Chapter7-9 Clinpsych
Chapter7-9 Clinpsych
• Shift from clinical use of MMPI & MMPI-2— • All psychological tests including
away from use of differential psychiatric MMPI-2 lack incremental validity.
diagnosis based on a single score to a more
o Cut-off scores validity: Varies on the nature
sophisticated profile analysis of scale scores.
of the sample population (which patients
• MMPI-2: Content scales have been have or don’t have the disorder).
developed (ex: identify health concerns,
• MMPI-2 cut off T score of 65+ may or
identity fears…)
may not be appropriate.
• Supplementary Scales: 450 MMPI scales
ranging from Dominance to Success in
Personnel Selection and Bias
Basketball! MMPI-2 there are 20 • Empirical Criterion Keying approach limits
supplementary scales (ex: Anxiety, Strength, usage of MMPI-2 to those that understand it.
Social Responsibility). • May not be appropriate to use MMPI-2 to
screen candidates for employment hiring
A Summary Evaluation of the
(invasion of privacy into religious beliefs,
MMPI and MMPI-2 Screening and sexual orientation).
The Question of Personality Traits
• MMPI original—may be biased against
• MMPI-2 useful for information about mental ethnic groups. Test Bias means that different
disorder diagnosis in terms of severity and predictions are made for two groups even
hypothesis generator. when they receive the same score.
• Not useful for a screening specific disorders Concerns about the MMPI-2
(ex: depression) as very long + time intensive.
• Atheoretical: MMPI measures symptoms of • The normative sample is too education;
psychopathology. Not useful for individuals without college degrees not
understanding general personality traits and represented. • Criteria for inclusion of
situational determinants. “normal respondents” is confusing. • Those
who are administered both versions of the
Reliability and Validity of MMPI-2 MMPI show different results on each version.
• Scores on MMPI-2 are lower than the MMPI
• Lacks internal consistency but do show
• Internal consistency of the MMPI-2 Scale is
good test-retest reliability.
low
The Revised NEO-Personality • Lack of validity scales, has no items to
assess response patterns and test taking
Inventory (NEO-PI-R)
approach.
Description
• May not be good for clinical diagnosis
• Self-report personality inventory that is because it was based of a “normal”
made up of the Five-Factor Model (FFM) personality.
• Validity needs to ask specific questions: • Exner’s Scoring System—strong for test-
Does the TAT predict aggression in situation retest reliability and construct validity.
A?
Reliability and Validity of
The Rorschach Inkblot Test Description and
Rorschach
Administration of Rorschach
• Many argue that reliability across time or
• Consists of 10 cards on which inkblot
test conditions does not exist for the
images are printed. 5 black & white and 5
Rorschach, while others counter-argue this
colored
statement.
• “Tell me what you see, there are no right or
• Clinicians who haven’t been trained
wrong answers, tell me what it looks like to
together & that use free-wheeling
you”
interpretation of the Rorschach makes
• Cards are administered in order and clinician interpreting the test difficult.
notes down patient’s responses word for
• Rorschach may be valid only under certain
word.
conditions; with the average validity being .41
• Other recorded aspects: lengths of time to (this has not been steady as another clinician
make response, total time spent on card, found a value of .29).
position of the card, all spontaneous remarks
(um, uh…). Rorschach Inkblot Method
• Inquiry: At the end patient is reminded of • Best viewed as a method of data collection
their responses to each card and asked what and not a “test”, as it is subject to
prompted that response. interpretation.
• Completions are scored along a 7-point • There are cases in which confidential
scale for adjustment-maladjustment. matters must be disclosed (i.e. Tarasoff case).
If the person is going to harm themselves or This tradition emerged as a reaction to the
others, then information can’t be privileged. dominant psychological perspectives of
the early 20th century, such as
• Tests might discriminate against minorities
psychoanalysis and introspection-based
(only include White-middle class populations)
structuralism, which emphasized internal
or include only certain population members
(ex: TAT only white members in cards) mental processes that were not directly
observable.
Use and Abuse of Testing: Test Bias
Behavioral Interviews:
• This is a validity issue (i.e. criterion or
performance varies significantly across Peterson and Sobell (1994) argue that this
groups). That it is more accurate for one model of behavioral assessment has great
potential to bridge the often wide gap
group than another.
between behavioral research and clinical
• Using traits characteristic for one practice. Yoman (2008) makes the case that
group (ex: men) but not the other an important first step in functional analysis is
group (ex: women). to define the “ultimate outcomes” of desired
behavior change. In other words, the behavior
• Differences in mean scores does not mean therapist asks the client about the hoped-for
bias, and bias can be overcome. results and, for each successive response,
queries about the intended result of that
The Use and Abuse of Testing: change. This interview will result in a chain of
Computer-Based Assessment behavior changes and results or
consequences that can then inform the
• Used to standardize tests, interpret therapist about how short-term
responses, cut costs, and increase clients consequences of behavior change may be tied
attention. to long-term consequences or “ulti mate
outcomes.”
