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Issues in Assessment, Part I PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. September 24, 2013. Announcements. Response paper due Exams handed back. Response Paper Questions for Hunsley , Lee, & Wood (2003) Article (due next Thursday). Questions

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  1. Issues in Assessment, Part I PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.September 24, 2013

  2. Announcements • Response paper due • Exams handed back

  3. Response Paper Questions for Hunsley, Lee, & Wood (2003) Article (due next Thursday) • Questions • 1. Why do you think these tests are so commonly used by practicing psychologists? • 2. Should these tests be taught to clinical psychology graduate students? • 3. Is there sufficient justification for using the Rorschach, TAT, projective drawings, or anatomically detailed dolls in forensic settings?

  4. In the News • Science and psychotherapy • One patient’s perspective • Equine therapy for veterans with PTSD in Wyoming • Prediction in the NCAA: mental disorders in student-athletes

  5. From Last Class • Prediction • Factors that affect predictive accuracy • Base rates • Clinician biases • Clinical vs. statistical method for combining observations

  6. Response Paper Questions for Garb & Boyle (2003) Article (due this Thursday) • Questions 1, 2, and 3: Describe three factors that make it difficult for therapists to learn from their own clinical experience

  7. On Clinical Judgment • “We (psychologists) of all people, ought to be highly suspicious of ourselves…[and] have no right to assume that entering the clinic has resulted in some miraculous mutations and made us singularly free from the ordinary human errors which characterized our psychological ancestors.” -Psychologist Paul Meehl

  8. Questions for Garb & Boyle (2003) Chapter, due this Thursday 9/23 • Questions 1, 2, and 3: Describe three factors that can prevent clinicians from learning from their own clinical experience.

  9. Biases in Clinical Judgment • Assessment data is interpreted in context of one’s own preconceived notions (theoretical model, biases, prejudices, etc.) • Information is made to fit the model, rather than vice versa • Example: bias to perceive psychopathology, labeling anger and aggression as childhood bipolar disorder

  10. Biases in Clinical Judgment • Real-world clinical examples • “Ellen's phobic anxieties focused on ‘fear of being bitten by a dog’ and ‘nighttime monsters’ impress me as directly related to displacements of her feelings about her older sister's aggression. Ellen's explicit statement, ‘my sister acts like a monster’ is balanced with equal sincerity by Ellen's assertion, ‘I like being around Sarah, if she is nice.’” – psychiatrist • “He has tolerated ECT well apart from a gradual decline in immediate recall and short-term memory functions (sufficient that he now questions his ability to learn new job skills if he were to succeed in obtaining employment). His increased concern about short-term memory loss prompts him to now consider filing for short-term Social Security medical disability benefits and doing volunteer work until more fully recovered from his mental illness.” – psychiatrist

  11. Biases in Clinical Judgment • Confirmation bias • Initial opinions are formed quickly • Selective attention to confirmatory evidence • Counting the hits and forgetting the misses

  12. Biases in Clinical Judgment • Overconfidence • “Virtually every available study shows that the amount of clinical training and expertise are unrelated to judgmental accuracy”(Faust & Ziskin, 1988) • Overconfidence interacts with confirmation bias (i.e., the more confident you are, the less need to look for disconfirmatory information)

  13. Biases in Clinical Judgment • Availability bias – relying on information that most easily comes to mind • We vividly recall instances of accurate judgment (the “hits”) and overestimate their frequency

  14. Experience and Clinical Judgment • Experience creates the “illusion of learning” • We draw conclusions about a group by examining only members of that group (e.g., alcoholism is a chronic disease because all the alcoholics in my clinic keep relapsing)

  15. Experience and Clinical Judgment • We see an unrepresentative sample of patients • We create contexts in which our judgments cannot be wrong • Hospitalizing an ambiguously suicidal patient • Awarding custody to one parent over the other

  16. On Clinical Judgment • We rarely get accurate, objective feedback about our judgments • Feedback for psychologists: • In clinical practice vs. research • Nature of feedback (client self-reports) • Comparison with physician feedback (lab tests, autopsies, etc.)

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