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Chapter 4

Chapter 4 -.doc

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PSYC 3140
Joel Goldberg

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Chapter 4 Clinical Assessment Procedures May 27, 2008 Reliability and Validity in Assessment Reliability • Generally, reliability refers to consistency of measurement • Interrater reliability: the degree to which two independent observers or judges agree • Test-retest reliability: measures the extent to which people being observed twice or taking the same test twice (maybe even several weeks or months apart), score in generally the same way o Only makes sense when the theory assumes that people will not change appreciably between testing on the variable being measured (ex. IQ) • Alternate-form reliability: using two forms of tests rather than giving the same test twice, perhaps when there is concern that people will remember their answers from the first test and aim merely to be consistent • Internal consistency reliability: assesses whether the items are related to one another (like on an anxiety questionnaire all the questions are related to anxiety) -In each of these types of reliability, a correlation (measure of how closely 2 variables are related) is calculated b/w raters or sets of itemsThe higher correlation, the better the reliability Validity • Generally, is related to whether a measure fulfills its intended purpose • Related to validity; unreliable measure will not have good validity • Content validity: whether a measure adequately samples the domain of interest • Criterion validity: evaluated by determining whether a measure is associated in an expected way with some other measure (the criterion) o Aka. Concurrent validity o That is actually shows that say depressed people show depressed scores and not depressed people don’t o Predictive validity: evaluating the ability of the measure to predict some other variable that is measured in the future (IQ on future school experience) • Construct validity: relevant when we want to interpret a test as measure of some characteristic or construct that is not simply defined (like anxiousness or distorted cognition) o Evaluated by looking at a wide variety of data from multiple scores o Is an important part of the process of theory testing Psychological Assessment • Designed to determine cognitive, emotional, personality, and behavioural factors in psychopathological functioning Clinical Interviews • The interviewer uses language as the principle mean to finding out about another • Different from a normal interview: the interviewer’s attention on how the respondent answers or does not answer the question (attentive to any emotion as well) • The paradigm w/in which an interviewer operates influences the type of information sought, how it is obtained, and how it is interpreted • They will inquire about the persons childhood history (psychoanalytical), current environmental conditions (behavioural) • The interviewer must obtain the trust of that person • Therapists empathize with their clients in order to get information out • Clinicians have a vague outline, but they all use different strategies of interviewing • Each clinician develops ways of asking questions with which he or she is comfortable and that seem to draw out information that will maximum benefit the client • Unstructured interview, so they must rely on intuition and general experience • Reliability for initial clinical interview is probably low (two interviewers may reach different conclusions about a client) , also validity is hard to confirm Structured interviews: one in which the questions are set out in a prescribed fashion for the interviewer o Structured Clinical Interview Diagnosis (SCID) for Axis 1 of DSM-IV  Branching interview (client response to one question determines the next question asked)  Rated on a 3 point scale of severity  Improvement of diagnostic reliability  Also developed for diagnosing personality disorders and more specific disorders (anxiety disorders) Psychological Tests • Psychological tests: standardized procedures designed to measure a person’s performance on a particular task or to assess his or her personality • It yields important information in their own right, such as personality characteristics or situational determinants of a person’s problems • The same test is administered to many people at different times • Standardization: statistical norms for the test can thereby be established as soon as sufficient data have been collected • 3 types of psychological tests: self-report personality inventories, projective personality tests, and tests of intelligence Personality Inventories o Person is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her o Minnesota Multiphasic Personality Inventory (MMPI): an inexpensive means of detecting psychopathology and detect a number of psychological problems (multiphasic)  Best known and most frequently used and researched  Widely used to screen large groups of ppl for whom clinical interviews are not feasible  MMPI – 2 has several designs to improve validity and acceptability  It has a difference in including minority groups. needless topics and sexist wording were removed  Reference to sexual adjustment, bowel and bladder functions, and excessive religiosity were removed o There is a validity scale that is designed to detect deliberately faked responses  Lie scale: a series of statements set a trap for the person who is trying to look too good (their scores would be viewed with more scepticism) Projective Personality Tests: psychological assessment device in which a set of standard stimuli-inkblots or drawings – ambiguous enough to allow variation in response is presented to the individual (unstructured material, and the unconscious process will reveal their true attitudes, motivations and modes of behaviour = projective hypothesis) o Rorschach Inkblot test: best known for its projective techniques (they are shown 10 inkblots at a time and asked to tell what figures or objects he or she sees in each of them) – there is black, white, greys, red splotches, and 3 pastel colors o Thematic Apperception Test (TAT): another well known projective test. They are shown a series of black and white pictures and asked to tell the story o Projective tests are to reduce the defence mechanisms of repression and get to the basic cause of distress o The content of the person’s responses is viewed as symbolic of internal dynamics (E.g. a man who sees buttocks in one of the inkblots might be judged to have homosexual interests) o Other uses of the inkblot test concentrate on the form of the person’s responses. The person’s responses are viewed as a sample of how he or she perceptually and cognitively organizes real life situations. o The Roberts Apperception Test for Children illustrates how the use of projective tests