Assessment Approaches Steve Del Chiaro, PsyD. San José State University [PSYC 160]
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…
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?
Approaches to Assessment • Testing • One assessment • Variety of assessment devices (battery) • Interview • Structured, semi-structured, and unstructured • Observational Methods
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
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.
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
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
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
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
Thematic Apperception Test (TAT) • Show a story card • Ask the client what's going on in this picture? • Allows access to unconscious material
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
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?
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
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
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
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)
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
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
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)
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
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
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 don’t like it • Tends to be long • Will make very general statements (may not be accurate)
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
Diagram Profile • 65 • L F K 1 2 3 4 5 6 7 8 9 0
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
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)
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
Clinical or Behavioral Interviewing • Assessment Interviews • Different contexts: • Legal • Therapeutic • Others?
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
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 client’s help to do this
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
Interviewing • Essential questions that affect treatment considerations • Suicidal? • Homicidal? • Psychotic?
Interviewing Issues • How important is it to match the client’s theoretical orientation with the therapist’s? • 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)
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?
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
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
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
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
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)