assessment approaches steve del chiaro, psyd. san josé state university [psyc 160]
TRANSCRIPT
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Assessment vs. Classification Classification categorizes Assessment may lead to
Determining a diagnosis Determining a specific treatment Determining impact of a treatment during
course of therapy Determining outcome of treatment
This all depends on our theory of pathology of course…
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Remember: Assumptions Matter
Assumptions cover everything! Assumption of causality dictate our
Assumptions of pathology what counts as “sick” or “problematic”?
Assumptions of etiology where does it come from?
Assumptions of assessment how do we know what it is? how do we measure it?
Assumptions of curative factors how do we “fix” it?
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Approaches to Assessment
Testing One assessment Variety of assessment devices
(battery) Interview
Structured, semi-structured, and unstructured
Observational Methods
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When to Assess Beginning of treatment
Determine choice of intervention or intervention strategy
End of Treatment Determine whether intervention was
effective THROUGHOUT treatment
Determine if intervention is having impact
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General Considerations Assessment approaches
Should be consistent across the treatment
Should have impact on what is done e.g. have bearing on intervention
Should attempt to measure variables of interest
Try to answer the Paul question What treatment by whom, for what problem, etc.
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Psychological Tests Structured assessment process Nomothetic tests
Large groups used to develop test Normed tests
Some of these have been normed statistically Normed = standardized across population or
populations Assessed for psychometric properties Look at individual with respect to group
scores
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Nomothetic Tests Rapid Assessment Instruments
(RAIs) BDI, BAI, SCL, DAS, etc Purpose: get meaningful data quickly Good for research May miss key clinical issues Not especially geared to client
problems
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Projective Tests Psychoanalytic tradition
Look for evidence of hidden unconscious problems
Cannot directly access unconscious Allow patient/client/analysand to
project own issues onto ambiguous stimulus materials
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Rorschach (ink blot test) Give unstructured or ambiguous stimuli to
which the patient or client responds This allows access to unconscious
material: attitudes, motivations; behavior styles
Major problems with reliability and validity Remember reliability and validity types
Typically used by psychoanalytic or psychodynamic therapists
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Thematic Apperception Test (TAT) Show a story card Ask the client what's going on in
this picture? Allows access to unconscious
material
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Drawing Tests House Tree Person (John Buck)
Given to children "Here I want you to draw as good a
house as you can." Do this for tree and person, too
House interpretations “Loosely based on research and on the
symbolic meaning of the aspects of the house.”
Exercise
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Critical Thinking Moment What are the challenges with
projective tests? Why would we used them? Are there arguments for using
them? What if they are not consistent
with your paradigm/theory?
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Objective Tests Roots in empirical tradition Objective measures utilize highly
structured response formats Consist of unambiguous stimulus items
Forced choice (e.g., true/false) Likert scale ratings
Result in a quantitative score that can be compared with normative score data Require minimal inference in scoring and
interpretation
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Objective Tests Disadvantages
Items can clue to what is being measured
social desirability biases faking
Forced-choice responses Misinterpretation of items
Especially double negative phrases Also with “double barreled” questions
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Objective Tests Minnesota Multiphasic Personality
Inventory II (MMPI-II) Most widely used objective test
Designed to screen patients for various psychological disorders
Most widely used in research MMPI-II was re-normed MMP-I was considered out dated
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MMPI Over 500 items
True/False responses 2 parts of MMPI:
Validity scales Tell whether profile is accurate measure of taker
& whether taker answered honestly 3 validity scales
Clinical scales What test tells about how taker is doing clinically 10 scales
Pattern is interpreted not one scale (1-0)
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MMPI Empirically derived test
AKA empirically keyed test Developed by Hathaway and McKinley
in 1942 Gave test to find out what
responses match personality styles
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Empirically Keyed test Step 1: Generate items
Need a lot of items Response format will be True/False
Step 2: Have two samples respond to items A sample of depressed people A sample of people that are not
depressed
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Empirically Keyed test Step 3: Compare each groups’
responses to each item Example
Building a measure of depression (MMPI Subscale)
Self-Assessment of Depression (SAD)
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% of Saying True
Item Depressed Non-
Depressed Key
Empirically Keyed test
I am a happy person. 4 52 F
I often feel blue. 75 30 T
My eyes are too far apart. 8 10 --
Sometimes my hair hurts. 60 15 T
