Context of Psych Assessment

Question 1

What is role of psychologist in assessment?

Answer 1

 Expert in human behavior
 Specialized training in personality functioning, psychological
testing and interpreting test scores in larger context, aid in problem-solving, assist with resources for patient/client

Question 2

When choosing a test, what are some practical things to consider?

Answer 2

 Length  Level of education  Pertinence to the referral question  Cost
 Need of training on the part of the examiner
 Incremental validity

Question 3

When a Px is referred to your for testing, what is the firs thing to ask yourself?

Answer 3

What is the referral question?

Can psych assessment answer that question? Who is the referral source and what are their expectations of me?

Question 4

Summarize Meehl’s research re: clinical judgement

Answer 4

 Meehl (1954) examined relative accuracy of clinical judgment vs. statistical formulas used on identical data sets
 Actuarial analysis used empirically derived formulas (e.g., regression equations) to determine patient outcomes
 Actuarial analysis consistently outperformed clinical judgment (13% greater accuracy); support for this conclusion

Question 5

What are some drawkbacks of the actuarial approach?

Answer 5

 Cannot account for low-frequency, rare events in the life of a patient
 Less practical for individuals vs. institutional decision-making

Question 6

When do you definitely want to use actuarial formulas vs. clinical judgement?

Answer 6

in situations where there are
clearly defined outcomes, errors are costly, and the clinician needs to have maximum accountability. (e.g. forensic setting)

Question 7

LIst four aspects of the clinical decision making process

Answer 7

data gatthering
data synthesis
sizing up the accuracy of verbal self-report vs. test data
determining what to report

Question 8

What else does research tell us about clinical judgement?

Answer 8

 Accuracy positively associated with intelligence,
artistic/dramatic interests, social detachment and good
social judgment
 Greater clinical experience helps
 Use of interviews with formalized assessments and
statistical interpretive rules used  Similarity in race and culture improved accuracy  Confidence not related to accuracy  More accountability improves accuracy

Question 9

Clinical psychologists are better than laypeople? What aren’t they better at?

Answer 9

 Clinical psychologists are more accurate than layperson in judgments about clinical dx, MS ratings, short- and long-term predictions of violence, psych and neuropsych test interpretation, competency evaluations

 No better than layperson when using projective instruments or making personality descriptions based on face-to-face interactions

Question 10

Name some impediments to clinical judgement

Answer 10

• mental heuristics (e.g. rep, avail, adjustment, and anchoring)
• Dx overshadowing
• Confirmation bias
• BIases based on Px characteristics

Question 11

What are some ways to improve clinical judgement?

Answer 11

 Use comprehensive, structured or semi-structured interview approach
 Dx should be carefully based on DSM-IV or ICD- 9/10 cx
 Take careful notes and avoid relying on memory  Attend to base rates  Get feedback from patients re: usefulness and
accuracy of info and recs  Stay informed of theoretical and empirical material
for clinical populations you assess!
 Be familiar with literature on bias and errors in clinical judgment Reduce hindsight bias and overconfidence by imagining alternative outcomes, diagnoses, etc.
 Search for evidence inconsistent with your hypothesis
 Use decision aides when available, such as DSM-IV guidelines, objective test scores, interpretation software, regression equations, etc. in combination with other clinical data.
 Use valid methods to detect response bias/malingering, especially if secondary gain is present