Objective Assessments and Private Practice

Jeffrey S Gallup MA LPCMansfield Counseling

Why should you use assessments?

Psychological test validity is very strong and compelling.

Psychological test validity is comparable to medical test validity.

Distinct assessments provide unique sources of information.

Clinicians that rely exclusively on interviews are prone to incomplete understandings.

What is assessment and am I allowed to use them?Assessment which means selecting, administering, scoring, and interpreting instruments designed to assess an individual's aptitudes, attitudes, abilities, achievements, interests, personal characteristics, disabilities, and mental, emotional, and behavioral disorders and the use of methods and techniques for understanding human behavior that may include the evaluation, assessment, and treatment by counseling methods, techniques, and procedures for mental and emotional disorders, alcoholism and substance abuse, and conduct disorders, but does not include the use of standardized projective techniques or permit the diagnosis of a physical condition or disorder.

- Texas State Board of Examiners of Professional Counselors About the Profession - Scope of Practice

Objective vs. Projective

Objective Tests

Ex. Minnesota Multiphasic Personality Inventory (MMPI) Objective test is a psychological test that

measures an individual's characteristics independent of rater bias or the examiner's own beliefs, usually by the administration of a bank of questions marked and compared against exacting scoring mechanisms that are completely standardized

Projective Tests

Ex. Rorschach Inkblot Test A personality test designed to let a person

respond to ambiguous stimuli, presumably revealing hidden emotions and internal conflicts projected by the person into the test

Projective tests have their origins in psychoanalytic psychology, which argues that humans have conscious and unconscious attitudes and motivations that are beyond or hidden from conscious awareness.

In simpler terms

As counselors we can use any assessment instrument (test), that produces objective (measurable) results.

Theses tests can measure – IQ, achievement, abilities, any diagnostic concerns, autism spectrum disorders, addictions, trauma, social/emotional/behavioral issues, personality, visual motor procession, learning disabilities. So pretty much if you have a concern you want to measure

objectively then there is an instrument to measure it.

Plate No. 6What do you see?

- Typically I see a CT scan of the brain.

- Since we are all going to see different things with projective tests, they tend not to be very effective in counseling.

Aiding treatment effectiveness

Assessments can help determine two immediate ideas. 1. Type of problem – depression, anxiety, bipolar or something

else. Then which specific symptoms are to be addressed. 2. Intensity of the problem – how severe is your clients concern.

If done early in your work with a client it helps establish a baseline in which progress can be measured against.

Assessment use = Evidence Based Treatment, i.e. the new DSM-5 Assessment Measures.

Example

As valid as medical tests

Psychological assessments shown to be as valid as medical tests - Psychological Testing and Psychological Assessment – A review of Evidence and Issues. (Meyer 2001)

Through meta-analytic reviews, Meyer and his colleagues drew comparisons between medical test validity and psychological test validity. They found that both psychological and medical tests have varying degrees of validity and that validity co-efficient for many psychological tests are indistinguishable from those of medical tests.

The next step, then is to look at the real-world value of using psychological assessment measures. The information gained form assessment can help to derive more value to our clients and referral sources.

Expertise and Rapport

• When you discuss and use an instrument with clients they typically see you as a professional that is using every resource to help them, and as an act of caring about them.

• Your first results at the outset of care provide you a baseline, and an increase in your understanding of your clients concerns.

• When explaining the results to parents or a client, this is a great time to develop rapport, probe further into areas that a client may not have discussed in much detail.

Improve Morale and Decrease early Termination

Positive results can be reinforced by showing a client that they are making objective improvements in their problems. This can increase a clients positive attitude leading to a cycle of greater or faster progress in care.

If you have a client that maybe considering terminating their care before they should – early termination. Using assessments can help to show them objectively that they have a need to continue counseling or that they are making gains in their treatment.

Accurate Diagnosis and catching medical Problems

Assessments tools can help you to clarify your diagnostic picture. Even when the labels are not important, it may provide valuable clues to creating and guiding your treatment plans.

