Chapter 8: Assessment (Integration and Clinical Decision Making)

Question 1

Personality

Answer 1

the tendency to consistently behave in specific ways

Question 2

Objective Personality Tests

Answer 2

tests that can be scored objectively, always using the same scoring system

Question 3

Behavior Checklists

Answer 3

lists of behaviors that are rated for frequency, intensity, or duration

Question 4

Projective Personality Tests

Answer 4

tests requiring drawings or a response to ambiguous stimuli, based on the assumption that responses reveal information about personality structure

Question 5

Validity Scales

Answer 5

scales designed to detect whether a person is faking good, faking bad, or responding randomly

Question 6

Malingering

Answer 6

emphasizing negative characteristics and deliberately presenting a more problematic picture

Question 7

Clinical Utility

Answer 7

the extent to which a test and the resulting data improve upon typical clinical decision-making and treatment options

Question 8

Empirical Criterion-Keying Approach

Answer 8

a method of test construction that involves the generation and analysis of a pool of items

those items that discriminate between two clearly defined groups are retained in the scale

Question 9

Content Approach

Answer 9

a method of test construction that involves developing items specifically designed to tap the construct being assessed

Question 10

Overpathologize

Answer 10

the tendency to exaggerate and overestimate the extent of pathology

Question 11

Code Types

Answer 11

summary codes for the highest two clinical scale elevations on the MMPI scales

Question 12

What are projective and self-report measures?

Answer 12

tools used to assess various aspects of personality or specific domains such as mood, distress, psychosocial functioning, etc.

Question 13

How can the subjective perceptions of clinical psychologists be highly inaccurate?

Answer 13

not immune to bias

prejudicing influence of theoretical orientations

extraneous client characteristics

deliberate attempts at deception

tendency to self-confirm working hypotheses

Question 14

What was Mischel’s idea of personality?

Answer 14

personality is like a person’s face: something consistent about face’s over course of time, personality is an enduring or persistent set of traits

but personality is not stable between different settings

huge overlap between personality and behavior

Question 15

Why are personality measures utilized?

Answer 15

is past behavior combined with a description of a social situation a better determinant?

for example, little reference is made to the construct of personality in applied behavior analysis

discriminative stimuli in that situation; past behavior is only important in that it reveals much about one’s reinforcement history

Question 16

How do we define psychopathology on the basis of unusual behavior across different situations?

Answer 16

by definition, if a patient’s maladaptive behavior exists only in a relatively narrow realm, it is unlikely that they are suffering from a major disorder such as depression, schizophrenia, phobia, etc.

important to understand the conditions that mediate the expression of those symptoms, and utilize that information to improve functioning

Question 17

What are validity scales?

Answer 17

some self-report personality instruments incorporate validity scales specifically to provide information regarding response style

among the first of these were the LFK scales included in the MMPI; subsequent versions have expanded these

useful in detecting random responding, attempts at “faking good”, “faking bad”, inconsistency, answering all true

Question 18

Why would someone participate in malingering during a test?

Answer 18

faking bad for financial gain or to get out of a crime

Question 19

Why would someone participate in faking good during a test?

Answer 19

want to be cleared

Question 20

Why would someone give random responses during a test?

Answer 20

maybe they are fed up with the task

Question 21

What is a “fake good” profile in MMPI-II?

Answer 21

scales of psychopathology are lower than average

Question 22

What is a “fake bad” profile in MMPI-II?

Answer 22

symptoms are exaggerated

Question 23

What are the tests that are designed specifically to detect malingering?

Answer 23

Test of Memory Malingering (TOMM), Green’s World Memory Test (WMT), and Medical Symptom Validity Tests (MSVT)

both capitalize on the fact that individuals who deliberately feign symptoms will tend to do so in a highly exaggerated way, that does not yield scores characteristic of genuine pathology

the WMT, in particular, has extremely high validity and is especially useful in both civil and criminal forensic investigations

even highly sophisticated individuals who are coached on strategies for undermining the test results are unlikely to suceed

Question 24

In what way are self-report measures are at least somewhat transparent?

