Psychological
assessment
this summary is based on notes from the compulsory reading and the slides
,Laura C./ Tilburg University/ 2024-2025
INTRODUCTION & COMMUNICATION SKILLS ................................................................. 6
Witteman et al. chapter 1: Psychological assessment: definition and ...................................... 6
introduction ........................................................................................................................... 6
THE ASSESSMENT PROCESS ................................................................................................ 6
ASSESSMENT INSTRUMENTS ................................................................................................ 7
OBSERVATION METHODS ............................................................................................................. 7
CLINICAL INTERVIEWS................................................................................................................. 7
SEMI-STRUCTURED INTERVIEWS .................................................................................................... 8
PSYCHOLOGICAL TESTES ............................................................................................................. 8
NORMAL VS ABNORMAL BEHAVIOUR ...................................................................................... 9
CATEGORICAL VS DIMENSIONAL PRESENTATION OF DISORDERS .................................................... 9
CATEGORICAL FRAMEWORK ......................................................................................................... 9
DIMENSIONAL FRAMEWORK ....................................................................................................... 10
THE PERSONALITY- MENTAL DISORDER RELATIONSHIP ............................................................... 10
van der Molen et al. chapter 2: The helper’s basic attitude ..................................................... 10
THE HELPER’S BASIC ATTITUDE ............................................................................................ 11
THE DIAGNOSIS-PRESCRIPTION MODEL ......................................................................................... 11
THE COOPERATION MODEL ........................................................................................................ 11
THE SOPHISTICATED HELPER .............................................................................................. 12
van der Molen et al. chapter 3: The client-centered approach ................................................ 12
ROGER’S THEORY & METHOD ............................................................................................. 13
A COGNITIVE THEORY OF EXPERIENCING ................................................................................ 15
ROGERS, WEXLER AND EMOTIONS ............................................................................................... 15
ASSESSMENT PROCESS: DECISION MAKING ................................................................. 16
Witteman et al. chapter 2: Judging and deciding .................................................................... 16
HEURISTICS COMMONLY USED IN CLINICAL SETTINGS ............................................................... 18
MEMORY HEURISTICS ............................................................................................................... 18
ATTENTION HEURISTICS............................................................................................................. 19
AFFECT HEURISTIC ................................................................................................................... 19
FAST AND FRUGAL HEURISTICS.................................................................................................... 20
TEAM DECISIONS ............................................................................................................ 20
IMPROVED JUDGMENT AND DECISION MAKING ......................................................................... 21
SYLLOGISTIC REASONING VS LOGICAL REASONING .......................................................................... 22
Witteman et al. chapter 3: Start of the assessment process................................................... 22
REFERRAL ..................................................................................................................... 22
THE REFERRER ........................................................................................................................ 22
THE CLIENT ............................................................................................................................ 23
CLINICIANS' CONSIDERATIONS ................................................................................................... 23
CLASSIFICATION ............................................................................................................. 24
WHAT IS A DISORDER? .............................................................................................................. 24
THE MEANING OF BEHAVIOUR IN CONTEXT ..................................................................................... 25
CLASSIFYING A MENTAL DISORDER .............................................................................................. 25
CULTURAL DIFFERENCES ........................................................................................................... 25
ARRANGING AND STRUCTURING THE PATTERN OF COMPLAINTS .......................................................... 26
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,Laura C./ Tilburg University/ 2024-2025
DIFFERENTIAL DIAGNOSES AND COMORBIDITY ................................................................................ 26
FURTHER TOPICS IN CLASSIFICATION............................................................................................ 26
ASSESSMENT PROCESS: INTELLIGENCE TESTING ......................................................... 28
Handbook of psychological assessment chapter 5: Wechsler Intelligence Scales .................. 28
WECHSLER INTELLIGENCE SCALES ....................................................................................... 28
PROS & CONS OF USING INTELLIGENCE TESTS ................................................................................ 28
ASSETS AND LIMITATIONS OF INTELLIGENCE TESTS ........................................................................... 29
MEANING OF IQ SCORES ........................................................................................................... 30
CAUTIONS AND GUIDELINES IN ADMINISTRATION............................................................................. 32
WAIS-IV/WISC-V SUCCESSIVE-LEVEL INTERPRETATION PROCEDURE ................................................. 33
WECHSLER INDEXES AND SUBTESTS............................................................................................. 36
ASSESSING BRAIN DAMAGE ........................................................................................................ 43
ASSESSING ADDITIONAL SPECIAL POPULATIONS.............................................................................. 45
Knowledge clip .................................................................................................................... 47
MEASURING COGNITIVE ABILITIES ........................................................................................ 47
WISC-V ................................................................................................................................ 47
WAIS-IV ............................................................................................................................... 48
CALCULATING THE SCORES ........................................................................................................ 50
Witteman et al. chapter 4: Explanation ................................................................................. 51
EXPLANATION ................................................................................................................ 51
JUDGMENTS ABOUT EXPLANATIONS OF MENTAL DISORDERS ............................................................... 51
THE NARRATIVE OF THE CLIENT.................................................................................................... 51
CAUSAL INTERPRETATIONS OF SYMPTOMS AND DISORDERS ............................................................... 52
CAUSAL EXPLANATIONS IN CLINICAL PRACTICE ............................................................................... 53
IS A CLASSIFICATION SUFFICIENT? ............................................................................................... 53
GOAL OF AN EXPLANATORY ANALYSIS ........................................................................................... 53