Every so often you may catch a problem that you did not anticipate. There are a variety of medical diagnoses that mirror psychological problems, such as –

• ADHD = Other Neurodevelopment profiles

• Post-traumatic stress disorder = Brain Trauma

• Panic Disorder = Thyroid Disorder

• Depression = Epstien-Barr or Metabolic Disorders

• Dementia = Deafness

Diagnostic Statistical Manual 5

For further clinical evaluation and research, the APA is offering a number of “emerging measures” in Section III of DSM-5. These patient assessment measures were developed to be administered at the initial patient interview and to monitor treatment progress

These assessments are easy too use, are available online for free, and can be completed quickly. But will not give you in-depth information about your client.

Court Testimony

Having accurate information can help your testimony stand during court appearances and may save you from being cross examined in court.

Be sure to be read your ethics and particularly in regards to using assessments. Be aware of the validity and reliability of the assessments that you are using and the reasons you chose to use that particular assessment.

Validity Checking

Almost every objective assessment has built in methods by which to determine when the client was completed the assessment if they were being appropriate open and honest in their responses.

Decrease Legal Liability

When using objective instruments it provides you further clinical/relevant information to create your treatment planning. Demonstrating in a forensic, malpractice, or other unforeseen legal situation that you have solid evidence for the methods that you are using to practice therapy.

Objective testing is another step to having an evidence-based practice. Projective testing is not allowed by our scope of practice. An example of projective testing is Rorschach Ink Blot.

Increasing Rapport with children

When working with children assessments can help you to gain a 3rd

perspective about the child’s problems after what they parents report, and your interview with the child.

Then you have the opportunity to quickly get to the child’s concerns and help them to feel as if counseling is having a positive impact on their problems.

Reviewing assessment results with parents can help increase their understanding of their child’s problem, and give you further opportunities to educate parents. Make sure to get as many perspectives as possible – including parents, step

parents, teachers, and the client themselves.

Challenging self-diagnosis

Challenging self-diagnosis

An objective assessment tool can help you when there is a need to confront a poor “self ” diagnosis.

Often we can spend a lot of time explaining to people that their diagnosis is not the most important piece of counseling. But showing them an objective assessment and then explaining that it measures thoughts and behaviors is a more effective way to help people focus on their thoughts and behaviors.

Lack of Familiarity

Many of us have taken at least 1 class in Tests & Measurements. But have done little with that education since then. Using a quick assessment several times and reading through the documentation will help you figure out how to give and score the test.

Often these assessments can be scored by adding up each of the questions and then comparing to a table.

Reviews and further information about each test can be found at the Buros Institute of Mental Measurements.

http://buros.unl.edu/buros/jsp/search.jsp

Example - Beck Depression Inventory

(0) I do not feel sad.

(1) I feel sad.

(2) I am sad all the time and I can't snap out of it.

(3) I am so sad or unhappy that I can't stand it.

When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression's severity. The standard cut-offs are as follows: 0–9: indicates minimal depression

10–18: indicates mild depression

19–29: indicates moderate depression

30–63: indicates severe depression.

Infringement on client time

Most of these tools can be completed in about 5 to 10 minutes. I suggest that you score between client sessions, and then review the results the next week.

This encourages clients to come back next week and gives you something to talk about and assists you in getting right to their concerns vs. “shooting the breeze”.

Typically once we are familiar with an assessment tool it should only take a few minutes to completely score the test and be ready to discuss the results.

Costs & Insurance Concerns

Instruments in the public domain are typically free to use or very inexpensive for you to purchase and keep in your office or clinic.

In dealing with insurances companies by having objective testing results can help in completing chart reviews and decrease the amount of time you spend discussing your treatment plans.

Recently Aetna has started to pay a small amount to cover your use of the assessments tool.

Qualifications

Level A: There are no special qualifications to purchase these products.

