introduction to clinical psychology science, practice and ethics chapter 5 general issues in...

Introduction to

Clinical PsychologyScience, Practice and Ethics

Chapter 5General Issues in Psychological Assessment

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Copyright ©Allyn & Bacon 2005

Stages of Psychological Assessment

Stage I: Planning the Assessment Stage II: Data Collection Stage III: Processing Assessment Data Stage IV: Communicating Assessment

Findings



Goals of Psychological Assessment

Classification Description Prediction


Classification

Diagnoses DSM-IV

Criticisms of Diagnoses Implies understanding Association with medical model Variable reliability Negative social stigma


Diagnoses: Responses to Criticisms

Categorization facilitates research Diagnostic labels can facilitate

treatment Diagnostic labels can facilitate

communication


Description

Dimensional (as opposed to categorical)

Person by situation Generates research hypotheses Facilitate treatment planning Evaluate treatment outcome


Prediction

Prediction terms: True positive False positive True negative False negative Sensitivity Specificity


Prediction

The Base Rate Problem Low base rate problems are difficult to

predict Low base rate problems tend to be

overpredicted (many false positives) Clinical versus Statistical prediction


Clinical versus Statistical Approaches

Clinical (or subjective) method – clinician constructs a model to explain client’s behavior and predict future behavior

Statistical (or quantitative or actuarial) – people are classified based upon the characteristics they share with others. They are expected to behave the way similarly classified people behave


Clinical versus Statistical Approaches

Paul Meehl (1954) Clinical versus Statistical Prediction: A Theoretical Analysis and Review of the Literature “in all but one…the predictions made

actuarially were either equal to or superior to those made by the clinician”

Jack Sawyer (1966) Statistical superior to clinical approach to

prediction Clinicians could not improve upon actuarial

prediction


Responses to Statistical Superiority

Methodologically weak studies Not Expert Judges Findings not cross-validated Poor Ecological Validity


Counter-arguments Methodologically weak studies

Methodologically weak and strong studies yield consistent findings (actuarial > clinical

Not Expert Judges But those that did yield use expert judges

yielded the same findings (actuarial > clinical) Findings not cross-validated

But those that did cross-validate yielded the same findings (actuarial > clinical)

Poor Ecological Validity But the tasks are not meaningless


Recent Review Meehl (1957, 1965, 1986) Dawes, Faust, & Meehl (1989) – reviewed

close to 100 studies – actuarial equal to or superior to clinical in every one.

Dawes (1994) House of Cards: Psychology and Psychotherapy Built on Myth

Milner & Campbell (1995) – “ The consensus of opinion is that statistical prediction is more accurate than clinical prediction”


Clinical Approach: Current Status

Clinical approach is necessary in situations for which no statistical equations have been developed.

Unforeseen circumstances impair the efficiency of the formula.

Rare, unusual events of highly individualized nature are to be predicted.

Clinician as data-gatherer


Stage II: Data Collection

Interviews Norm-referenced tests Observations Informal assessment methods Life records


Stage III: Processing

Clinical Judgment Computer assisted assessment


Clinical Judgment:Threats to Accuracy

Preconceived Notions Confirmation Bias Hindsight Bias Overconfidence

Recall successes Only examining certain types of cases Self-fulfilling prophecy


Reducing Impact of Biases

Search for alternative explanations Understand the impact of base rates Decrease reliance on memory


Computer-assisted assessment

Professional time savings Test administration consistency Rapid turnaround time Scoring accuracy Data analysis Special populations


Communicating Assessment Findings

Goals Address the referral question Improve understanding Impact client Provide a written record A legal document



Include all relevant information Delete irrelevant or damaging

information Avoid undue generalizations Use behavioural referents Communicate clearly Eliminate biased terms



Identifying Information Reason for Referral Background Information Behavioural Observations Assessment Results and

Interpretation Summary Recommendations

introduction to clinical psychology science, practice and ethics chapter 5 general issues in...

Documents

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statistical prediction

actuarial prediction

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communication slide

meaningless slide

prediction prediction

treatment outcome slide