Transcript Assessment Techniques

Assessment Approaches
Steve Del Chiaro, PsyD.
San José State University
[PSYC 160]
Assessment vs. Classification
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Classification categorizes
Assessment may lead to
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Determining
Determining
Determining
of therapy
Determining
a diagnosis
a specific treatment
impact of a treatment during course
outcome of treatment
This all depends on our theory of pathology of
course…
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Remember: Assumptions Matter
Assumptions cover everything!
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Assumption of causality dictate our
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Assumptions of pathology
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Assumptions of etiology
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where does it come from?
Assumptions of assessment
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what counts as “sick” or “problematic”?
how do we know what it is?
how do we measure it?
Assumptions of curative factors
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how do we “fix” it?
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Approaches to Assessment
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Testing
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Interview
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One assessment
Variety of assessment devices (battery)
Structured, semi-structured, and
unstructured
Observational Methods
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When to Assess
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Beginning of treatment
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End of Treatment
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Determine choice of intervention or
intervention strategy
Determine whether intervention was
effective
THROUGHOUT treatment
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Determine if intervention is having impact
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General Considerations
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Assessment approaches
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Should be consistent across the treatment
Should have impact on what is done
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e.g. have bearing on intervention
Should attempt to measure variables of
interest
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Try to answer the Paul question
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What treatment by whom, for what problem, etc.
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Psychological Tests
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Structured assessment process
Nomothetic tests
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Large groups used to develop test
Normed tests
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Some of these have been normed statistically
Normed = standardized across population or
populations
Assessed for psychometric properties
Look at individual with respect to group scores
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Nomothetic Tests
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Rapid Assessment Instruments (RAIs)
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BDI, BAI, SCL, DAS, etc
Purpose: get meaningful data quickly
Good for research
May miss key clinical issues
Not especially geared to client problems
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Projective Tests
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Psychoanalytic tradition
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Look for evidence of hidden unconscious
problems
Cannot directly access unconscious
Allow patient/client/analysand to project
own issues onto ambiguous stimulus
materials
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Rorschach (ink blot test)
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Give unstructured or ambiguous stimuli to
which the patient or client responds
This allows access to unconscious material:
attitudes, motivations; behavior styles
Major problems with reliability and validity
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Remember reliability and validity types
Typically used by psychoanalytic or
psychodynamic therapists
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Rorschach inkblot
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Thematic Apperception Test
(TAT)
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Show a story card
Ask the client what's going on in this
picture?
Allows access to unconscious material
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Thematic
Apperception
Test
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Drawing Tests
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House Tree Person (John Buck)
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Given to children
"Here I want you to draw as good a house
as you can."
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House interpretations
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Do this for tree and person, too
“Loosely based on research and on the
symbolic meaning of the aspects of the house.”
Exercise
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Critical Thinking Moment
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What are the challenges with projective
tests?
Why would we used them?
Are there arguments for using them?
What if they are not consistent with
your paradigm/theory?
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Objective Tests
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Roots in empirical tradition
Objective measures utilize highly structured
response formats
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Consist of unambiguous stimulus items
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Forced choice (e.g., true/false)
Likert scale ratings
Result in a quantitative score that can be
compared with normative score data
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Require minimal inference in scoring and
interpretation
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Objective Tests
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Disadvantages
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Items can clue to what is being measured
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social desirability biases
faking
Forced-choice responses
Misinterpretation of items
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Especially double negative phrases
Also with “double barreled” questions
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Objective Tests
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Minnesota Multiphasic Personality
Inventory II (MMPI-II)
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Most widely used objective test
Designed to screen patients for various
psychological disorders
Most widely used in research
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MMPI-II was re-normed
MMP-I was considered out dated
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MMPI
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Over 500 items
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True/False responses
2 parts of MMPI:
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Validity scales
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Clinical scales
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Tell whether profile is accurate measure of taker &
whether taker answered honestly
3 validity scales
What test tells about how taker is doing clinically
10 scales
Pattern is interpreted not one scale (1-0)
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MMPI
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Empirically derived test
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AKA empirically keyed test
Developed by Hathaway and McKinley in
1942
Gave test to find out what responses
match personality styles
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Empirically Keyed test
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Step 1: Generate items
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Need a lot of items
Response format will be True/False
Step 2: Have two samples respond to
items
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A sample of depressed people
A sample of people that are not depressed
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Empirically Keyed test
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Step 3: Compare each groups’
responses to each item
Example
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Building a measure of depression (MMPI
Subscale)
Self-Assessment of Depression (SAD)
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Empirically Keyed test
Item
% of Saying True
NonDepressed Depressed Key
I am a happy person.
4
52
F
I often feel blue.
My eyes are too far apart.