Level B: Tests can be purchased by individuals with: Certification by or full active membership in a professional organization (ASHA, AOTA, APA, AERA, ACA, AMA, NASP, NAN, INS) that requires training and experience in a relevant area of assessment. A master’s degree in psychology, education, occupational therapy, speech-language pathology, social work, or in a field closely related to the intended use of the assessment, and formal training in the ethical administration, scoring, and interpretation of clinical assessments.

Level C: Tests with a C qualification require a high level of expertise in test interpretation, and can be purchased by individuals with: Licensure or certification to practice in your state in a field related to the purchase. OR A doctorate degree in psychology, education, or closely related field with formal training in the ethical administration, scoring, and interpretation of clinical assessments related to the intended use of the assessment.

Test Publishers

Pearson – www.pearsonassessments.com

Phone: 1.800.627.7271

PAR – www.parinc.com

Phone: 1.800.331.8378

Western Psychological Services – www.wpspublish.com

Phone: 1.800.648.8857

Hawthorne Educational Services, Inc. - www.hawthorne-ed.com

Phone: 1.800.542.1673

Further Resources

DSM-5 Online Assessments http://www.psychiatry.or

g/practice/dsm/dsm5/online-assessment-measures

Essentials of Assessment Report Writing –published by Wiley Publishers

Objective Assessments in Private Practice By Jeffrey S Gallup MA LPC NCC and Kathryn Johnson MA LPC NCC 

1 WHY SHOULD I USE ASSESSMENTS IN MY PRACTICE 

Clinicians that rely exclusively on interviews are prone to incomplete understandings.  

Psychological test validity is very strong and compelling. 

Distinct assessments provide unique sources of information. 

Psychological test validity is comparable to medical test validity. 

 

2 ASSESSMENTS IN SIMPLER TERMS 

As counselors we can use any assessment instrument (test) that produces objective (measurable) 

results. That we are qualified to purchase from the testing publishers.  

Publishers generally categorize their tests into the following areas 

Adult Clinical 

Autism Spectrum Disorders 

Child Clinical 

Cognitive, Achievement, & Learning 

Development & Adaptive Behavior 

Industrial‐Organizational 

Neuropsychology 

Occupational Therapy & Sensory Processing 

Social, Emotional, & Behavioral Issues 

Speech‐Language‐Hearing 

There is an amazing amount of assessments available to us, the Buros Mental Measurement Yearbook 

has been reviewing and cataloging psychometric assessments since 1938. 

3 AIDING TREATMENT EFFECTIVENESS 

Using assessments helps you to reach the goal of providing EVIDENCE BASED TREATMENT – helping you 

to determine the exact problem to be treated and how severe that problem is, then as you continue to 

provide care you can use assessments to help objectively determine the progress you are making.  

Your first results at the outset of care provide you a baseline, and an increase in your understanding of 

your clients concerns. 

Assessments tools can help you to clarify your diagnostic picture. Even when the labels are not 

important, it may provide valuable clues to creating and guiding your treatment plans.  

Every so often you may catch a problem that you did not anticipate. There are a variety of medical 

diagnoses that mirror psychological problems, such as –  

ADHD = Other Neurodevelopment profiles 

Post‐traumatic stress disorder = Brain Trauma 

Panic Disorder = Thyroid Disorder 

Depression = Epstien‐Barr or Metabolic Disorders 

Dementia = Deafness 

4 DECREASING LIABILITY  

When using objective instruments it provides you further clinical/relevant information to create your 

treatment planning. Demonstrating in a forensic, malpractice, or other unforeseen legal situation that 

you have solid evidence for the methods that you are using to practice therapy. 

5 INCREASING RAPPORT AND CHALLENGING SELF‐DIAGNOSIS 

When working with children, assessments can help you to gain a 3rd perspective about the child’s 

problems after what their parents report, and your interview with the child. Then you have the 

opportunity to quickly get to the child’s concerns and help them to feel as if counseling is having a 

positive impact on their problems.  

Reviewing assessment results with parents can help increase their understanding of their child’s 

problem, and give you further opportunities to educate parents. 

