Assessment in Clinical Settings

• Tests are focused and specific.

• Clinical “assessment” includes a broad info-gathering and interpretation.

Assessment vs. Testing

• The collecting of relevant information in an effort to reach a conclusion• Clinical assessment is used to determine how and why a person is behaving abnormally and how that person may be helped• Focus is idiographic – on an individual person• Also may be used to evaluate treatment progress

What is clinical assessment?

Info-gathering model

Therapeutic model

Differential treatment model

3 Models of How Testing Is Used by Clinicians and Counselors

Rank Test Rank Test

7.5 Sentence Completion Tests (all kinds)

9 House-Tree-Person Test

10 Draw-a-Person Test

11 Wechsler Memory Scale

12 Rotter Sentence Completion Test

13 Memory for Design's

14 Vineland Social Maturity Scale

15 Stanford-Binet Intelligence Scale

1 Wechsler Adult Intelligence Scale

2 Minnesota Multiphasic Personality Inventory

3 Bender Visual Motor Gestalt Test

4 Rorschach Inkblot Test

5 Thematic Apperception Test

6 Wechsler Intelligence Scale for Children—Revised

7.5 Peabody Picture Vocabulary Test

Tests most frequently used:

Rank Tests Rank Tests

25 Differential Aptitude Tests

26 Gray Oral Reading Test

27 Wechsler-Bellevue Intelligence Scale

28 Cattell Infant Intelligence Scale

29 Goldstein-Scherer Tests of Abstract and Concrete Thinking.

30 Blocky Pictures

16 Strong Vocational Interest Blank—Men

17.5 Bender Visual Retention Test

17.5 Edward Personal Preference Schedule

19 Strong Vocational Interest Blank—Women

20.5 Children's Apperception Test

20.5 Progressive Matrices

22 Kuder Preference Record

23 Porteus Mazes

24 Full Range Picture Vocabulary Test

Clinical interview

Assessment of Intellectual

functioning

Personality Assessment

Behavioral Assessment

• Structured: predetermined set of questions. May be scored. Leads to diagnosis.

• Nondirective clinical interview: few predetermined questions, most are ad hoc…flexible, but can lead to hypothesis confirmation bias (i.e., seeking information to confirm a predetermined hunch).

• Semi-structured: some predetermined questions, some open-ended, plus follow-up questions.

The Clinical Interview

Neuropsychological Assessment:

• Electroencephalogram (EEG)

• Event-related potential (ERP)

• Imaging techniques; e.g., PET, MRI

Intelligence tests:

Most commonly used tests are:

• Wechsler adult intelligence scale(WAIS-IV)

• Binet-simon intelligence scale

Intellectual functioning

WAIS-IV is divided into four major scales, which are further subdivided into a number of mandatory and optional(supplemental) subsets:

1. Mandatory subsets arrives at a persons full IQ scale.

2. The supplemental subsets provide additional information that is valuable, about a persons cognitive ability.

The Wechsler adult intelligence scale(WAIS-IV):

WORKING MEMORY SCALE:

• digit span

• Arithmetic

• Supplemental subsets: letter number sequence (16-69 only)

PROCESSING SPEED SCALE:

• Symbol search

• Coding

• Supplemental subsets: Cancellation(16-69 only)

VERBAL COMPREHENSION SCALE:

• Similarities

• Vocabulary

• Information

• Supplemental subsets: comprehension

PERCEPTUAL REASONING SCALE:

• Block design

• Matrix reasoning

• Visual puzzles

• Supplemental subsets: Picture completion, figure weights(16-69 only)

Major scales:

Definition: A type of paper and pencil personality assessment, often in multiple choice or true/false formats, that assesses personality.

Often used to:

• increase client insight

• identify psychopathology

• assist in treatment planning

Each objective personality test measures different aspects of personality based on the specific constructs defined by the test developer.

Objective Personality Testing

Most widely used personality test.

Developed in 1942, revised last in 1989.

90 minutes to take the 527 items.

Provides six validity scales, ten basic (clinical) scales, and fifteen content scales.

Commonly used scales: three validity scales and ten basic scales.

Minnesota Multiphasic Personality Inventory - 2

It is important to understand the meaning of each scale.

A high L (Lie) means the client is having trouble admitting to his or her faults– makes entire test results suspect.

The Basic Scales are useful in diagnosis and treatment planning

Look at patterns of responses.

“Clinical significance” is a T score of 65 or greater.

Content Scales, identify 15 specific traits such as anxiety, fears, anger, cynicism, low self-esteem.

Reliability estimates on the different scales.

Some high inter-correlations in scales, probably because scales share some items.

Second most used objective personality test.

Designed to assess DSM-IV-TR personality disorders and clinical symptomatology.

Adolescent version also exists.

175 true/false items take 25 minutes.

Has six different major scales: 1. Clinical Personality Pattern Scales2. Severe Personality Pathology Scales3. Clinical Syndrome Scales4. Severe Clinical Syndrome Scales5. Modifying Indices6. Validity Index

Millon Clinical Multi-axial Inventory, 3rd Ed. (MCMI-III)

Uses Base Rate (BR): Converts raw score to a more meaningful standardized score

Sets median for non-psychiatric individuals at 35, and 60 for psychiatric population.

