Week 1 Introduction to psychological assessment Flashcards
Reading notes:
Handbook of Psychological Assessment
Reading notes:
Handbook of Psychological Assessment
- Overall this outlines the difference, importance, benefits and disadvantages of psychometric testing a psychological testing. The main message is that a clinical psychologist should be able to do both psychometric and clinical work and not just one or the other. Overall knowing both should be able to enable effective descriptions of the problem along with recommendations on how to assist the problem.
- They are initially concerned with clarifying their roles
- The central role of clinicians conducting assessments should be to answer specific questions and make clear, specific, and reasonable recommendations to help improve functioning.
- In contrast, psychological assessment attempts to evaluate an individual in a problem situation so that the information derived from the assessment can somehow help with the problem.
- Tests are only one method of gathering data, and the test scores are not end products but merely means of generating hypotheses
- An advantage of the data-oriented intelligence tests was that they appeared to be objective, which would reduce possible interviewer bias
- Their predictions were generally accurate and usable. However, these facts created the early expectation that all assessments could be performed using the same method and would provide a similar level of accuracy and usefulness
- Again, there was an emphasis on the tools as primary, with a deemphasis on the input of the clinician
- The objective psychometric approach is most appropriately applicable to ability tests such as those measuring intelligence or mechanical skills.
- “Clinical assessment is individually oriented, but it always considers social existence; the objective is usually to help the person solve problems.”
- The above knowledge should be integrated with relevant general coursework, including abnormal psychology, the psychology of adjustment, theories of personality, clinical neuropsychology, psychotherapy, and basic case management.
- Their training focuses on developing competency in administration and scoring rather than on knowledge relating to what they are testing
- Clinicians should be not only knowledgeable about traditional content areas in psychology and the various contexts of assessment but also able to integrate the test data into a relevant description of the person
- Yet the goal is not merely to describe the person but rather to develop relevant answers to specific questions and present clear, specific, and reasonable recommendations that aid in problem solving and facilitate decision making
The eight phases of using data for a psychological assessment:
Phase 1: Clarify and evaluate referral question
The first phase, discussed above, is the clarification and evaluation of the referral question. As referral questions are one source of data, the clinician is already starting to develop hypotheses about what is going on for a client, what impact it has on his or her life, under what conditions the current problems developed, and even possible recommendations for how to improve the client’s functioning and life in general.
Phase 2: Conduct clinical and collateral interviews
Phase 2 focuses on collecting another source of data through clinical interviews and other background information (e.g., through collateral interviews, such as with parents or teachers, or through reviewing records or previous reports). Clinicians must understand the strengths and limitations of data collected from clinical interviews (see Chapter 3). It is from these data, though, that clearer initial hypotheses can be formed about the client’s cognitive, emotional, personality, academic, neuropsychological, adaptive, and other areas of functioning.
Phase 3: Develop Hypothesis
Based on the information collected in Phases 1 and 2, the third phase focuses on developing hypotheses about what factors (situations, internal dynamics, etc.) may be causing and/or reinforcing whatever problems the client is having. These hypotheses require the clinician to have a firm grasp on many content areas of psychology, including personality theory, developmental psychology, abnormal psychology, developmental neurobiology, and even areas outside of psychology like biology, sociology, and cultural anthropology. These hypotheses must be grounded in clear and logical clinical science and theory, regardless of theoretical orientation. For example, a hypothesis about the etiology of a client’s low self-esteem may revolve around negative self-talk (from a cognitive behavioural perspective) or the internalization of a mother’s criticism (from a psychodynamic perspective). Regardless of theoretical orientation, the hypothesis must make sense within a specific psychological framework.
Phase 4: Select tests
The importance of deliberateness when selecting tests to use in a specific assessment battery cannot be overstated. In addition to the considerations discussed earlier (see Table 1.1), the clinician must be confident that the tests selected can rule in or out the specific hypotheses generated in Phase 3 (as well as any modified hypotheses later on). Special attention should always be paid to cultural and sociodemographic characteristics of the client in order to ensure that the tests selected are appropriate, given the development, standardization, and norming procedures of the tests being considered.
