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Chapter 4

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Department
Psychology
Course
PSYB32H3
Professor
Konstantine Zakzanis
Semester
Summer

Description
Chapter 4: Clinical Assessment and Procedures Reliability and Validity Reliability  Reliability refers to the consistency of measurement. The higher the correlation, the better the reliability.  There are several types of reliability:  Inter-rater reliability: the degree to which two independent observers or judges agree.  Test-retest reliability: the extent to which people being observed twice are taking the same test twice, perhaps several weeks or months apart, score in generally the same way. An example of a situation in which this type of reliability makes sense is in evaluating intelligence tests.  Alternate-form reliability: the extent to which scores on two forms of the test are consistent. Sometimes, psychologists use two forms of a test rather than giving the same test twice, perhaps when there is a concern to people will remember their answers from the first test.  Internal consistency reliability: determines whether the items on the test are related to one another. In an anxiety questionnaire containing 20 items, we would expect items to be interrelated, or to correlate with one another, if they truly tap anxiety. For example, a person for reports dry mouth in a threatening situation would be expected to report increases in muscle tension as well. Validity  Validity is generally related to whether a measure fulfills its intended purpose.  Validity is related to reliability: unreliable measures will not have a good validity.  Content validity: refers to whether a measure adequately samples the domain of interest.  Criterion validity: evaluated by determining whether a measure is associated in an unexpected 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). For example criterion validity for a test can be established by showing that the test is actually related to a disorder; E.g. depressed people score higher on the test than do non– depressed people.  Construct validity: when you want to interpret a test as a measure of some characteristic or construct that is not simply defined. For example people vary in their willingness to admit to undesirable characteristics such as anxiety proneness; and thus scores on the questionnaire might be partly determined by this characteristic. Construct validity is evaluated by looking at a wide variety of data from multiple sources. Psychological Assessment  Psychological assessment techniques are designed to determine cognitive, emotional, personality, and behavioral factors in psychopathological functioning. Clinical Interviews  The interviewer uses language as the principal means of finding out about another person. Characteristics of a Clinical Interview  In a clinical interview, the interviewer pays much attention to how the respondent answers-or does not answer. The clinician may be attentive to emotions accompanying speech.  The paradigm within which an interviewer operates influences the type 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.  The behaviorally oriented clinicians likely to focus on current environmental conditions that can be related to changes in the person's behavior.  Like scientists, clinical interviews in some measure find only the information for which they are looking for.  The interviewer must obtain the trust of the person.  Psychodynamic clinicians assume that people entering therapy usually are not even aware of what is truly bothering them.  Behavioral clinicians, although concentrate more on what can be observed, also appreciate the difficulties people have in sorting out the factors responsible for their distress.  Most clinicians empathize with their clients in an effort to draw them out.  For humanistic therapists, a simple summary statement of what the client has been saying can help sustain the momentum of talk about painful and possibly embarrassing events and feelings, and in accepting attitude toward personal disclosures dispel the fear that revealing secrets of the heart to another human being will have disastrous consequences.  The information learned through these interviews may not always be dependable  Exactly how information is collected is left largely up to the particular interviewer and also depends on the responsiveness and responses of the interviewee.  Reliability for initial clinical interview of new clinicians is probably low as clinicians are still learning their own techniques. Structured Interviews  A structured interview is one in which the questions are set out in its prescribed fashion for the interviewer. Investigators have developed structured interviews, such as the Structured Clinical Interview Diagnosis(SCID) for axis I of the DSM-IV.  In the SCID, the client’s response to one question determines the next question that is asked. It contains detailed instruction to the interviewer concerning when and how to probe in detail and want to go on to questions bearing on another diagnosis.  Most symptoms are rated on a three-point scale severity.  The use of structured interview is a major factor in the improvement of diagnostic reliability.  Structured interviews also been developed for diagnosing personality disorders and more specific disorders such as anxiety disorders.  The inter-rater reliability for structured interviews is generally good.  The SCID has been recommended for clinicians who are pressed for time and wish to evaluate the possible existence of selected axis I disorders. Psychological Tests  Psychological tests are standardized procedures designed to measure a person's performance on a particular task or to assess his or her personality, or thoughts, feelings, and behavior.  If results of a diagnostic interview are questionable, psychological tests can provide information that can be used in a supplementary way to arrive at a diagnosis.  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. The process of establishing the statistical norms for a test is called standardization. Personality Inventories  In personality inventories, the person is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her.  Minnesota's Multiphasic Personality Inventory (MMPI) is the most frequently used and researched psychological test. This inventory test is called multiphasic because it was designed to detect a number of psychological problems. If an individual answered a large number of the items in a scale in the same way as had a certain diagnostic group, his or her behavior is expected to resemble that of the particular diagnostic group.  The old version of this inventory test lack of representation of racial minorities. The new version was standardized using a sample that was much larger and more representative than 1980 US Census figure. A new scale that deals with substance abuse, type a behavior, and marital problems were added to the new version.  There are validity scales included in the MMPI designed to detect deliberately fake responses. Projective Personality Test  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.  