EXPLANATION HYPOTHESIS ........................................................................................................ 54
ELEMENTS OF AN EXPLANATORY MODEL ........................................................................................ 54
ASSESSMENT PROCESS 3: CASE APPLICATION ............................................................. 56
van der Molen et al. chapter 5: The Helper at Work ................................................................ 56
CLARITY OF GOALS .......................................................................................................... 56
THE ROLES OF THE HELPER ................................................................................................. 56
A HELPING MODEL ........................................................................................................... 57
PROBLEM CLARIFICATION .......................................................................................................... 57
GAINING NEW INSIGHT.............................................................................................................. 58
TREATMENT OF THE PROBLEM ..................................................................................................... 59
THE HELPER AS A PERSON .................................................................................................. 60
Witteman et al. chapter 5: Indication for Psychotherapy ........................................................ 62
TREATMENT PLANNING ..................................................................................................... 63
PROTOCOL-BASED TREATMENTS .......................................................................................... 63
SYSTEMATIC TREATMENT SELECTION .................................................................................... 64
CHARACTERISTICS OF THE CLIENT ............................................................................................... 64
THE CLIENT'S PRESENTING COMPLAINTS ....................................................................................... 64
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THE CLIENT'S PREFERENCES ....................................................................................................... 64
INDICATION THROUGH NEGOTIATION .................................................................................... 65
Witteman et al. chapter 6: The Report ................................................................................... 65
THE REPORT................................................................................................................... 65
ASSESSMENT PROCESS 4: INDICATION ........................................................................ 67
van der Molen et al. chapter 6: Basic Communication Skills for Problem Clarification ............ 67
STARTING THE INTERVIEW AND MAKING AN INITIAL CONTRACT ..................................................... 68
'NON'-SELECTIVE LISTENING SKILLS, ATTENDING BEHAVIOUR ...................................................... 69
SELECTIVE LISTENING SKILLS .............................................................................................. 70
ASKING QUESTIONS ................................................................................................................. 70
PARAPHRASING OF CONTENT ..................................................................................................... 71
REFLECTION OF FEELING ........................................................................................................... 71
CONCRETENESS...................................................................................................................... 72
SUMMARIZING ........................................................................................................................ 73
REGULATING SKILLS ......................................................................................................... 73
GOAL SETTING AND GOAL EVALUATION ......................................................................................... 73
SITUATION CLARIFICATION ......................................................................................................... 73
THINKING ALOUD ..................................................................................................................... 74
ENDING THE COUNSELLING INTERVIEW ......................................................................................... 74
van der Molen et al. chapter 7: Advanced Communication Skills ............................................ 75
INTERPRETATION ............................................................................................................. 76
GIVING INFORMATION ...................................................................................................... 77
DIFFERENTIATING SKILLS .................................................................................................. 77
ADVANCED ACCURATE EMPATHY ................................................................................................. 77
CONFRONTATION .................................................................................................................... 77
POSITIVE RELABELLING ............................................................................................................. 78
EXAMPLES OF ONE’S OWN ......................................................................................................... 79
DIRECTNESS........................................................................................................................... 79
van der Molen et al. chapter 8: Strategies for the Treatment of the Problem ............................ 80
TREATMENT ................................................................................................................... 80
LEVELS OF TREATMENT .............................................................................................................. 80
GOAL-DIRECTED ACTION ................................................................................................... 81
FORMULATING GOALS ............................................................................................................... 81
CREATING AN ACTION PROGRAMME ............................................................................................. 82
TREATMENT AS EDUCATION ........................................................................................................ 82
TERMINATION................................................................................................................. 82
FORENSIC ASSESSMENT ............................................................................................. 85
THE SITUATION IN NL................................................................................................................ 85
BORDERLINE PD ..................................................................................................................... 85
NARCISSISTIC PD .................................................................................................................... 86
ANTISOCIAL PERSONALITY DISORDER ........................................................................................... 86
THE DIAGNOSTICIAN ........................................................................................................ 86
DEMANDS FOR DIAGNOSTICIAN .................................................................................................. 87
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,Laura C./ Tilburg University/ 2024-2025
THE QUALITIES OF A DIAGNOSTICIAN ............................................................................................ 87
ASSESSMENTS FOR THE COURTS.......................................................................................... 87
DIAGNOSTIC PROCESS .............................................................................................................. 88
PSYCHOLOGICAL EXAMINATION .................................................................................................. 89
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,Laura C./ Tilburg University/ 2024-2025
Introduction & communication skills
Witteman et al. chapter 1: Psychological assessment: definition and
introduction
psychological assessment= shared decision-making process that involves a clinician
identifying a diagnostic question, generating and testing hypotheses about the client's
cognitive, emotional, and behavioural functions, and synthesizing information gathered from
various sources and methods rooted in scientific psychology; this process leads to a detailed
understanding and depiction of the client's issues, which is then communicated to the client,
along with treatment recommendations.