Phases 5 and 6: Reject/Modify/Accept hypothesis
Phase 5 centres on administering and scoring tests in order to collect data to evaluate the hypotheses generated in Phase 3. Phase 6, one of the most difficult phases, relates to the actual evaluation of test data within the context of the hypotheses generated previously. Phases 4 through 6 are iterative and recursive. As test data are collected, hypotheses can be rejected, modified, or accepted. Rejected hypotheses are abandoned, and the clinician can confidently move on to evaluating other hypotheses. Modified hypotheses may require the selection of new tests; while some tests may help develop modified hypotheses, additional tests are often necessary to actually evaluate these new hypotheses. While rejecting and modifying hypotheses is often relatively straightforward, accepting hypotheses can be much more difficult, especially when it comes to personality or emotional functioning. It is often the case that a test or test score can rule out a hypothesis but cannot rule it in . For example, a high score on the Working Memory Index (WMI) of the WISC-V may rule out the presence of the inattentive subtype of attention-deficit/hyperactivity disorder (ADHD). This is because a child with ADHD would find it very difficult, if not impossible, to perform extremely well on WMI tasks that require both selective and sustained attention. However, a low score on the same WMI cannot rule ADHD in . Because multiple factors can affect performance on the WMI, more testing would be necessary to investigate the case of whether or not ADHD was present.
Phase 7: Create dynamic model of the person
Phase 7 is a complicated phase requiring the clinician to make sense of all of the data collected in a way that can be clearly communicated to the client and/or referral source. Rather than presenting an acontextual list of a client’s strengths and weaknesses or, even worse, presenting data test by test (which requires the audience to then determine which findings are important and connect the dots to make sense of the feedback), clinicians should create a dynamic understanding of how factors interact to explain what is happening for the client. To do this process well takes good training, supervision, and experience.
Phase 8: Develop recommendations
The final phase of the data interpretation process is linking the results to clear, specific, and reasonable recommendations that are likely to improve the client’s life and functioning. Chapter 14 focuses on this process. In short, clinicians must understand treatment options from two different perspectives. First, clinically, clinicians must understand what is likely to link to and address the specific problems that emerged from the assessment, including the dynamics identified in Phase 7. Second, clinicians must understand the research behind interventions, how effective they have been shown to be, and what about them has been suggested or found to be the reasons that they are effective. Clinicians must consider both the empirical support of interventions and the likelihood of the interventions benefitting the specific client in his or her specific context and situation. Recommendations cannot be vague or broad, such as recommending “therapy” to a client. They should be both clear and specific. Additionally, they should be reasonable, given the circumstances. Although a specific treatment may be the best choice for a specific client, for a number of reasons, if that treatment is not available to the client (because of, for example, geographic location or financial limitations), then making a recommendation for that kind of treatment will not ultimately benefit the client.
Phases in Clinical Assessment PG 32-37 NOTES
- Although the steps in assessment are isolated for conceptual convenience, in actuality, they often occur simultaneously and interact with one another.
- The clinician should integrate data and serve as an expert on human behaviour rather than merely an interpreter of test scores.
- Clinicians may need to uncover hidden agendas, unspoken expectations, and complex interpersonal relationships. One of the most important general requirements is that clinicians understand the vocabulary, conceptual model, dynamics, and expectations of the referral setting in which they will be working.
- Further, clinicians must evaluate whether the referral questions are appropriate for psychological assessment and whether they have a level of competence necessary to conduct an assessment to answer the specific questions.
- Clinicians should be familiar with operational definitions for problems such as anxiety disorders, psychoses, personality disorders, and organic impairment so that they can be alert to their possible expression during the assessment procedure.
- Clinicians should also be familiar with problems that can arise from medical conditions and substance use.
- It is essential that clinicians have in-depth knowledge about the variables they are measuring; if not, their evaluations are likely to be extremely limited.
- It is important that the examiner also consider whether a specific test or tests are appropriate to use on an individual or group. Doing this demands knowledge in such areas as the client’s age, sex, ethnicity, race, culture, educational background, motivation for testing, anticipated level of resistance, social environment, and interpersonal relationships. Finally, clinicians need to assess the effectiveness or utility of the test in aiding the treatment process.
- This process generally follows a sequence of developing hypotheses, identifying relevant facts, making inferences, and supporting these inferences with relevant and consistent data.
- Wright (2010) conceptualized an eight-phase approach (Figure 1.1) for using data in a psychological assessment. It should be noted that, in actual practice, these phases are not as clearly defined as indicated in the figure, but often occur simultaneously. For example, when a clinician reads a referral question or initially observes a client, he or she is already developing hypotheses about that person and checking to assess the validity of these observations.