Answer 24

i.e., a sophisticated test-taker with elementary knowledge of psychology may be able to detect the purpose of certain items, and attempt to distort their responses accordingly

projective measures are much less obvious, but may have markedly less test validity and hence add little to the assessment as a whole

Question 25

How does cultural bias influence validity?

Answer 25

must maintain awareness that ethnic and cultural background influence our clinical opinions as well as interpretation of test results

particularly true where cutoff scores are used to demarcate normal from abnormal scores

estimate the anticipated bias: if the patient is very similar to members of the standardization group (e.g., Caucasian Canadian versus Caucasian northern USA) it may be feasible to use the test with suitable cautions

written report status that the results may be less accurate than they appear

Question 26

What are the five steps necessary to develop a parallel test form?

Answer 26

translate test items into the language spoken by the target population; a seperate translator than reverses the process back into English (many phrases and concepts do not directly translate from one language to another, significant disparities between the two versions are a clear indication that language refinement is necessary)

an initial group of subjects take the translated test; look for difficulty with wording and complaints about the applicability of the items

reliability should be analyzed to see if the test has potential value

means and distribution of all test scales re recalculated so the values will be comparable between the original population and the new population

ongoing validation studies

Question 27

Are self-report and projective measures of any value?

Answer 27

we can differentiate between “basic” research into the construct validity of any given instrument, and “applied” research the deal strictly with questions of clinical utility

basic questions aside, it becomes a simple question: does the use of this instrument make any difference in treatment outcome?

numerous studies tell us that many self-report and projective measures can have excellent psychometric properties: whether or not they contribute to improved clinical outcomes is a seperate question

Question 28

How are psychological tests compared to medical tests?

Answer 28

psychological tests can have validity and reliability equal to or, in some cases, superior to those of traditional medical etsts

yet medical tests make a much greater contribution to clinical outcomes

this is not to say that psych tests have poor content validity, just that knowledge of those constructs may not influence treatment that much

challenges their continued use for planning interventions

we spend more time pursuing and refining the psychometric characteristics, and simply expect clinical utility to follow from that naturally

Question 29

What is the Minnesota Multiphasic Personality Inventory?

Answer 29

MMPI and its descendants are amongst the most commonly used

original version was created in 1943 and standardized on hospital inpatients, as well as their visitors

MMPI-2, contains 567 items which are all endorsed as true or false: scoring generally occurs by computer software, or acetate overlays

covers a broad range of clinical conditions and results in “code types” based on the two highest scale evaluations

descriptions of individuals who score high or low on individual scales is also common

contain an assortment of validity scales useful in assessing the interpretability of the profile

Question 30

What are the criticisms of MMPI?

Answer 30

excessive overlap among some of the scales, and poor specificity, i.e., other-pathologizes

Question 31

What is the reliability of the MMPI?

Answer 31

median reliability of the MMPI-2 scales is 0.62 (clinical) and 0.64 (validity)

a number of MMPI scales have poor internal consistency although the test-retest reliability statistics are all in 0.80

keep in mind, that categorical diagnosis is an inherently unreliable task in some diagnostic categories

the MMPI has been exhaustively researched since its original inception

Question 32

What is the administration of the MMPI?

Answer 32

computer, Scrantron-like sheet fastened to a booklet comprised of pages with various widths

there are audiotaped question sets available for individuals unable to read the items

Question 33

What is computer interpretation?

Answer 33

interpretive summaries generated by computers are available

must be used with great caution, and the psychologist maintains responsibility

conversely, picking and choosing passages only because they correspond to the clinicians subjective impressions of the client may be a significant source of bias

as with all psychological test results, any tests given must be interpreted and inconsistencies among the data, or between the data and the clinician’s impressions must be addressed in the report

Question 34

What is the MCMI-III and MACI?

Answer 34

heavily steeped in Theodore Millon’s theories of personality

175 items in length; take less time to complete than MMPI-2

designed to assay disorders, personality style, clinical syndromes

like the MMPI-2, not appropriate for use with general population

standardization sample contained both US and Canadian adults with psychiatric diagnoses: ethnic groups are arguably underrepresented; however, norms have been developed for use with correctional populations

internal consistency values range from the 0.7 to 0.9 levels and test-retest values tend to exceed 0.80

objections have been raised concerning item overlap, and also the tendency for the instrument to be inadequately specific

Question 35

What is the personality assessment inventory (PAI)?

