Lecture 6

Assessment: Interviews, Tests, Techniques

Clinical Psychology Lectures

Psychodiagnostic Assessment

• Also termed: personality assessment, diagnostic assessment, pretreatment assessments or psychological assessment.

Watkins et al. (1995) Camera et al. (2000) N = 179

Clinical Interview 1 (95%) Not included in study

Wechsler Adult Intel. Scale 2 (93%) 1 (85%)

MMPI-2 3 (85%) 2 (77%)

Sentence Completion 4 (84%)

TAT 5 (82%) 6 (60%)

Rorschach 6 (82%) 4 (69%)

Bender – Gestalt 7 (80%) 5 (63%)

Drawing Tests 8 (80%) 8 (36%)

Beck Depression Inventory 9 (71%) 10 (30%)

Wechsler Intell Scale for Kids 10 (69%) 3 (75%)

Wide Range Achievement Test - 7 (48%)

Wechsler Memory Scale - 9 ((32%)

Rank Order of Tests Used in Internship Sites

Clinical Interviews (a.k.a. Initial Interview)

• Mainstay of clinical work

Purposes of Clinical Interview

• Gather clinical data on problem experienced

• Process information

• First clinical exposure

• Initiate and develop therapeutic alliance

• Context for understanding difficulties and treatment

Kinds of Data Gathered

•Demographic

•Presenting Problem

•Hx of Problem

•Medical Hx

•Current and Past Living Situation

•Family Hx

•Childhood, Adolescence, Early Adult

•Previous Treatment

Interview Skills

• Develop Rapport

• Active Listening• Primary Listening Skills

• Secondary Listening Skills

Primary Listening Skills

• Primary Listening Skills• Open ended questions

• Paraphrasing

• Reflection of affect

• Clarifications

• Summarizing

• Minimal Encourages

Secondary Listening Skills

Secondary Listening Skills

• Normalizing

• Structuring

• Probing

YouTube Link

• Carl Rogers initial session showing interview skills

• http://www.youtube.com/watch?v=m30jsZx_Ngs&feature=related

• Watch for Listening Skills examples

Semi- Structured Interviews

• Flexibility of the interaction between patient and clinician

• Can talk about whatever issues come up and clinician can probe.

• Clinical does have some information tries to obtain to develop diagnostic and formulation information

Semi- Structured Interviews - Pros

• Rapport

• Flexibility

• Modifiable

• Not limited to certain tools or norms

• Useful and used commonly in clinical settings

Semi- Structured Interviews - Cons

• Reliability and validity from clinician to clinician?

• Unstructured or semi structured lack reliability

• May be susceptible to clinical biases (pre-judgment, looking for confirming evidence)

• Not good for research purposes

Semi- Structured Interviews

Semi Structured Interview ExampleDr. J. Wald, UBC Clinic

http://www.youtube.com/watch?v=fxyf9ILvLAo&feature=related

Structured Interviews

• Based on very specific diagnostic criteria from current nomenclature

• Very highly structured in terms of information sought

• Purpose: Provide clear diagnosis and not really interested in other domains

Structured Interviews: Pros

• Reliability

• Good research tool

• Modules for specific disorders

Structured Interviews: Cons

• Content constrained by diagnosis

• Time consuming

• No other pertinent information gathered

• Not as conducive to establishing rapport

• Process information not focused on, just content

Structured Interviews

Structured Interview Example SCID-101 Interview

Objective Tests

• Self-report tests: describe thoughts, emotions, attitudes, behaviors…..