A BR of 75 indicates that some of the features are present while a BR of 85 indicates that the trait is clearly present.

Reliability ranges from .67 to .90.

Other studies demonstrated predictive validity for the instrument with DSM-IV-TR diagnoses.

Most widely used personality assessment for normal functioning (for adolescent through adults).

Based on Jung’s work, following characteristics derived: extroverted or introverted, sensing or intuiting, thinking or feeling.

Myers and Briggs added judging or perceiving.

Some have questioned the reliability of results

Most agree with results and they seem to correlate with scores on other tests (e.g., CPI).

The Myers-Briggs Type Indicator

Describe basic personality characteristics.

Used with normal clients; helpful to further client insight.

Twenty folks scales, 3 vectors

13 “special scales” available with computer scoring, usually used for career and business-related activities.

Uses T scores. Generally, the higher the better, but some argue that low scores fit their personality better.

Reliability: .68 - .76.

Some scales correlate too highly with one another (questionable factor purity).

The California Personality Inventory (CPI)

There are dozens of common objective personality tests. Some others, include:• 16 PF: Measures 16 personality factors identified by Raymond Cattell.• Taylor-Johnson Temperament Analysis: Assesses personality variables that effect social, family, marital, work, and other environments. • The Marital Satisfaction Inventory: Assesses the severity and nature of conflict in a relationship. •Miller Marriage Satisfaction Rating Scale: Reports how a couples’ satisfaction compares to another couples’. (On-line—lack of validity data).

Name Recognition

Projective Test

Defined:

Type of personality assessment where a client is presented a stimuli and personality factors are interpreted.

Often used to identify psychopathology and to assist in treatment planning.

Much more difficult to measure validity when one is dealing with abstract responses to vague stimuli, such as those in projective tests.

Story tellingThematic

Apperception Test(TAT)• Developed in 1938 Henry Murray • Series of 31 cards with vague

pictures on them.• 8 to 12 cards generally used during

an assessment • Examiner asks the client to create

and describe a story that has a beginning, middle and end.

• Based on Murray's need-press theory: People driven by internal desires, such as attitudes, values, goals, etc. (needs), or external stimuli (press) from the environment.

• No universally agreed upon scoring and interpretation method.

Rorschach Inkblot

technique

Herman Rorschach developed inkblot test in 1921 by splattering ink on paper and folding them in half.

Chose 10 final cards that have become the Rorschach inkblot test still used today.

When giving the Rorschach, clinicians show clients cards, one at a time, and ask them to tell them what they see on the card.

Rorschach believed images on the inkblots allowed one to express his or her unconscious.

Difficulty showing adequate validity.

Requires extensive training and practice to use.

Expert scoring system uses three components:

Location: where on blot response occurred (e.g.,):

1. whole blot (w), 3. unusual details (Dd),

2. common details (D), 4. white space details (S)

Determinants: how examinee understood what was seen:

form (“that looks just like a bat”)

color (e.g., “it’s blood, because it’s red”)

shading (“it looks like smoke because it’s grayish-white”).

Content: 22 categories, e.g.,: whole human, human detail, animal, art, blood, clouds, fire, household items, sex, etc. Specific content can hold meaning.

Sentence-completion tasks have become very popular in clinical assessment. They are simple to administer and take little time.

Test takers are presented with a series of sentence steins, such as "My mother..." or "I hate...," which they complete in their own words.

Although some people view these as self-report tasks, most clinicians see sentence completion as a projective technique. Test takers are confronted with ambiguous stimuli, and the way they respond to these stimuli is likely to reveal their personal issues.

Sentence completion test

Drawing tests try to tap into unconscious. Focus might vary depending on content of test.

Some popular ones:

• House-Tree-Person

• Kinetic-House-Tree-Person

• Draw-A-Man

• Draw-A-Woman

• Kinetic Family Drawing: Draw a picture of your family all doing something together.

Projective Drawing

The process of measuring and observing a person’s actual behavior to try and better understand behaviors and thoughts behind it.

Core of this is naturalistic observation

Self- Monitoring:

One of the component of behavioral assessment, hen a person is asked to keep a mood journal and track their moods over the course of a week or month.

Inventories and checklists:

Online popular, in the form of quizzes, also a component, For instance, the Beck Depression Inventory(BDI)

Behavioral Assessment:

Single-construct tests such as the Beck Depression Inventory or Beck Anxiety Inventory.

State vs. trait testing such as

Spiel berger’s State-Trait Anger Expression Inventory (STAXI) and

State-Trait Anxiety Inventory (STAI)

Specialized Tests for Clinical Disorders

• Clinical assessment results in making decisions for clients that will critically affect their lives.

• Such decisions can result in a person being labeled, institutionalized, incarcerated, stigmatized, placed on medication, lose or gain a job, have access to their children, and more.

• Examiners must remember the impact that their decisions will have on clients and monitor:

• the quality of the tests they use

• their level of competence to administer tests,

• their ability at making accurate interpretations of client material.

Final Thoughts on Clinical Assessment