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Chapter 4

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Konstantine Zakzanis

Abnormal Psychology; Chapter 4 - Clinical Assessment Procedures  all clinical assessment procedures are more or less formal ways of finding out what is wrong with a person, what may have caused a problem or problems, and what steps may be taken to improve the individual's condition Reliability and Validity In Assessment Reliability  reliability refers to consistency of measurement  inter-rater reliability - refers to 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, perhaps several weeks or months apart, score in generally the same way  this reliability only makes sense when the theory assumes that people will not change appreciable between testings on the variable being measured  sometimes psychologists use two forms of a test rather than giving the same test twice - when there is a concern that people will remember their answers from the first test - this approach enables the tester to determine alternative - form reliability - the extent to which scores on the two forms of the test are consistent  internal consistency reliability - assesses whether the items on a test are related to one another  in each of these types of reliability, a correlation - a measure of how closely two variables are related - is calculated between raters or sets of items  the higher the correlation, the better the reliability Validity  validity is generally related to whether a measure fulfills its intended purpose  validity is related to reliability: unreliable measures will not have good validity, because an unreliable measure does not yield consistent results, an unreliable measure will not related very strongly to other measures  content validity - refers to whether a measure adequately samples the domain of interest  ex. there is an interview that is often used to make an Axis I diagnosis - it has excellent content validity because it contains questions about all the symptoms that are involved in Axis I diagnoses  ex. there is a measure of life stress - it consists of a list of 43 life experiences - respondents indicate which of these experiences they have had in some time period - content validity is less certain here  criterion validity - is evaluated by determining whether a measure is associated in an expected way with some other measure (the criterion)  sometimes these relationships may be concurrent (both variables are measured at the same point in time, and the resulting validity is sometimes referred to as concurrent validity)  ex. a measure of the distorted thoughts believed to play an important role in depression - criterion validity for this could be established by showing that the test is actually related to depression; that is, depressed people score higher on the test than do non-depressed people 1 Abnormal Psychology; Chapter 4 - Clinical Assessment Procedures  construct validity - relevant when we want to interpret a test as a measure of some characteristic or construct that is not simply defined  construct validity is evaluated by looking at a wide variety of data from multiple scores  ex. people diagnosed as having an anxiety disorder and people without the diagnosis could be compared on their scores on the self-report measure of anxiety proneness  the self report measure would achieve some construct validity if the people with anxiety disorders scored higher than a control group  when the self-report measure is associated with the observational one, its construct validity is increased Psychological Assessment  psychological assessment techniques are designed to determine cognitive, emotional, personality and behavioural factors in psychopathological functioning Clinical Interviews  a clinical psychologist who asks a client about the circumstances of his or her most recent hospitalization is similarly conducting an interview - finding out about the other person Characteristics of Clinical Interviews  a clinical interview is different from a casual conversation or a poll - the attention the interviewer pays to how the respondent answers- or does not answer questions is a difference  the paradigm within which an interviewer operates influences the types of information sought, how it is obtained and how it is interpreted  a psychoanalytically trained clinician can be expected to inquire about the person's childhood -he or she is also likely to remain sceptical of verbal reports  the behaviourally oriented clinician is likely to focus on current environmental conditions that can be related to changes in the person's behaviour  psychodynamic clinicians assume that people entering therapy usually are not even aware of what is truly bothering them  humanistic therapists employ specific empathy techniques to accomplish these goals  interview vary in the degree to which they are structured  exactly how information is collected is left largely up to the particular interviewer and depends too on the responsiveness and responses of the interviewee  reliability for initial clinical interviews is probably low; two interviewers may well reach different conclusions about the same client Structured Interviews  mental health professionals need to collect standardized information, particularly for making diagnostic judgements based on the DSM  a structured interview is one in which the questions are set out in a prescribed fashion for the interviewer 2 Abnormal Psychology; Chapter 4 - Clinical Assessment Procedures  investigators have developed structured interviews, such as the Structured Clinical Interview Diagnosis (SCID)  the SCID is a branching interview; that is, the client's response to one question determines the next question that is asked  the use of structured interviews is a major factor in the improvement of diagnostic reliability  inter-rater reliability for structured interviews is generally good Psychological Tests  psychological tests - are standardized procedures designed to measure a person's performance on a particular task or to assess his/her personality, or thoughts, feelings and behaviour  if the results of a diagnostic interview are inconclusive, psychological tests can provide information that can be used in a supplementary way to arrive at a diagnosis  psychological tests structure the process of assessment - the same test is administered to many people at different times, and the responses are analyzed to indicate how certain kinds of people tend to respond  statistical norms for the test can thereby be established as soon as sufficient data has been collected - this process is called standardization  three basic types of psychological tests: self-report personality inventories, projective personality tests and tests of intelligence Personality Inventories  in a personality inventory - a person is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him/her  the best known and frequently used psychological test is the Minnesota Multiphasic Personality Inventory (MMPI) - there is a revised version known as MMPI-2  the MMPI is called multiphasic because it was designed to detect a number of psychological problems  the difference between MMPI and MMPI-2 is that the MMPI-2 uses a sample that is much larger and more representative Projective Personality Tests  a projective test is a psychological assessment device in which a set of standard stimuli-inkblots or drawings - ambiguous enough to allow variation in responses is presented to the individual  the assumption is that because the stimulus materials are unstructured, the client's responses will be determined primarily by unconscious processes and will reveal his/her true attitudes, motivation and modes of behaviour - this notion is referred to as the projective hypothesis  ex. if a client reports seeing eyes in an ambiguous inkblot, the