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PSYC 3553 – Psychopathology Week 4: Assessment and Diagnosis • September 29, 2009

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What is assessment?

•  Goals of clinical assessment: •  How and why a person is behaving abnormally •  How that person may be helped •  Also may be used to evaluate treatment

progress

•  Focus is idiographic – on an individual person

Characteristics of Assessment Tools

•  Standardization

•  A test is administered to a large group, and their performance serves as a common standard (norm) against which individual scores are judged

•  The “standardization sample” must be representative

•  One must standardize administration, scoring, and interpretation

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•  Reliability: The consistency of a test

•  Test–retest reliability

•  Interrater reliability

•  Validity: the accuracy of the test results

•  Face validity

•  Predictive validity

•  Concurrent validity

Characteristics of Assessment Tools

Are Classifications Reliable and Valid?

•  Reliability: different diagnosticians agreeing on diagnosis using same classification system •  DSM-IV: greater reliability than previous editions

•  Used field trials to increase reliability

•  Validity: accuracy of information diagnostic categories provide •  DSM-IV has greater validity than any previous

edition

•  Conducted extensive lit reviews and field studies

I. Clinical Interviews

•  Face-to-face encounters •  Often the first contact between a client and a

therapist/assessor

•  Used to collect detailed information, especially personal history, about a client

•  Allow the interviewer to focus on whatever topics they consider most important

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II. Psychological Tests

•  Six categories of psychological tests

1.  Projective tests

2.  Personality Inventories

3.  Response Inventories

4.  Psychophysiological Tests

5.  Neurological/neuropsychological Tests

6.  Intelligence Tests

  Projective tests: Interpret characteristics onto vague & ambiguous stimuli or follow open-ended instruction

•  Strengths and weaknesses: •  Helpful for providing “supplementary” information

•  Rarely demonstrated much reliability or validity •  May be biased against minority ethnic groups

II. Psychological Tests

Example: The Rorschach Inkblot

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Example: Thematic Apperception Test

Example: Sentence-Completion Test

•  “I wish ___________________________”

•  “My father ________________________”

Example: Draw-a-Person Test

•  “Draw a person”

•  “Draw another person of the opposite sex”

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II. Psychological Tests

  Personality inventories - self-report questionnaires

  Focus is on behaviors, beliefs, and feelings   Ask how similar/dissimilar a person is to a set

of statements

•  Strengths and weaknesses: •  Objectively scored and standardized •  Although more valid than projective tests,

often we cannot directly examine trait

Example – The MMPI

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II. Psychological Tests

  Response inventories •  Usually based on self-reported responses •  Focus on one specific area of functioning

•  E.G., emotion, social skills, cognition

•  Strengths and weaknesses:

•  Have strong face validity •  Rarely careless/inaccurate questions •  Few subjected to careful procedures

II. Psychological Tests

  Psychophysiological tests •  Measure physiological response as an

indication of psychological problems

•  Most popular is the polygraph (lie detector)

•  Strengths and weaknesses: •  Require expensive equipment that must be

tuned and maintained •  Physical evidence for psychological

symptoms

II. Psychological Tests

  Neurological tests: direct assessment brain function

  Neuropsychological tests: indirect assessment via cognitive, perceptual & motor function

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Example: Bender Visual-Motor Gestalt

II. Psychological Tests

  Intelligence tests •  Designed to measure intellectual ability •  Assess both verbal and non-verbal skills

•  Generate an intelligence quotient (IQ)

•  Strengths and weaknesses: •  Highly standardized, reliable and valid

•  Influences on performance…cultural factors

Clinical Observations

•  Naturalistic observations •  Occur in everyday environments: homes, schools…

•  Analog observations •  If impractical, conduct observations in artificial

settings

•  Self-monitoring •  People observe themselves and carefully record the

frequency of certain behaviors, feelings...

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Clinical Observations

•  Strengths and weaknesses: •  Different observers focus on different aspects?

•  Careful training and use of observer checklists

•  “Overload,” “observer drift,” and observer bias

•  Client reactivity may also limit validity

•  Observations may lack cross-situational validity

Treatment: How Might Clients Be Helped?

•  Treatment decisions: begin with assessment info & diagnosis to determine treatment plan

•  Other factors: therapist’s orientation, current research, empirical support, evidence-based treatment

•  Difficult question to answer: • How do you define success?

• How do you measure improvement? • How do you compare treatments – differing in

range, complexity, skill, knowledge

The Effectiveness of Treatment

•  Is therapy generally effective? •  … more effective than no treatment or placebo

•  In one study, average person in treatment was better off than 75% of untreated

•  Consumer Reports found that “consumers” of therapy found it to be helpful or at least satisfying

•  Can therapy can be harmful? Has potential…

• Studies report ~5% get worse with treatment

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The Effectiveness of Treatment

•  Are particular therapies effective for particular problems?

•  Studies now conducted to examine efficacy of specific treatments for specific disorders:

•  Recent studies focus on the effectiveness of combined approaches • Drug therapy combined with certain forms of

psychotherapy – to treat certain disorders