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Chapter 4


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University of Toronto Scarborough
Konstantine Zakzanis

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 individuals condition Reliability and Validity in Assessment Reliability - in a general sense, reliability refers to consistency of measurement; there are several types of reliability inter-rater reliability the relationship between the judgments that at least 2 raters make independently about a phenomenon test-rest reliability the relationship between the scores that a person achieves when he/she takes the same test twice I.O.W. it measures the extent to which people being observed twice or taking the same test twice score in generally the same way alternate-form reliability the relationship between scores achieved by people when they complete 2 versions of a test that are judged to be equivalent I.O.W. this refers to the extent to which scores on the 2 forms of the test are consistent internal consistency reliability the degree to which different items of an assessment are related to one another - in each of these types of reliability, a correlation a measure of how closely 2 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 relate very strongly to other measures content validity the extent to which a measure adequately samples the domain of interest - for example an interview used to make an axis I diagnosis has excellent content validity because it contains questions about all the symptoms that are involved in axis I diagnoses criterion validity the extent to which 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) - for example, there is a measure of the distorted thoughts believed to play an important role in depression - criterion validity for this test 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 - alternatively, criterion validity can be assessed by evaluating the measures ability to predict some other variable that is measured in the future; this kind of criterion validity is often called predictive validity - for example, IQ tests were originally developed to predict future school performance; similarly a measure of distorted thinking could be used to predict the development of episodes of depression in the future construct validity the extent to which scores or ratings on an assessment instrument relate to other variables or behaviors according to some theory or hypothesis - construct validity is relevant when we want to interpret a test as a measure of some characteristic or construct that isnt simply defined - a construct is an inferred attribute, such as anxiousness or distorted cognition, that a test is trying to measure - consider an anxiety-proneness questionnaire as an example; the construct validity question is whether the variation we observe between people on a self-report test of anxiety proneness is really due to individual differences in anxiety proneness - just because we called our test a of measure anxiety-proneness and the items seem to be about the tendency to become anxious, it is not certain that the test is a valid measure of anxiety proneness - another example; people diagnosed as having an anxiety disorder and people without such a 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 - if the measure has construct validity, we would expect scores of patients with anxiety disorders to become lower after a course of a therapy that is effective in reducing anxiety Psychological Assessment - psychological assessment techniques are designed to determine cognitive, emotional, personality, and behavioral factors in psychopathological functioning Clinical Interviews - we interpret the term interview as any interpersonal encounter, conversational in style, in which one person, the interviewer, uses language as the principal means of finding out about another, the interviewee Characteristics of Clinical Interviews clinical interview a conversation between a clinician and a patient that is aimed at determining diagnosis, history causes for problems, and possible treatment options - the paradigm within which an interviewer operates influences the type of information sought, how it is obtained, and how it is interpreted - clinicians recognize the importance of establishing a relationship with the client; the interviewer must obtain the trust of the person so then the person can open up to them more easily - most clinicians empathize with their clients in an effort to draw them out, to encourage them to elaborate on their concerns, and to examine different facets of a problem - it is important to look at situational factors of the interview that may exert strong influences on what the patient says or does; for example, if a teen is asked how long have you been smoking weed?; they would likely be honest to a young, informally dressed psychologist rather than a 60 year old psychologist in a business suit - interviews 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 - to the extent that an interview is structured, the interviewer must rely on intuition and general experience - thus, reliability for initial clinical interviews is probably low; that is, 2 interviewers may well reach different conclusions about the same patient - both reliability and validity may indeed by low for a single clinical interview that is conducted in an unstructured fashion; but clinicians usually do more than 1 interview with a given patient, and hence a self- corrective process is probably at work Structured Interviews structured interview an interview in which the questions are set out in a prescribed fashion for the interviewer; assists professionals in making diagnostic decisions based upon standardized criteria - the Structured Clinical Interview Diagnosis (SCID) is a branching interview; that is, the clients response to one question determines the next question that is asked - it also contains detailed instructions to the interviewer concerning when and how to probe in detail and when to go on to questions bearing on another diagnosis - most symptoms are rated on a 3-point scale of severity, with instructions in the interview schedule for directly translating the symptom ratings into diagnoses - the use of structured interviews is a major factor in the improvement of diagnostic reliability - with adequate training of clinicians, inter-rater reliability for structured interviews is generally good Psychological Tests psychological tests standardized procedures designed to measure a persons performance on a particular task or to assess his/her personality - 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 further 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 standardization the process of constructing an assessment procedure that has norms and meets the various psychometric criteria for reliability and validity - there are 3 types of psychological tests: self-report personality inventories, projective personality tests, and tests of intelligence Personality Inventories personality inventory a self-report questionnaire by which an examinee indicates whether statements assessing habitual tendencies apply to him/her Minnesota Multiphasic Personality Inventory (MMPI) a lengthy personality inventory by which individuals are diagnosed through their true-false replies to groups of statements indicating states such as anxiety, depression, masculinity-femininity, and paranoia - MMPI is the best-known and most frequently used and researched psychological test in the US - MMPI is called multiphasic because it was designed to detect a number of psychological problems - there are 10 scales - the MMPI-2 has several noteworthy changes designed to improve its validity and acceptability - the new version was standardized using a sample that was much larger and more representative of 1980 US census figures - several items containing allusions to sexual adjustment, bowel and bladder functions, and excessive religiosity wee removed because they were judged in some testing contexts to be needlessly intrusive and objectionable; sexist wording was removed, along with outmoded items - MMPI is reliable and has adequate criterion validity when it is related to ratings made by spouses or clinicians Projective Personality Tests
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