Psychological assessment

Psychological assessment
There is no best assessment measure.
Using multiple techniques and multiple sources of information will provide the best assessment.
Clinical interviews

• Formal and structured
• Informal and less structured

Characteristics of clinical interviews
The attention the interviewer pays to how the responded answers questions, or does not answer them.
Great skill is necessary to carry out good clinical interviews.
The interviewer must obtain the trust of the person.

• Most clinicians empathize with their clients in an effort to draw them out and to encourage them to elaborate on their concerns.

Interviews may vary to the degree to which they are structured.

• In practice, most clinicians probably operate from only the vaguest outlines.
  Exactly how information is collected is left largely up to the particular interviewer and depends on the responsiveness and responses of the interviewee.
• To the extent that an interview is unstructured, the interviewer must rely on intuition and general experience.
• Reliability for unstructured clinical interviews is probably lower than for structured interviews.

Structured interviews
Structured interview: the questions are set out in a prescribed fashion for the interviewer.
Branching interview: the client’s response to one question determines the next question that is asked.
It also contains detailed instructions to the interviewer concerning when and how to probe in detail and when to go on to questions about another diagnosis.
In practice, most clinicians review the DSM symptoms in an informal manner without using a structured interview.
Assessment of stress
Measuring stress is important in the total assessment picture.
To understand the role of stress, we must first be able to define and measure it.
Stress: the subjective experience of distress in response to perceived environmental problems.
Life stressors: the environmental problems that trigger the subjective sense of stress.
The Bedfort college life events and difficulties schedule
Widely used to study life stressors.
The LEDS included and interview that covers over 200 different kinds of stressors. It is semistructured.
The interviewer and interviewee work collaboratively to produce a calendar of each of the major events within a given time period.
After the interview, raters evaluate the severity and several other dimensions of each stressor.
Goals

• Address a number of problems in life stress assessment.
• Exclude life events that might just be consequences of symptoms.

The LEDS includes a set of strategies to carefully date when a life stressor occurred.
Self-report stress checklists
Because intensive interview measures are so comprehensive, they take a good deal of time to administer.
Often clinicians and researchers want a quicker way to assess stress and may turn to self-report checklists.
These checklists typically list different life events and participants are asked to indicate whether or not these events happened to them in a specified period of time.
Difficulty:

• Great deal of variability in how people view these events
• Difficulties with recall

Personality tests
Self-report personality inventories
In a personality inventory, the person is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her.
Standardization: the responses of a particular person can be compared with the statistical norms.
Minnesota multiphasic personality inventory (MMPI)
Designed to detect a number of psychological problems.
The MMPI has been widely used to screen large groups of people whom clinical interviews are not feasible.
In developing tests, the investigators used several steps

• Many clinicians provided statements that they considered indicative of various mental problems
• Patients diagnosed with particular disorders and people with no diagnoses were asked to rate whether hundreds of statements described to them.
• Items where selected for the final version of the test if patients in one clinical group responded to them more often in a certain way than did those in other groups.

With additional refinements, sets of these items were established as scales for determining whether a respondent should be diagnosed in a particular way.
Like many other personality inventories, the MMIP-2 is typically administered and scored by computer.
The MMPI-2 includes several ‘validity scales’ designed to detect deliberately faked responses.
Projective personality tests
A projective test: a psychological assessment tool in which a set of standard stimuli ambiguous enough to allow variation in responses is presented to a person.
The assumption is that because the stimulus materials are unstructured and ambiguous, the person’s responses will be determined primarily by unconscious processes and will reveal his or her true attributes, motivations, and modes of behavior. → The projective hypotheses.
The Thematic apperception test (TAT) is a projective test.
A person is shown a series of black-and-white pictures one-by-one and asked to tell a story related to each.
There are few reliable scoring methods for this test, and the norms are based on small and limited sample.
The construct validity of the TAT is also limited.
The Rorschach inktbolt test
Aperson is shown 10 inkblots, one a time, and asked to tell what the bold looks like.
Half the inkbolts are in black, white, and shades of gray, two also have red splotches, and three are in pastel colors.
Exner designed the most commonly used system for scoring the Rorschach test.

• Concentrates on the perceptual and cognitive patterns in a person’s responses.
• The person’s responses are viewed as a sample of how he or she perceptually and cognitively organized real-life situations.

The Exner scoring system has norms, although the sample on which they are based was rather small and did not represent different ethnicities and cultures well.
It is unclear whether the Rorschach provides information that could not be obtained more simply.
Intelligence tests
An intelligence test (or IQ test) is a way of assessing a person’s current mental ability.
Beyond predicting school performance, intelligence tests are also used in other ways:

• In conjunction with achievement tests, to diagnose learning disorders and to identify areas of strengths and weakness for academic planning.
• To help determine whether a person has intellectual developmental disorder
• To identify intellectually gifted children so that appropriate instruction can be provided them in school
• As a part of neuropsychological evaluations.

IQ is correlated with mental health.
IQ measures only what psychologists consider intelligence.
Behavioral and cognitive assessment

• Aspects of the environment that might contribute to symptoms
• Characteristics of the person
• The frequency and form of problematic behaviors.
• Consequences of problem behaviors

Direct observation of behavior
Cognitive behavior therapist try to fit events into a framework consistent with their points of view.
In formal behavior observation, the observer divides the sequence of behavior into various parts that make sense within a learning framework, including such things as the antecedents and consequences of particular behaviors.
Behavioral observation is also often linked to intervention. The cognitive behavioral clinician’s way of conceptualizing a situation typically implies a way to try to change it.
Many therapist contrive artificial situations in their consulting rooms or in a laboratory so they can observe how a client or a family acts under certain conditions.
Behavioral assessment
Self-observation
Self-monitoring: asking people to observe and track their own behavior and responses.
Ecological momentary assessment (EMA).
Involves the collection of data in real time as opposed to the more usual methods of having people reflect back over some time period.
Methods for EMA range from having people complete diaries at specified times during the day, to supplying them with smart-phones that do not only signal when reports are to be made, but also allow them to enter their responses directly into the device.
But
Behavior may be altered by the very fact that is is being self-monitored.
Reactivity: the phenomenon wherein behavior changes because it is being observed.
Cognitive-style questionnaires
Cognitive questionnaires tend to be used to help plan targets for treatment as well as to determine whether clinical interventions are helping to change overly negative thought patterns.
Dysfunctional attitude scale (DAS)