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College aantekeningen Methoden van Professioneel Handelen (SOW-PSB1PS12N)

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Dit is een samenvatting van alle colleges van het vak 'Methoden van Professioneel Handelen' uit het 1e jaar van de bacheloropleiding Psychologie (NL). De samenvatting is deels in het Nederlands en deels in het Engels. Ik heb voor de toets zelf alleen deze samenvatting geleerd en daarmee een 8,5 geh...

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  • September 6, 2021
  • 19
  • 2020/2021
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  • Linda kwakkenbos
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Week 1
Stappen in het proces:
1. Verheldering/ analyse van het probleem
2. Overwegen van oplossingen op basis van kennis/bewijs en probleem analyse
3. Voorstel en implementatie van een oplossing/interventie
4. Evaluatie van het effect van de interventie

“Assessment is a conceptual, problem-solving process of gathering dependable, relevant info about an
individual in order to make an informed decision
It is a decision making process in which the assessor iteratively formulates and tests hypotheses by integrating
data in a dynamic fashion”

Meerdere factoren in assessment (biologisch - psychologisch - sociaal - cultureel - ontwikkeling)

Fouten bij beslissingen:
- mensen zijn niet altijd consistent
- mensen nemen vaak irrelevante info mee
- mensen zien te veel ‘speciale gevallen’
- expert zien afwijkende groepen (en niet meer wat ‘normaal’) is
- mensen lijden aan de ‘fundamental attribution error’ =
schrijf alles toe aan de persoon en niet aan de omstandigheden → ik faal: komt door de
omstandigheden / jij faalt: komt omdat je dom bent
- mensen vinden leren van feedback vaak lastig
- mensen worden beïnvloed door recente ervaringen
- mensen kunnen moe en verveeld raken

Over het algemeen zijn logica zijn kansrekening te abstract voor ons: mens is meer ‘psychologica’
Om in complexe situaties zoals de klinische praktijk toch te kunnen oordelen en beslissen, hebben wij
efficiënte (maar niet onfeilbare) strategieën ontwikkeld: heuristieken, en gebruiken we intuïtie (= Systeem 1)

Vaak geven we eerst snel een antwoord, dat we misschien rationeel corrigeren → het gaat nooit andersom
- Systeem 1: intuïtief / heuristisch
- snel, automatisch, kost geen inspanning, associatief
- Systeem 2: rationeel / overdacht
- langzaam, gecontroleerd, vereist inspanning, serieel

Op ervaring gebaseerde verkorte denk routes, redeneerstrategieën die info overslaan om snel tot een
conclusie te komen: altijd efficiënt en soms ook feilbaar → leidt tot bias = vertekening, vooroordeel

(https://conversietopper.nl/heuristieken/#Ankerheuristiek)

Gebaseerd op het geheugen
Availability heuristic
- hoe makkelijker men zich iets herinnert, hoe waarschijnlijker men het zal vinden en hoe meer het een
rol speelt in beslissingen
- plays a role in info-gathering processes: primacy, recency or vividness/saliency presented by client
Anchoring and adjustment
- gaat over de invloed van wat als eerst wordt getoond op wat daarna wordt getoond
- primacy bias = the first info presented to the person influences the decision
- recency bias = the last info presented to the person influences the decision

Gebaseerd op aandacht
Representativeness heuristic

, - hoe meer kenmerken X heeft van een bepaalde groep / lijkt op een prototype van die groep → hoe
makkelijker X wordt geoordeeld tot die groep te behoren
- vulnerability for the inductive/intuitive system
- can place too much decisional “weight” on highly representative evidence and too little decisional
weight on relevant prior probabilities for a particular diagnosis and/or discrepant evidence

Gebaseerd op gevoel
Affect heuristic
- oordelen op basis van gevoel en niet op basis van inhoud: stemmingscongruent

Verschillende biassen
Hindsight bias
when an assessor overestimates the probability of a particular diagnosis when the diagnosis is already known
- patient needs to get tested for dementia: gets birthdate wrong each time, meaning she has dementia →
in reality the medical records were off
- automatic, intuitive and thus related to failures in inductive reasoning

Regret bias
when an evaluator overestimates the base rate of a potential diagnosis hat has a possible severe outcome
because of anticipated regret should the evaluator miss the diagnosis
- ondanks onzekerheid behandeling inzetten omdat je geen spijt wil krijgen
- let’s go ahead and treat is as if it’s X
- automatic, intuitive and thus related to failures in inductive reasoning

