Assessment Approaches

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Assessment Approaches

• Steve Del Chiaro, PsyD.
• San José State University 
• PSYC 160

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Assessment vs. Classification

• Classification categorizes
• Assessment may lead to
• Determining a diagnosis
• Determining a specific treatment
• Determining impact of a treatment during course
  of therapy
• Determining outcome of treatment
• This all depends on our theory of pathology of
  course

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Remember Assumptions Matter

• Assumptions cover everything!
• Assumption of causality dictate our
• Assumptions of pathology
• what counts as sick or problematic?
• Assumptions of etiology
• where does it come from?
• Assumptions of assessment
• how do we know what it is?
• how do we measure it?
• Assumptions of curative factors
• how do we fix it?

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Approaches to Assessment

• Testing
• One assessment
• Variety of assessment devices (battery)
• Interview
• Structured, semi-structured, and unstructured
• Observational Methods

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When to Assess

• Beginning of treatment
• Determine choice of intervention or intervention
  strategy
• End of Treatment
• Determine whether intervention was effective
• THROUGHOUT treatment
• Determine if intervention is having impact

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General Considerations

• Assessment approaches
• Should be consistent across the treatment
• Should have impact on what is done
• e.g. have bearing on intervention
• Should attempt to measure variables of interest
• Try to answer the Paul question
• What treatment by whom, for what problem, etc.

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Psychological Tests

• Structured assessment process
• Nomothetic tests
• Large groups used to develop test
• Normed tests
• 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

• Rapid Assessment Instruments (RAIs)
• 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

• Psychoanalytic tradition
• 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)

• 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
• 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)

• 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

• House Tree Person (John Buck)
• Given to children
• "Here I want you to draw as good a house as you
  can."
• Do this for tree and person, too
• House interpretations
• Loosely based on research and on the symbolic
  meaning of the aspects of the house.
• Exercise

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Critical Thinking Moment

• 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

• Roots in empirical tradition
• Objective measures utilize highly structured
  response formats
• Consist of unambiguous stimulus items
• Forced choice (e.g., true/false)
• Likert scale ratings
• Result in a quantitative score that can be
  compared with normative score data
• Require minimal inference in scoring and
  interpretation

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Objective Tests

• Disadvantages
• Items can clue to what is being measured
• social desirability biases
• faking
• Forced-choice responses
• Misinterpretation of items
• Especially double negative phrases
• Also with double barreled questions

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Objective Tests

• Minnesota Multiphasic Personality Inventory II
  (MMPI-II)
• Most widely used objective test
• Designed to screen patients for various
  psychological disorders
• Most widely used in research
• MMPI-II was re-normed
• MMP-I was considered out dated

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MMPI

• Over 500 items
• True/False responses
• 2 parts of MMPI
• Validity scales
• Tell whether profile is accurate measure of taker
  whether taker answered honestly
• 3 validity scales
• Clinical 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

• Empirically derived test
• 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

• Step 1 Generate items
• Need a lot of items
• Response format will be True/False
• Step 2 Have two samples respond to items
• A sample of depressed people
• A sample of people that are not depressed

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Empirically Keyed test

• Step 3 Compare each groups responses to each
  item
• Example
• Building a measure of depression (MMPI Subscale)
• Self-Assessment of Depression (SAD)

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Empirically Keyed test
I am a happy person. 4 52 F
I often feel blue. 75 30 T
My eyes are too far apart. 8 10 --
Sometimes my hair hurts. 60 15 T
I sunburn easily. 25 31 --
I like the color green. 27 85 F
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Empirically Keyed test

• Step 4 Cross-Validate
• 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

• Advantages
• No assumptions about capability to self-report
  behavior
• Researchers can assess poorly defined constructs
• Explicitly built to differentiate groups
• Disadvantages
• Test takers often dont like it
• Tends to be long
• Will make very general statements (may not be
  accurate)

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MMPI

• Look at pattern of responding
• 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

• 65
• L F K 1 2 3 4 5 6 7 8 9 0

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MMPI

• Advantages
• No assumptions about capability to self-report
  behavior
• Great for teasing out fakers and other invalid
  profiles
• Enormous data base to compare results
• Disadvantages
• 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

• Idiographic assessment approaches
• Examine changes for specific individual on
  assessment based on that person
• Want to look at data for each individual
• Remember single-case designs
• example, Functional Analysis (Ch 9)

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Idiographic Assessment

• 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)
• Subject to reactivity
• Increases desirable and decreases undesirable

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Clinical or Behavioral Interviewing

• Assessment Interviews
• Different contexts
• Legal
• Therapeutic
• Others?

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Clinical or Behavioral Interviewing

• 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

• 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 clients help to do this

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Interviewing

• 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

• Essential questions that affect treatment
  considerations
• Suicidal?
• Homicidal?
• Psychotic?

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Interviewing Issues

• How important is it to match the clients
  theoretical orientation with the therapists?
• Data say not important, but it may be better if
• Cant possibly match all clients to all
  orientations (too many cells for research)

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Assessment Interview

• 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

• 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

• 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

• Emphasizes objectivity and involves assigning
  scores to the various characteristics of patients
  and determining correlations between
  characteristics
• 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

• Emphasizes the application of judgment to the
  individual case
• More subjective, experiential, and intuitive
• 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

• Each side has advantages and disadvantages
• Subjective, clinical approach valuable
• 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
• Use heuristics that bias what we attend to
  (salience, recency, familiarity)

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Clinical Judgment Subjective and Objective

• Actuarial approach is valuable when
• 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
• Lose individual in assessment or decision process

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Clinical Judgment Subjective and Objective

• 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