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1

AAAbbbnnnooorrrmmmaaalllPPPsssyyyccchhhooolllooogggyyyD

DDooouuuggglllaaasss AAA... HHHccckkke

eerrr

AAAdddjjjuuunnnccctttPPPrrro

oofffeeessssssooorrrooofffSSSo

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ooccciiiaaalllaaannndddBBBeeehhhaaavvviiiooorrraaalllSSSccciiieeennnccce

eesss

2

CCChhhaaapppttte

eerrr3333

CCCllliiinnniiic

ccaaalllAAAsssssseeessssssmmme

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eennnttt:::HHHooowwwaaannndddWWWhhhyyyDDDoooeeesssttthhheeeCCCllliiieeen

nntttBBBeeehhhaaavvveeeAAAbbbnnnooorrrm

mmaaallllllyyy???Thespecifictoolsusedinan

assessmentdependontheclinicianstheoreticalorientationHundredsof

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clinicalassessmenttoolshavebeendevelopedandfallintothreecategories:ClinicalinterviewsTestsObservations4

CCCl

lliiinnniiicccaaalllIIInnnttteeerrrvvvi

iieeewwwsssFace-to-faceencountersOftenthefirstcontactbetween

aclientandaclinician/assessorUsedtocollectdetailed

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information,especiallypersonalhistory,aboutaclientAllowtheinterviewertofocusonwhatevertopicstheyconsidermostimportant5

CCCllliiinnniiicccaaalllIIInnnttteeer

rrvvviiieeewwwsssConductingtheinterviewFocusdepends

ontheoreticalorientationCanbeeitherunstructuredorstructured

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Inunstructuredinterviews,cliniciansaskopen-endedquestionsInstructuredinterviews,cliniciansaskpreparedquestions,oftenfromapublishedinterviewscheduleMay

includeamentalstatusexam6

CCCllliiin

nniiicccaaalllTTTeeessstttsssDevicesfor

gatheringinformationaboutafewaspectsofapersonspsychological

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functioning,fromwhichbroaderinformationcanbeinferredMorethan500differenttestsareinuseTheyfallintosixcategories7

CCCllliiinnniiicccaaalllTTTe

eessstttsss1.ProjectivetestsRequirethatsubjectsinterpretvague

andambiguousstimuliorfollowopen-endedinstructionMainlyused

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bypsychodynamicpractitionersMostpopular:RorschachTestThematicApperceptionTestSentenceCompletionTest

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iicccaaalllTTTeeesssttt:::TTThhheeemmmaaatttiiicccAAAppppppeeerrrccce

eeppptttiiiooonnnTTTeeesssttt

CCCl

lliiinnniiicccaaalllTTTeeesssttt:::S

SSeeennnttteeennnccceee--CCCo

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oommmpppllleeetttiiiooonnnTTTeeesssttt

Iwish

___________________________Myfather

________________________CCCl

lliiinnniiicccaaalllTTTeeesssttt:::DDDr

rraaawwwiiinnngggsss

Draw-a-Person(DAP)test:

DrawapersonDrawanotherpersonoftheopposite

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sexCCCllliiinnniiicccaaalllTTTeeessstttsss

1.ProjectivetestsStrengthsandweaknesses:

HelpfulforprovidingsupplementaryinformationHaverarelydemonstratedmuchreliabilityorvalidity

MaybebiasedagainstminorityethnicgroupsCCCllliiinnni

iicccaaalllTTTeeessstttsss

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2.PersonalityinventoriesDesignedtomeasurebroadpersonalitycharacteristicsFocusonbehaviors,beliefs,andfeelingsUsuallybasedonself-reportedresponses

Mostwidelyused:MinnesotaMultiphasicPersonalityInventoryForAdults:MMPI(original)or

MMPI-2(1989revision)ForAdolescents:MMPI-ACCCllliiinnniiic

ccaaalllTTTeeesssttt:::MMMMMMP

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PPIII

MMMiiinnnnnneeesssoootttaaaMMMuuullltttiiippphhhaaasssiiicccP

PPeeerrrsssooonnnaaallliiitttyyyIIInnnv

vveeennntttooorrryyy

Consistsofmorethan

500self-statementsthatcanbeansweredtrue,false,orcannot

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sayStatementsdescribephysicalconcerns;mood;morale;attitudestowardreligion,sex,andsocialactivities;andpsychologicalsymptomsAssessescarelessresponding&lying

