Handbook of Psychological Assessment, Gary Groth-Marnat, A. Jordan Wright, 2016
Chapters:
Chap 1: Introduction (pp. 1 – 37)
Chap 2: Context of clinical assessment (pp. 39 – 74)
Chap 3: The assessment interview (pp. 77 – 111)
Chap 4: Behavioral assessment (pp. 113 – 136)
Chap 5: Wechsler intelligence scales (pp. 139 – 161)
Chap 10: NEO personality inventory (pp. 489 – 512)
Chap 11: The Rorschach (pp. 513 – 527)
Chap 12: Screening for neuropsychological impairment (pp. 615 – 652)
Chap 13: Brief instruments for treatment planning, monitoring, and outcome assessment (pp. 653 –
670)
Chap 14: Treatment planning and clinical decision making (pp. 671 – 705)
1
,Chapter 1:Introduction
Role of the clinician
The central role of clinicians conducting assessment should be to answer specific questions and make
clear, specific, and reasonable recommendations to help improve functioning. To fulfil this role,
clinicians must integrate a wide range of data and bring into focus diverse areas of knowledge.
Psychometrics tend to use test merely to obtain data, and their task is often perceived as emphasizing
the clerical and technical aspects of testing. Their approach is primarily data oriented, and the end
product is often a series of traits or ability descriptions. These descriptions are typically unrelated to
the person’s overall context and do not address unique problems the person may be facing. In
contrast, psychological assessment attempts to evaluate an individual in a problem situation so that
the information derived from the assessment can somehow help with the problem. Psychological
assessments places data in a wide perspective, with its focus being problem solving and decision
making.
When psychological test were originally developed, group measurements of intelligence met with
early and noteworthy success, especially in military and industrial settings where individual
interviewing and case histories were too expensive and time consuming.
Advantage was that the data-oriented intelligence test was that they appear to be objective, which
would reduce possible interviewer bias. More important they were quite successful in producing a
relatively high number of true positives when used for classification purposes.
Later assessment strategies often tried to imitate the methods of earlier intelligence test for variables
such as personality and psychiatric diagnosis. A further development consistent with the
psychometric approach was the strategy of using a ‘’ test battery’’. It was reasoned that if a single test
could produce accurate descriptions of an ability or trait administering a series of tests could create a
total picture of the person. The goal then was to develop a global yet definitive description for the
person using purely objective methods.
Behind this approach were the concepts of individual differences and trait psychology. These
concepts assume that one of the best ways to describe the differences among individuals is to
measure their strengths and weaknesses with respect to various traits. Thus, the clears approach to
the study of personality involved developing a relevant taxonomy of traits and then creating test to
measure those traits.
The objective psychometric approach is most appropriately applicable to ability tests such as those
measuring intelligence or mechanical skills. Its usefulness decreases, however, when users attempt to
assess personality traits such as dependence, authoritarianism, or anxiety. Personality variables are
far more complex and, therefore, need to be validated in the context of history, behavioural
observations and interpersonal relationships.
Psychological assessment is most useful in the understanding and evaluation of personality and
elucidating the likely underlying causes of problems in living. These issues involve a particular
problem situation having to do with a specific individual. The central role of the clinician performing
psychological assessment is that of an expert in human behaviour who must deal with complex
processes and understand test scores in the context of a person’s life.
2
,In addition to an awareness of the role suggested by psychological assessment, clinicians should be
familiar with core knowledge related to measurement and clinical practice. This includes descriptive
statistics, reliability (and measurement error), validity (and meaning of test scores), normative
interpretation, selection of appropriate tests, administration procedures, variables related to diversity
(ethnicity, race, age, gender, culture etc.), testing individuals with disabilities, and an appropriate
amount of supervised experience.
These knowledge should be integrated with relevant general coursework, including abnormal
psychology, the psychology of adjustment, theories of personality, clinical neuropsychology,
psychotherapy and basic case management. A problem in many training programs is that, although
students frequently have knowledge of abnormal psychology, personality theory, and test
construction, they usually have insufficient training to integrate their knowledge into the
interpretation of test results. Their training focuses on developing competency in administration and
scoring rather than knowledge relating to what they are testing.