Confirmatory bias
general tendency to give greater attention to confirmatory evidence and/or seek confirmatory evidence, while
undervaluing disconfirming evidence and/or not actively seeking to disconfirm a hypothesis
- can also contribute to errors in interpretation by causing an examiner to put more evidentiary weight on
the confirmatory evidence and to discount any collected evidence that is in contradiction
- can lead to premature closure → tendency to stop considering other possibilities
- both inductive/intuitive and deductive/analytic decision-making systems are vulnerable

Diagnostic bias
when a psychologist always sees some kind of diagnosis
- must maintain constant awareness of possibility of “no diagnosis” + remember that many “symptoms”
of psychological disorders are extremely common, nonspecific, and thus not necessarily indicative of a
disorder + must constantly be reminded that evidence of impairment and dysfunction is part of the
diagnostic criteria for many diagnoses
- holding a stereotypical view of specific symptoms and how they fit with specific disorders can contribute
greatly to this sort of bias

Availability bias en representative bias

Klinische intuïtie
- gebruiken van ‘ingeblikte’ kennis en eerdere ervaringen in nieuwe situaties
- snel gemaakte, impliciete combinatie van kennis en ervaring die sterk aanvoelt
- afhankelijk van hoe goed die kennis en ervaring was, is dat of betrouwbaar of feilbaar
- waar heuristieken een deel van de info overslaan, gebruikt intuïtie alle info, in ingeblikte vorm

Algemene bekende keerzijden van veel ervaring
- luiheid, ‘overconfidence’
- ‘garden path thinking’, tunnelvisie
- geen motivatie of belangstelling voor open staan voor kritische feedback

, - deliberatieve systeem 2 processen zijn veranderd in automatische systeem 1 processen, terwijl klinisch
werk aandacht voor detail vereist

Concluderend
- psychodiagnostiek is een complexe taak die beslist aangepakt moet worden
- er is veel sprake van onzekerheid en onvolledigheid en daarom moet je heuristieken of intuïtie
gebruiken → dat is efficiënt maar ook riskant
- het getuigt van professioneel handelen als je je hiervan bewust bent en openstaat voor kritische feedback

Diagnostic decision-making is ‘wicked’ in the realm of psychological diagnoses:
- there are no gold standards for judging accuracy of the diagnostic decision
- psychological disorders are often comorbid → sometimes there are more diagnoses and sometimes
there is no diagnosis
- real-word assessment decisions must often be made under incredible time and resource pressures

Inductive reasoning
a decision maker starts with a specific observations → moves to broader generalizations about the likely
implications of those observations
- bottom-up approach: begins with specific observations → detection of potential patterns within those initial
observation → formulation of potential explanations for those patterns
- more open-ended and exploratory processes

Deductive reasoning
an assessor starts with a general concept, idea and/or hypothesis and works down to specific conclusions or
observations that would be expected if the concept, idea or hypothesis were correct
- top down approach: start with hypothesized diagnosis → consider what he/she would expect to
observe if the diagnosis were to be confirmed → gather the relevant data to confirm or disconfirm the
hypothesized diagnosis
- more structured and confirmatory
- risk: one begins to twist facts to suit theories, instead of theories to suit facts

The dual-process model of decision making
Beschrijft twee systemen: system 1 (intuitive) and system 2 (analytical)

Experience and decision-making training to minimize decision-making errors

Experience
- beginners tend to use deductive/analytical systems, assessors intermediate in their experience are
more likely to use inductive/intuitive heuristics and assessment experts take conscious reflective
approach that uses both processes in a dynamic and interactive way → what separates beginning
assessors from experienced assessors is the accuracy of their intuitive system
- argument could be that, to become an expert, an assessor needs exposure to a wide variety of cases
in order to understand differential diagnosis and to resist the decision-making biases that are reinforced
by narrow training and experience
- another potential limitation is the potentially inflating effects on confidence: overconfidence → in
addition to experience over time, assessors need reflective feedback about the accuracy of their
previous diagnoses to improve intuitive decision making

Decision-making training
- suggested this should focus on educating about decision-making errors with assumption that
awareness of these biases would minimize their influence → however, unclear whether it’s sufficient

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