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Konstantine Zakzanis

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Chapter 4 - Psychological assessment designed to determine cognitive, emotional, personality, behavioural factors in psychopathological functioning CLINICAL INTERVIEWS o Clinical interview pays more attention to respondents answers or questions o Paradigm within which an interview operates influences type of information sought, how it is obtained, and how it is interpreted o A psychoanalytical trained clinician expected to inquire about persons childhood; likely to remain sceptical of verbal report as analytic paradigm holds that most significant aspects of disturbed/ normal developmental history are repressed into unconscious o Behaviourally oriented clinician focus on current environmental conditions related to changes in person’s behaviour o Clinical interview varies within paradigm adopted by interviewer. Find only the information for which they are looking o Clinicians recognize importance of establishing rapport with client. The interviewer must obtain trust of the person o Psychodynamic clinicians assume people entering therapy usually are not even aware of what is truly bothering them o Behavioural clinicians appreciate difficulties people have in sorting out factors responsible for their distress o Clinicians emphasize with clients in effort to encourage elaboration on their concerns, to examine different facets of a problem o Humanistic therapists employ specific empathy techniques to accomplish these goals o Clinicians often overlook situational factors of interview that may exert strong influences on what the client says or does o To the extent that an interview is unstructured, the interviewer must rely on intuition and general experience o Reliability for initial clinical interviews is low. Reliability/validity low for a single clinical interview conducted as unstructured STRUCTURED INTERVIEWS  Investigators developed structured interviews - Structural Clinical Diagnosis (SCID) for Axis I of DSM-IV, assists researchers/clinicians in making diagnostic decisions  Branching interview, client’s response to one question determines next question asked  Structured interview - questions are set out in a prescribed fashion for interviewer  Developed for diagnosing personality disorders and some specific disorders - anxiety disorder  Rogers argued that structured clinical interviews are essential in order to improve validity of diagnoses  Analyzed which clinical interview is best to use in particular assessment situations depending on primary goal  Recommended SCID for clinician pressed for times/wishes to evaluate existence of selected Axis I disorders  Many structural clinical interviews are available, should have high clinical utility across assessment situation PSYCHOLOGICAL TESTS o Standardized procedures designed to measure person’s performance on particular task/assess personality, thoughts, feelings, behaviour o If results of diagnostic interview are inconclusive, psychological tests provide information used in a supplementary way to diagnosis o Alert clinician possible presence schizophrenia. Yield to important information own right (personality characteristics/situational problems o Statistical norms for test established as soon as sufficient data have been collected – standardization o Response to a particular person can then be compared with statistical norms. Three basic types of psychological tests 1. PERSONALITY INVENTORIES –self-report questionnaire indicating if statements assessing habitual tendencies apply to self  Minnesota Multiphasic Personality Inventory (MMPI) –1940s by Hathaway/McKinely, revised 1989 MMPI-2  Intended to serve as inexpensive means of detecting psychopathology, MMPI is multiphasic as designed to detect a number of psychological problems  Used to screen large groups of people for whom clinical interviews are not feasible  Investigators relied on factual information. (1) many clinicians provided statements considered indicative of various mental problems (2) items rated as self-descriptive by clients already diagnosed w disorders and by large group of individuals considered normal  If individual answered questions, same as large group, individuals behaviour resemble diagnostic group  MMPI-2 includes African Americans and native Americans 2. PROJECTIVE PERSONALITY TEST – psychological assessment device where set of standard stimuli, inkblots confusing enough to allow variation in responses is presented to individual  Unstructured -> client’s responses determined by unconscious, reveal true attitudes, motivation, modes of behaviour – projective hypothesis Client reports seeing eyes in inkblot the projective hypothesis - paranoia  Rorschach Inkblot Test – person shown 10 inkblots (white, black and shades of grey, two have red slashes on them)  Erdberg/Exner concluded (research literature) that respondents who see a great deal of human movement in inkblots use inner resources when coping with needs, colour more likely to seek environment interaction  Hermann Rorschach noticed his two children saw in clouds reflected their personalities  Thematic Appreciation Test (TAT) – person shown series of black/white pictures asked to tell a story related to each  Projective techniques - psychoanalytic paradigm, tests assumes respondent unable/unwilling to express true feelings  Validity in identifying people with schizophrenia or at risk of developing schizophrenia  most likely attributed fact that person’s responses on test are related to communication disturbances that are an important symptom of schizophrenia  Roberts Appreciation Test for Children illustrates how use of projective tests has evolved to provide more standardized, objectively scored assessment tools – pictures of children/families are presented to child, who tells a story about each one 3. INTELLIGENCE TESTS–Alfred Binet constructed mental test- help Parisian school board determine children need special schooling  Intelligence test (IQ) is a standardized means of assessing a person’s current mental ability  Individually administered tests – Wechsler Intelligence Scale for Children (WISC), Wechsler Adult Intelligence Scale (WAIS), Stamford-Binet – all based on assumption that a detailed sample of an individual’s current intellectual functioning can predict how well the individual will perform in school Used with achievement tests diagnose learning disabilities, mentally retardation, gifted, as neuropsychological evaluations  Scores on most IQ tests are standard deviation. Approx. 