CCCllliiinnniiicccaaalllTTTeeesssttt:

::MMMMMMPPPIII

MMMiiinnnnnneeessso

ootttaaaMMMuuullltttiiippphhha

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aasssiiicccPPPeeerrrsssooonnnaaallliiitttyyyIIInnnvvveeennntttooorrryyy

Comprisedoftenclinicalscales:Hypochondriasis(HS)Depression(D)

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Conversionhysteria(Hy)Psychopathicdeviate(PD)Masculinity-femininity(Mf)Scoresrangefrom0120Above70=deviant

GraphedtocreateaprofileParanoia(P)Psychasthenia(Pt)

Schizophrenia(Sc)Hypomania(Ma)Socialintroversion(Si)16

17

1819

20

21

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CCCllliiinnniiicccaaalllTTTeeessstttsss

2.PersonalityinventoriesStrengthsandweaknesses:

Easier,cheaper,andfastertoadministerthanprojectivetestsObjectivelyscored

andstandardizedAppeartohavegreatervaliditythanprojectivetestsMeasured

traitsoftencannotbedirectlyexaminedhowcanwe

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reallyknowtheassessmentiscorrect?TestsfailtoallowforculturaldifferencesinresponsesCCCllliiinnniiicccaaal

llTTTeeessstttsss

3.ResponseinventoriesUsuallybased

onself-reportedresponsesFocusononespecificareaoffunctioningAffective

inventories(example:BeckDepressionInventory)Socialskillsinventories

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CognitiveinventoriesCCCllliiinnniiicccaaalllTTTeeessstttsss

3.ResponseinventoriesStrengthsandweaknesses:

IncreasinginuseandnumberNotallhavebeensubjectedto

carefulstandardization,reliability,and/orvalidityprocedures(BDIandafewothersareexceptions)

CCCllliiinnniiicccaaalllTTTe

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eessstttsss

4.PsychophysiologicaltestsMeasurephysiologicalresponseasanindicationofpsychologicalproblemsIncludesheartrate,bloodpressure,

bodytemperature,galvanicskinresponse,andmusclecontractionMostpopularisthe

polygraph(liedetector)CCCllliiinnniiicccaaalllTTTe

eessstttsss

4.PsychophysiologicaltestsStrengths

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andweaknesses:RequireexpensiveequipmentthatmustbetunedandmaintainedCanbeinaccurateandunreliableCCCllliiinnniiic

ccaaalllTTTeeessstttsss

5.Neurologicalandneuropsychological

tests

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23

24

25

26

27

28

29

Neurologicaltestsdirectlyassessbrainfunctionbyassessingbrainstructureandactivity

Examples:EEG,PETscans,CATscans,MRINeuropsychologicaltestsindirectlyassessbrain

functionbyassessingcognitive,perceptual,andmotorfunctioningMost

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widelyusedistheBenderVisual-MotorGestaltTestCCCllliiinnniiicccaaalllTTTeeesssttt:::BBBe

eennndddeeerrrVVViiisssuuuaaalll--MMMo

ootttooorrrGGGeeessstttaaallltttTTTeees

ssttt

CCCllliiinnniiiccca

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aalllTTTeeessstttsss

5.NeurologicalandneuropsychologicaltestsStrengthsandweaknesses:CanbeveryaccurateAt

best,though,thesetestsaregeneralscreeningdevicesBestwhenusedin

abatteryoftests,eachtargetingaspecificskillareaCCCllli

iinnniiicccaaalllTTTeeesssttts

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ss

6.IntelligencetestsDesignedtomeasureintellectualabilityComposedofaseriesoftestsassessingbothverbalandnonverbalskills

Generateanintelligencequotient(IQ)CCCllliiinnniiiccca

aalllTTTeeessstttsss

6.IntelligencetestsStrengths

andweaknesses:Areamongthemostcarefullyproducedof

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allclinicaltestsHighlystandardizedonlargegroupsofsubjectsHaveveryhighreliabilityandvalidityBecauseintelligenceisaninferred

quality,itcanonlybemeasuredindirectlyCCCllliiinnniiic

ccaaalllTTTeeessstttsss

6.Intelligencetests

Strengthsandweaknesses:Performancecanbeinfluencedbynonintelligence

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factors(e.g.,motivation,anxiety,test-takingexperience)TestsmaycontainculturalbiasesinlanguageortasksCCCllliiinnniiicccaaal

