This is a summary of the book "Clinical Assessment: Psychodiagnostic Decision Making" for the course "Clinical Assessment" for the study Psychology. This course is given at the Radboud University in Nijmegen. The book is written by Cilia Witteman, Paul van der Heijnen and Laurance Claes.
Clinical Assessment: Summary Chapter 1-3-4-5-6
Chapter 1: Psychological Assessment: defniion and introducion
Psychological assessment: psychological assessment is a shared decision-making process in
which a clinical iteratiely deenes a diagnostc questonn formulates and tests hypotheses
about the client’s cognitie-afectie functons and behaiiourn and integrates the
informaton thus collected from a number of sources and using diferent methods based on
scientec psychology in a dynamic fashionn resultng in a representaton and understanding
of the problem that is shared with the client in such a ways that releiant indicaton for
treatment ensue.
4 categories:
1. Classiecaton
2. Explanaton
3. Predicton and Indicaton
4. Eialuaton
The assessment processes
Requires psychological insight + theoretcal knowledge + professional skills
‘Golden standard’ for the outcome of this process is ofen lacking in clinical practces
(we don’t exactly know how to deene a mental disorder; lack of feedback; no
informaton about client afer treatment; clients also recogniee themselies in
clinician’s descripton eien if it’s not about them)
Empirical Cycle: scientecally sound procedure for collectng informaton.
o Observaion: collecton of data
o Inducion: inferring what might be happening + formulaton of hypotheses
(=most difcicult phase)
o Deducion: deriiing testable predictons
o Tesing
o Evaluaion
Férnandee-Ballesteros et al. (2001) technical
guidelines to ensure quality and transparency in
psychology
The following steps of the empirical cycle are followed in
all phases:
1. Formulatng hypotheses
2. Formulatng ierieable predictons based on these
hypotheses
3. Choosing the instruments to be used to test these
hypotheses
4. Determining the testng criterion or the expected
scores on the instruments
5. Administering methods and instruments and
scoring and interpretng their results
6. Eialuatng and conerming or refutng the
hypotheses based on the results
,Using assessment instruments
Observaion methods: Why? Who? What? Where? When? How ofen?
Obseriaton unique informaton we cannot always obtain by asking questons (e.g.
eatng disorder underweight)
Helpful in mapping interactons between clients and their context don’t always
haie an oierall perspectie on these contexts (ask them to register behaiiour)
Disadvantage: obseriatons can be diferent in qualityn because not eieryone is
equally good at. Parents usually see more problems with their children than others.
It’s important to explicitly state what needs to be obseriedn and to stress that it’s
only necessary to obserie (not interpret! Kicking table is. “angry”)
Obseriaton in natural context is less structured than controlled but more
accurate.
Disadvantage: labour intensiie and expensiie
Standardieed (reduce judgement errors) is. non-standardieed (risks judgement
errors). But there is not a suitable assessment scale for eiery problematc behaiiour.
Actor observer efect: our own problematc behaiiour is atributed to external
factorsn while the problematc behaiiours of other atributed is to internal factors.
Time sampling: speciec exed tme period or point in tme – marking how ofen a
certain type of behaiiour occurs in a speciec period of tme. (most suitable for
problematc behaiiour
Event sampling: measuring how ofen the behaiiour itself happens.
Clinical Interviews
Ideographic approach: person-oriented; the uniqueness of the indiiidual is keyn
seeking a complete descripton of an indiiidual.
closely related to clinical judgement
Nomotheic approach: emphasis on general lawsn and their person is understood
through analytcal thinking.
closely related to statstcal judgement (formulas)
Statstcal judgement leads to beter predictons of human behaiiour than clinical
judgement. Clinicians make judgement errors.
Clinicians can increase the reliability of their statements by structuring their
judgements or organieing them into statstcal formulas.
Semi-structured interviews
Clinicians rarely follow the prescribed algorithms when classifying disorder form a
picture based on the most striking criteria and then base their judgement on that.
This intuitie modus is fast but can lead to unreliable and incorrect classiecatons
Semi-structured interiiew: higher reliability. They systematcally assess all complaints
and symptoms; they do not oierlook important symptoms higher reliability.
Also: lack of insight in clients. Semi-structured questons can be asked to giie speciec
examples of the complaints/problems they menton.
Disadiantages: iery tme consuming; focus on complaints and symptoms according
to a exed protocol is not always match what clients themselies want to tell the
clinician (or the order) link to therapeutc relatonship and alliance.
Remain an eye for the context – not just the symptoms.
, Semi structured interiiew + good contact = recommended.
Psychological tests:
You haie a hypothesisn and test this with a psychological test. Only test those tests
that can ierify or falsify their predictons and the results can say something about the
probability of their hypotheses.
Psychological test: eialuatie instrument or procedure that allows sampling a client’s
behaiiour in a giien domainn to be obtained and then eialuated and scored following
a standardieed process.
You can make more ialid statements about the presence of certain personality traitsn
mental disorders and cognitie functoning than on the basis of a clinical interiiew
alone.
Validity of psychological tests is strongn coniincing and comparable to the ialidity
commonly used in medial tests. It proiides unique informaton and clinicians who
base their statements exclusiiely on clinical interiiews without tests obtain
incomplete sight into mental and psychiatric problems.
Other adiantages: practcal in use (easy to do); well-constructedn reliable and ialid
tests are aiailable; possibility to compare the scores to a norm group;
Ofen use self-report
Disadvantages: (1) lack of insight and psychological expertse – but this expertse is
needed from the psychologistsn not the client; (2) many people haie limited access to
their own cognitie processes – and ofen do not know why they do something; (3)
scores on questonnaires are ofen distorted by clients’ psychological defences and all
kinds of judgment errors about their own abilites. More useful to let someone else
measure certain aspects.
Quality of psychological tests
Ethical guidelines for psychological tests a lot depending on the results
Reliability: says something about the stability of the scores (how well do you measure
what you want to measure) – iia Cronbach’s alphan stabilityn st. error of
measurement
Validity: whether a test measures what it pretends to measure.
Many people see scores as objectie measures – but they must be seen as
probabilitesn or scores within a conedence interial.
Reliability and ialidity are measured: if a client ets within a reference group – look at
norm data of that age group.
Using psychological tests can signiecantly improie the reliability and ialidity of the
assessmentn but the test themselies must be sufciently reliable and ialid. Manuals
of psychological tests generally contain enough informaton.
Defning normal and abnormal behaviour
We ofen don’t know what normal and abnormal isn we don’t know what a disorder is.
Many deenitons of normal:
Absence of mental disorders – problem: you haie to deene wat a mental disorder is
Mental disorders are ofen associated with signiecant sufering or limitatons in
socialn occupatonal or other important actiites. An expected response, or one that
is expected in a culture is not a mental disorder (e.g. mourning).
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