Luteijn & Barends Chapter 1

Question 1

the clinical psychodiagnositics is based on three elements:

Answer 1

• theory development of the problems/complaints and problematic behavior
• operationalization and its subsequent measurements
• application of relevant diagnostic methods

Question 2

What typically initiates a clinical psychodiagnostic examination?

Answer 2

It usually begins with a referral to the diagnostician but can also start with a direct question from the client.

Question 3

Why does the diagnostician analyze both the referrer’s and the client’s questions?

Answer 3

Because they may differ in focus; understanding both ensures the diagnostician considers multiple perspectives when forming diagnostic questions.

Question 4

What are three example questions that could arise in a diagnostic case involving compulsive behavior?

Answer 4

Is it an obsessive-compulsive disorder (OCD)?

What causes and perpetuates the disorder?

Which psychotherapy is suitable for the client?

Question 5

What is a “diagnostic scenario”?

Answer 5

A provisional theory about the client’s issues that outlines what the problems are and how they can be explained.

Question 6

What are the five steps in testing a diagnostic theory?

Answer 6

1. Translate theory into hypotheses.
2. Choose tools to test hypotheses.
3. Predict expected outcomes.
4. Apply tools and analyze results.
5. Accept/reject hypotheses based on results.

Question 7

What are the five basic questions that guide psychodiagnostic work?

Answer 7

Recognition – What are the problems?

Explanation – Why do they exist and persist?

Prediction – What’s the future outlook?

Indication – How can they be resolved?

Evaluation – Has the intervention worked?

Question 8

What are the three elements of the recognition process?

Answer 8

a) Inventory & description
b) Organization & categorization
c) Evaluation of severity

Question 9

What are the three types of measurement in recognition, and how do they differ?

Answer 9

• Criterion-oriented: Compare to a standard.
• Normative: Compare to a reference group.
• Ipsative: Compare to the individual’s past self.

Question 10

What is the difference between classification and diagnostic formulation?

Answer 10

• Classification: Assigns symptoms to standardized categories (e.g., DSM-5).
• Diagnostic formulation: Provides a personalized understanding based on individual context and functioning.

Question 11

What are the two principles behind classification approaches?

Answer 11

• All-or-nothing: Category-based (e.g., DSM diagnosis).
• More-or-less: Dimension-based (e.g., scoring on behavior scales).

Question 12

What is an example of a diagnostic formulation in behavioral therapy?

Answer 12

A holistic theory where obsessions and compulsions are linked by a shared factor (e.g., anxious arousal), and marital issues are seen as perpetuating the behavior.

Question 13

What are the strengths and weaknesses of classification vs. diagnostic formulation?

Answer 13

Classification: Facilitates communication; limited by labeling and co-morbidity.

Formulation: Personalized; supports therapy planning; may lack empirical support.

Question 14

What three components are involved in explaining behavior?

Answer 14

Identify the main problem

Identify conditions that cause it

Clarify the causal relationship

Question 15

How do person-oriented and situation-oriented explanations differ?

Answer 15

Person-oriented: Focus on traits/internal factors

Situation-oriented: Focus on external/contextual factors

Question 16

What’s the difference between a cause and a reason in psychological explanation?

Answer 16

Cause: Objective determinant (e.g., gravity)

Reason: Meaningful or intentional explanation (e.g., reckless behavior)

Question 17

What is the distinction between synchronous and diachronous conditions?

Answer 17

Synchronous: Occur alongside the behavior

Diachronous: Occur prior to the behavior

Question 18

What are induced vs. persistent conditions?

Answer 18

Induced: Trigger the behavior

Persistent: Maintain the behavior over time

Question 19

Why is it important to consider multiple types of explanations?

Answer 19

Because different explanations serve different diagnostic and treatment goals. Focusing on one limits the range of understanding and possible interventions.

Question 20

What is an eclectic approach in psychodiagnostics?

Answer 20

A method that integrates multiple theories (e.g., biological, developmental, systemic) to provide a more comprehensive explanation of behavior.

Question 21

What does prediction in psychodiagnostics involve?

Answer 21

Estimating the likelihood of future behavior or outcomes based on current observations (e.g., suicide risk, treatment success).

Question 22

What is a predictor and a criterion in prediction?