llOOObbbssseeerrrvvvaaatttiiiooonnnsss

SystematicobservationofbehaviorSeveralkinds:NaturalisticAnalog

Self-monitoringCCCllliiinnniiicccaaal

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aclinician

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31

32

33

34

35

Ifnaturalisticobservationisimpractical,analog

observationsareusedinartificialsettingsCCCllliiinnniiiccca

aalllOOObbbssseeerrrvvvaaatttiiiooonnns

ss

NaturalisticandanalogobservationsStrengthsand

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weaknesses:ReliabilityisaconcernDifferentobserversmayfocusondifferentaspectsofbehaviorValidityisaconcernRiskof

overload,observerdrift,andobserverbiasClientreactivitymayalsolimitvalidity

Observationsmaylackcross-situationalvalidityCCCllliiinnniiiccca

aalllOOObbbssseeerrrvvvaaattti

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iiooonnnsss

Self-monitoringPeopleobservethemselvesandcarefullyrecordcertainbehaviors,feelings,orcognitionsastheyoccurovertime

CCCllliiinnniiicccaaalllOOObbbssseeer

rrvvvaaatttiiiooonnnsss

Self-monitoringStrengths

andweaknesses:UsefulinassessinginfrequentbehaviorsUseful

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forobservingoverlyfrequentbehaviorsProvidesameansofmeasuringprivatethoughtsorperceptionsValidityisoftenaproblemClientsmay

notreceivepropertrainingandinstructionClientsmaynotrecordinformationaccurately

Whenpeoplemonitorthemselves,theyoftenchangetheirbehaviorDDDiiia

aagggnnnooosssiiisss:::DDDoooe

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eesssttthhheeeCCCllliiieeennntttsssSSSyyynnndddrrrooommmeeeMMMaaatttc

cchhhaaaKKKnnnooowwwnnnDDDiiisssooorrrd

ddeeerrr???

Usingallavailableinformation,cliniciansattemptto

paintaclinicalpictureInfluencedbytheirtheoreticalorientation

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Usingassessmentdataandtheclinicalpicture,cliniciansattempttomakeadiagnosisAdeterminationthatapersonsproblemsreflectaparticular

disorderorsyndromeBasedonanexistingclassificationsystemCCCllla

aassssssiiifffiiicccaaatttiiiooonnnSSSy

yysssttteeemmmsss

Listsof

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categories,disorders,andsymptomdescriptions,withguidelinesforassignmentFocusonclustersofsymptoms(syndromes)IncurrentuseintheUS:DSM-IV-TR

DiagnosticandStatisticalManualofMentalDisorders(4thedition),TextRevisionD

DDSSSMMM--IIIVVV--TTTRRR

Publishedin

1994,revisedin2000(TR)Listsapproximately400disorders

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ListedintheinsidebackflapofyourtextDescribescriteriafordiagnoses,keyclinicalfeatures,andrelatedfeatureswhichareoften

butnotalwayspresentTTThhheeeDDDSSSMMM--IIIV

VV--TTTRRR

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37

38

3940

41

42

43

Mostwidely

usedclassificationsystemintheUSMultiaxialUses5axes(branches

ofinformation)todevelopafullclinicalpicturePeopleusuallyreceivea

diagnosisoneitherAxisIorAxisII,butthey

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mayreceivediagnosesonbothLLLiiifffeeetttiiimmmeeePPPrrreeevvvaaallleeennnccceeeo

oofffDDDSSSMMM--IIIVVV--TTTRRRDDDiiia

aagggnnnooossseeesss

TTThhheeeDDDS

SSMMM--IIIVVV--TTTRRR

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AxisIMostfrequentlydiagnoseddisorders,exceptpersonalitydisordersandmentalretardationMMMaaajjjooorrrAAAxxxiiisssIIID

DDiiiaaagggnnnooossstttiiicccCCCaaattte

eegggooorrriiieeesssTTThhheeeDDDSSSMMM--

IIIVVV--TTTRRR

AxisII

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PersonalitydisordersandmentalretardationLong-standingproblemsAxisIIIRelevantgeneralmedicalconditionsAxisIVPsychosocialandenvironmental

problemsTTThhheeeDDDSSSMMM--IIIVVV--TTTR

RR

AxisVGlobalassessmentofpsychological,social,andoccupational

functioning(GAF)Currentfunctioningandhighestfunctioninginpast

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year0100scaleIIIsssDDDSSSMMM--IIIVVV--TTTRRRaaannnEEEffffffeeecccttti

iivvveeeCCClllaaassssssiiifffiiicccaaat

ttiiiooonnnSSSyyysssttteeemmm???