• Internet-based psychological testing may
lack qualities of traditional testing—less - Ang basic goal of the interview is
reliable, valid, lack of control over the testing to identify specific problem
situation, technological issues, and cultural behaviors, situational factors that
differences in test interpretation.
maintain the problem behavior, and
the consequences that result from
• Computer Based Test Interpretation the problem behavior. Behavioral
(CBTI’s): Generate quick responses and interview allows therapist to
assess the client’s “hope” for end
process complex scores, but they must result
results. Ultimate Outcomes:
in inaccurate interpretations of results. Happiness, life satisfaction, making
the world better.
• CBTI’s must be clinically useful (should aid
in clinical understanding and treatment), valid
Observation Methods
(accurate interpretations) and reliable 1. Naturalistic Observation
(interpretations should be similar for similar Observing individuals in their
scores). natural environment, will enable a
clinician to better understand the
BEHAVIORAL ASSESSMENT problem.
• Observation in a natural
Traditional assessment environment has limitations and is
easier for children than adults who -Task Accomplishment (meeting
may be outpatients. and balancing of family members’
needs in the con text of the meal)
A clinician can try to understand a - Affect Management (expression
person with a phobia’s fear of and management of feelings
heights, a student’s avoidance of expressed by family members)
evaluation settings, or anyone’s - Interpersonal Involvement (the
tendency to over eat. These people degree to which family members
could be interviewed or assessed show concern for one anothers’
with self-report inventories. Pero needs)
dli lang jod dara nag satisfy ang - Behavior Control (use of
mga clinicians because according discipline and consistency)
to them. To determine the - Communication (appropriateness
frequency, strength, and and directness of verbal and non-
pervasiveness of the problem verbal communication
behavior or the factors that are - Roles (how family members divide
maintaining it, behavioral tasks and responsibilities)
clinicians advocate direct SCHOOL OBSERVATION
observation. - used to assess problem behaviors
that may be observed in school
In some cases, it is possible to use classrooms or other settings
observers who are - An example of a behavioral
characteristically part of the observation system used in school
person’s environment (e.g., spouse, settings is Achenbach’s revised
parent, teacher, friend, or nurse). Direct Observation Form of the
Child Behavior checklist.
Clinical psychologists must take - It consists of 88 problem items as
pains to make sure that people are well as an open-ended item that
not observed without their allows assessors to indicate
knowledge kay ug mahibaw-an nila problem behaviors not covered by
they might act differenty and dli na these items. Assessors are
siya matawag ug natural.. instructed to rate each item
according to its frequency, dura
Examples of Naturalistic observation tion, and intensity within a 10-
HOME OBSERVATION minute observation period. It is
- involves the use of a videotaped recommended that three to six 10-
interaction of the entire family minute observation periods be
eating at mealtime, without the completed over at least two days,
presence of a clinician or prefereably in both the morning
researcher. and afternoon.
- One of the most well-regarded - McConaughy and colleagues
systems for home observation is (2010) revealed that the DOF
the Mealtime Family Interaction helped identify youth with ADHD
Coding System (MICS; 1994), even after accounting for the
which is based on the McMaster predictive value of parent and
Model of Family Functioning teacher rating scales of
- Trained coders watch the videotape inattentiveness and hyperactivity.
and rate the family on several HOSPITAL OBSERVATION
domains, including: - Observation techniques have long
been used in such settings as
psychiatric hospitals and - Controlled observation is
institutions for those with mental sometimes referred to as analogue
retardation. behavioral observation (Haynes,
- An example of a hospital 2001). Such observation can occur
observation measure is the Time in a clinic setting or in the natural
Sample Behavior Checklist environment. The important feature
(TSBC) developed by Gordon Paul is that the environment is
and his associates (Mariotto &Paul, “designed” such that it is likely that
1974). It is a time-sample the assessor will observe the
behavioral check list that can be targeted behavior or interactions—
used with chronic psychiatric for example, asking couples to
patients. Time-sample means that discuss relationship problems in
observations are made at regular the laboratory to observe couple
intervals for a given patient. interaction patterns.
Observers can make a single 2- Parent–Adolescent Conflict
second observation of the patient - To more accurately assess the
once every waking hour. Thus, a nature and degree of parent–
daily behavioral profile can be adolescent conflict, Prinz and Kent
constructed on each patient. (1978) developed the Inter action
- Interobserver reliability for this Behavior Code (IBC) system.
checklist has typically been quite - Using the IBC, several raters
high, and scales such as the TSBC review and rate audiotaped
are helpful in providing a discussions of families attempting
comprehensive behavioral picture to resolve a problem about which
of the patient. they disagree.
- For example, using the TSBC, - Items are rated separately for each
Menditto et al. (1996) documen ted family member according to the
how a combination of a relatively behavior’s presence or absence
new antipsy chotic medication during the discussion (or for some
(clozapine) and a structured social items, the degree to which they are
learning program (Paul & Lentz, present).
1977) helped significantly decrease Consider a family consisting of a
the frequency of inappropriate
parent (Karen) and an adolescent
behaviors and aggressive acts over
a 6-month period in a sample of (Alex) who frequently experience
chronically mentally ill patients on conflicts related to household
an inpatient unit. responsibilities.
COGNITIVE-BEHAVIORAL
ASSESSMENT
- Cognitions relate to the
development of pathological
situation, its maintenance and
changes.
- • Notion that client’s thoughts play
a vital role in behavior.
- • Cognitive Functional Approach:
Functional analysis of the client’s
thinking process must be made to