Often we can spend a lot of time explaining to people that their diagnosis is not the most important 

piece of counseling. But showing them an objective assessment and then explaining that it measures 

thoughts and behaviors is a more effective way to help people focus on their thoughts and behaviors. 

6 CONCERNS 

6.1 LACK OF FAMILIARITY Many of us have taken at least 1 class in Tests & Measurements. But have done little with that education 

since then. Using a quick assessment several times and reading through the documentation will help you 

figure out how to give and score the test. Often these assessments can be scored by adding up each of 

the questions and then comparing to a table. 

6.2 INFRINGEMENT ON CLIENT TIME & COST Most of these tools can be completed in about 5 to 10 minutes. I suggest that you score between client 

sessions, and then review the results the next week. This encourages clients to come back next week 

and gives you something to talk about and assists you in getting right to their concerns vs. “shooting the 

breeze”. Instruments in the public domain are typically free to use or very inexpensive for you to 

purchase and keep in your office or clinic.  

In dealing with insurances companies by having objective testing results can help in completing chart 

reviews and decrease the amount of time you spend discussing your treatment plans. 

7 PUBLIC DOMAIN ASSESSMENTS 

Hamilton Anxiety Scale  

Depression Anxiety Stress Scale 

Center for Epidemiological Studies Depression Scale 

Adult Attachment Scale Instrument and Scoring 

CAGE Questionnaire (CAGE) 

Internet Addiction Test (IAT) 

Adult ADHD Self Report Scale (ASRS v1.1) 

Buss‐Perry Aggression Questionnaire (AGQ) 

Generalized Anxiety Disorder 7 Item (GAD‐7) 

Hamilton Anxiety Rating Scale (HAM‐A) 

Liebowitz Social Anxiety Scale (LSAS) 

Panic and Agoraphobia Scale (PAS) 

Spence Children’s Anxiety Scale (SCAS) 

Social Phobia Inventory (SPIN) 

Taylor Manifest Anxiety Scale (TMAS) 

Zung Self‐Rating Anxiety Scale (SAS) 

Autism Spectrum Quotient (AQ) 

Childhood Autism Spectrum Test (CAST) 

Altman Self‐Rating Mania Scale (ASRM) 

Young Mania Rating Scale (YMRS) 

Edinburgh Postnatal Depression Scale (EPDS) 

Geriatric Depression Scale (GDS) 

Kutcher Adolescent Depression Scale (KADS‐11) 

Major Depression Inventory (MDI) 

Montgomery‐Asberg Depression Rating Scale (MADRS) 

Zung Self‐Rating Depression Scale (SDS) 

Eating Disorders (2) 

Binge Eating Scale (BES) 

Eating Attitudes Test 26 Item (EAT‐26) 

Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) 

Empathy Quotient (EQ) 

Personality Type Indicator (PTI) 

 

8 TEST PUBLISHERS & RESOURCES 

Pearson – www.pearsonassessments.com Phone: 1.800.627.7271 

PAR – www.parinc.com Phone: 1.800.331.8378 

Western Psychological Services – www.wpspublish.com Phone: 1.800.648.8857 

Hawthorne Educational Services, Inc. ‐ www.hawthorne‐ed.com Phone: 1.800.542.1673 

9 FURTHER RESOURCES 

DSM‐5 Online Assessments http://www.psychiatry.org/practice/dsm/dsm5/online‐assessment‐

measures 

Essentials of Assessment Report Writing – published by Wiley Publishers 

10 REFERENCES 

Buros Center for Testing – www.buros.org 

Texas LPC Board Code of Ethics ‐ https://www.dshs.state.tx.us/counselor/lpc_ethics.shtm 

Texas LPC Board Scope of Practice ‐ https://www.dshs.state.tx.us/counselor/lpc_scope.shtm 

Psychological Assessments shown to be as valid as medical tests – 

https://www.apa.org/monitor/julaug01/psychassess.aspx 

Psychological testing and psychological assessment. A review of evidence and issues – 

http://www.ncbi.nlm.nih.gov/m/pubmed/11279806