Answer 22

Predictor: Present behavior

Criterion: Future behavior

Question 23

Why is prediction considered probabilistic rather than certain?

Answer 23

Because behavior patterns are based on statistical relationships (e.g., correlations) that do not guarantee outcomes for individuals

Question 24

Why does Maris prefer the term "risk assessment" over "prediction"?

Answer 24

Because it more accurately reflects the uncertainty and probabilistic nature of predicting individual behavior based on group data.

Question 25

How can the accuracy of clinical prediction be improved in suicide risk assessment?

Answer 25

By measuring psychological pain and pain tolerance, and by including multiple perspectives through intervision (team discussions).

Question 26

Why are predictions in psychodiagnostics often problematic in legal and societal contexts?

Answer 26

Because the standard errors are large, making accurate and reliable predictions difficult.

Question 27

What is a downside of making firm predictions in psychological assessments?

Answer 27

They can be anti-therapeutic by ignoring the potential for future change.

Question 28

What is the goal of the indication phase in diagnostics?

Answer 28

To determine whether treatment is needed, and if so, what kind and from whom.

Question 29

What are the three key elements required for indication?

Answer 29

Knowledge of treatments and therapists Knowledge of treatment effectiveness Client’s acceptance of the indication

Question 30

What does the indication strategy (Vertommen & Van Audenhove, 1986) include?

Answer 30

Explore the client’s perspective Provide treatment information Compare preferences with professional judgment Mutually agree on treatment and therapist

Question 31

Why is knowledge of treatment effectiveness often limited?

Answer 31

Outcome studies are often too general and lack specificity for certain clients or interventions.

Question 32

What is the usual effect size of psychological treatments?

Answer 32

Typically modest, less than 0.70 SD (Cuijpers et al., 2008).

Question 33

What two aspects are assessed during the evaluation phase?

Answer 33

Whether therapy aligned with the diagnosis and proposal Whether changes occurred in the client’s behavior or experience

Question 34

How can we prove that the therapy caused change?

Answer 34

Using methods like n=1 designs, especially in behavioral therapy.

Question 35

What are the five phases of De Groot’s empirical cycle?

Answer 35

Observation Induction Deduction Testing Evaluation

Question 36

How applicable is De Groot's empirical cycle to psychodiagnostics?

Answer 36

Only partly; the five stages exist in rudimentary form in practice.

Question 37

What is the first task of the diagnostician when receiving a referral?

Answer 37

To analyze and clarify the request and help question.

Question 38

What are the three types of analysis in the application phase?

Answer 38

1. Information about the referrer 2. Content and type of request 3. Exploration of the client’s mindset

Question 39

What tools help analyze the client's mindset?

Answer 39

For adults: MAP (Multimodal Anamnesis for Psychotherapy) For children: CBCL (Child Behavior Checklist)

Question 40

What should the diagnostician reflect on?

Answer 40

Personal biases Knowledge limitations Relevance and weight of information Possible need for referral

Question 41

Does more information always improve predictions?

Answer 41

No, adding more info doesn’t necessarily lead to better predictions (Garb, 1998).

Question 42

What is a diagnostic scenario?

Answer 42

An organized structure combining client and referrer questions, forming a tentative theory of the client’s problem.

Question 43

What order should be followed in addressing basic diagnostic questions?

Answer 43

1. Recognition 2. Explanation 3. Prediction 4. Indication (Note: In practice, these may overlap.)

Question 44

What is the purpose of hypothesis formulation in diagnostics?

Answer 44

To create testable assumptions about behavior that can be empirically verified.

Question 45

What kinds of hypotheses are formed in each phase?

Answer 45

Recognition: Presence of psychopathology Explanation: Predisposing and perpetuating factors Prediction: Likely outcomes Indication: Suitable treatments and therapists

Question 46

What is meant by the client's theory of illness, healing, and health?

Answer 46

- Illness: How the client views the cause - Healing: What kind of help the client thinks will work - Health: What the client hopes to achieve

Question 47

What’s an example of an indication hypothesis?

Answer 47

If a client has depression due to poor marital communication, and wishes to improve it, couples therapy focusing on communication may be indicated.

Question 48

What determines the selection of appropriate diagnostic examination tools, and how do they differ based on the type of diagnostic question?

