Chapter 9: Assessment (Integration and Clinical Decision-Making) Flashcards
Case Formulation
a description of the patient that provides information on his or her life situation, current problems, and a set of hypotheses linking psychosocial factors with the patient’s clinical condition
Retrospective Recall
using data that rely on people to remember events that happened to them at some point in the past
Self-Serving Attributional Bias
a tendency to take more personal credit for successes than for failures, by attributing success but not failure to internal, stable, and global causes
Biases
judgments that are systemically different from what a person should conclude based on logic or probability
Heuristics
mental shortcuts that make decision-making easier and faster but often lead to less accurate decisions
Computer-Based Interpretations
reports generated by computer programs that match a patient’s general pattern of responses on a psychological test to summaries of research evidence about the typical characteristics of people with the same pattern of test responses
What is the therapeutic model of assessment?
an approach to psychological assessment in which clients are actively engaged to participate in discussions about the reasons for the assessment, the results of the testing, and how the assessment data should be integrated and interpreted
What does the process of assessment involve?
clarifying the question that will be the focus
generating hypotheses
gathering data
examining the data: looking at consistencies and contradictions
formulating conclusions and making recommendations
How do different sources of information interact in assessment?
each source of information potentially carries a new set of strengths, biases, and weaknesses
synthesis and formulation of all of this information is amongst the most challenging tasks the psychologist faces
critical to bear in mind that multiple sources of information are seldom truly independent from one another
highly shaped by self-interest, emotion, concern for the patient, finances, wishing to make a favorable impression, collusion, etc.
What are the patterns in case formulation?
detecting patterns in the patient’s behavior, and presenting complaints is both challenging and potentially useful
colored by one’s theoretical orientation
should be done amidst a careful consideration of the patient’s strengths and weaknesses
What is case formulation?
process in which the patient and their circumstances are described to provide a context useful for making treatment recommendations
demonstrates linkages between the patient’s presenting complaints
offers insight as to the treatments that may be most effective
incorporates a prognosis
identifies anticipated obstacles to treatment (and ways in which they can be overcome)
outlines a range of intervention options
What are the components of a case conceptualization “grid”?
predisposing: things that made it more likely they would have the concerns they brought to you
precipitating: what is it that changed at the same time that their symptoms and signs started to occur?
perpetuating: what is it that’s keeping this thing going?
bio, psycho, and social factors of each
protective factors: good support system, cognitive ability, other strengths
What are the psychologist factors of assessment?
psychologists’ own experiences, theoretical orientation, and cognitions greatly affect clinical decision-making
selective attention to data that support our initial hypotheses
take that as further evidence of our competence in a particular area
biases are reflected in the judgments that we habitually make that reveal a tendency to over- or underemphasize something
What is bias of the fundamental attribution error?
under emphasize environment
What is the bias of inattention to base rates?
base rate is how frequently something is observed
small condition has vague symptoms so we think we have it, even though no chance
wanting to go to more exotic diagnoses
What is the bias of the belief in the law of small numbers?
seeing phenomenon in a couple patients and generalizing
What is the bias of recession to the mean?
scoring closer to average scores
What is the bias of inferring causation from correlation?
two things occur together but share no causal relationship
What is hindsight bias?
gets new info, thinks they knew it all the time
What is a bias blind spot?
see error in colleagues but not in yourself
What is the bias of the representativeness heuristic?
over emphasize how much you’ve done something
What is the bias of the availability heuristic?
grab what’s closest to mind
What is the bias of the affect heuristic?
gut reaction
What is the bias of anchoring and adjustment heuristic?
form an early impression which gets you to pay selective attention and disregard information you deem irrelevant
How are patient factors a threat to the validity of assessments and case formulations?
patient self-report, both on psychometric instruments and in interview, is almost entirely based on their memories
retrospective recall is generally suboptimal in accuracy
What was the research by Gosling et al. (1998) that compared audio and video taped discussion to subject recall of their participation?
research by Gosling e al. (1998) compared audio and video taped discussion to subject recall of their participation
relatively low correlations (about 0.40) between participants recall and objective records
generally better for concrete, verifiable acts than ones that required interpretation
participants tended to over report the frequency with which they engaged in socially desirable acts, and under report less flattering ones
What was the research by Schiffman et al. (1997) that found results regarding patient self-reports?
asked participants to keep a formal record of substance use, such as cigarettes, and provide verbal report re: number of relapses they’d experience within the monitoring period
only a small majority (about 57%) could even recall whether they had done so
cannot be explained on the basis of deliberate lying as they were also the ones who maintained the written record
What is MFT research?
favorability of reports that one partner makes about another are directly correlated with their subjective satisfaction with the marriage
of great concern, variables such as these are most likely to be of interest to psychologists
What is the information that is favored when making assessments and case formulations?
premium on objective, archival, and collateral information rather than patient self-report
a caution: don’t assume these inaccuracies are always a function of deliberate deception
How can clinical judgments be improved?
awareness of biases is not enough
make systematic clinical observations
use relatively structured interviews
taking careful and detailed notes (rather than relying on memory): consider recording if patient will consent
use computer scoring schemes
retain awareness of biases and preconceptions
be aware of relevant research in psychological assessment, psychopathology, and prevention/intervention
use clinical decision-making trees
What are heuristics?
heuristics are mental habits, or shortcuts, we use to simplify the process of decision-making: may undermine the validity of our clinical decision-making
rather than being a testament to our clinical acumen, both biases and heuristics imply error
should depend as heavily as we can on objective information and clear outline diagnostic criteria, such as those embodied in the DSM
Why does any lack of certainty need to be communicated in assessment?
any lack of certainty (there will always be some) should be clearly outlined in written reports
missing information should be identified and there should be some discussion of how that information, where it available, might influence conclusions and recommendations
debriefing patient and referral source provides a useful check on accuracy of the history we have taken as well as agreement, or disagreement, with the psychologist’s opinions and recommendations
What is included in a psychological assessment and report?
identifying patient/client information
reason for referral
background information (including, as relevant, developmental history, educational history, employment history, family history, relationship history, medical history, history of symptoms and disorders)
assessment methods (including tests administered)
interview data and behavioral observations
test results (including interpretation of test scores)
diagnostic impressions and case formulation
summary
recommendations
What is included in a treatment plan report?
identifying patient/client information
reason for referral
evaluation of primary symptoms and problems
diagnosis
patient strengths
treatment-related goals and objectives
proposed treatments
potential barriers to treatment
criteria for treatment termination or transfer to other service provider
service provider responsible for treatment implementation and evaluation of treatment
What is the importance of providing assessment feedback?
verify the general accuracy of the assessment results
correct any errors or misunderstanding that occurred during the assessment process
refine the interpretation of the results to ensure an optimal fit with the individual’s life circumstances
put the individual’s symptoms, problems, and experiences in the context of his or her life history and current life circumstances
provide some psychological relief for the individual by presenting an integrated picture that helps make sense of the individual’s difficulties
provide concrete information about steps the individual can take to address personal dfficulties
help the individual identify potentially stressful situations that can exacerbate difficulties
collaborate with the individual in creating therapeutic goals that build on personal strengths
What is the therapeutic model of assessment?
portrays client as active participants in their assessments, not just sources of information
clients engaged in that process were less likely to end therapy prematurely, and stronger therapeutic alliances resulted from that approach
