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