Chapter 4: Clinical Assessment and Procedures
Reliability and Validity
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
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 is generally related to whether a measure fulfills its intended
Validity is related to reliability: unreliable measures will not have a good
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
The interviewer uses language as the principal means of finding out about
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
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
Exactly how information is collected is left largely up to the particular
interviewer and also depends on the responsiveness and responses of the
Reliability for initial clinical interview of new clinicians is probably low as
clinicians are still learning their own techniques.
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
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 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
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
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
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
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
They help determine whether a person is mentally retarded or intellectually
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
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
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,
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
An important aspect of behavioral assessment is intervention. The behavioral
clinician's way of conceptualizing a situation typically implies a way to try to
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-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.