=>in psychological assessment we analyse the behaviour, thoughts, and emotions
of clients in a systematic way and based on psychological theories, in order to
understand and predict their course
- there are four basic question categories:
o classification (the complains are analysed and described in detail)
o explanation (the aim is to find out how the identified problems came up to be and
how they persist)
o prediction + indication (these questions related to how future behaviour will
develop and whether or not something needs to be done about it; if intervention is
needed, the clinician has to look for the most beneficial course of treatment)
o evaluation
The assessment process
- de Groot’s empirical cycle was
translated for psychological
assessment by de Bruyn in 1992;
Fernandez-Ballesteros et al. in 2001
proposed guidelines for the
psychological assessment based on
the empirical cycle
- a scientifically sound procedure for
collecting information (logically
and methodologically) should
follow these steps:
o observation (collection of information)
o induction (inference to formulate hypotheses, based on theory)
o deduction (derive testable predictions)
o testing hypotheses and predictions
o evaluation of the process and its outcome
- in all phases of the assessment the following steps of the empirical cycle are followed:
I. formulating hypotheses
II. formulating verifiable predictions based on the hypotheses
III. choosing instruments to test predictions
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IV. establishing the testing criterion/ the expected scores on the instruments
V. administering the methods and using the instruments chosen + scoring and
interpreting the results
VI. evaluating and confirming/ refuting the hypothesis based on the results
Flowchart of the psychological assessment process according
to Witteman
Assessment instruments
observation methods
clinical interviews
semi-structured interviews
psychological tests
Observation methods
- observation is the most used method in
assessment
- provide a lot of unique information that
we cannot obtain just by asking questions or
taking tests
- extremely used when it comes to
clinicians having to understand the interaction
between clients and their context (as clients
themselves usually do not have an overall
objective perspective on these contexts)
- clients can observe themselves and
register their behaviour= self-registration; if
self-registration is needed it’s important that
the client knows exactly what needs to be
observed (as usually people tend to interpret
behaviour instead of objectively observing it)
- 2 types of observations:
o standardized
o non-standardized
standardized observation uses evaluation scales- this reduces the probability of judgment
errors
the non-standardized observations are more prone to judgment errors (the actor-observer
effect= a fundamental attribution error can occur, in which our own problematic behaviour is
attributed to external factors, while the problematic behaviour of others is attributed to their
internal factors)
Clinical interviews
- there are two views on how to make the most valid statements about people and
their complaints:
o the ideographic approach (person-oriented approach)
o the nomothetic approach (norm-oriented approach)
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ideographic approach: emphasizes uniqueness, individual differences, and context-specific
understanding
nomothetic approach: emphasizes generalizability, patterns, and comparisons to norms; the
person is understood through analytical thinking, theory formation and empirical testing
Semi-structured interviews
- most clinicians rely on their intuition and focus on the most striking criteria to make
decisions
+ -
- higher reliability of the diagnostic - time consuming (> 2hrs)
judgement as well as of the - the structured part of the interview
interrater reliability and test-retest involves fixed protocols that might
reliability not match the client and do not
- important symptoms are not facilitate the development of a
overlooked (due to the systemic strong relationship between the
way of assessment)= higher therapist and client
validity of the diagnostic - more problem-oriented than
judgement person-oriented
Psychological tests
psychological tests= a tool or procedure used to assess a client's behaviour in a specific
domains, with the results being evaluated and scored through a standardized process; this
method provides more accurate insights into personality traits, mental disorders, and
cognitive functioning than relying solely on a clinical interviews
+ -
- easy to administer - often involve self-report
- there are many well-constructed, - to be able to objectively self-report
reliable and valid psychological tests one needs to have knowledge and
available expertise in recognising and
- it’s possible to compare the score of understanding psychopathology
the client with those of a standard/ - clients do not think about themselves
norm group (= objectively in the same terms as clinicians do
determining whether and how - many people have a limited access to
someone deviated from the norm) their own cognitive processed (they
do not know exactly why they do/
did something)
- the scores on questionnaires can be
distorted by client’s psychological
defences and other kinds of
judgment errors about their own
abilities
- psychological tests must be applied responsibly, because important decisions about
the person being assessed are often made on the basis of the results
