Chapter 9: Assessment (Integration and Clinical Decision-Making)

Question 1

Case Formulation

Answer 1

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

Question 2

Retrospective Recall

Answer 2

using data that rely on people to remember events that happened to them at some point in the past

Question 3

Self-Serving Attributional Bias

Answer 3

a tendency to take more personal credit for successes than for failures, by attributing success but not failure to internal, stable, and global causes

Question 4

Biases

Answer 4

judgments that are systemically different from what a person should conclude based on logic or probability

Question 5

Heuristics

Answer 5

mental shortcuts that make decision-making easier and faster but often lead to less accurate decisions

Question 6

Computer-Based Interpretations

Answer 6

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

Question 7

What is the therapeutic model of assessment?

Answer 7

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

Question 8

What does the process of assessment involve?

Answer 8

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

Question 9

How do different sources of information interact in assessment?

Answer 9

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.

Question 10

What are the patterns in case formulation?

Answer 10

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

Question 10

What is case formulation?

Answer 10

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

Question 11

What are the components of a case conceptualization “grid”?

Answer 11

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

Question 12

What are the psychologist factors of assessment?

Answer 12

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

Question 13

What is bias of the fundamental attribution error?

Answer 13

under emphasize environment

Question 14

What is the bias of inattention to base rates?

Answer 14

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

Question 15

What is the bias of the belief in the law of small numbers?

Answer 15

seeing phenomenon in a couple patients and generalizing

Question 16

What is the bias of recession to the mean?

Answer 16

scoring closer to average scores

Question 17

What is the bias of inferring causation from correlation?

Answer 17

two things occur together but share no causal relationship

Question 18

What is hindsight bias?

Answer 18

gets new info, thinks they knew it all the time

Question 19

What is a bias blind spot?

Answer 19

see error in colleagues but not in yourself

Question 20

What is the bias of the representativeness heuristic?

Answer 20

over emphasize how much you’ve done something

Question 21

What is the bias of the availability heuristic?

Answer 21

grab what’s closest to mind

Question 22

What is the bias of the affect heuristic?

Answer 22

gut reaction

Question 23

What is the bias of anchoring and adjustment heuristic?

Answer 23

form an early impression which gets you to pay selective attention and disregard information you deem irrelevant

Question 24

How are patient factors a threat to the validity of assessments and case formulations?

Answer 24

patient self-report, both on psychometric instruments and in interview, is almost entirely based on their memories

retrospective recall is generally suboptimal in accuracy

Question 25

What was the research by Gosling et al. (1998) that compared audio and video taped discussion to subject recall of their participation?

Answer 25

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

Question 26

What was the research by Schiffman et al. (1997) that found results regarding patient self-reports?

Answer 26

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

Question 27

What is MFT research?

Answer 27

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

Question 28

What is the information that is favored when making assessments and case formulations?

Answer 28

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

Question 29

How can clinical judgments be improved?

Answer 29

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

Question 30

What are heuristics?

Answer 30

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

Question 31

Why does any lack of certainty need to be communicated in assessment?

Answer 31

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

Question 32

What is included in a psychological assessment and report?

Answer 32

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

Question 33

What is included in a treatment plan report?

Answer 33

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

Question 34

What is the importance of providing assessment feedback?

Answer 34

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

Question 35

What is the therapeutic model of assessment?

Answer 35

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