Classificationsystemsarejudgedbytheirreliabilityandvalidity

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Herereliability=differentdiagnosticiansagreeingonadiagnosisusingthesameclassificationsystemDSM-IV-TRhasgreaterreliabilitythananypreviouseditions

UsedfieldtrialstoincreasereliabilityReliabilityisstillaconcernI

IIsssDDDSSSMMM--IIIVVV--TTTRRRaaannnE

EEffffffeeeccctttiiivvveeeCCCl

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llaaassssssiiifffiiicccaaatttiiiooonnnSSSyyysssttteeemmm???

Thevalidity

ofaclassificationsystemistheaccuracyofinformationthatthediagnosticcategories

providePredictivevalidityisofthemostuseclinicallyDSM-IV-TRhas

greatervaliditythananypreviouseditionsConductedextensiveliterature

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45

46

47

48

4950

IIIsssDDDSSSMMM--

IIIVVV--TTTRRRaaannnEEEffffffeeeccct

ttiiivvveeeCCClllaaassssssiiifffiiiccca

aatttiiiooonnnSSSyyysssttteeem

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mm???

Beyondconcernsaboutreliabilityandvalidity,agrowingnumberoftheoristsbelievethattwofundamentalproblemsweakentheDSM-IV-TR:

BasicassumptionthatdisordersarequalitativelydifferentfromnormalbehaviorRelianceon

discretediagnosticcategoriesCCCaaannnDDDiiiaaagggnnnooos

ssiiisssaaannndddLLLaaabbbeeel

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lliiinnngggCCCaaauuussseeeHHHaaarrrmmm???

MisdiagnosisalwaysaconcernMajorissueis

relianceonclinicaljudgmentAlsopresentistheissueoflabelingand

stigmaDiagnosismaybeaself-fulfillingprophecyBecauseoftheseproblems,

someclinicianswouldliketoceasethepracticeofdiagnosis

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TTThhheeeEEEffffffeeeccctttiiivvveeennneeessssssooofffTTTrrreeeaaatttm

mmeeennnttt

Morethan400formsoftherapyin

practice,butistherapyeffective?Difficultquestiontoanswer:Howdo

youdefinesuccess?Howdoyoumeasureimprovement?

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studiestypicallyassessoneofthefollowingquestions:Istherapyingeneraleffective?Areparticulartherapiesgenerallyeffective?Areparticulartherapies

effectiveforparticularproblems?TTThhheeeEEEffffffeeeccct

ttiiivvveeennneeessssssooofffTTTrrreeea

aatttmmmeeennnttt

Istherapy

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generallyeffective?ResearchsuggeststhattherapyisgenerallymoreeffectivethannotreatmentorplaceboInonemajorstudyusingmeta-analysis,the

averagepersonwhoreceivedtreatmentwasbetteroffthan75%oftheuntreated

subjectsTTThhheeeEEEffffffeeeccctttiiivvve

eennneeessssssooofffTTTrrreeea

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aatttmmmeeennnttt

Istherapygenerallyeffective?Somecliniciansareconcernedwitharelatedquestion:Cantherapycan

beharmful?HasthispotentialStudiesreport~5%getworsewith

treatmentTTThhheeeEEEffffffeeeccctttiiivvve

eennneeessssssooofffTTTrrreeea

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aatttmmmeeennnttt

Areparticulartherapiesgenerallyeffective?

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Generally,therapy-outcomestudieslumpalltherapiestogethertoconsidertheirgeneraleffectivenessOnecritichascalledthistheuniformitymyth

Itisarguedthatscientistsmustlookattheeffectivenessofparticulartherapies

Thereisamovement(rapprochement)tolookatcommonalitiesamongtherapiesT

TThhheeeEEEffffffeeeccctttiiiv

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vveeennneeessssssooofffTTTrrreeeaaatttmmmeeennnttt

Areparticulartherapieseffectivefor

particularproblems?Studiesnowbeingconductedtoexamineeffectivenessofspecifictreatments

forspecificdisorders:Whatspecifictreatment,bywhom,isthemosteffective

forthisindividualwiththatspecificproblem,andunderwhich

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setofcircumstances?Recentstudiesfocusontheeffectivenessofcombinedapproachesdrugtherapycombinedwithcertainformsofpsychotherapyto

treatcertaindisorders

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