This assumes that because the stimulus materials are unstructured, the clients response will be determined primarily by unconscious processes and will reveal his or her true attitudes, motivations, and modes of behavior. This notion is referred to as projective hypothesis.  The Rorschach Inkblot test is a test in which a person is shown 10 inkblots, one at a time, and asked to tell what figures are objects he's or she sees. Half the inkblots are in black and white and shades of gray, tw have red splotches, and three are in pastel colors.  The Thematic Apperception Test is a test in which a person is shown a series of black-and-white pictures one by one and asked to tell a story related to the picture.  These projective techniques are derived from the psychoanalytic paradigm. This paradigm assumes that the respondent would not be able to express his or her true feelings if asked directly. The content of the person's responses was viewed symbolic of internal dynamics.  Other forms of the Rorschach test treats it as a perceptual – cognitive task; the person's responses are viewed as a sample of how he or she perceptually and cognitively organizes real-life situations.  In Roberts Apperception Test for Children, the scoring technique of this Thematic Apperception Test provides objective criteria for scoring, along with normative data to determine whether the child's pattern of responses is abnormal. This is unlike the Thematic Apperception Test for adults that are impressionistic and nonstandardized.  Critiques of projective testing have been and remain particularly concerned about its use as part of assessment and testimony in the courtroom.  Schools in the US use projective techniques for various educational purposes including determining eligibility for certain programs and indicating intervention needs. Intelligence Tests  Intelligence test, often referred to as an IQ test, is a standardized means of assessing a person's current mental ability.  The WAIS and the 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 or she will perform in school.  Intelligence tests are used in conjunction with achievement tests, to diagnose learning abilities and to identify areas of strengths and weaknesses for academic purposes.  They help determine whether a person is mentally retarded or intellectually gifted.  Intelligence tests are used as part of neuropsychological evaluations. For example, the periodic testing of a person believed to be suffering from a degenerative dementia so that the deterioration of mental ability can be followed over time.  IQ tests language skills, abstract thinking, non-verbal reasoning, visual – spatial skills, attention and concentration, and speed of processing.  The mean is 100.  15 or 16 is the standard deviation.  Those with a score below 70 are 2 standard deviations below the mean of the population and are considered to have significant sub average general intellectual functioning. Those with scores above 130 are considered intellectually gifted.  IQ tests are highly reliable and have good criterion validity.  Regarding construct validity, it is important to keep in mind that IQ test measure only what psychologists consider to be intelligence.  High levels of emotional intelligence are associated negatively with alexithymia, a condition of reduced emotional awareness that is a risk factor for a variety of adjustment problems high levels of emotional intelligence are also associated with greater levels of subjective well-being and reduced proneness to depression. Behavioral And Cognitive Assessment and Case Formulation  Traditional assessment concentrates on measuring underlying personality structures and traits, such as obsessiveness, paranoia, coldness, aggressiveness and so on.  Cognitive behavioral clinicians develop a specific case formulation for each client. 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 maintained the problem.  This includes underlying processes that can be tested as hypothesis  Behaviorally oriented clinicians often use a system that involves the assessment of four sets of variables (SORC) o s stands for stimuli, and environmental situations that precede the problem o o stands for organismic, referring to both the physiological and psychological factors assumed to be operating under the skin. For example the Teague's cost in part by excessive use of alcohol or by a cognitive tendency toward self deprecation manifested in such statements as “I never do anything right” o r refers to overt responses. Clinicians must determine which behavior is problematic, as what is the behaviors frequency, intensity, and form o C refers to, consequent variables, events that appear to be reinforcing or punishing the behavior in question.  Followers of Skinner who focuses more on observable stimuli and responses underplay the organismic variable.  Consequent variables received less attention from cognitively oriented therapist then organismic variables because the therapist perspective does not typically emphasize reinforcement.  Cognitive – behavioral case formulation: this approach place considerably more emphasis on cognitive events such as people’s distorted thinking patterns, negative self instructions, irrational automatic thoughts and beliefs, and schemas.  Complex psychological problems can present a challenge for clinicians from the perspective of assigning diagnosis, assessing and conceptualizing the problems, identifying obstacles to treatment, developing an appropriate and effective treatment plan.  Transtheoretic approach: an approach that is not specific to only a cognitive – behavioral case formulation. Direct Observation of Behaviour  Behavioral observation: the observer divides the uninterrupted sequence of behavior into various parts and applies terms that make sense within the learning framework  An important aspect of behavioral assessment is intervention. The behavioral clinician's way of conceptualizing a situation typically implies a way to try to change it.  Because it's difficult to observe this behavior, many therapists contrive artificial situations and are consulting rooms are in a laboratory so they can observe how a client or family acts under certain conditions. Self Observation  Self-monitoring: researchers may ask individuals to observe their own behavior and keep track of various categories of response. This method has been used to gather data about moods, stressful experiences, coping behaviors, and thoughts.  Self-observation has also been referred to as ecological momentary assessment (EMA). This involves the collection of data and real-time as opposed to people having to reflect back over some time period. This method can include having people complete diaries to supplying them with handheld computers allows them to enter their responses directly into the computer.  The retrospective recall of moods, thoughts, or experiences may be inaccurate and thus have been eliminated in this method.  Recalling the information can be biased.  Research indicat
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