• Items usually describing some behavior are presented• Multiple choice alternatives

• True or False alternatives

• Ratings of agreement

•

• Objective because:• Items are presented same to all

• Options for responding are same (e.g., True or False)

• Measures characteristics that the responder is aware of (surface level)

• Widely used

Objective Tests Advantages

• Economical

• Administration and Scoring Easy

• Are objective in sense that stimuli are same

• Can be quite reliable

Objective Tests - Problems

• Surface or behavioral in nature only

• Single summary score not representative

• Transparency in meaning

Watkins et al. (1995) Camera et al. (2000) N = 179

Clinical Interview 1 (95%) Not included in study

Wechsler Adult Intel. Scale 2 (93%) 1 (85%)

MMPI-2 3 (85%) 2 (77%)

Sentence Completion 4 (84%)

TAT 5 (82%) 6 (60%)

Rorschach 6 (82%) 4 (69%)

Bender – Gestalt 7 (80%) 5 (63%)

Drawing Tests 8 (80%) 8 (36%)

Beck Depression Inventory 9 (71%) 10 (30%)

Wechsler Intell Scale for Kids 10 (69%) 3 (75%)

Wide Range Achievement Test - 7 (48%)

Wechsler Memory Scale - 9 ((32%)

Rank Order of Tests Used in Internship Sites

Clinical Objective Tests

• Minnesota Multiphasic Personality Inventory

• Personality Assessment Instrument

• Millon Clinical Multiaxial Inventory

MMPI

• One of the most frequently used

• Hathaway & McKinley

• Measures personality and psychopathology

• 13 Scales: 3 Validity and 10 Clinical

MMPI

Copyright © 2006 Pearson Education Canada Inc.

Table 4-6

Copyright © 2006 Pearson Education Canada Inc.

Validity and Response Biases

• L (Lie)• Once in a while I think of things too bad to talk about

• At times I feel like swearing

• F (Infrequency)• I am troubled by attacks and vomiting

• Evil spirits possess me at times

• K• At times I feel like smashing things

• It takes a lot of argument to convince most people of the truth.

Clinical Scales

• Neurotic Spectrum: 1,2,3, & 7

• Psychopathic: 4

• Psychotic Spectrum: 6,8,9

Interpretation

• Not simply elevation equals diagnosis

• Multistage• Validity

• Pattern interpretation

• Incorporate with other scales

Pros of MMPI/MMPI-2

• Strong empirical basis

• Body of research

• Good reliability and validity

• Well-known and respected

• Lots of clinical information

• Ease of administration

• Objective and comprehensive

Cons of MMPI/MMPI2

• Excessive length

• Standardization sample

• Not sure if research on the MMPI can truly be generalized to the MMPI-2.

• The labels antiquated

• Normative sample not representative.

• Interpretive process complicated

Expertise and Movie Example

Projective Tests

• Rather than objective stimuli use ambiguous stimuli that requires subject to impose their interpretation and respond

• By doing so, revealing something of themselves

• Can have standardized administration, but possible responses are not pre-determined (i.e., not true or false)

• Assess behavior at deeper level (defenses, conflicts, interpersonal styles, motivation, etc.)

• Widely used

• Projective Hypothesis

• Measure:• Psychological states

• Personality styles or traits

• Underlying psychological makeup (defenses, coping, behavioral styles and so forth)

Response Determination

• A response is not an accident, but a function of the subject’s psychological attributes

Types of Projectives

• Association Techniques (RIT)

• Construction Techniques (TAT)

• Completion Techniques (Sentence Completion)

• Choice or Ordering Techniques (Picture Arrangement)

• Expressive Techniques (Role Play, etc)

Watkins et al. (1995) Camera et al. (2000) N = 179

Clinical Interview 1 (95%) Not included in study

Wechsler Adult Intel. Scale 2 (93%) 1 (85%)

MMPI-2 3 (85%) 2 (77%)

Sentence Completion 4 (84%)

TAT 5 (82%) 6 (60%)

Rorschach 6 (82%) 4 (69%)

Bender – Gestalt 7 (80%) 5 (63%)

Drawing Tests 8 (80%) 8 (36%)

Beck Depression Inventory 9 (71%) 10 (30%)

Wechsler Intell Scale for Kids 10 (69%) 3 (75%)

Wide Range Achievement Test - 7 (48%)

Wechsler Memory Scale - 9 ((32%)

