Exam 2 Clinical and Counseling Chapter 6 Assessment o Assessment the process of systematically gathering info about a person in relation to his her environment so that decisions can be made based on the info that are in the best interest of the individual o Goals Classification Description Prediction Based on theoretical orientation Natural common sense understanding Psychopathology etiology diagnosis prognosis Cognitive behavioral problem definition and monitoring of change measurement of desirable outcomes Phenomenological help client experience self and developmental potential Community identification of interactions and needed system changes o Sources of Assessment Data o Change school environment Interviews Psychological tests Behavioral observations Biological physiological measurements o Steps in Assessment process 1 Deciding what is being assessed Suicidal not doing well in school 2 Determining the goals of the assessment Treatment decisions custody evaluation 3 Selecting standards for making decisions Valid and reliable measures 4 Collecting assessment data 5 Processing data generating hypothesis making decisions 6 Communicating information o Step 1 Deciding what is being assessed Is there a significant psychological problem What caused the problem What is the course of the problem going to be if it goes untreated Referral questions Presenting concerns Emotion mood depression anxiety Cognition intellectual cognitive schema perceptions of self Physiological heart rate Environment family school work Behavioral observe child in school environment parent report Determined by one s theory o Step 2 determining the goals of assessment Diagnosis DSM 5 Important for treatment insurance reimbursement DIS diagnostic interview survey lay person SCID structured clinical interview for diagnosis o Emphasis is set on symptom clusters o Requires clinical decisions Severity of problem Substantial differences of severity heterogeneity Example Depression o Age of onset earlier usually worse o Number of episodes o Number of symptoms o Duration of each episode o Functioning roles of everyday functioning parent work school Screening basic needs Screen large groups to find those at high risks Screen for cancer depression suicide Example those who are at high risk for depression Prediction Low base rate Lethality suicidal homicide How are people going to behave in the future Prediction of violence is difficult True case sensitivity True non case specificity Case True positive false positive Non case false negative true negative 100 women 10 identified on mammogram as having tumor o 1 in 10 has cancer o Among 90 not identified don t have cancer o Sensitivity false negatives 1 1 0 100 o Specificity false positives 90 9 90 90 Evaluation of an intervention Example constantly monitor effects of treatment anti depressant BDI Criteria must be developed to establish a meaningful change o Step 3 Selecting standards for making decisions Normative standards Compared with others o Comparing IQ age sample representation Self referent standards Compared with one s own data at other points in time o Used to be an A student now getting a C o Step 4 Collecting assessment data theory driven Interviews Structured unstructured Psychological tests intelligence tests personality tests objective projective Projective tests responses to ambiguous stimuli responses are open ended and subjective o Scored based on interpretations of examiner o Lacks validity and reliability o Distinguishing characteristics of projective tests Unstructured stimuli Use indirect methods Sensitive to unconscious Global picture of personality Open to interpretations o Rorschach Inkblot Test 10 cards with ambiguous inkblots Respondent is asked to indicate what he seems After responses are obtained the examiner asks the respondent to indicate where he saw what he saw Scoring Location area of inkblot used o Entire blot W o Common detail D o Unusual detail Dd o Use of white space S o The basis for the response is usually the whole inkblot requires integration o Or a detail either a commonly or an uncommonly selected on o Or the negative space around or within the inkblot o Color responses often provide a direct insight into emotional life o Developmental quality each location score in relation to degree of integration Synthesized response O ordinary response V vague response v synthesized response Determinants o Form is it good How accurately does the response conform to the inkblot form Ordinarily elaborated Ordinary 0 Unusual u Minus o Color o Movement o Shading o Texture Organization Approach Content o Thematic Appreciation Test 31 cards presenting pictures of varying level of ambiguity Respondent is instructed to tell a story about what is happening in the picture what has led up to the event in the picture what is happening now and what the outcome will be Scoring Hero his her needs environmental forces that thwart or aid the hero Themes Outcome Quality of Relationships Coping Styles Objective tests self reports person s descriptions or accounts of their behavior attitudes emotions and perceptions of themselves o Scored quantitatively o Distinguishing Characteristics Group norms Well defined stimuli Easy administration and scoring o Minnesota Multiphasic Personality Inventory 2 MMPI2 567 True False questions Normative sample of 2600 adults selected to be nationally representative Severe clinical samples impatient and outpatient Validity scales to detect patterns of unreliable or biased responding rates of responding Clinical scales 10 scales that are compared to normative base Hypochondriasis Depression Hysteria Psychopathic deviate Masculinity femininity Paranoia psychasthenia Schizophrenia Hypomania Social Introversion Physiological neurological assessment Direct observation of behavior Reliability Internal consistency items are related Test retest repeat test at two time points Inter rater 2 different raters agree Validity actually assessing what it is suppose to assess Content do the items represent fully the content of area being assessed Construct measures the structure and features of the hypothetical construct Concurrent correlated with another measure Predictive IQ and subsequent grades o Step 5 Processing data generating hypotheses making decisions Clinicians are subject to errors in human information processing biases errors in judgment Selective attention focusing only on one component Experienced clinicians are more susceptible
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