Module 2

Question 1

What are the three main stages of the assessment process?

Answer 1

1) Information input - collecting info from sources, address the referral question, formulate assessment goals and working hypotheses
2) Information evaluation - interpretation and integration of assessment data
3) Information output - biopsychosocial formulation, conclusions and recommendations

Question 2

Sellbom et al: What are the two founding premises of psychological assessment?

Answer 2

Assessments must be evidence-based and multimodal

Question 3

Sellbom et al: What does multimodal mean?

Answer 3

A multimodal approach means to corroborate a range of different sources to best understand the client. Eg: client’s history, structured interview, self report inventories, and clinical impression.

Question 4

Sellbom et al: What are the benefits of a multimodal approach?

Answer 4

Increases reliability of info
Draws on the strengths of each test while reducing the limitations of each one
Minimises bias associated with particular measures
Leads to a more confident diagnosis
When various tests are inconsistent, this can reveal important info about the test-taker

Question 5

Sellbom et al: What are some of the limitations of the DSM-IV-TR?

Answer 5

1) It is based on a medical model and does not consider underlying processes or liabilities (ie it is concerned only with the signs and associations of the disorder
2) It is categorical in nature, even though human nature, mental illness, and mental health are distributed dimensionally
3) It does not address etiological contributions to disorders
4) Axis I and II represent a consensual opinion of a committee of experts not extensive empirical evidence
5) It is skewed towards the nomothetic end of the spectrum
6) It requires a specific number of symptoms to achieve a diagnosis, ruling out people with subthreshold symptoms regardless of their level of impairment

Question 6

Sellbom et al: What were the two major shifts/advances made going into DSM-V?

Answer 6

1) A cross-cutting assessment domain - eg: measuring depressed mood, anxiety, substance use or sleep problems for all patients in a mental health centre
2) Moving away from the 10 diagnostic categories of personality disorders and instead having 6 broad personality trait domains onto which people can be mapped

Question 7

Sellbom et al: What are the 4 types of assessment instruments discussed in this article?

Answer 7

1) Interviews
2) Self-report inventories
3) Performance-based techniques
4) Cognitive testing

Question 8

Sellbom et al: What are the 4 major considerations when deciding which tests to use?

Answer 8

1) The test’s psychometric properties
2) Clinical utility
3) Client factors
4) Clinician variables (eg: clinical expertise)

Question 9

Sellbom et al: With regards to psychological assessments, what is incremental validity?

Answer 9

Incremental validity is the extent to which a new assessment/test provides information over and above that of the assessments/tests already used. If you choose to use an additional number of tests, each needs to bring something new to the table

Question 10

Sellbom et al: What are the 3 levels of interpretation of psychological tests?

Answer 10

Level 1: Concrete level, recognise scores only, don’t draw any conclusions
Level 2: What are the patterns in the scores? Are there significant differences?
Level 3: Interpret the scores in the larger context, incorporate details specific to the client

Question 11

Sellbom et al: What are the 4 stages of the assessment procedure?

Answer 11

1) Referral question
2) Preliminary information
3) Assessment procedure
4) Treatment recommendations

Question 12

Sellbom et al: In terms of the assessment procedure, what 6 areas need to be explored?

Answer 12

1) Informed consent
2) Presenting problems and symptoms
3) Psychosocial background history
4) Clinical interview
5) Diagnostic clarification
6) Personality profile, coping, self-concept, and interpersonal styles

Question 13

Sellbom et al: What are some potential issues specific to the assessment process?

Answer 13

1) Time constraints
2) Severity of psychopathology may affect self-reports
3) Comorbidity
4) Risk of harm to self or others
5) Environmental influence

Question 14

Sellbom et al: Define formulation

Answer 14

“The process by which we systematically, comprehensibly, and objectively assemble and integrate available information to arrive at an understanding of what is happening with the patient.”

Question 15

What is face validity? Provide an example. What are the advantages and disadvantages?

Answer 15

Face validity refers to what a test/item appears to be measuring.
For example, the item “I think newborn babies look very much like little monkeys” measures one’s tendency to care for others. It has low face validity.
Low face validity can be advantageous, as it reduces personal bias (i.e. in example above, people will be motivated to show they’re caring, so this low face validity question removes this bias). A disadvantage of low face validity is that is makes what is being measured questionable

Question 16

What is content validity?

Answer 16

Content validity refers to whether the items on a test represent the domain the test aims to measure.
It depends on how the developers of the test defined the domain - what they called “apple” might not be what you now call “apple”. You have to go beyond just looking at the title of the scale.

Question 17

What are the two types of criterion-related validity? Define each.

Answer 17

Concurrent validity - the extent to which scores are related to a currently available criterion
Predictive validity - the extent to which scores can predict future performance on another relevant criterion (eg: can scores on a depression scale predict clinical diagnosis of depression?)

Question 18

What are the two types of construct validity? Define each with examples.

Answer 18

Convergent validity - the extent to which two theoretically related constructs have correlated scores (eg: happiness and contentment)
Divergent/discriminant validity - the extent to which unrelated constructs have uncorrelated scores (eg: happiness and sleep quality)

Question 19

What is test-retest reliability?

