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Assessment & Diagnosis
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  • 1. PSYC 3553 – Psychopathology Week 4: Assessment and Diagnosis • September 29, 2009
  • 2. What is assessment?
    • Goals of clinical assessment:
      • How and why a person is behaving abnormally
      • How that person may be helped
      • Also may be used to evaluate treatment progress
    • Focus is idiographic – on an individual person
  • 3. Characteristics of Assessment Tools
    • Standardization
      • A test is administered to a large group, and their performance serves as a common standard (norm) against which individual scores are judged
      • The “ standardization sample ” must be representative
      • One must standardize administration, scoring, and interpretation
  • 4.
    • Reliability : The consistency of a test
      • Test – retest reliability
      • Interrater reliability
    • Validity : the accuracy of the test results
      • Face validity
      • Predictive validity
      • Concurrent validity
    Characteristics of Assessment Tools
  • 5. Are Classifications Reliable and Valid?
    • Reliability : different diagnosticians agreeing on diagnosis using same classification system
      • DSM-IV : greater reliability than previous editions
      • Used field trials to increase reliability
    • Validity : accuracy of information diagnostic categories provide
      • DSM-IV has greater validity than any previous edition
      • Conducted extensive lit reviews and field studies
  • 6. I. Clinical Interviews
    • Face-to-face encounters
      • Often the first contact between a client and a therapist/assessor
    • Used to collect detailed information, especially personal history, about a client
    • Allow the interviewer to focus on whatever topics they consider most important
  • 7. II. Psychological Tests
    • Six categories of psychological tests
      • Projective tests
      • Personality Inventories
      • Response Inventories
      • Psychophysiological Tests
      • Neurological/neuropsychological Tests
      • Intelligence Tests
  • 8.
    • Projective tests : Interpret characteristics onto vague & ambiguous stimuli or follow open-ended instruction
    • Strengths and weaknesses :
      • Helpful for providing “supplementary” information
      • Rarely demonstrated much reliability or validity
      • May be biased against minority ethnic groups
    II. Psychological Tests
  • 9. Example: The Rorschach Inkblot
  • 10. Example: Thematic Apperception Test
  • 11. Example: Sentence-Completion Test
    • “ I wish ___________________________”
    • “ My father ________________________”
  • 12. Example: Draw-a-Person Test
    • “ Draw a person”
    • “ Draw another person of the opposite sex”
  • 13.  
  • 14. II. Psychological Tests
    • Personality inventories - self-report questionnaires
      • Focus is on behaviors, beliefs, and feelings
      • Ask how similar/dissimilar a person is to a set of statements
    • Strengths and weaknesses :
      • Objectively scored and standardized
      • Although more valid than projective tests, often we cannot directly examine trait
  • 15. Example – The MMPI
  • 16. II. Psychological Tests
    • Response inventories
      • Usually based on self-reported responses
      • Focus on one specific area of functioning
        • E.G., emotion, social skills, cognition
      • Strengths and weaknesses :
        • Have strong face validity
        • Rarely careless/inaccurate questions
        • Few subjected to careful procedures
  • 17. II. Psychological Tests
    • Psychophysiological tests
      • Measure physiological response as an indication of psychological problems
      • Most popular is the polygraph (lie detector)
    • Strengths and weaknesses :
      • Require expensive equipment that must be tuned and maintained
      • Physical evidence for psychological symptoms
  • 18. II. Psychological Tests
    • Neurological tests: direct assessment brain function
    • Neuropsychological tests: indirect assessment via cognitive, perceptual & motor function
  • 19. Example: Bender Visual-Motor Gestalt
  • 20. II. Psychological Tests
    • Intelligence tests
      • Designed to measure intellectual ability
      • Assess both verbal and non-verbal skills
      • Generate an intelligence quotient (IQ)
    • Strengths and weaknesses :
      • Highly standardized, reliable and valid
      • Influences on performance…cultural factors
  • 21. Clinical Observations
    • Naturalistic observations
      • Occur in everyday environments : homes, schools…
    • Analog observations
      • If impractical, conduct observations in artificial settings
    • Self-monitoring
      • People observe themselves and carefully record the frequency of certain behaviors, feelings...
  • 22. Clinical Observations
    • Strengths and weaknesses :
      • Different observers focus on different aspects?
        • Careful training and use of observer checklists
      • “ Overload,” “observer drift,” and observer bias
      • Client reactivity may also limit validity
      • Observations may lack cross-situational validity
  • 23. Treatment: How Might Clients Be Helped?
    • Treatment decisions : begin with assessment info & diagnosis to determine treatment plan
    • Other factors : therapist’s orientation, current research, empirical support, evidence-based treatment
    • Difficult question to answer:
      • How do you define success ?
      • How do you measure improvement ?
      • How do you compare treatments – differing in range, complexity, skill, knowledge
  • 24. The Effectiveness of Treatment
    • Is therapy generally effective ?
      • … more effective than no treatment or placebo
      • In one study, average person in treatment was better off than 75% of untreated
      • Consumer Reports found that “consumers” of therapy found it to be helpful or at least satisfying
      • Can therapy can be harmful? Has potential…
        • Studies report ~5% get worse with treatment
  • 25. The Effectiveness of Treatment
    • Are particular therapies effective for particular problems ?
      • Studies now conducted to examine efficacy of specific treatments for specific disorders:
      • Recent studies focus on the effectiveness of combined approaches
        • Drug therapy combined with certain forms of psychotherapy – to treat certain disorders