Psy631 Psychological Assessment

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Psy631Psychological Assessment

• The Assessment Interview
• DSM-IV
• William P. Wattles, Ph.D.

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Core Concepts

• Diagnosis/Labeling
• In Context
• Abnormal per culture
• Multiple Causality
• On a Continuum
• Neurons (Mind/Body Connection)
• Data (Empiricism)

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Diagnosis/Labeling

• Diagnosis. The method or process by which the
  nature or category of an individual's disorder is
  determined

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Advantages and Disadvantages of Diagnosis

• Advantages
• Facilitate Treatment
• Enhance Research
• Improve Teaching

• Disadvantages
• Oversimplifies complex problems
• Diagnosis can stigmatize
• Diagnosis can be demoralizing.

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In Context

• Behavior is only abnormal in a situational
  context.

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In Context

• Demographic contextual variables influence
  diagnosis, and treatment of abnormal behaviors.

• Age
• Race
• Gender
• Class
• Culture

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Abnormal per culture

• Definitions of abnormal behavior vary across
  cultures and historical periods.
• Cultural and historical relativism.

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Cultural Relativity Theory

• A theory stating that human behavior lies on a
  continuum and that it is the role of culture to
  limit the spectrum by defining acceptable forms
  of behavior.

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Multiple Causality

• Mental disorders can result from a variety of
  causes.
• Different theoretical perspectives can contribute
  to the field.

• Psychological
• Biological
• Internal
• External

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On a Continuum

• Emotional and behavioral symptoms occur along a
  continuum that ranges from mild to severe. Also,
  many forms of abnormality are exaggerated
  versions of normal feelings and behaviors.

• Paranoia-
• Extreme, irrational distrust of others.

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Neurons (Mind/Body)

• Brain abnormalities can cause emotional symptoms
  and emotional stress can cause physical symptoms.

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Data (Empiricism)

• Psychology is a science
• Empirical data

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Science Methodology

• Control and manipulation
• Connectivity to current knowledge
• Building upon existing base
• Convergence of multiple sources
• Different methods and progress
• Probabilistic reasoning
• Correlation and prediction
• Multiple Causation and Interaction
• The role of chance

From Stanovich, K. How to think straight about
psychology
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Science Methodology

• Systematic Empiricism
• Public Knowledge
• Operationalism
• The role of Theory
• Falsifiability
• Testimonials and case study evidence
• Placebo
• Correlation and Causality

From Stanovich, K. How to think straight about
psychology
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What Is Psychological Abnormality?

• Many definitions have been proposed, yet none are
  universally accepted
• Most definitions, however, share some common
  features
• The Four Ds
• Deviance Different, extreme, unusual
• Distress Unpleasant upsetting
• Dysfunction Causes interference with life
• Danger Poses risk of harm

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Deviance

• No one had ever won the Tour de France six times.

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Deviance

• From what?
• From behaviors, thoughts, and emotions considered
  normal in a specific place and time and by
  specific people
• From social norms
• Stated and unstated rules for proper conduct in a
  given society or culture
• Examples?
• Judgments of deviance also depend on specific
  circumstances (i.e., social context)

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Eccentricity

• Eccentric Departing from a recognized,
  conventional, or established norm or pattern. See
  Synonyms at strange.

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Distress

• According to many clinical guidelines, behavior
  must be personally distressing before it can be
  labeled abnormal
• Not always the case
• Examples?

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Dysfunction

• Abnormal behavior tends to be dysfunctional it
  interferes with daily functioning
• Dysfunction alone does not mean abnormality.

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Danger

• Abnormal behavior may become dangerous to oneself
  or others
• Behavior may be careless, hostile, or confused

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Danger

• Although cited as a feature of psychological
  abnormality, dangerousness is an exception rather
  than a rule

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The Assessment Interview

• Without Interview data, most psychological tests
  are meaningless.

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The Assessment Interview

• Behavioral Observations
• Unique characteristics
• Patients reaction to events
• Rapport builder
• Check against test validity

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Interview vs. Conversation

• Interview
• Sequence
• Organized
• Discuss unpleasant subjects
• One-sided

• Conversational elements
• Build rapport
• Help Client relax
• Observe social skills

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Interview Goals

• Assess
• strengths
• Level of adjustment
• Nature and history of problem
• Diagnosis
• Relevant personal and family history.

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• Content Versus Process
• Information explicitly given by client.
• Information gleaned from observation.
• i.e., dreams

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Psychometric considerations

• Interrater Reliability
• Varies from .23 to .97
• Dilemma of differing results
• Interviews structure versus flexibility

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Halo Effects

• Tendency of interviews to develop a general
  impression of a person and then infer other
  seemingly related characteristics.
• NYT clipping
• jurors

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Halo Effect

• May cause interview to exaggerate or minimize
  pathology.

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Confirmatory Bias

• Occurs when interviewer makes an inference and
  that directs the interview to confirm the
  inference.

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Unstructured Interview

• Data should be treated cautiously and hypotheses
  considered tentative needing further support.
• Adding structure increases reliability.

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Unstructured Interviews

• Interviews allow clinicians to place test results
  in context.
• Build rapport
• Encourage client self-exploration

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Minimum requirements

• Interviewer must show
• Sincerity
• Acceptance
• Understanding
• Genuine interest
• Warmth
• Positive regard

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Interview Prep

• Setting lighting, comfortable seating, proper
  space, comfortable but tidy.
• Introduce self and preferred manner of address
• Explain purpose of interview, check clients
  expectation.
• Explain how interview and test data will be used.

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Interview Prep

• Explain confidentiality
• Limits
• Danger to self or other
• Child abuse
• Get a release if relevant
• Explain assessment procedure
• Clarify fee arrangements.

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Directive versus Nondirective

• You only learn if the client is talking
• Clients agenda or yours?
• Author suggests not competing styles.

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Sequence of interview tactics

• Many begin with open-ended questions.
• Lack of structure contrasts to most other
  assessment processes.
• Can Observe
• Verbal fluency
• Level of assertiveness
• Tone of voice
• Anxiety
• Energy level

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Avoidance of why questions.

• Increases defensiveness
• Sounds critical and accusatory
• Can lead to justification or excuse-making.

WHY?
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Structured Interviews

• Criterion Variance-vague guidelines for
  categories of information to be included.
• Information variance-variability in the amount
  and type of information.

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The End
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