Week 6 - Integration & Clinical Decision Making

Question 1

How do you integrate testing data?

6 STEPS

Answer 1

1. INTERPRET all tests independently
2. Start to look for PATTERNS (common findings/unusual results)
3. Can help to ORGANIZE data conceptually
4. DEVELOP hypothesis about data in whole
5. APPLY hypothesis and data to client
6. RELATE hypothesis BACK to referral question

Question 2

What is the data that needs to be collected and integrated?

Answer 2

• behavioural observations
• mental status
• psychosocial history
• psychological tests (cog, academic, self-report, personality, projective)
• clinical impressions
• diagnostic impressions

Question 3

What is a case formulation?

Answer 3

A DESCRIPTION of the client that provides information on life situation, current problems, and a set of hypotheses LINKING psychosocial factors with the client’s clinical condition

• Integrates material
• Addresses diagnostic issues
• Hypotheses about development of problem
• Hypotheses about maintenance of problem
• Makes predictions about trajectory with and without treatment
• Informs the treatment plan
• Takes into account obstacles to implementing the treatment plan

Question 4

How do TV shows formulate cases?

Answer 4

• Latch onto obscure detail
• strays from science to get drama
• overly dramatic

Question 5

How do you start a case formulation?

6 STEPS

Answer 5

1. Develop a COMPREHENSIVE problem list.
2. Determine the NATURE of each problem, including its origin, current precipitants, and consequences.
3. Identify PATTERNS or commonalities among the problems.
4. Develop working HYPOTHESIS to explain the problems.
5. EVALUATE and REFINE the hypotheses, using all information gathered during the assessment and the patient’s feedback on the hypotheses.
6. If the psychologist moves from conducting an assessment to providing treatment, the hypotheses should be RECONSIDERED, re-evaluated, and revised (as necessary) based on DATA GATHERED during treatment.

Question 6

What are some threats to validity (client factors)?

2 FACTORS

Answer 6

1. Retrospective recall:
   - using data that rely on PEOPLE to remember events that happened to them in the PAST
2. Possible biases in self-presentation:
   - research suggests that this is not always accurate and can be INFLUENCED by presenting problems or circumstances

Question 7

What are some threats to validity (clinician factors)?

9 FACTORS

Answer 7

1. Self-serving attributional bias:
   - tendency to take more PERSONAL CREDIT for success than for failures (attribute success to internal, stable and global causes)
2. Biases:
   - Judgments that are systematically DIFFERENT from what a person should conclude based on logic or probability
3. Heuristics:
   - MENTAL SHORTCUTS that people often use to ease the burden of decision- making
   - end to result in ERRORS in decision-making
   - underlie cognitive biases
4. Fundamental attributional error:
   - The tendency to OVERETIMATE the influence of personality traits and to underestimate the influence of situational effects on the person’s behaviour
5. Belief in the law of small numbers:
   - Relying on DIRECT experience with a small number of patients and discounting information drawn from RESEARCH sample
6. Inferring causation from correlation:
   - Inferring TWO characteristics causes another characteristic and discounting other variables
7. Confirmatory bias:
   - Looking for evidence to SUPPORT the hypothesis and NOT actively looking for evidence that would refute or temper the strength of the hypothesis
8. Bias blind spot:
   - Believing that they are LESS LIKELY than other people to have their decisions affected by errors and biases
9. Affect heuristic:
   - The AFFECTIVE qualities (e.g., likeability) can lead to a judgment based solely on EMOTIONAL considerations (e.g., attractiveness), with only minimal attention paid to the full range of relevant factors

Question 8

What are some underlying factors that can contribute to validity?

5 FACTORS

“_________” self-reflection is necessary in this field

Answer 8

1. LACK of consultation (make sure to consult w/ a team)
2. Organizational factors
   • Overworked
   • Lack of support
   • Focus on quantity over quality
3. LAPSE in professional development (some psychologists may be overconfident, older psychologists letting their care go- not keeping up to date w/ research)
4. Compassion fatigue (lose sense of empathy for clients, “I don’t really care anymore”)
5. Burnout (important to have people around that you trust and these people more likely notice this before you, can be slow or instant)
   ————————————————————————
   Constant

Question 9

What are ways to improve clinical judgment?

11 FACTORS

Answer 9

1. Use APPROPRIATE psychological tests
2. Use decisions TREES
3. Attempt to SYSTEMATIZE any unstructured tasks
4. Be aware of RELEVANT research
5. Be aware of PERSONAL biases
6. Be SELF-CRITICAL
7. Seek CONSULTATION
8. DON’T rush
9. Check for SCORING ERRORS
10. Use DSM CRITERIA
11. Know and use NORMATIVE DATA

Question 10

What should be include in a psychological assessment report?

9 STEPS

Answer 10

1. IDENTIFYING client information
2. REASON for referral
3. BACKGROUND information (family history, medical history, disorder history)
4. ASSESSMENT methods (including tests administered)
5. INTERVIEW data and behavioural observations
6. TEST results (including interpretation of test scores)
7. DIAGNOSTIC impressions and CASE formulation
8. SUMMARY
9. RECOMMENDATION

Question 11

What are the 4 general sections when report writing?

Answer 11

1. Importance of knowing the “audiences” for the report
2. Confidentiality and privacy considerations (informed consent consider throughout)
3. Separating/identifying facts (client opinion and psychologist opinion)
4. Using computer-based interpretations of test results

Question 12

What are some factors to consider when report writing?

6 FACTORS

Answer 12

• Write in the THIRD person (no “I” and “me”)
• Write in the PAST TENSE
• Use QUALIFIERS (separating where you get your information from)
  Ex) client “alleged” her husband hitting her, not SAYING it happened because we don’t know
• Be clear, concise, and organized
• Avoid JARGON, or at least explain it (speak common language, but also professional, specific to who the audience is)
• EXPLAIN test results and scores (i.e., what percentiles mean)
• Include only information that is NECESSARY and REVELANT to the referral question

Question 13

What is the purpose of assessment feedback?

Answer 13

• Explaining and providing information of a debrief to the client after the session (what the formulation and diagnosis you came up with)
• 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 difficulties
• Help the individual IDENTIFY potentially stressful situations that can exacerbate difficulties
• COLLABORATE with the individual in creating therapeutic goals that build on personal strengths