The approach of this book is consistent with that of psychological assessment:
Clinicians should be not only knowledgeable about traditional content areas in psychology and the
various contexts of assessment but also able to integrate the test data into a relevant description of
the person.
Patterns of test usage in clinical assessment
Psychological assessment is crucial to the definition, training, and practice of professional psychology.
Assessment skills are strong prerequisites for internships and postdoctoral training. The theory and
instruments of assessment can be considered the very foundation of clinical investigation, applied,
research, and program evaluation.
The 10 most frequently used test are WAIS, Minnesota Multiphasic Personality Inventory, Rorschach,
Bender Visual Motor Gestalt Test, TAT, projective drawings (human figure drawing, house-tree-
person), Wechsler Memory Scale, BDI, Millon Clinical Multiracial Inventories and California
Psychological Inventory. The pattern for the 10 most popular tests has remained quit stable since
1969, except that the raking of Human figure drawings dropped. It is expected that some newer
measures, especially the personality assessment inventory would be raked quite highly in use. There
is no recent survey published yet.
Although there has been a reduction, the Rorschach and TAT continue to have a strong foothold in
clinical practice. This can be attributed to lack of time available for practitioners to learn new
techniques, expectations that students in internships know how to use them unavailability of other
practical alternatives, and the fact that practitioners usually give more weight to clinical experience
than to empirical evidence. This suggests distance between the quantitative, theoretical world of the
academic and the practical, problem-oriented world of the practitioner. In contrast to the continued
use of projective instruments in adult clinical settings, psychologist in child settings are likely to rely
more on behaviour rating scales (e.g. Child Behaviour Checklist), than projective tests.
3
, The earliest form of assessment was through clinical interview. Clinicians like Freud, Jung and Adler
used unstructured interaction to obtain information regarding history, diagnosis, and underlying
structures of personality. Later clinicians organized interviews using outlines of the areas that should
be discussed.
During the 1960s and 1970s, much criticism was directed toward the interview, leading many
psychologist to perceive interviews as unreliable and lacking empirical validation test, in many ways,
were designed to counter the subjectivity and bias of interview techniques.
During the 1980s and 1990s, a wide variety of structured interview techniques gained popularity and
have often been found to be reliable and valid indicators of a client’s level of functioning. Structured
interview such as the Diagnostic Interview Schedule (DIS), Structured Clinical Interview for the DSM
(SCID), and Renard Diagnostic Interview are often given preference over psychological test. These
interviews, however, ware very different from the traditional unstructured approaches. They have the
advantage of being psychometrically sound even though they might lack important elements of
rapport, idiographic richness, and flexibility that characterize less structured interactions.
A further trend has been the development of neuropsychological assessment. The discipline is a
synthesis between behavioural neurology and psychometrics and was created from a need to answer
questions such as the nature of a person’s organic deficits, severity of deficits, localization, and
differentiating between functional versus organic impairment. The pathognomonic sign approach and
the psychometric approaches are two clear traditions that have developed in the discipline. Clinicians
relying primarily on a pathognomonic sign approach are more likely to interpret specific behaviours
such as perseverations or weaknesses on one side of the body which are highly indicative of the
presence and nature of organic impairments. These clinicians tend to rely on the radiations of
assessment associated with Luria and base their interview design and tests on a flexible method of
testing possible hypotheses for different types of impairment. In contrast, the more quantitative
tradition represented by Reitan and his colleagues is more likely to rely on critical cut-off scores,
which distinguish between normal persons and those with brain damage. In actual practice, most
clinical neuropsychologist are more likely to combine the psychometric and pathognomonic sign
approaches.
The two major neuropsychological test batteries are the:
-Luria-Nebraska Neuropsychological Battery
-Halstead Reitan Neuropsychological test Battery
A typical neuropsychological battery might include tests specifically designed to assess organic
impairment along with tests such as the MMPI, WAIS and the Wide range Achievement test (WRAT-
4).
Behavioural assessment could involve measurements of movements (behavioural checklists,
behavioural analysis), physiological responses (galvanic skin response GSR), electromyography (EMG)
or self-reports (self-monitoring, SCL-90). Whereas the early behavioural assessment techniques
showed little concern with the psychometric properties of their instrument, there has been an
increasing push to have them meet adequate levels of reliability and validity.
Evaluating psychological tests
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