75
8
30
10
T
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Sometimes my hair hurts.
I sunburn easily.
60
25
15
31
T
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I like the color green.
27
85
F
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Empirically Keyed test
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Step 4: Cross-Validate
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Give the measure to two new samples of
depressed and non-depressed people
Evaluate how well the scale differentiates
the samples
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Empirical Keying Approach
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Advantages
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No assumptions about capability to self-report
behavior
Researchers can assess poorly defined constructs
Explicitly built to differentiate groups
Disadvantages
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Test takers often don’t like it
Tends to be long
Will make very general statements (may not be
accurate)
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MMPI
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Look at pattern of responding
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Look at clinical scales in context of validity
scales
Look at each clinical scale in context of the
rest of the scales
This is complex and requires very specific
training
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Diagram Profile
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65
L F K
1 2 3 4 5 6 7 8 9 0
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MMPI
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Advantages
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No assumptions about capability to self-report
behavior
Great for teasing out fakers and other invalid
profiles
Enormous data base to compare results
Disadvantages
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Historically overpathologized certain groups
Will make very general statements (may not
apply)
Some clinicians find better use of that time used
to take test
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Psychological Tests
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Idiographic assessment approaches
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Examine changes for specific individual on
assessment based on that person
Want to look at data for each individual
Remember single-case designs
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example, Functional Analysis (Ch 9)
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Idiographic Assessment
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Want to know when, where, what it buys
Look at variables of interest (frequency,
strength, duration)
Examine in different situations of interest
(home, school, work, institution)
Self-report data (Self-Monitoring)
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Subject to reactivity
Increases desirable and decreases undesirable
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Clinical or Behavioral
Interviewing
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Assessment Interviews
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Different contexts:
Legal
Therapeutic
Others?
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Clinical or Behavioral
Interviewing
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Attempt to get as much information
from client as possible
Again, depends on what the question is,
the purpose of the interview
Arrange this material in way that allows
one to take action with client
Different theories yield different
strategies
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Interviewing
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Key is to be able to do some
intervention with the client
Need to look at variables such as
ethnicity and gender
Important to enlist the client’s help to
do this
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Interviewing
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Rapport building
Make sure client understands the
importance of the questions
Convey difference between assessment
and actual treatment
Using open ended questions
Using silence
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Interviewing
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Essential questions that affect
treatment considerations
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Suicidal?
Homicidal?
Psychotic?
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Interviewing Issues
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How important is it to match the client’s
theoretical orientation with the
therapist’s?
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Data say not important, but it may be
better if…
Can’t possibly match all client’s to all
orientations (too many cells for research)
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Assessment Interview
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Typically called “intake”
Assessment measures (gathering
objective data)
What are they coming in for?
What attempts have they made in the
past to deal with problems?
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Assessment Interview
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What are their strengths/weaknesses?
Harm to self or others?
Alcohol, drug, medication, medical
conditions, health, nutrition, etc
Social support available
History/family history
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Clinical Judgment: Subjective
and Objective Approaches
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Different opinions
Use statistics (particularly Bayesian
Statistics) to determine course of
treatment OR
Use judgment and experience to
determine course
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Actuarial, Quantitative, or
Statistical Approach
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Emphasizes objectivity and involves assigning
scores to the various characteristics of
patients and determining correlations
between characteristics
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e.g., In 85% of people with a broken arm, surgery
is not needed, a cast will assist in the mending of
the broken bone
e.g., Those depressed clients treated with CBT vs.
nothing, 65% will improve depressed behaviors
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Subjective, Clinical Approach
and Heuristics
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Emphasizes the application of judgment to
the individual case
More subjective, experiential, and intuitive
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e.g., This particular person, with this broken arm,
should receive surgery because some other factor
participates in the decision
This particular depressed client will not respond to
CBT for these reasons
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Clinical Judgment: Subjective
and Objective
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Each side has advantages and disadvantages
Subjective, clinical approach valuable:
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Information is needed about areas or events for
which no adequate tests are available and/or no
statistical equations have been developed
Rare, unusual events of a highly individualized
nature are to be predicted or judged
Clinical approach problems:
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Use heuristics that bias what we attend to
(salience, recency, familiarity)
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Clinical Judgment: Subjective
and Objective
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Actuarial approach is valuable when:
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Outcome to be predicted is objective and specific
Outcomes for large, heterogeneous samples are
involved, interest in the individual case is minimal
Reason to be particularly concerned about human
judgmental error or bias
Actuarial approach problems:
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Lose individual in assessment or decision process
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Clinical Judgment: Subjective
and Objective
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Bottom line is can do both
Need to be very aware when choosing
the strategy
Need to know that clinical, subjective
approach has many problems
Need to keep in mind that statistical
data may be very useful
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