validity refers to the extent to which a test or assessment measures what it is intended
to measure
reliability refers to the consistency and stability of test scores or measurements over
time, across different raters, or under varying conditions; a reliable test should
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produce consistent results when administered to the same individuals or groups on
multiple occasions
! a test can be reliable but not valid, but it cannot be valid if it is not reliable
- testing tips:
o screen broadly before more focused assessment with (e.g., semi-structured
interviews)
o determine testing criterion in advance and mind the correct reference (norm)
group
o consider the time criterion (enduring symptoms)
o address topics that clients won’t bring up (substance use, suicidality, psychotic
symptoms, sexual problems)
o don’t forget client’s strengths: what do they enjoy, what are they good at,
resilience and ability to change, daily activities, insight, support network
Normal vs abnormal behaviour
- definitions of normal:
absence of mental disorder
still, one need to first define what a disorder is; additionally, there are many ideas
about normality and normal behaviour (and they differ from culture to culture, from
ethnic groups to ethic groups, etc)
successful adaptation to (changing) circumstances
this definition has its advantage in the fact that takes into account the context in which
behaviour takes place; however, in an extreme situation, extreme behaviour is
necessary for survival, while it is difficult to see such behaviour as normal (e.g.: the
child-soldier behaviour- during the war it’s an extreme behaviour that ensures one
adapts to the context, but it is not a normal behaviour)
- abnormality= deviation from a statistical norm
defining abnormality this way has its advantage in the fact that now we can
use a number to express how much someone deviates from the reference
group; however, statistical norms are not always available, and we do not
know exactly how many standard deviations one should deviate before
speaking of ‘abnormal’
=> the lack of a definition makes it difficult to formulate general assessment criteria in terms
of what is deviant or what is abnormal
Categorical vs dimensional presentation of disorders
- mental problems and personality characteristics can be arranged categorically or
dimensionally
Categorical framework
- in a categorical presentation, a disorder is either present or absent; it is assumed
that:
o there is a clear distinction between a disorder and normal behaviour
o there is homogeneity within categories assumed (=there are very few differences
between clients with the same diagnosis)
o categories are mutually exclusive
- DSM-5 and ICD-10 take a categorical approach to viewing abnormality in
psychology
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- disadvantages of the categorical approach:
there is extensive comorbidity between supposedly separate disorders
psychopathology is dimensional rather than categorical
the classifications have limited validity in predicting the course of the
disorder, performance on psychological tests or treatment response
many classifications are rather heterogeneous in nature
the classifications not otherwise specified (NOS) are the most prevalent group
of classifications
Dimensional framework
- RDoC (Research Domain Criteria) is a dimensional framework1 for investigating
clinical disorders
- RDoC describes psychological function and dysfunction in terms of transdiagnostic
processes; it defines 5 transdiagnostic domains, each with subdomains:
o negative valence systems (with subdomains such as fear, anxiety, etc)
o positive valence systems (e.g.: approach motivation, reward learning)
o cognitive systems (attention, perception)
o systems for social processes (e.g. affiliation. attachment)
o arousal/regulatory systems: processes that manage physiological arousal, sleep,
and homeostasis
- this framework includes developmental processes and environmental factors
- the disadvantage of RDoC is that mental disorders are seen as ‘disorders of brain
circuits’ and less attention is paid to psychosocial factors
- psychological assessment clarified these 4 main aspects:
o classification (presence/absence of a problem)
o explanation (how the problem arose and how it persists)
o prediction (what is likely to happen in the future)
o indication (can something be done and what could be most beneficial)
The personality- mental disorder relationship
- the vulnerability hypothesis: personality is seen a s potential risk factor for the
development of clinical syndromes (e.g.: if you score high on negative affectivity you
have an increased risk of getting depressed); personality, however, can be a protective
factor when one is resilient
- the ‘scar’ hypothesis: this hypothesis claims that mental disorders influence the
personality and its development (e.g.: if you have been depressed for a very long time
your personality development can also be impacted)
- the spectrum hypothesis: personality and mental disorder can be seen as a
continuum
van der Molen et al. chapter 2: The helper’s basic attitude2
1
Psychopathology is dimensional in nature: no clear-cut difference between normal/abnormal, overlap across
dimensions, dynamic fluctuations over time
2
chapter 1 is also included in mandatory reading but it is an introduction chapter with no significant information
for this lecture; thus, it is not part of the summary
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