Psychological Assessment

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Psychological Assessment

• William P. Wattles, Ph.D.

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Psychological Report

• The end product of assessment.
• More than merely test results
• Must interact with the data to make useful
  conclusions about
• Referral question
• Making decisions
• Problem solving

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Referral Question

• A brief description of the client
• general reason for conducting the evaluation

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Referral Question

• Orients the reader to the initial focus of the
  report and what follows.
• Clinician must clarify the referral question.

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Referral Question

• Referred for a psychological
• lacks focus and precision
• leads to shotgun reports
• A wide variety of often-fragmented descriptions
  in the hope that something useful can be found.

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Referral Question

• Example
• Mr. Smith is a 35-year-old, white, married male
  with a high school education who presents with
  complaints about depression and anxiety.

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Report Format

• Please follow example
• Add Discussion (case conceptualization) section
  before Impressions and recommendations.

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Discussion Section

• This is where you put it together.

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clarity

• She was attractive, well spoken, and had high
  mannerisms

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Translate Technical concepts

• Examples page 631

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Be concise

• Jesse S is a 23-year-old Caucasian female who
  presents with having the desire to feel fully
  fulfilled. She wants to feel settled in her
  life. The current evaluation was designed for
  the patient to gain personal insight regarding
  dissatisfaction with her current daily
  activities. (44)

12
Be concise

• Jesse S is a 23-year-old Caucasian female who is
  dissatisfied with her daily activities and wants
  to feel fully fulfilled. (21)

13
Be concise

• The patient answered all
• The inquiries presented to him
• my questions.

14
Simple language

• When this issue was further questioned, MT .
• Asked to elaborate, MT

15
Simple language

• She displayed a euthymic mood, which she
  described as great.

16
Avoid pejorative terms

• She was low on the Lie scale indicating that she
  received a normal score and appeared to answer
  honestly and openly.

17
Avoid jargon

• People with this profile tend to be narcissistic,
  selfish, and self-indulgent.

18
Seek active verbs

• The older sister was described as stubborn
  implying a strain in the relationship.

19
watch for redundancy

• Her past work history consists of working on a
  local

20
Seek clarity

• Mrs. Ls Mother is a resigned OB/GYN nurse

21
Short

• She made no eye contact even though she was
  familiar with the interviewer. Her eyes focused
  on the hairline of the interviewer.
• She appeared to look over my head rather than
  making eye contact.

22
Dont over do quotes

• we werent poor but we werent well off either.

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quotes

• because the other students think she gets all
  of the questions correct but she still doesnt
  know everything she feels like she needs to
  know.

24
Be concise

• Given the behavioral observations, length and
  depth of clinical interview and MMPI-2 test
  profile, I believe this evaluation is an accurate
  assessment of TSs current level of functioning.

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Details and examples

• She admits that they sometimes overcompensate
  in caring for their children because neither of
  them received enough attention from their parents
  growing up

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Be direct, dont repeat

• After high school, she felt that college was the
  next logical step for her. She felt that my
  parents were completely behind me as though it
  was the next natural step, but also to make sure
  that I did end up going to college. She repeated
  many times that you dont really have a choice
  about college in my family they make you think
  you do, but you really dont. Ms. Davis went on
  to say that she had been brought up thinking
  this, and she didnt even consider any other
  options after high school. (95)

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Interpretation goes in discussion

• The results of CAs WAIS-III indicates that she
  has above average intelligence especially with
  regards to her phenomenal attention span and her
  ability to solve visual problems using her visual
  motor skills. Her very high scores on her
  WAIS-III could be contributing to her unhappiness
  in her present occupation. She may feel that she
  is not using her strengths in the best possible
  fashion and that she has not lived up to her
  expectations.

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Case Conceptualization

•  S.L. is currently experiencing a great deal of
  subjective distress. Her current difficulties
  with depressive and anxiety symptoms are likely
  related to her self-concept, which has been
  shaped and distorted by her long-term
  interpersonal relationships with her family and
  her ex-boyfriend. The unreasonably high demands
  she places on herself set the stage for what she
  views as failure.

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Details and behavior

• During this time, G admitted to having been in
  trouble with the law. She refused to specify the
  type trouble. She also reported that she got into
  a lot of other trouble due to her sexual
  behavior. Again, she would specify what this
  other trouble was

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Initial Reports

• Length of papers 627-1960 words
• Best paper was relatively long
• You can check length

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Referral Section

• Brief
• Guides report

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General Comments on Papers

• Appearance example wearing house slippers,
  relevant to psy functioning.
• Good use of quotes Would keep cats until it
  killed her

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Use examples

• One patient had strict parents
• Examples help identify where the blame lies
• Didnt want to rat on her friends

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Language

• Proof read. One paper good content many errors in
  verbs etc.
• Avoid slang or colloquial language (I.e., blew it
  off) unless they are the clients words in quotes

35

• She did not display irregular emotion during the
  interview.

36
Colloquial Language

• Kim was kicked out of college her freshman year
  because of poor grades.
• The university suspended Kim her freshman year
  due to poor grades.

37
Simple language

• Ms. Heather presented, in the interview,
  congruent behaviors to that of someone with lower
  self-esteem.
• Ms. Heather shows signs of low self-esteem.
• Low self-esteem may contribute to her eating
  problems.

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Psychological Functioning

• Conceptualize
• Collect facts and observations
• Dont stop there
• Synthesize those observations and data into a
  picture of psychological functioning

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Strengths and Weaknesses

• Important to identify strengths to use and
  encourage

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Example

• The client was alert and oriented to all spheres.
  Her affect was full range, and her mood was
  euphoric. Her speech rate, quality, and content
  were within normal limits.