I sunburn easily. 25 31 --
I like the color green. 27 85 F
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Empirically Keyed test Step 4: Cross-Validate
Give the measure to two new samples of depressed and non-depressed people
Evaluate how well the scale differentiates the samples
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Empirical Keying Approach Advantages
No assumptions about capability to self-report behavior
Researchers can assess poorly defined constructs
Explicitly built to differentiate groups Disadvantages
Test takers often don’t like it Tends to be long Will make very general statements (may not
be accurate)
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MMPI Look at pattern of responding
Look at clinical scales in context of validity scales
Look at each clinical scale in context of the rest of the scales
This is complex and requires very specific training
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MMPI Advantages
No assumptions about capability to self-report behavior
Great for teasing out fakers and other invalid profiles
Enormous data base to compare results Disadvantages
Historically overpathologized certain groups Will make very general statements (may not
apply) Some clinicians find better use of that time
used to take test
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Psychological Tests Idiographic assessment approaches
Examine changes for specific individual on assessment based on that person
Want to look at data for each individual Remember single-case designs
example, Functional Analysis (Ch 9)
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Idiographic Assessment Want to know when, where, what it buys Look at variables of interest (frequency,
strength, duration) Examine in different situations of interest
(home, school, work, institution) Self-report data (Self-Monitoring)
Subject to reactivity Increases desirable and decreases undesirable
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Clinical or Behavioral Interviewing Assessment Interviews
Different contexts: Legal Therapeutic Others?
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Clinical or Behavioral Interviewing Attempt to get as much information
from client as possible Again, depends on what the
question is, the purpose of the interview
Arrange this material in way that allows one to take action with client
Different theories yield different strategies
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Interviewing Key is to be able to do some
intervention with the client Need to look at variables such as
ethnicity and gender Important to enlist the client’s help
to do this
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Interviewing Rapport building Make sure client understands the
importance of the questions Convey difference between
assessment and actual treatment Using open ended questions Using silence
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Interviewing Essential questions that affect
treatment considerations Suicidal? Homicidal? Psychotic?
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Interviewing Issues How important is it to match the
client’s theoretical orientation with the therapist’s? Data say not important, but it may be
better if… Can’t possibly match all client’s to all
orientations (too many cells for research)
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Assessment Interview Typically called “intake” Assessment measures (gathering
objective data) What are they coming in for? What attempts have they made in
the past to deal with problems?
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Assessment Interview What are their
strengths/weaknesses? Harm to self or others? Alcohol, drug, medication, medical
conditions, health, nutrition, etc Social support available History/family history
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Clinical Judgment: Subjective and Objective Approaches Different opinions Use statistics (particularly
Bayesian Statistics) to determine course of treatment OR
Use judgment and experience to determine course
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Actuarial, Quantitative, or Statistical Approach Emphasizes objectivity and involves
assigning scores to the various characteristics of patients and determining correlations between characteristics e.g., In 85% of people with a broken arm,
surgery is not needed, a cast will assist in the mending of the broken bone
e.g., Those depressed clients treated with CBT vs. nothing, 65% will improve depressed behaviors
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Subjective, Clinical Approach and Heuristics Emphasizes the application of judgment
to the individual case More subjective, experiential, and
intuitive e.g., This particular person, with this broken
arm, should receive surgery because some other factor participates in the decision
This particular depressed client will not respond to CBT for these reasons
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Clinical Judgment: Subjective and Objective Each side has advantages and
disadvantages Subjective, clinical approach valuable:
Information is needed about areas or events for which no adequate tests are available and/or no statistical equations have been developed
Rare, unusual events of a highly individualized nature are to be predicted or judged
Clinical approach problems: Use heuristics that bias what we attend to
(salience, recency, familiarity)
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Clinical Judgment: Subjective and Objective Actuarial approach is valuable when:
Outcome to be predicted is objective and specific
Outcomes for large, heterogeneous samples are involved, interest in the individual case is minimal
Reason to be particularly concerned about human judgmental error or bias
Actuarial approach problems: Lose individual in assessment or decision
process