Lecture notes Clinical Assessment and Decision Making
Lecture 1: Introduction & Roadmap Part I
Content of first two lecture
- Definition
- Knowledge & skills
- Roadmap
- Using instruments
- Defining (ab)normality
- Personality
- Phases in the process
o Referral
o Presenting complaints
o Classification
o Explanation
o Indication for treatment
- The report
Definition clinical assessment
Synonyms of clinical assessment in mental health care:
- Psychological assessment
- Psychodiagnostics
= It entails solving the problem of someone’s psychological disorder by making decisions
about its presentation, by formulating and testing hypotheses about what it is and how it is
caused, by gathering and integrating information from many sources (tests and observations
are just one of those many sources)
Definition psychological assessment
= “A shared decision-making process in which a clinician iteratively defines a diagnostic
question, formulates, and tests hypotheses about the client’s cognitive functions and
behaviour, and integrates the information thus collected from a number of sources and
using different methods based on scientific psychology in a dynamic fashion, resulting in a
representation and understanding of the problem that is shared with the client in such a
way that relevant indications for treatment or care ensue”
4 basic questions psychological assessment
1. Classification (Does this person have PTSD?), looking if someone meets the criteria
2. Explanation (Why does (s)he refuse to eat?)
3. Predication and indication (will cognitive behavioural therapy help this person?)
4. Evaluation (Was the intervention successful?)
Knowledge and skills psychological assessment
- Required knowledge
o Psychopathology and psychological theory
o Instruments and their psychometric qualities
o Treatment protocols
o …
, - Required skills
o (self) reflection
o Building therapeutic alliance
o Conversational skills
o Test skills
o …
Roadmap
If you have the needed knowledge and skills, you can start
this roadmap, which shows the whole psychological
process. You first need to accept the referral, then
conclude if there is an emergency (if yes, you won’t follow
the whole process), and decide if it is useful to include an
explanatory analysis
The toolkit for psychological assessment
- Observation, already starts at the first encounter, and will proceed throughout the
procedure, you can also use observations of others. There is a lot of behavior to be
observed, which won’t necessary be scored within a test
- Interview, you need certain conversational skills, to make sure the conversation will
lead to the way you want it to go, structure is needed and necessary. Sometimes you
may also interview others about the patient
- Tests, which one will depend on a lot of factors like time, money etc.
o Why?
o Which?
o How to interpret the results?
Consult the COTAN database
Psychological tests the COTAN database
= Dutch Committee on Tests and Testing (Commissie Testaangelgeneheden van het NIP).
Criteria:
- Availability, e.g., do you need to go through great lengths to receive the test from the
researcher
- Adaptation/translation for the Netherlands, about which languages but also if it’s
done correctly
- Standardization, is it described or are there many loose ends
- Validity (construct (does it measure what it is supposed to measure) and criterion
(does it predict a certain outcome)
- Reliability
- Norms
Always look at why something is insufficient, because it can give you an idea about e.g.,
limitations and how to interpret them
Cotan rating: Wechsler intelligent test for Children – 5th ed. (WISC-V-NL) (2018)
- Basis of the test construction: good
- Quality of test materials: good
- Quality of manual: good
, - Norms: sufficient
- Reliability: good
- Construct validity: sufficient
- Criterion validity: insufficient (due to lack of research)
Cotan rating: Beck depression inventory – 2nd ed. (BDI-II-NL)
- Basis of the test construction: good
- Quality of test materials: good
- Quality of manual: good
- Norms: insufficient
- Reliability: good
- Construct validity: sufficient
- Criterion validity: insufficient
Cotan rating: Rorschach test (1921)
- Basis of the test construction: insufficient
- Quality of test materials: insufficient
- Quality of manual: insufficient
- Norms: insufficient
- Reliability: insufficient
- Construct validity: insufficient
- Criterion validity: insufficient
Psychological assessment: (ab)normality
What stands out? Your own (cultural) reference frame is also important in
this, and can also change over time e.g.:
- DSM-II (1968) many sexuality deviations were seen as disorders
- ‘Homosexuality revision’ (DSM-II, 1973) already partly revised, and
nowadays it is not seen as a disorder anymore (however,
unfortunately not worldwide)
In tests abnormality is decided in a more psychometric way, e.g., intelligent
tests, further away from mean the more extreme and ‘abnormal’. People
are compared to the average. +/- 2 standard deviations are seen as extreme
Psychological assessment: disorders and personality
- Vulnerability hypothesis: certain personality traits make one
vulnerable for the development of disorders
- Scar hypothesis: a disorder affects one personality
- Spectrum hypothesis: personality and disorders to be
considered a continuum (see picture)
Psychological assessment: referral
- My child needs help
- My parent(s) need help
- I need help
- You need help
- My patient needs help