Answer 48

The selection of examination tools follows theory development and operationalization of the problem behavior. Hypotheses must lead to testable statements about a client’s behavior or experience. Tools are chosen based on: Nature of the question Psychometric quality (reliability, validity) Efficiency considerations (duration, scoring ease) Tools differ by diagnostic question: Recognition: Use objective instruments covering broad or specific disorders (e.g., SCL-90), as well as observations, anamneses, and informants. Explanation: Use tools that assess explanatory factors like intelligence, personality, cognitive skills, family and situational context. Prediction: Require instruments with predictive validity. Indication: May include client-focused questionnaires (e.g., Vertommen et al., 1989). Not all theories can be fully tested—diagnosticians must sometimes rely on informed judgment.

Question 49

How are testable predictions formulated, and why is it crucial to define examination criteria beforehand?

Answer 49

After selecting tools, diagnosticians establish criteria to judge whether hypotheses are confirmed. Criteria could be: A diagnostic category (e.g., DSM-5) Score thresholds on scales Observed behaviors or statements from interviews Why define criteria early? Prevents confirmation bias Avoids over-interpreting ambiguous findings Ensures objectivity and consistency Although the criteria can be adapted during testing, initial predictions must be made and any changes justified with reasoning. This maintains scientific integrity.

Question 50

What is involved in the administration and scoring phase of the diagnostic cycle, and how should results be interpreted?

Answer 50

During this phase, the diagnostician: Administers tools and collects both quantitative data (scores) and qualitative data (behavioral observations) Uses norm tables to interpret test scores Notes the client’s performance style and their relationship to the diagnostician Important process: Analyze each test independently, before comparing with hypotheses Preserve raw data to prevent losing valuable information New insights or hypotheses may emerge from test behavior Comparison to hypotheses occurs only after initial analysis, ensuring an open-minded approach.

Question 51

How are hypotheses tested during the argumentation phase, and how is evidence weighed?

Answer 51

In this step, results are matched with predictions. The diagnostician considers: Psychometric strength of tools Reliability of sources (e.g., teacher’s vs. parent’s judgment) Decisions are made as follows: If data matches prediction → hypothesis accepted If unclear → hypothesis retained If contradicted → hypothesis rejected The process is never random; each decision is substantiated. Both supporting and opposing data are used to reach balanced conclusions. If unexpected findings arise, they may lead to: - A new theory (possibly restarting the cycle) - A refined theory that better integrates the data

Question 52

What are the purposes and structure of the diagnostic report, and how should it be communicated to both referrers and clients?

Answer 52

The report has two main goals: Substantiating conclusions Communicating clearly with referrer and client Structure follows the 5 diagnostic steps and includes: Distinctions between facts, interpretations, and conclusions Clarification of source reliability (e.g., validated tests vs. interviews) A separate section with technical test details for deeper review Communication with the client must: Be clear, tailored to their understanding Allow space for feedback, corrections, and additional info Avoid technical jargon, while explaining reasoning Clients now have full ethical rights to access their report, and it may be beneficial for therapeutic motivation.

Question 53

What are Diagnosis and Treatment Combinations (DTCs), and what are their advantages and limitations?

Answer 53

DTCs link a diagnosis to a standardized, evidence-based treatment protocol. They are used to: Increase efficiency and cost-effectiveness Ensure consistent care (e.g., at PsyQ, clients are assigned by main complaint to one of 9 departments) Process: Client referred to relevant department based on complaint Diagnosis confirmed (or not) using criteria Treatment carried out according to protocol Client is either discharged, transferred, or referred back Criticisms of DTCs: Clients with multiple issues may not fit neatly into one department Unclear complaints make referral hard Over-focus on initial problem can miss deeper issues Assumes direct diagnosis-treatment interaction, but research is limited Time constraints often prevent thorough diagnostics of underlying causes

Question 54

How has clinical diagnostics evolved, and what defines modern diagnostic practice?

Answer 54

Old approach: administer tests, assign labels. Modern approach: theory-based, client-focused, ethical, and professional. Key traits of current practice: Sound, validated judgments Theoretical grounding from thorough request and complaint analysis Flexibility, creativity, and professional rigor Ethical transparency and client participation The process sharpens the diagnostician’s skills and respects the client’s right to a thoughtful, tailored outcome.