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53 Cards in this Set
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Assessment: Prognosis and Treatment Outcome i. prognosis: ii. issues that affect prognosis: |
i. prognosis: expected course of a disorder and expected degree and speed of recovery - also potential effectiveness of treatment options ii. motivation to get better, ability to form a therapeutic alliance (basis of good treatment outcome), availability of treatment, social and family support, finances |
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Assessment: Treatment Recommendations i. what can affect treatment outcomes? ii. what does it involve? |
i. - does person have history or capacity to form rltnshps? problems with authority, dependency, excessive hostility, passive aggressive interpersonal behav - negatively effect. - other factors: intelligence, tolerance of anxiety, psychological mindedness - env context of person: ex. if treating child, parents need show cooperation, agreement and commitment to follow through ii. usually emotional experiences and anxiety. ex: exposure treatment to spider phobia, therefore patients need to be able to tolerate these emotional states |
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What affects likelihood of forming a therapeutic alliance? |
- whether indiv has history or capacity to form relationships |
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psychological mindedness: |
indiv ability to observe her own internal life, see patterns in own behav, and develop insight (effects treatment outcome) |
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ego-strength: |
ability of ego to deal effectively with demands of the ID and superego. Helps us maintain emotional stability and deal with internal and external stress. ie. how alb ethey are to deal with anxiety/other emotions (factors effecting treatment outcomes) |
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Assessment: provision of therapeutic context |
- important to establish collaborative, positive and therapeutic experience during assessment - may be first therapeutic exp for indiv, most likely a lot of shame and anxiety - assessment itself can be therapeutic for patients - clinician should be warm, open, nonjudgmental, and professional - so patient can develop good positive attitude to clinical enterprise and optimism for treatment |
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Assessment: communication of findings to referral source and to the patient i. psychological report ii. what here can enhance therapeutic benefit of assessment? |
- referral source: ie, Doctor or whoever sent the patient to the clinician i. comm through psychological report (ex on page 113) outlines the problem, formulation, prognosis, and treatment recommendations - report: reason for referral, background info, behavioral observations, intellectual and cognitive functioning, personality functioning, impressions, summary, recommendations ii. providing patients with specific and detailed feedback from the assessment can increase their self-esteem and reduce indicators or distress - patients can now name and explain their distressing exp, and understand the nature of their problems, makes them optimistic about treating them |
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Role of assessment in research |
must clearly diagnose participants in research project, experimental group must clearly have the disorder of interest, assessment also provides info about nature of the disorder: severity and chronicity of symptoms, comorbidity assessement b4 and after to treatment to see if treatment had an effect clinical psychologists are encouraged to do this for indiv too to see the effectiveness of their own treatments |
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assessment and the importance of context & ex of contextual factors |
example: has patient been diagnosed with depression following the death of their child? Or has patient had it for 20 yrs? Is patient motivated to be rid of disorder? contextual factors: gender, race, socioeconomic status, family history, history of symptom picture, history of interpersonal rltnshps, history of fn'ing, culture |
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what are the two approaches a clinician uses to make judgments and decisions based on the assessment information which is usually very complex, contradictory, and may not be entirely valid or reliable? |
1. quantitative/actuarial approach 2. Clinical judgement or subjective approach |
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quantitative/actuarial approach |
- interpreting data from assessment and making decisions - clinician interprets psychological tests by comparing to normative data - involves clinician assigning a score to person's characteristics and the use of statistical formulas or cutoff scores - uses these to make decisions |
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clinical judgement/subjective approach |
- interpreting data from assessment and making decisions - decisions made basedo n clinical exp, inutition, subjective impressions, and idiosyncratic info - info can be quatitative, qualitative, or impressionistic - can be unclear/ambiguous but provides much broader and deeper exploration of issues than quantitative alone - clinician will first need to determine which info is accurate - process itself can be quite inaccurate |
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Paul Meehl landmark paper |
- quantitative decision making methods better than decisions based on clinical judgement for results of assessment - statistical models better than or equal to clinical judgement in some but not all |
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clinical decision making and errors in judgement (5) |
