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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% of Saying True

Item Depressed Non-

Depressed Key

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 don’t 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 client’s 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

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)

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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