Answer 35

344 item self-report for adults, about 1 hour to complete

parallel form for adolescents (PAI-A)

reading level is grade 4 which provides an advantage over the MMPI for less literate individuals

contains validity scales as well as clinical scales and has about the best psychometric characteristics of any of the inventories commonly used

code types can be derived, and scoring can be conveniently completed on the computer

Question 36

What is the California Psychological Inventory (CPI)?

Answer 36

“sane man’s MMPI”: only one (discussed here) appropriate for general population

tends to describe personality well but is less useful for detecting frank psychopathology

Question 37

What are self-report checklists?

Answer 37

much more symptom/sign oriented than personality inventories

more narrow in focus, but have good psychometric properties

not helpful in detecting unexpected psychopathology: doesn’t necessarily imply better treatment outcomes

Question 38

What is the child behavior checklist (CBCL)?

Answer 38

separates problems/items into either externalizing or internalizing categories

externalizing: acting-out behaviors such as aggression, stubbornness, refusal, fighting, and being argumentative

internalizing: subjective distress, preoccupation, and low mood

excellent reliability and validity

both caregivers and children can complete seperate versions of the scale, and the correspondence between them can be subsequently compared

Question 39

What are the criticisms of CBCL?

Answer 39

version completed by the subject and a caregiver often result in scores that correlate poorly

even scales intended for use by adults, in describing adults tend not to produce highly consistent results

Question 40

What is symptom checklist-90-revised (SCL-90-R)?

Answer 40

amongst the most used self-report measures

contains nine scales that cover a broad range of symptoms applicable to many seperate diagnostic categories

internal consistency and test-retest reliability are fairly good

shows some sensitivity to treatment changes although the construct validity of the measure itself has been called into question

again, insufficient specificity and high inter-correlations amongst the subscales

Question 41

What is the beck depression inventory-II (BDI-II)?

Answer 41

useful in quantifying subjective feelings of sadness and anxiety

not sufficient (by itself) for the diagnosis of depressive disorder given that is considers a timeframe of only two weeks due to the wording of its questions

there is also a children’s version, the Children’s Depression inventory (written by a different author), but alike in layout

Question 42

What is the outcome questionnaire 45 (OC-45)?

Answer 42

designed specifically for detecting changes in symptom distress, interpersonal relations, and social role functioning, not a diagnostic tool per se

although the skills correlate highly, it yields a total score which provides a decent reflection of overall client distress

good psychometric characteristics across a number of populations and pathologies, and there is mounting evidence that it is useful in gauging clinical process

meta-analytic research suggests that it can lead to marked improvements in treatment success rates as well as maintenance rates

Question 43

What is the central approach of projective measures?

Answer 43

provide some incomplete, or ambiguous stimuli to which a patient responds following some instructions from the examiner

may be less transparent in that it is often less obvious what constructs they are intended to assess

Question 44

What is the heritage of projective measures?

Answer 44

the term “projective” reveals both a psychoanalytic heritage as well as the assumption that responses to these instruments depend on clients projecting something of themselves into the stimulus situation

secondary to assessing the validity of these instruments as diagnostic tools

for example, cognitive researchers often use task ambiguity to make inferences about mental events

Question 45

What is the Rorschach inkblot test?

Answer 45

full Rorschach set contains 10 cards

originally they were all black and white, were subsequently modified to include some color cards

administration occurs by presenting the cards in a fixed order and asking the client to report what they see in each image

no standard means of interpreting or scoring patient responses until the mid-1990s

utilizes the same cards, but standardizes the instructions, circumstances under which clarification can be requested from the patient, and the scoring

attempts to develop norms in 2007 but suffered form high levels of variability in the data gathered different countries

should not be used exclusively for diagnosis

Question 46

What is the thematic apperception test (TAT)?

Answer 46

31 cards depicting ambiguous social situations

examinees are asked to tell a story about each card; each story must contain a beginning, middle, and end

the entire set of cards is not always utilize, neither is there a fixed order in which they should be presented

no norms or standardized method of scoring

no evidence concerning the validity of the instrument