Rank Order of Tests Used in Internship Sites

Rorschach

Attack Issues

• Poor psychometrics

• Non-empirical basis for scoring and interpretation

• Methodological

• Lack of standardized procedures

• Comprehensive System

Free Association

• Example (see next card)

Inquiry Stage

• Example

Coding

• Location

• Determinants

• Form level

• Content

• Popularity

• Organizational Activity

Interpretation

• Use normative data and assess:• Information Processing

• Cognitive Mediation

• Ideation

• Capacity for Control & Tolerance for Stress

• Affect

• Self-perception

• Interpersonal Perception and Relations

Validity Comment

Pros

• Easy to administer.

• Exner’s Comprehensive System.

• Standardized administration, scoring, and interpretation.

• Large normative sample and normative data for various scores.

• Evidence of acceptable reliability and validity.

• Taps information that not tapped by objective tests.

• May be resistant to faking.

• Second most researched personality assessment instrument.

Cons

• Not developed for purpose it is currently used for.

• Early research with different systems has created confusion and bias.

• Lack of research and normative information for minorities.

• Additional reliability and validity, especially on specific scores, necessary.

• Complexity and scoring and interpretation.

• May be of limited use in children especially over the long term.

Thematic Apperception Test (TAT)

• Motivational, interpersonal, and social-cognitive aspects of functioning

Mark H Example of Card 1

Scoring

• Not really scored, more themes determined based on a variety of domains (like content analysis)

• Domain examples:• Drives

• Relationships• Conflicts• Defenses• Ego Strength

Social Cognitions and Object Relations Scale

• Complexity of object relations

• Affect tone

• Capacity for emotional investment in relationships

• Understanding social causality

Pros

• Potentially valuable tool to assess deeper aspects of personality.

• Focuses on global aspects of person’s interpersonal and motivational world.

• Aids in development of rapport.

• Adequate reliability and validity of some scoring and interpretive schemes.

Cons

• No standardized administration or normative data.

• General reliability and validity are difficult to establish.

• Subjectivity in scoring and interpretation.

•

Neuropsychological Assessment

• Problems that arise clearly from structural damage• Disrupts cognition, affect, behaviour

Give example of D.B. (Police Officer)

Basic Symptoms from Diffuse Damage (some focal)

1. Memory Problems

2. Orientation Problems

3. Learning, comprehension, & Judgement Problems

4. Emotional Control Problems

5. Apathy/Emotional Blunting

6. Initiation of Behavior

Basic Symptoms from Diffuse Damage (some focal)

7. Loss of Control of Propriety/Ethical Behaviour

8. Receptive/Expressive Communication Problems

9. Visuospatial & Motor Activity Problems

Neuropsychological Syndromes

• Reflect underlying structural brain pathology

• More than one syndrome can co-occur and can change over time

• Six Syndromes

Neuropsychological Syndromes

1. Delerium

2. Dementia

3. Amnestic Syndrome

4. Neuropsychological Delusion Syndrome

5. Neuropsychological Mood Syndrome

6. Neuropsychological Personality Syndrome

1. Delerium

•Rapid onset of widespread disorganization

•Generalized disturbance in brain metabolic functions

•Some causes: Brain injury, toxins, anoxia, withdrawal

• Impairment in:• Information processing• Psychomotor activity

Delerium Cont’d

• One step above coma

• Lasts for short period of time

• Causes:• Psychoactive drug abuse

• Infection

• Toxins (e.g., mercury)

Dementia

• Progressive deterioration

• Episodic memory (memory for events) not semantic memory (memory for language, concepts) problems

• Deficits in abstract thinking, acquisition of new information, visualspatial comprehension, motor control, problem solving, and judgement

Dementia

• Accompanied by deterioration in emotional control of moral/ethical behaviour

• Progressive but can be reversed in certain, limited situations (drug interactions)

Other Focuses

• Determine functional impairments from brain injury

• Head injury