Answer 19

Test-retest reliability refers to how consistent a test is over time

Question 20

What is inter-rater reliability?

Answer 20

Inter-rater reliability refers to how ratings by different people agree with each other

Question 21

What is inter-method reliability?

Answer 21

Refers to the consistency between two methods (eg: assessments) with identical content, but non-identical items. It is rare, but reduces the limitations of test-retest reliability (eg: participants remembering the questions)

Question 22

What is internal consistency?

Answer 22

Refers to the consistency/inter-correlation of items within a test

Question 23

What are the two most commonly assessed forms of reliability?

Answer 23

Internal consistency and inter-rater reliabiiity

Question 24

What is the statistic used to measure internal consistency? What is a acceptable, good and excellent score?

Answer 24

Cronbach’s alpha
Acceptable = .6 to .7
Good = .7 to .9
Excellent = greater than .9

Question 25

Why do we care about validity, reliability, standardisation and norms? How can we reduce measurement error?

Answer 25

We care about these things because when they are compromised, we have larger measurement error (observed value = true value + measurement error). We can reduce measurement error by using psychometrically sound measures correctly, doing repeated measures, using latent variable modelling, and using confidence intervals.

Question 26

What are 2 current trends in psychological testing?

Answer 26

1) A shift away from lengthy, expensive tests, to brief, inexpensive and problem-oriented tests. Part of this trend also involves unifying measures of the same constructs and getting researchers to have confidence in using newer scales (eg: PROMIS) 2) The integration of computers, smart phones and technology, which makes all aspects of psychological testing easier

Question 27

What are the key differences between a clinical interview and a normal conversation with a friend?

Answer 27

A clinical interview has a specific purpose - to provide the psychologist with information to diagnose and treat the patient A clinical interview has clearly defined roles - the psychologist and the patient A clinical interview has a defined timeframe (eg: 1 hour session)

Question 28

What are the two types of clinical interviews?

Answer 28

Intake interviews and Mental Status Exams (MSE)

Question 29

What are 3 keys elements of any type of clinical interview?

Answer 29

1) Safe space for discussion 2) Confidentiality 3) Open-ended questions

Question 30

What are 3 benefits of clinical interviews?

Answer 30

1) Uncovers information to diagnose and treat the client 2) Provides verbal and non-verbal information 3) Builds trust

Question 31

What are 2 limitations of clinical interviews?

Answer 31

1) Can't tell if the client is telling the truth or not | 2) Possible biases of the psychologist

Question 32

What is the difference between a therapeutic interview and an assessment interview?

Answer 32

Therapeutic interview = generic activities within a session designed to advance some treatment goal Assessment interview = an array of activities in order to gain information that leads to the development of treatment goals and intervention plans or other decisions

Question 33

What are the 4 different philosophical/theoretical orientations psychologists may have?

Answer 33

Psychodynamic, cognitive-behavioural, client-centred (includes humanistic and existential), and family systems

Question 34

What are 2 recent trends in clinical interviewing?

Answer 34

1) Computer-assisted diagnoses and interviews (pretty good overall, but too many false positives) 2) Telepsychiatry (good for rural, reliable, good cost)

Question 35

What are some recommendations to improve clinical interviewing?

Answer 35

Prepare for the interview Determine the purpose of the interview Clarify the purpose and parameters to the client Conceptualise the interview as collaborative Truly hear the interviewee Use structured interviews Encourage client to describe complaints in concrete behavioural terms Complement the interview with other methods (eg: psychological testing) Identify the antecedents and consequences of problem behaviours Differentiate between skill and motivation Obtain base rates of behaviours Avoid expectations and biases Use a disconfirmation strategy (look for info that disproves your hypothesis) Counter the fundamental attribution error (when the cause of a problem is assumed to be due to one set of factors, when it's actually due to another) Delay reaching decisions while the interview is being conducted Consider the alternatives Provide a proper termination

Question 36

What are the main sections of an MSE?

Answer 36

``` Appearance, behaviour and attitude Mood and affect Speech Thought (content and form) Perception (eg: hallucinations) Cognition (consciousness, orientation, attention, memory) Insight (understanding of their own condition) Judgment (ability to make decisions) ```

Question 37

What are some features of good psychological reports?

Answer 37

Info is presented in small, digestible chunks Well ordered, clear subheadings Succinct examples provided State test results without bias or judgment Recommendations are specifically tailored to the individual

Question 38

What are some features of poor psychological reports?

Answer 38

Language that lacks confidence ("he seems a bit unhappy") Dull terminology ("good", "bad", "happy", "sad") Does not fulfil reason for referral Presents therapeutic information No specific recommendations

Question 39

What are the main sections in a psychological report?

Answer 39

Referral - brief Presenting problems - include client's own words Psychiatric history Medical history Forensic history Substance use - why do they think they're using it? Could be a coping mechanism Current medication - itemised list Family history - structure and relations, how do they fit into their family? Findings from psychological tests - are they consistent with their presentation?

Question 40

What are the 4 P's of case formulation?

Answer 40

Predisposing Precipitating Perpetuating Protective