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Chapter 4

PSYB32_Chapter 4

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 4-Clinical Assessment Procedures  All clinical assessment procedures are ways of finding out what is wrong with a person, what may have caused the problems, and what steps may be taken to improve the persons’ conditions  Note for assessment, are they able to comprehend (reading level) and can they comprehend and go through with assessment (cognitive ability, physical ability) these must be tested FIRST  Note: validity scales used in tests such as NIM (Negative Impression Management) to see if people are faking responses (making it seem as they have an illness) Reliability and Validity in Assessment  The field of psychology psychometrics exists primarily for the study of validity and reliability Reliability  Reliability is consistency of measurement o Inter-rater reliability—the extent that two judges agree about a event o Test-retest reliability—the extent to which people being observed twice, or taking the same test twice, score generally the same o Alternate-form reliability—the extent to which scores on two forms of the test are consistent  Is used because there is a concern that people will remember answers from first test o Internal consistency reliability—assesses whether the items on a test are related to each other  In each of these types of reliability a correlation is calculated between raters or sets of items Validity  Validity is related to whether a measure fulfills it’s purpose  If a question is intended to measure hostility. Does it do so?  Unreliable measures will not have good validity  Content validity refers to whether a measure adequately samples the domain of interest  Criterion validity is evaluated by determining whether a measure is associated in an expected way with some other measure (the criterion)  If both variables are measured at the same time it is called concurrent validity  Criterion validity can also be assessed by evaluating it’s ability to predict another variable that is measured in the future—predictive validity  Construct validity—is the extent that a construct can enter a network of lawful relationships (facts, statements, etc)  It is relevant when we want to interpret a test as a measure of some construct o Ex. Level of anxiety Psychological Assessment Clinical Interviews  An interview is any interpersonal encounter in which the interviewer uses language as the means of finding out about another Characteristics of Clinical Interviews  One way in which a clinical interview is different from a casual conversation is how the interviewer pays close attention to how the respondent answers (or doesn’t answer) questions  The paradigm in which an interviewer operates influences the type of information sought, how it is obtained, and how it is interpreted  Psychodynamic and behavioural clinicians agree that people entering therapy usually are not aware of what is truly bothering them  Most clinicians empathize with clients in an attempt to draw them out  Clinicians often tend to overlook situational factors of the interview that may influence what the patient says or does  Exactly how information is collected is left to the interviewer and depends on the responses and responsiveness of the interviewee  If an interview is unstructured the interviewer must rely on intuition and experience. As a consequence the reliability is low  Because interviews are conducted in confidentiality there is no way to establish reliability or validity  But take into consideration that clinicians also conduct more than one interview Structured Interviews  A structured interview is one in which the questions are set on in a prescribed fashion for the interviewer  Example Structured Clinical Interview Diagnosis (SCID) for Axis I and the SCID-II for Axis II  The SCID is a branching interview, the client’s response to one question determines the next question asked  Most symptoms are rated on a three point scale of severity  Structured interviews are essential to improve validity and reliability of diagnosis Psychological Tests  Psychological tests are designed to measure a person’s performance on a task or to assess his/her personality, thoughts, feelings, and behaviours  If the results of a diagnostic interview are inconclusive, psychological tests can provide info that can be used for diagnosis  Statistical norms for a test can be established as soon as sufficient data is collected (distribute tests and obtain responses) this process is called standardization Personality Inventories  In a personality inventory the person is asked to complete a self-report questionnaire indicating whether statements about habitual tendencies apply to him/her  Minnesota Multiphasic Personality Inventory (MMPI) is intended to detect a number of psychopathology (hence multiphasic)  Is used to screen a large group of people  In developing the test first clinicians provided statements that they considered indicating mental problems.  Second, these items that discriminated among patients were retained  Sets of these items were established as scales for determining how a respondent should be diagnosed  The MMPI-2 was changed to improve it’s validity and reliability  The original sample lacked representation of racial minorities  Some people falsify responses to appear abnormal but most do not because of a desire to be helped  The test includes a validity scale designed to detect fake responses such as the lie scale Projective Personality Tests  A projective test is a psychological assessment device in which a set of ambiguous stimuli are presented to the individual  The assumption is that the stimuli are unstructured so that the patient’s responses will be determined by unconscious processes and will reveal their true attitudes, feelings, motivations—Projective hypothesis  Rorschach Inkblot test a person is shown 10 inkblots  The thematic apprehension test is where the person is shown a series of black and white pictures and are asked to tell a story and the clinician (through projective hypothesis) infer from the responses  Projective techniques are derived from psychoanalytical paradigm  Test is left unclear so as to bypass the defence mechanisms of the ego and to get to the basic causes of distress  The content of a person’s responses are viewed as symbolic of internal dynamic  Other uses of the Rorschach test concentrate on the form of the person’s responses, the person’s responses are viewed as a sample of how they perceptually and cognitively organize life situations  The system may have more validity in some cases than others. Such as for schizophrenia  The Roberts Apprehension Test for Children is like the TAT but provides objective criteria for scoring and normative data and also provides info about a child’s coping skills  Cultural processes are central to responses in the Rorschach but have not received examination Intelligence Tests  Binet constructed tests to see if children needed special schooling  An intelligence test is a standardized way of assessing one’s mental ability  They are used to: o Identify strengths and weaknesses o Determine whether a person is mentally retarded o Determine whether a person is intellectually gifted o As part of neuropsychological evaluations  A score of 70 is two standard deviations (15) below the mean (100) and is considered as having subaverage intellectual functioning  A score of 130 is two standard deviations above the mean and is considered gifted  IQ tests are highly reliable and have good validity  They predict later educational and occupational achievement  IQ tests measure only what psychologists consider intelligence  IQ tests explain only a small part of the differences in people’s school performances  There is interest in emotional intelligence reflected in such abilities as delaying gratification and being sensitive to the needs of others o High levels are associated with greater levels of well being and reduced proneness to depression and alexithymia o Low emotional awareness is a risk factor for adjustment problems Behavioural and Cognitive Assessment  Behavioural and cognitive clinicians use a system that involves the assessment of four variables SORC: o S stands for stimuli (environmental situations) o O stands for organismic, referring to physiological and psychological factors o R refers to overt responses (behaviour frequency, intensity, and form) o C refers to consequences that appear to reinforce or punish behaviours  O variables are underplayed by Skinnerians who focus more on responses, where as cognitive therapists pay less attention to C variables and more to O variables  Cognitive behavioural case formulation is an approach that places more emphasis on cognitive events such as distorted thinking patterns and irrational beliefs/schemas  The information necessary fo
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