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Observation vs Interpretation

• Her calm demeanor while discussing her anxiety
  about graduate school, and her boyfriend
  suggested that this client keeps her emotional
  reactions to herself and maintains an
  intellectual stance on her personal issues.

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Example

• Mrs. H is a 57-year-old, Caucasian, married
  female who presents with concerns regarding a
  specific goal, her future retirement in order to
  spend time with her grandchildren.

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Passive voice

• Also, should his emotional situation persist or
  worsen, it is recommended that Andrew seeks the
  help of a counselor.

44
Referral Section vs. Summary

• C.S. states this is not what I imagined doing
  with my life. This dissatisfaction results in
  physical, emotional and social problems whose
  effects she seeks to minimize.

45
Good but can we improve?

• The client was very articulate and well educated,
  but her appearance was incongruent. She was
  dressed in very sloppy and causal attire.

46
Precise Language

• Articulate
• Expressing oneself easily in clear and effective
  language.
• Redundant
• Needlessly repetitive verbose

47
Example

• When describing her family background, however,
  the possible use of reaction formation became
  evident.

48
Explore for data

• She also stated that she felt inferior and
  lacked confidence in herself as a teacher, but
  offered no substantial reason why.

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Example

• his mood changed from enthymic to closed and
  quiet

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Diagnosis

• Andrew is a 24-year-old man referred because of
  his current unemployment and because he has been
  unable to find a job. Due to this situation,
  Andrew is going into a state of depression

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• Kim is a 23-year-old white female who presents
  with difficulties coping with stress brought upon
  her by school.
• Better

52

• Kim is a 23-year-old white female college student
  complaining of stress related to school.

53

• Kim approached the interview very willingly and
  appeared to be excited to do the interview. She
  wore sweatpants and a tee shirt. Her hair was
  pulled back into a clip. She was very talkative
  and maintained appropriate eye contact. She was
  very cooperative and answered all questions
  willingly, many times volunteering information
  beyond what had been asked of her but still
  remaining on the subject. She willingly expanded
  on all of her answers, many times without being
  prompted.

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• He is the only child of John and Vickie Xxxxxx .
  He has an older brother that his mother gave
  birth to out of wedlock prior to marrying Eric's
  father.

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• She wore coordinating accessories and seemed very
  contentious of her attire and posture.

56

• At age ten his father became a member of AA,

57

• Laura C. is a 23 year old woman who is
  self-referred because she not happy with her
  current living situation. She says that she feels
  so alone. She reportedly has gained weight over
  the last several months. She claims it is due to
  her unhappiness about being alone.

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• Laura also reports that her weight gain has not
  affected her relationship with her boyfriend.

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Verify with examples

• Her problems stem from her current occupation as
  a teacher. She has undergone significant life
  events in the last year.

60
Verify with examples

• She reports that she makes friends easily

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Use Examples

• In addition to confronting his wifes mortality,
  Harold is being forced by her illness to
  recognize his own vulnerabilities

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Verify with examples

• quit her job as a registration representative at
  _______ because of the unfair working conditions.

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Example

• His affect was full range, although his mood was
  quite dysphoric.

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Example

• In an effort to alleviate her frustration and
  anger, and to come to a compromise with Mr.
  Oranda about their differences in their expected
  roles, Mrs. Oranda states that she has made a
  conscious effort to talk to, rather than argue
  with, Mr. Oranda.

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Example

• Her affect was full range, however her mood was
  agitated.

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Example

• Within normal limits.

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Example

• She states she has many friends, and socializes
  with them on a weekly basis.

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Example

• Ms. A described her high school academic
  performance as above average, stating that she
  never studied

69
Wordy

• Brittany was explicit during the interview when
  discussing her home environment in reference to
  how physically violent it is.
• Brittany explicitly described the violence in her
  home.

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Example

• Brittanys academic and behavior problems began
  when her parents started drinking and fighting 2
  years ago.

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Be succinct 38 vs 29

• In order to improve her sleep schedule, she could
  be given information on sleep principles. For
  example, some principles are going to bed at the
  same time each night and not doing anything in
  the bed but sleeping.

• To help with fatigue she could be given
  information on sleep such as going to bed that
  same time each night and not doing anything in
  bed but sleeping.

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The You in a Report

• Personal opinion versus observation and
  hypothesis
• Sort through the abundant information

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Presenting problem versus reason for referral

• reported that she wished to be thinner
• She reports 9-10 year struggle with anorexia. As
  a result of this, she has had to seek medical
  treatment to pass four kidney stones and treat
  multiple stomach ulcers. Ms. Heather has had
  difficulty in maintaining a regular menstrual
  cycle and has experienced fainting spells due to
  low blood sugar a few times per month.

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• She is approximately 5 foot tall, 100 pounds
• She appears
• She reported that she is

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5 feet 100 lbs is BMI 19.5

• BMI Categories
• Underweight lt18.5
• Normal weight 18.5-24.9
• Overweight 25-29.9
• Obesity BMI of 30 or greater

76

• she stated that being the only child made them
  over protective and that she hoped they would
  ease up after she finished college. She
  explained that the more they monitored her plate,
  the more stress she felt and the more creative
  she got with hiding her food. She is still living
  at home. (24)

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Questions to ask

• Ms. Dubose is a 22 year old white female whose
  reason for referral was unhappiness with current
  job and disappointment with her professional
  direction.

78

• Despite the time difference between her recent
  return to academia and completion of her nursing
  studies, Mrs. Js performance in Francis Marion
  Universitys graduate program is excellent.

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The End