesses (psychotic, bipolar, etc)
