Summary Psychological Assessment

Psychological Assessment
Literature


Lecture 1
Chapter 1: Psychological Assessment : Definition and Introduction
What is psychological assessment?
 Analyses of human behavior (often unconsciously)
 Psychological assessment: analyzing the behavior, thoughts and emotions of clients
in a systematic way and based psychological theories (understand and predict their
course of well-being)
 Shared decision-making process
 Diagnostic question is defined
 Testing hypotheses
 4 basic parts: classification, explanation, prediction & indication and evaluation
 Issues with defining mental disorders
 Lack of well-founded feedback on diagnostic judgements
 Try to be as scientific as possible
empirical cycle
Using assessment instruments
 Observation (most commonly used) e.g. also parents observing their children
 Standardized: evaluation scales (less judgement error)
 Non-standardized (actor-observer effect) fundamental attribution error
 Time sampling: starting from fixed period in time
 Event sampling: starting from behavior itself
 Clinical interviews
 Idiographic (clinical judgement) and nomothetic approach (statistical
judgement)
 Semi-structured interviews
 Clinicians rarely count symptoms to diagnose a disorder but rather follow their
intuition
 Advantage over questionnaires because specific questions can be asked
 Time-consuming
 Problem-oriented
 Focus should be to maintain contact to the client
 Psychological tests
 Verify predictions
 Scoring behavior in standardized process
 Usually validity high
 Easy to administer
 Compare client with norm group
 Self-reports (that have disadvantages in case of lacking self-insight)
 Quality of psychological tests
 APA ethical guidelines (quality criteria)
 Reliability (stability of scores)
 Validity (does it measure what is supposed to be measured?)
Defining normal and abnormal behavior

,  Different views on normality
 Mental disorder: significant suffering or limitations in social, occupational or other
important activities
 Mental disorders might be defined as deviation from statistical norm (also has
disadvantages) how much deviation still normal?
 Categorical presentation (presence/absence) DSM-5 (issue of comorbidity,
dimensional nature of psychopathologies, limited validity, NOS most prevalent)
 Dimensional presentation (analyzing domains on different levels) no strict
distinction between normal and abnormal
 Clinicians tend to think in categories
 High correlation between personality and mental disorders
 Personality as a risk factor for the development of clinical syndromes
 Personality as protective factor




Lecture 2
Chapter 3 : Start of the Assessment Process: Referral, Presenting Complaints
and Classification
Referral
 Knowing about the referrer (his theoretical approach, decision-making power)
 Specific content (asking for treatment/second opinion…)
 Client´s attitude towards application, their specific question and agreement with
assessment
 Competence of clinician to address problem, clarification of roles (e.g. with children)
 Rights of the clients over those of referrer
 First contact and first impressions (posture, behavior, handshake, hygiene level)
 Assessment in professional room (quiet and neutral space)
 Empathic contact (building a relationship)
 At the beginning more open questions (invite client to structure meeting)
 Mental status evaluation (presence of abuse, medical illness)
Classification
 Formulate hypotheses
 Instruments (observation, semi-structured interview and psychological tests)
 DSM: disorder means to meet certain number of criteria
 Reification: belief that an agreed-upon construct is actually an existing entity
 Many ways how a certain disorder can manifest (comorbidity)
 Symptoms are not caused by the disorder but they are part of it
 Stigmatization, social exclusion and suspected negative prognosis
 Interpretation of behavior is dependent on the context
 Occurrence of specific symptoms together determines presence of disorder (taking
circumstances and gender into account)
 Being aware of culture (manifestation and interpretation of disorder can differ)
 Screening list: insight into most important problems
 Necessity of differential diagnosis
 Comorbidity choose main classification to indicate focus of treatment
 Become more strict with the course of classification phase
 Insights into relational functioning useful for personality classification

,  Awareness about strengths and weaknesses of used instruments and manuals




Chapter 4 : Explanation
 Identify where problems originate (trigger and cause of problem)
 Hypotheses require testing!
 Careful with causal explanations
 People put issues in a story to explain it valuable for clinician (says something
about client, e.g. because narrative contains information that would not be necessary
to tell)
 Stories are always subjective
 Different than empirical approach (data and rules based)
 Story model by Pennington and Hastie: judicial decision making is applicable
to stories of clients in clinical practice (principles: coverage, coherence and
uniqueness)
 Taking decision responsibly without being guided by first impressions too much
psycho-logic of clinicians
 DSM suggests no causal relations of disorders
 Biopsychosocial model accepted as explanation for disorders (continuum between
biological and psychosocial causes)
 Difficult to make a causal interpretation of the mental disorder of a client (important to
include past)
 Common causes: trauma and lack of self-esteem
 With the right explanation the treatment is probably more effective (time preference)
 Results from RCT apply to average client (not to all)
 Explanatory analysis only applied when really necessary
1. Theoretical explanatory model of the problem (manuals, research articles)
 Basing decisions on objective evidence
 Explanations influenced by therapy approach
 Construction of an individual explanatory model
 Collaborative empiricism
2. Testing explanations
Guidelines for constructing a theoretical explanatory model
 Goal: represent the essentials of the problem
 Individual explanatory model (“integrated image”) all information integrated into a
single model
 Convenient visualization
 Efficient grouping of most important factors
 Model should be economic (information which is typical and unique for problem is
included) and valid
 Elements: behavior, factors (e.g. risk factors, coping strategies) and explanatory
mechanisms that describe interrelations of most important symptom

Lecture 3
Communication skills
Chapter 2 : The Helper´s Basic Attitude
Typical Attitudes of Friends and Relatives

,  People have implicit beliefs about how to help their friends
 Motivations of both parties are often incongruent
 Fundamental beliefs of relatives play a role in discussing any matters
 Role of culture
 Good relationship may be barrier to effective helping
 Dilemma of how much responsibility should be taken for another person especially
parent-child relationship
motivates authoritarian behavior
The Basic Attitude of the Helper
 The Diagnosis-Prescription Model
 Goal-oriented and reductive approach
 Helper controls the conversation (little room for client to express own ideas)
 Advice is given in directive manner
 Studies show that the given advice is often followed with this model
 The Cooperation Model
 Helper pays attention (helps client to understand own problem to a deeper
level)
 Being accepting and attentive
 Helper wants to achieve greater insight into client´s thoughts help client
clarify and refine own ideas
 Helper and client work together on the clarification and solution of the problem
 Meta-conversation about how client wants helper to act may be necessary
making agreements
 Some clients resist cooperation model
The Sophisticated Helper
 Helper tries to put order into thoughts and feelings of client and puts them into
perspective
 Maintaining a good relationship that works for both sides
 Client-centredness  passivity




Chapter 5: The helper at work
Clarity of goals
 Helper is responsible for a structured discussion
 Goals are important to fin out whether conversation was effective (where goals
reached?)
 Goal of the client is often to get rid of initial “problem” that motivated them to
come to therapy often vague
 Process goals: used by the helper to create the right conditions for effective
counselling
 Creation of a calm and trusting atmosphere
 Responsibility of the helper
 Usually the same for any client
 As therapy progresses the client defines process goals as well
 Outcome goals: depending on the individual problem
 Client´s responsibility
 Solution to problem is client´s affair