65%of population receives scores between 85 and 115  Having a score below 70 are 2 standard deviations below the mean of population, considered to have ”significant sub-average general intellectual functioning” 2.5% fall in extreme  Scores above 130 2 standard deviations above the mean, considered gifted; 2.5% fall in this extreme  Emotional intelligence important protective factor in terms of levels of adjustment. High levels of emotional intelligence are associated with greater levels of subjective well-being and reduced proneness to depression BEHAVIOURAL AND COGNITIVE ASSESSMENT o Traditional assessment concentrates on measuring underlying personality structures and traits (paranoia) o Case formulation: map of ones presenting problems, territory of problems, processes that caused and maintain the problem o Includes a clinician’s inferences about underlying processes that can be tested as hypotheses. Used as basis for panning interventions, evolves over time as further information is discovered o Behaviourally oriented clinicians often use a system that involves assessment of 4 sets of variables, referred to by SORC - S – stimuli, environmental stimulations that precede probe - O – organismic, both physiological/psychological factors assumed to be operating under skin - R – responses; behaviour clinicians determine what behaviour is problematic as well as behaviours frequency, intensity and form - C – consequent variables, events that appear to be reinforcing or punishing the behaviour in question o A behaviourally oriented clinician attempts to specify SORC factors for a particular client o Several alternative approaches to individual cognitive-behavioural case formulation o Complex psychological problems are a challenge for clinicians for assigning diagnoses, assessing, conceptualizing problems, identifying obstacles to treatment, and developing an appropriate and effective treatment plan o The Causal Analysis and Synthesis of Events (CASE) system: method intended to be useful when dealing with both intrapersonal interpersonal clinical problems. Helpful in training therapists, to allow dialogue between therapists of different theoretical orientations FOCUS ON DISCOVERY o Jacqueline Persons: approach formulates and individualized cognitive-behavioural theory about particular case (helps therapist) o Formulation based on a general cognitive-behavioural theory o Purpose of formulation: explain how a client’s problems relate to one another, help therapist select treatment targets o first focus on issues that have a causal role in other problems- Different formulations imply different intervention strategies o Persons/Davidson: person complaining of severe fatigue 2 formulations appeared possible: - abuse of sleep medication or negative thinking in reaction to a stressor PROBLEM LIST - Difficulties client has in various domains. Comprehensive list helps ensure significant problems not missed, facilitates search for themes and speculation about causal relations DIAGNOSIS - Include psychiatric diagnosis as it can lead to initial hypotheses about how to formulate the case, provide info about possible interventions WORKING HYPOTHESES  “Heart” of formulation. Mini theory of case develops through adaptation of general theory, describes relations of prob  Describe hypotheses about - schemes that appear to cause problems – external precipitants/activating situations internal structures and the origins or historical incidents or circumstances that contributed to the development of the schemas or functional relationships among problems  Clinician tells a story that includes the problem list and the working hypotheses STRENGTHS AND ASSETS  Help therapist to develop the working hypothesis , enhance the treatment plan and determine realistic treatment goals TREATMENT PLAN - Based on cognitive-behavioural case formulation, 6 components: goals, modality, frequency, initial interventions, adjunct therapies, obstacles o The info necessary for a behavioural or cognitive assessment and case formulation is gathered by several methods: 1. DIRECT OBSERVATION - Behavioural observation: observer÷ uninterrupted sequence of behaviour, applies terms - make sense within a learning framework - Acknowledges consequences of ignoring child’s question. Behaviour therapist advise parents to attend to Kevin’s requests when expressed in an ordinary tone of voice – link to intervention - Behavioural clinician’s way of conceptualizing a situation typically implies a way to try to change it 2. SELF-OBSERVATION - Behaviour therapists/researchers have asked individuals to observe own behaviour, keep track of various categories of response – self-monitoring – used to collect a wide variety of data of interest to both clinicians and researchers including moods, thoughts - AKA ecological momentary assessment (EMA) – Collection of data in real time as opposed to more usual methods of having people reflect back over some time period and report on recently experienced thoughts, moods and stressors o Range from having people complete diaries at specified times, supplying handheld computers that signal when reports are made  Main reason for using EMA is that recall of moods, thoughts, and experiences may be inaccurate  Memory researchers show that recalled information can be biased  Useful in clinical settings, revealing information traditional assessment procedures miss - Research shows behaviour altered as it is being self-monitored; self-consciousness required for self-monitoring affects behaviour – known as Reactivity - desirable behaviour increases in frequency when self-monitored, undesirable decreases 3. INTERVIEWS AND SELF-REPORT INVENTORIES - Behaviour therapist’s job to determine factors that help therapist conceptualize clients problem - Concurrent validity in self-report inventory made - showing correlation with variety of observational data on social skills - Most employed cognitive assessment methods are self-report questionnaires, tap wide range of cognitions, such as fear of negative evaluation, tendency to think irrationally, tendency to make - inferences about life experiences - Cognitive Style Questionnaire (CSQ), measure of cognitive vulnerability factor in hopelessness theory of depression - Abramson/Metalsky created CSQ 1982, used in over 30 published studies - Info bout psychometric/validity properties not published until Abramson describe
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