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Chapter 13

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Department
Psychology
Course
PSY100H1
Professor
David Goldstein
Semester
Fall

Description
Chapter 13: Clinical Instruments and Methods Introduction 1. The tests and techniques covered here have some similarities to the tests of normal personality traits covered in the previous chapter, but they also have differences. 2. The most obvious similarities between the two categories lie in the nature of the test items and response formats. 3. A second similarity is that the two categories are conveniently subdivided into comprehensive instruments and specific domain instruments. 4. Tests in both categories have used similar strategies for development, although criterion-keying has been more important for the clinical instruments. 5. Tests in both categories also share the concern about response sets and faking. 6. There are several differences and the most obvious is their respective orientation. Tests in this chapter relate primarily to psychopathology or at least to some personal difficulty. 7. The clinical instruments are almost always administered on an individual basis, specifically in a clinical setting. 8. The manuals for clinical instruments emphasize use of the results for diagnosis, treatment, planning and follow-up evaluation. The Clinical Interview as Assessment Technique 9. The interview is not a single, specific test, thus it cannot be directly compared with other specific tests. 10. Concern about the technical adequacy of the traditional clinical interview, augmented by the demands of managed care, has led to the development of the structured clinical interview. Unstructured, Semistructured and Structured Interviews 11. The unstructured interview, sometimes called the "traditional" interview, follows no particular pattern and varies from one client to another as well as from one clinician to another. 12. The structured clinical interview aims to cover the same topics, with the same questions, with every client. Furthermore, there is a specific record of responses, not just a general impression or recollection. 13. The semistructured approach falls between the two approaches. It has some standard questions, but it is partly tailored to the individual client. The DSM 14. One cannot understand most of the contemporary structured interviews without reference to the Diagnostic and Statistical Manual of Mental Disorders. 15. It is the common standard for diagnostic labels in contemporary clinical practice and has assumed enormous importance for communicating among professionals. 16. The main outcome in using the DSM is arrival at a diagnostic category, essentially a label and thus, results in a nominal classification, although some categories have subdivisions for varying levels of severity. 17. It is symptom oriented. 18. These three features provide the basis for most structural clinical interviews: determine symptoms, leading to classification in DSM-IV. Structured Clinical Interview for DSM-IV Axis I Disorders 19. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) is the most widely referenced of the structural clinical interviews. 20. How the SCID-I-CV works: (1) There is an Administration Booklet, containing questions and directions for proceeding, and a Scoresheet for recording and coding responses. (2) After recording basic identifying information, start with one of the major DSM categories (these categories correspond to SCID modules) (3) Ask questions about symptoms (4) record responses, but also code responses, indicating presence (+), absence (-) or inadequate information (?) (5) follow the "skip out" rules (6) when the interview has been concluded, complete the Diagnostic Summary. 21. The "absence" code applies not only to complete absence of the symptom, but also to what are called "subthreshold" levels-that is something not up to the level indicated as clinically significant in the DSM. 22. The "skip-out" rules direct the interviewer to discontinue asking questions in a particular category when it becomes apparent that it is not fruitful to continue pursuing that category. 23. It should be emphasized that the clinical interview is not intended to be the only source of information about a client. The Employment Interview: A Sidebar 24. Virtually everything said about the clinical interview applies equally well to the employment interview, except that the goal is employee selection rather than diagnosis. 25. Paralleling the specificity and relevance criteria used in the structured clinical interview, the structured employment interview emphasizes (a) asking the same questions of all candidates (b) coding responses and (c) concentrating on areas directly relevant to the job. Examples of Comprehensive Self-Report Inventories 26. The structured interviews just covered were typically comprehensive but were distinguished by their interview nature. What we cover next are strictly self-report in nature. The Minnesota Multiphasic Personality Inventory (MMPI) 27. A comprehensive, self-report clinical instrument 28. Weighing in at a hefty 567 items, the MMPI-2 requires 60-90 minutes to complete and may take as much as two hours for examinees with low reading levels or high distractibility levels. 29. The original MMPI had two key features. (1) validity indexes were explicitly used (2) the test used criterion-keying to develop nine clinical scales. 30. The normals were 724 hospital visitors and they served as the basis for T-score and percentile norms. 31. The 1989 revision- there were five main types of revisions. 32. (1) a few items were revised or replaced, esp items with obsolete or gender-specific references (2) clinical scales were now referenced by number rather than by diagnostic terminology (3) entirely new norms were developed (4) several new validity indexes were added (5) the T-score to signal high scores was lowered from 70 to 65. 33. We can divide MMPI-2 scores into six major categories. 34. (1) there are validity indexes. There are four old and 3 new indexes. If one or more of all validity indexes is grossly atypical, than the other scores may not be interpreted at all. 35. The K (correction) score is a score by itself and leads to modification of several clinical scale scores. 36. (2) The 10 clinical scales are the most distinctive scales in the MMPI-2. The clinical scales and traditional validity indexes constitute what are called the basic scales. 37. (3) The third category consists of the content scales which were developed by rational analysis of the items. 38. Number of item per scale ranges from 16-33, with a median of 24 items. Thus the content scales are considerably shorter, on average, than the clinical scales. 39. (4) The fourth category consists of a daunting list of supplementary scales, so many that there may not be a definitive count. 40. (5) The fifth consists of what are called critical items which are literally just reports of responses to individual items. 41. (6) consists of code types- a mechanism for reporting as well as a category of scores 42. MMPI-2 norms are based on 1138 men and 1462 women, 2600 total drawn from six states, several military bases and one Indian reservation. The norm sample is reasonably representative of the US adult population in terms of most characteristics, but overrepresented at higher educational and professional occupational levels. 43. T-scores are the typical reporting medium. 44. There are three major methods for reporting the MMPI-2 scores: profiles, narratives, and code types. 45. One profile form reports the traditional validity indexes and clinical scales and a similarly configured profile is used for the content scales. 46. There are narrative reports like the Minnesota Report: Adult Clinical System-Revised. This extensive report-often 15 pages- incorporates profiles for the validity indexes, clinical scales, content and some supplementary scales, and responses to critical items. 47. Code types are relatively unique to this instrument. They utilize the clinical scale numbers and the letter designations for the traditional L. F and K validity indexes. 48. In actual practice, greatest attention is devoted to the two highest scores and this is called a two point code type. 49. Internal consistency of the validity indexes and clinical scales is generally weak and test-retest reliability is noticeably better. 50. The reliability data are more favorable for the content scales that for the clinical scales even though the content scales are generally much shorter than the clinical scales. 51. Factor analytic studies suggest that the MMPI-2 measures only about four underlying dimensions. The two most well defined of these dimensions are psychotic mentation and neurotic tendencies. The Million Clinical Multiaxial Inventory (MCMI) and the Million Family 52. The MCMI fits in our classification scheme as a comprehensive inventory with an orientation toward the abnormal. 53. A main competitor of the MMPI. 54. The MCMI is a good example of a combined approach to development of a clinical inventory. 55. (1) it begins with an orientation around Millon's theor
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