- biases - normal human decision making errors - both in research and clinical 1. base rate issue 2. Barnum effect 3. illusory correlation 4. preconceived ideas and confirmatory bias 5. inappropriate use of heuristics |
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clinical decision making and errors in judgement: base rate issue |
- not taking into account rate of behav, trait, symptoms, disorders in general population |
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clinical decision making and errors in judgement: Barnum effect |
- variation of base rate issue - PT Barnum - american showman - making statements about indiv that sound idiosyncratic and unique but are actually so commonplace that the statements become meaningless - ex. horoscopes |
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Clinical decision making and errors in judgement: Illusory correlation |
- clinicians who believe certain signs or behav. may be indicative or some meaningful clinical entity when there is no relationship - their belief is what perpetuates the belief, not based on real data |
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Clinical decision making and errors in judgement: preconceived ideas and confirmatory bias |
- sim. to illusory correlation - clinicians look for evidence to confirm their preconceived notions and ignore disconfirming info - ex full moon and odd behav. ppl notice times where these V. meet, but ignore times they do not |
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Clinical decision making and errors in judgement: inappropriate use of heuristics i. heuristics ii. representativeness heuristic iii. availability heuristic |
i. cognitive shortcuts that normally serve us well in making quick decisions and judgments - errors occur when heuristics are used in inappropriate situ. ii. erroneous belief in reliability and validity of small numbers iii. putting too much weight on info that is vividly/easily recalled - believe the more easily we can bring an event to mind the more frequently it occurs - in clinical work, comes into play when low-frequency event occurs in dramatic way |
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idiosyncratic |
individual or peculiar |
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nosology |
branch of medical science dealing with the classification of diseases |
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Reliability |
Extent to which procedure yields same results on repeated basis |
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Validity |
Degree to which tool measures what it claims to measure |
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Who started psychological testing and why? |
Alfred Binet in early 1900s in Paris, to determine appropriate classroom placement for school children based on test scores. Also used by USA to test military personnel for emotional/cognitive problems |
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psychological assessments are _______ and ________ to the field of clinical psychologists. |
Unique and important - certain assessments are almost exclusively done by clinical psychologists |
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Psychological assessments are used for: (5) - 5 psyc professions |
1. clinical decision making in mental health 2. health psychologists --> assess variables 3. functional status and rehabilitation for potential injury --> rehabilitation psychologists 4. brain-related problems and strengths for brain injury --> neuropsychologists 5. various criminal behavior --> forensic psychologists |
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Psychological assessment: to gather _____ data, to _____, in order to _____ regarding ______. Ultimate goal ________ |
Clinical psychologist gathers, synthesizes, and integrates the psychological, historical, contextual, and collateral data to generate and test hypotheses regarding behavior. Done in an effort to develop descriptions, explanations, predictions and recommendations regarding the psychological difficulties a person experiences. Ultimate goal: provide quality info that can aid in the treatment of the patients' difficulties |
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Psychological testing: vs Psychological assessment: |
Testing: administering, scoring, and interpreting psychological tests --> provide the info that the clinical conlusions, decisions, and recommendations are based upon Assessment: uses many sources of data (way beyond test scores), to get answers to psychological problems indiv. is facing, also how and why problems developed and what is causing them to be maintained. Therefore much broader and encompassing much more - assessments can also be very specific to address limited components of behavior/functioning - can also be done on couples/families, not just indiv. |
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What % of CP work is dedicated to assessment? What % of CP's do assessments? |
13-15% of work, 90% of CPs, second most frequent activity for CPs (providing treatment is first) |
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Core competencies of scientifically-minded psychologists: (5) |
1. access and apply current scientific knowledge and skills appropriately and habitually - as part of the way you approach problems - look at things from diff perspective and try to account for the causality 2. contribute to empirical knowledge in field - do research of some sort/consult with ppl who do research 3. critically evaluate your own interventions and outcomes 4. practice vigilance about how socio-cultural variables influence scientific practice - be knowledgeable about diff cultural norms 5. subject work to scrutiny of colleagues and others, meet with colleagues to discuss cases. standards of practice and code of ethics |
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I. Nomethic: vs. II. Idiographic: |