has evolved to provide more standardized, objectively scored assessment tools. This test is similar to the TAT, but the Roberts test provides objective criteria for scoring, along w/ normative data to determine whether the child’s pattern of responses is abnormal o Cultural processes are central to responses on the Rorschach but haven’t received adequate empirical examination Intelligence Tests o Originally Binet constructed a mental test to help a school board predict which children are in need for help o Aka. IQ test o Intelligence test: a standardized means of assessing a person’s current mental ability o Wechsler Adult Intelligence Scale (WAIS) and for children (WISC) o Standford-Binet test. They are all based on the assumption that a detailed sample of individuals current intellectual functioning can predict how well he or she will perform in school o They are also used:  In conjunction with achievement tests to diagnose learning disabilities and identify strength and weakness areas  To Help determine whether a person is mentally retarded  To Identify intellectually gifted children so that appropriate instruction can be provided to them in school  As a part of Neuropsychological evaluations o They include language skills, abstract thinking, nonverbal reasoning, visual- spatial skills, attention and concentration, and speed of processing o Scores on most IQ tests are standardized so that 100 is the mean and 15 or 16 is the standard deviation (a measure of how scores are dispersed above and below the average). Approx 65% receive between 85-115 o Those with below 70 are 2 standard deviations below the mean of the population and have significant sub-average intellectual functioning o Those with above 130 are considered intellectually gifted (2.5% falls in each extremes) o They are highly reliable and have good criterion validity – but only measure what psychologist consider intelligence. Doesn't take in the account of emotional intelligence for E.g. o Alexithymia: high levels of emotional intelligence leads to reduced emotional awareness that is a risk factor for a variety of adjustment problems. But High levels of emotional intelligence are also associated w/ greater levels of subjective well-being and reduced proneness to depression. Behavioural and Cognitive Assessment • Traditional assessment concentrates on measuring underlying personality structures and traits (E.g. obsessiveness, paranoia, coldness, aggressiveness) • Behavioural and cognitive clinicians use a system that involves the assessment of 4 sets of variables, SORC o S (Stimuli): the environmental situation that precede the problem (the situations that cause the problem) o O (organismic): physiological and psychological factors assumed to be operating under the skin (ex. Fatigue caused by alcohol) o R (overt responses): determining what behaviour is problematic, the frequency, intensity and form o C (consequent): events that appear to be reinforcing or punishing the behaviour in question • O receives the most attention, C the least • Cognitive and cognitive-behaviour therapists put more emphasis on cognitive events such as people’s distorted thinking patterns, negative self instructions, irrational automatic thoughts and beliefs, and schemas • Pearsons and Davidson have described an approach that formulates an individualized cognitive-behavioural “theory” about a particular case w/ a view to helping a therapist develop an effective and efficient plan for treatment • This formulation is based on a general cognitive-behavioural therapy • Purpose: explain how a client’s problems relate to one another in order to help the therapist select treatment “targets” o 5 components of their approach:  Problem list: includes the difficulties the client is having in various domains (psychological, interpersonal, occupational, medical, financial, housing, legal, and leisure). Usually a list is made of these  Diagnosis: diagnoses can lead to initial hypotheses about how to formulate the case and provide information about possible interventions  Working Hypothesis: “heart” of Pearson and Davidson’s formulisation. the mini theory of the case develops through adaption of general theory and describes relation among the problems • It describes the hypotheses about the negative schemas that appear to cause the problem, or activating situations • It tells a story of the relations among the components of the problem list  Strengths & Assets: this information can help the therapist develop the working hypothesis, enhance the treatment plan, and assist in determination of realistic treatment goals  Treatment plan: based directly on the cognitive-behavioural case formation and has 6 components: goals, modality, frequency, initial interventions, adjunct therapies, and obstacles (goals and obstacles are very important) Direct Observation of Behaviour -The information necessary for behavioural or cognitive assessment is gathered by several methods, including direct observation of behaviour in real life, interview and self report measures • Behavioural observation: the observer divides the uninterrupted sequence of behaviour into various parts and applies terms that make sense w/in a learning framework • Behaviour therapists focus a lot on overt behaviour in a variety of settings. They can also show the present of an internal state as well (presentation and anxiety scale) Self-observation Self monitoring: the client is asked to self observe instead of the therapist and keep tract of various categories of response o Stressful experiences, coping behaviours, and thoughts • Self observation is also referred to as ecological momentary assessment (EMA) o Involves a collection of data in real time as opposed to the more usual methods of having people reflect back over some time period and report on recently experience thoughts moods and stressors (diaries) o The main reason for using this, is because sometimes recalling from memory (retrospect recall) can be inaccurate or bias o But sometimes just the fact that one knows they are self monitoring may produce inaccurate recording (reactivity) o Also useful in clinical settings, revealing information that traditional assessment procedures might miss Interviews and self-report inventories • Interviews and self-reports are done by skilful questioning and careful observation of the client’s emotional reaction during the interview and SORC factors • The most widely employed cognitive assessment method are self report questionnaires Specialized approaches to cognitive assessment • when patients are asked about their thoughts in interviews and self-report inventories, they have to reflect backward in time and provide a retrospective report of their thoughts in certain situations. This can be inaccurate information. • Researchers employing cognitive assessment set themselv
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