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PSY 606
Thomas Hart

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Chapter 4 Clinical Assessment Procedures May 27, 2008 Reliability and Validity in Assessment Reliability • Generally, reliability refers to consistency of measurement • Interrater reliability: the degree to which two independent observers or judges agree • Test-retest reliability: measures the extent to which people being observed twice or taking the same test twice (maybe even several weeks or months apart), score in generally the same way o Only makes sense when the theory assumes that people will not change appreciably between testing on the variable being measured (ex. IQ) • Alternate-form reliability: using two forms of tests rather than giving the same test twice, perhaps when there is concern that people will remember their answers from the first test and aim merely to be consistent • Internal consistency reliability: assesses whether the items are related to one another (like on an anxiety questionnaire all the questions are related to anxiety) o The higher correlation, the better the reliability Validity • Generally, is related to whether a measure fulfills its intended purpose • Related to validity; unreliable measure will have good validity • Content validity: whether a measure adequately samples the domain of interest • Criterion validity: evaluated by determining whether a measure is associated in an expected way with some other measure (the criterion) o Aka. Concurrent validity o That is actually shows that say depressed people show depressed scores and not depressed people don’t o Predictive validity: evaluating the ability of the measure to predict some other variable that is measured in the future (IQ on future school experience) • Construct validity: relevant when we want to interpret a test as measure of some characteristic or construct that is not simply defined (like anxiousness or distorted cognition) o Evaluated by looking a wide variety of data from multiple scores o Is an important part of the process of theory testing Psychological Assessment • Designed to determine cognitive, emotional, personality, and behavioural factors in psychopathological functioning Clinical Interviews • The interviewer uses language as the principle mean to finding out about another • Difference from a normal interview: the interviewer’s attention on how the respondent answers or does not answer the question (attentive to any emotion as well) • They will inquire about the persons childhood history (psychoanatical), current environmental conditions (behavioural) • The interviewer must obtain the trust of that person • Therapists empathize with their clients in order to get information out • Clinicians have a vague outline, but they all use different strategies of interviewing • Each clinician develops ways of asking questions with which he or she is comfortable and that seem to draw out information that will maximum benefit the client • Unstructured interview, so they must rely on intuition and general experience • Reliability for initial clinical interview is probably low (two interview may reach different conclusions about a client) , also validity is hard to confirm • Structured interviews: one in which the questions are set out in a prescribed fashion for the interviewer o Structured Clinical Interview Diagnosis (SCID) for Axis 1 of DSM-IV  Branching interview (client response to one question determines the next question asked)  Rated on a 3 point scale of severity  Improvement of diagnostic reliability Psychological Tests • Psychological tests: standardized procedures designed to measure a person’s performance on a particular task or to assess his or her personality • It yields important information in their own right, such as personality characteristics or situational determinants of a person’s problems • The same test is administered to many people at different times • Standardization: statistical norms for the test can thereby be established as soon as sufficient data have been collected • 3 types of psychological tests: self-report personality inventories, projective personality tests, and tests of intelligence • Personality Inventories o Person is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her o Minnesota Multiphasic Personality Inventory (MMPI): an inexpensive means of detecting psychopathology and detect a number of psychological problems (multipahic)  MMPI – 2 has several designs to improve validity and acceptability  It has a difference in including minority groups, needless topics and sexist wording o There is a validity scale that is designed to detect deliberately faked responses o Lie scale: a series of statements set a trap for the person who is trying to look too good (their scores would be viewed with more scepticism) o Projective Personality Tests: psychological assessment device in which a set of standard stimuli-inkblots or drawings – ambiguous enough to allow variation in response is presented to the individual (unstructured material, and the unconscious process will reveal their true attitudes, motivations and modes of behaviour = projective hypothesis) o Rorschach Inkblot test: best known for its projective techniques (they are shown 10 inkblots at a time and asked to tell what figures or objects he or she sees in each of them) – there is black, white, greys, red splotches, and 3 pastel colors o Thematic Apperception Test (TAT): another well known projective test. They are shown a series of black and white pictures and asked to tell the story o Projective tests are to reduce the defence mechanisms of repression and get to the basic cause of distress • Intelligence Tests o Originally Binet constructed a mental test to help a school board predict which children are in need for help o Aka. IQ test o Intelligence test: a standardized means of assessing a person’s current mental ability o Wechsler Adult Intelligence Scale (WAIS) and for children (WISC) o Standford-Binet test. They are all based on the assumption that a detailed sample of individuals current intellectual functioning can predict how well he or she will performing school o They are also used to :  In conjunction with achievement tests to diagnose learning disabilities and identify strength and weakness areas  Help determine whether a person is mentally retarded  Identify intellectually gifted children so that appropriate instruction can be provided them in school  Neuropsychological evaluations o They include language skills, abstract thinking, nonverbal reasoning, visual- spatial skills, attention and concentration, and speed of processesing o 65% receive between 85-115 o Those with below 70 are 2 standard deviations below the mean of the population and have significant subaverage intellectual functioning o Those with above 130 are considered intellectually gifted (2.5% falls in each extremes) o They are highly reliable and have good criterion validity – but only measure what psychologist consider intelligence Behavioural and Cognitive Assessment • Behavioural and cognitive clinicians use a system that involves the assessment of 4 sets of variables, SORC o S (Stimuli): the environmental situation that precede the problem (the situations that cause the problem) o O (organismic): physiological and psychological factors assumed to be operating under the skin (ex. Fatigue caused by alcohol) o R (responses): determining what behaviour is problematic, the frequency, intensity and form o C (consequent): events that appear to be reinforcing or punishing the behaviour in question • O receives the most attention, C the least • Cognitive and cognitive-behaviour therapists put more emphasis on cognitive events such as people’s distorted thinking patterns, negative self instructions, irrational automatic thoughts and beliefs, and schemas • Pearsons and Davidson o 5 components of their approach:  Problem list: includes the difficulties the client is having in various domains (psychological, interpersonal, occupational, medical, financial, housing, legal, and leisure). Usually a list is made of these  Diagnosis: diagnoses can lead to initial hypotheses about how to formulate the case and provide information about possible interventions  Working Hypothesis: “heart” the mini theory of the case develops through adaption of general theory and describes relation among the problems • It describes the hypotheses bout the negative schemas that appear to cause the problem, or activating situations • It tells a story of the relations among the components of the problem list  Strengths & Assets: this information can help the hypotheses and treatment plan  Treatment plan: based directly on the cognitive-behavioural case formation and has 6 components: goals, modality, frequency, initial interventions, adjunct therapies, and obstacles (goals and obstacles are very important) o The information necessary for behavioural or cognitive assessment is gathered by several methods, including direct observation of behaviour in real life, interview and self report measures • Behaviour therapists focus a lot on overt behaviour in a variety of settings. They can also show the present of an internal state as well (presentation and anxiety scale) • Sometimes the client is asked to self observe instead of the therapist and keep tract of various categories of response (self monitoring) o Stressful experiences, coping behaviours, and thoughts • Self observation is also referred to as ecological momentary assessment (EMA) o Involves a collection of data in real time as opposed to the more usual methods of having people reflect back over some time period and report on recently experience thoughts moods and stressors (diaries) o The main reason for using this, is because sometimes recalling from memory (retrospect recall) can be inaccurate or bias o But sometimes just that fact that one knows they are self monitoring may produce inaccurate rec
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