Types of referral settings notes:
- Throughout the assessment process, practitioners should try to understand the unique problems and demands encountered in different referral settings. Otherwise, examiners— despite being skilled in administering and interpreting tests— might administer a needless series of tests and, at worst, provide useless information to referral sources and patients themselves. That is, a thorough investigation of the underlying motive for a referral can sometimes lead to the discovery that evaluation through testing is not even warranted.
- many of these situations have hidden agendas that may not be adequately handled through psychological testing alone. One of the most useful questions in addressing these issues is to ask what decisions need to be made regarding the patient.
- Overall, this speak on how their referral question may be vague to the point where people ask for a psychological assessment due to policy. Overall referrals not giving specific questions for the request.
- It must be stressed that the responsibility for exploring and clarifying the referral question lies with the clinician, who should actively work with the referral source to place the client’s difficulty in a practicable context.
- Explaining the limitations, possible outcomes, c;arifyinmg referral questions, be open and clear and know there expectations and let them know if that could be met.
- Know your work setting a processes.
- Psychologists in psychiatric settings who receive vague requests for “a psychological” sometimes develop a standard evaluation based on what they have learned about what this term implies on their specific unit.
- Overall psychologist can work in schools, psychiatry wards, legal where they are serving the decision maker. Whereas within a clinical psychology setting you are the decision make.
- Speaks about the complexities that can arise in different work setting. Similar to work in regard to request for different prac, duel cases, therapy else where etc.
The difference between psychological ‘tests’ and ‘assessments’
Psychological testing
Testing is considered a specialist sub-skill of assessment.
It’s an ‘objective and standardised measure of a sample of behaviour’ (Anastasi & Urbina, 1997).
The important distinction between assessment and testing is that testing uses standardised and objective measures or tools to collect information on an individual; as testing is data-oriented, the testing results in a score or several scores on the individual’s traits or abilities.
The difference between psychological ‘tests’ and ‘assessments’
Psychological assessments
A psychological assessment is defined as a flexible, not standardised, process.
It aims to make a determination or decision that’s defendable based on the data being collected as part of the process of assessment.
The focus is on problem-solving and decision-making, so it’s much broader than testing and requires more expertise than testing.
- An extremely complex process of solving problems (answering questions) in which psychological tests are often used as one of the methods of collecting relevant data.
- An important point to remember is that a test is a sample of behaviour collected in a standard way. Furthermore, the use of tests for decision-making should occur in the context of a broader psychological assessment, with testing being one method of gathering information about the individual.
Overview of assessment
Problem clarification
Data collection
Problem solution
Idiographic aims (More of a individulised assessment
- Making an assessment: An assessment involves using multiple tests to gain a comprehensive understanding of the client, including their strengths and difficulties.
- Focused on the individual: It is more focused on the individual than positioning within a group, and is mainly focused on the uniqueness of the individual. Here, the person’s particular characteristics are examined within the complexity of individual characteristics. The aim is an idiographic assessment that is less rigid and requires judgement rather than evaluation against a set of criteria.
- A case formulation problem: The process generates a formulation for the person to determine their characteristics and situation to understand the person individually and in context.
Nomothetic aims (bassicly testing, numbers, stats etc)
- Making a diagnosis: People often associate clinical assessment with just making a diagnosis; diagnosis can certainly be an essential step.
- Placement of the person within (or outside) the group: In this reasonably standardised process, criteria are ticked off to allow placement of the person in a particular taxonomy.
- A classification/ordering along a problem dimension: This relates to placing the person on a dimension (for example, on the autism spectrum). Often, this is a role that is specifically suited to testing. Many tests are designed explicitly as unidimensional measures (for example, anxiety).
Predisposing:
Predisposing:
Factors that contribute to or increase vulnerability to a problem (e.g. may be genetics, parental approaches etc.).
Precipitating:
Precipitating:
Triggering factors (e.g. how the problem started – what was happening in the person’s life that triggered the problem).
Perpetuating:
Perpetuating:
The factors that maintain or keep the problem going.
Protective:
Protective:
The factors that keep the person safe, or less vulnerable.
Reliability: (AKA Consistency) Think of R for Repeating
This refers to the repeatability or consistency of scores (that is, whether assessments provide reliable or consistent scores).
Validity: (AKA Accuracy) Think of the V as a dart meaning accuaracy
This refers to the accuracy or utility of scores (whether the scores on the assessments are valid or accurate).