projective hypothesis might be that the client tends toward paranoia  the Rorschach Inkblot Test - the best known projective technique; 3 Abnormal Psychology; Chapter 4 - Clinical Assessment Procedures  in this test, a person is shown 10 inkblots, one at a time, and asked to tell what figures or objects he/she sees in each of them - half the inkblots are in black, white, and shades of grey, two also have red splotches, and three are in pastel colours  the Thematic Apperception Test (TAT) - another well known projective test  in this test, a person is shown a series of black-and-white pictures one by one and asked to tell a story related to each  projective techniques are derived from the psychoanalytic paradigm  the use of projective tests assumes that the respondent would be either unable or unwilling to express his/her true feelings if asked directly  other uses of the Rorschach test, concentrate more on the form of the person's responses - the test is considered more as a perceptual cognitive task, and the person's responses are viewed as a sample of how he/she perceptually and cognitively organizes real-life situations  respondents who see a great deal of human movement in the Rorschach inkblots tend to use inner resources when coping with their needs, whereas those responses involve colour are more likely to seek interaction with the environment  critics of projective testing have been and remain particularly concerned about its use as part of assessment and testimony in the courtroom  another common use is to establish post-traumatic stress dysfunction in personal injury cases - these measures are often used regardless of concerns about their reliability and validity  projective techniques continue to be used across grades for various educational purposes, including determining eligibility for certain programs and indicating intervention needs Intelligence Tests  an intelligent test often referred to as an IQ (intelligence quotient) test - is a standardized means of assessing a person's current mental ability  individually administered tests, such as the Wechsler Adult Intelligence Scale (WAIS), the Wechsler Intelligence Scale for Children (WISC) and the Stanford - Binet, are all based on the assumption that a detailed sample of an individual's current intellectual functioning can predict how well he/she will perform in school  intelligence tests are also used:  in conjunction with achievement tests, to diagnose learning disabilities and to identify areas of strengths and weaknesses  to help determine whether a person is mentally retarded  to identify intellectually gifted children  as part of neuropsychological evaluations  those with a score below 70 are considered to have "significant subaverage general intellectual functioning"  those with above 130 are considered "intellectually gifted"  IQ tests are highly reliable and have good criterion validity - they distinguish between individuals who are intellectually gifted and individuals with mental retardation 4 Abnormal Psychology; Chapter 4 - Clinical Assessment Procedures  IQ tests measure only what psychologists consider to be intelligence - the tasks and items on the IQ tests were created by psychologists  high levels of emotional intelligence are associated with greater levels of subjective well-being and reduced proneness to depression Behavioural and Cognitive Assessment and Case Formulation  traditional assessment concentrates on measuring underlying personality structures and traits  cognitive-behavioural clinicians develop a specific case formulation for each client  a case formulation is "a provisional map of a person's presenting problems that describes the territory of the problems and explains the processes that caused and maintain the problem"  it includes a clinician's inferences about underlying processes that can be tested as a hypotheses  it is used as the basis for planning interventions and evolves over time as further information is discovered  behaviourally oriented clinicians often use a system that involves the assessment of four sets of variables - referred to by the acronym SORC  S - stimuli, the environmental situations that precede the problem  O - organismic, referring to both physiological and psychological factors assumed to be operating "under the skin"  R - overt responses, behavioural clinicians must determine what behaviour is problematic as well as the behaviour's frequency, intensity and form  C- consequent variables, events that appear to be reinforcing or punishing the behaviour in question  alternative approaches to individual cognitive-behavioural case formulation have been described - these approaches emphasize on cognitive events such as people's distorted thinking patterns, negative self-instructions, irrational automatic thoughts and beliefs and schemas  case formulation is an essential step to providing effective, purposive treatment, particularly for complex presentations  the Casual Analysis and Synthesis of Events (CASE) system is a comprehensive, systematic, but flexible method intended to be useful when dealing with both interpersonal and intrapersonal clinical problems Direct Observation of Behaviour  behaviour therapists try to fit events into a framework consistent with their point of view  in formal behavioural observation - the observer divides the uninterrupted sequence of behaviour into various parts and applies terms that make sense within a learning framework  the behavioural clinician's way of conceptualizing a situation typically implies a way to try to change it  since it is difficult to observe most behaviour, many therapists contrive artificial situations in their consulting rooms or in a lab so they can observe how a client acts under certain conditions  observational techniques can also be applied within a framework that makes use of mediators 5 Abnormal Psychology; Chapter 4 - Clinical Assessment Procedures Self-Observation  behaviour therapist & researchers ask individuals to observe their own behaviour and to keep track of various categories of response - this approach is called self-monitoring  self-observation has also been referred to as ecological momentary assessment or EMA  EMA involves the collection of data in real time as opposed to having people reflect back over some time period and report back their thoughts, moods and stressors  main reason for using EMA is that the retrospective recall of moods, thoughts, or experiences may be inaccurate ex. recalled information can be biased  EMA can be useful in clinical settings - revealing information that traditional assessment procedures might miss  behaviour may be altered by the very fact that it is being self-monitored - the self-consciousness required for self-monitoring affects the behaviour  the phenomenon of behaviour changing because it is being observed is called reactivity Interviews & Self-Report Inventories  the behaviour therapist's job is to determine, by skillful questioning and careful observation of the client's emotional reactions during the interview  behaviour therapists make use of self-report inventories, some are similar to the personality tests but others have a greater situational focus  a widely employed cognitive assessment methods are also self-report questionnaires that tap a wide range of cognitions, such as fear of negative evaluation Specialized Approaches to Cognitive Assessment  a key feature of contemporary approaches in cognitive assessment is that the development of methods is determined by theory as well as by the purposes of the assessment  researchers employing cognitive assessment set themselves the task of trying to identify different kinds of cognitions - they obtain their ideas both from clinical reports of practitioners who have first- hand experience wit
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