I. attempt to establish empirical/scientific knowledge. Study of cohorts of indiv. with constructs (variables) II. study of the indiv., see as unique agent with unique history ^^ clinical work (II) and research (I) |
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Two purposes of psychological assessment: |
1. idiographic approach: understand indiv/couple/family and Psyc issues pertaining to them. Assessment: specific, detailed, ect. Used in direct clinical work 2. Nomothetic: assessments on groups in order to understand broader issues pertaining to types of problems/treatments. Used in research |
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Tools of psychological assessment: (2) |
1. Tests 2. Techniques ^ some assessment tools are both tests and techniques |
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Assessment: Tests |
- Highly reliable and valid instruments, developed to measure specific aspect of functioning - Typically self-report. - Produce scores which can be compared to normative sample. |
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Assessment: examples of Tests (4) |
1. Wechsler intelligence tests 2. Minnesota Multiphasic Personality Inventory 2 3. Child Behavior Checklists 4. Behavioral Anger Response Questionnaire |
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Assessment: Techniques |
- Give info that patient may be unaware of (cannot give through self-report), - Usually compared to norms - Beyond simple tests scores |
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Assessment: Examples of techniques (5) |
1. Semi- or unstructured clinical interviews 2. Projective techniques such as the Thematic Apperception Test or drawing tasks 3. Collateral reports 4. History Taking 5. Behavioral observations |
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Assessment: Tests - drawbacks |
- Must have strong reliability and validity, often causes trade-off with depth of info that can be gleaned |
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Assessment: Techniques - drawbacks |
- Provide much more depth than tests but less reliability and validity (especially semi- or unstructured clinical interviews) |
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Psychodiagnosis |
- uses both psyc tests and tools to gather data, providing info about indiv's assets, liabilities, strengths, defenses, conflicts, symptoms, vulnerabilities - nature and origin of problem and treatment planning - Provided template that most clinical assessments followed |
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Types of psychological assessment: (7) |
1. Psychodiagnostic assessment 2. intellectual/cognitive 3. behavioral 4. health 5. Psychophysiological 6. Rehabilitative 7. Forensic ^ often combines, both idiographic and nomothetic, both children and adults ^ |
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Types of assessment: psychodiagnostic |
- issues contributing to psyc problems of patient - includes: personality variables, symptom constellation, env. influences, personality, underlying conflicts - either formal diagnosis or describing impression of "diagnosis" w potential causes and treatment reccomendations |
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Types of assessment: intellectual/cognitive |
- determines strengths and liabilities of intellectual and cognitive fn'ing - example: neuropsychological assessment for brain-injured persons |
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Types of assessment: Behavioral |
- determine causes, reinforcement histories, maintenance issues for problems - env. determinants of behav |
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Types of assessment: Health |
- determine factors influencing patient's health - example: hypertension and anger styles |
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Types of assessment: psychophysiological |
- assessing heart rate, skin temp., muscle control, ect. that are factors in physical and psyc problems |
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Types of assessment: rehabilitative |
- determine functioning of patient following injury (physical or psyc) |
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Types of assessment: Forensic |
assess factors that may have contributed to clinical behav |
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What happens in psychological assessment? |
- gather info in reliable and valid manner - develop and test hypotheses - develop understanding of the nature of the problems including development and maintenance - suggestions for remediation/treatment |
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Goals of psychological assessment: (6) |
1. Problem explication 2. Formulation 3. Prognosis 4. Treatment issues and recommendations 5. Provision of therapeutic context 5. Communication of Findings |
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Problem Explication |
- figure out problem - detailed description - usually give formal diagnosis - do by structured/unstructured interview, objective texting, projective techniques, and psychological techniques |
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Formulation |
- determining causes, maintenance factors, interplay of issues that influence and continue problem - provides info to appropriate treatment - personal characteristics, behaviors, interpersonal styles, environment ** causal hypotheses about genesis and treatment ** |
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What info do they look for in formulation? (4) |
1. intraindividual issues: motivation, learning history, cognitive styles, interpersonal styles, reinforcement history, ect 2. Interpersonal issues: ability to establish relationships and social network, intimate relationships 3. Env. Issues: traumatic or other exp, current living, relationships, family env., events that reinforce maladaptive behav 4. Process-related issues: behavior during interview - openness, motivation, willingness to participate, anxiety, ect |
