Psychodiagnostics summary
Chapter 1: The diagnostic process
1.1 Introduction
History ® Psychodiagnostics was not popular. Perceived as being a tedious, time-consuming pursuit that labeled
people based on unreliable projective techniques and lengthy questionnaires.
Clinical psychodiagnostics is based on three elements:
• Theory development of the problems/complaints and problematic behavior.
• Operationalization and its subsequent measurement.
• The application of relevant diagnostic methods.
↳ The quality of these three elements is grounded in conceptual and empirical research. This means that
hypotheses about behavior, cognition and emotion/motivation are formulated based on a theory, and are
operationalized, measured and tested using a step-by-step diagnostic process. This is a scientifically regulated
thought to action process that results in responsible statements about the client’s behavior or problems.
Goal of psychodiagnostics:
1. Collecting information about the client and his or her environment:
2. To design the best approach to interests and problems
3. To evaluate the approach to interests and problems (during and after treatment)
A clinician’s capacity to help a client is directly related to the skills in defining symptoms and strengths
1.2 Steps in the diagnostic process
The diagnostic process has five steps:
1. Application
2. Diagnostic reflections
3. Diagnostic scenario
4. Diagnostic research/examination
5. Reporting
Exploration ® Request, request for help and exploration of
the problem (interview).
The diagnostic process usually begins with the client’s
referral to the diagnostician, but it may also begin with the
direct question to the diagnostician.
Analyze both the client’s request for help and the referrer’s
request.
Example:
Request for help = Client wants to be cured of his compulsive
behavior.
Referrer’s request = Referrer would like to know whether
there is evidence of OCD.
Induction ® Diagnostic scenario: subdivision of basic
questions, formulation of theory and converting into concrete
hypotheses.
Based on the questions from the exploration phase, the
diagnostician will construct a diagnostic scenario that
contains a provisional theory about the client, which
describes what the problems are and how they can be
explained.
Deduction ® Selection a specific set of research tools, which
can either support or reject the formulated hypotheses. And
1
,making predictions about the results or outcomes from this set of tools, to give a clear indication as to when the
hypotheses should be accepted or rejected.
Testing ® Applying and processing instruments.
Evaluation ® Based on the results that have been obtained, giving reasons for why the hypotheses have either
been accepted or rejected. This results in the conclusion.
1.3 The diagnostic cycle
Empirical cycle ® A model for answering questions in a scientifically justified manner. It is a basic diagram for
scientific research and not for psychodiagnostics practice. That’s why the five stages can only be found in
rudimentary form (niet volledig) in psychodiagnostics.
Consists of:
• Observation: collecting and classifying empirical materials.
• Induction: includes formulation of theory and hypotheses.
• Deduction: testable predictions are derived from hypotheses.
• Testing: new materials are used to determine whether predictions are correct.
• Evaluation: finally results in the evaluation.
1.4 The diagnostic process: from application to the report
Application
The diagnostician’s first task is to analyze the request and request for help. He will also consult file data (such as
reports from previous examinations). This analysis results in:
• Information about the referrer.
• Details about the type and content of the request.
• Referrer’s knowledge about the client.
1. The information about the referrer includes several elements:
a) Important to understand the referrer’s frame of reference. It contains his vision of the client’s
behavior and performance.
b) The analysis of the request results in clarification of the relationship between the diagnostician and
referrer. The referrer might be part of a team to which the diagnostician also belongs, and sometimes he
may not. And information about the nature of setting provides insight into the content and seriousness
of the problems.
c) Important to make a distinction between the referrer in name and the actual referrer. Referrer in name
® requires an examination to be carried out (e.g. psychiatrist).
Actual referrer ® takes the initiative (e.g. court or insurance company).
d) Referrer’s differ from each other in terms of the nature and extent of the powers which are available
to them.
2. Analysis of request also aims to understand the type and content of the request:
a) The referrer’s request may adhere to an open-ended format (no hypotheses) or closed format
(hypotheses).
b) Contents of a request are connected to the setting from which the request originates. E.g. ambulant
services/primary care centers ® specific requests.
Residential psychiatric centers ® more complex, exploring underlying factors.
c) Requests can be classified according to the five basic questions. They may also exist as a
combination (what’s going on, how to understand and what should be done?)
3. The analysis is supported by:
a) What the referrer already knows about the client (information client functioning).
b) Helps to determine whether the client presented himself to the referrer and whether he consents to the
examination.
2
,The analysis of request includes exploration of the client’s mindset. During the first meeting, the client’s attitude
to the examination is evaluated: Is the client there on his own initiative? Does he consent? Does he have a well-
defined request for help? What is the main problem?
The diagnostician’s reflections
The diagnostician’s reflection ® A reflection phase:
• Studying file data
• Weight is given the pieces of information. Will partly be influenced by the diagnostician’s character. He
won’t be entirely impartial towards the requester and the client.
• Be aware of own bias, knowledge, preferences.
• Reflection involves any new questions about the problem that may have occurred.
↳ Attaching different degrees of importance to sources of information rarely leads to better predictions. Adding a
large volume of information doesn’t improve prediction either.
Diagnostic scenario
Diagnostic scenario ® The diagnostician organizes:
• All of the requester’s and client’s questions from the application phase.
• All of the questions that have occurred to him.
• His knowledge of the problem
↳ Based on this information, he proposes an initial, tentative (voorlopig) theory about the client’s problematic
behavior.
1.5 Five basic questions in clinical psychodiagnostics
There are five basic questions that form the basis for most of the questions that are posed by clients, referrers and
diagnosticians:
1. Recognition ® What are the problems; what works and what doesn’t?
2. Explanation ® Why do certain problems exist and what perpetuates them?
3. Prediction ® How will the client’s problems subsequently develop in the future?
4. Indication ® How can the problems be resolved?
5. Evaluation ® Have the problems been resolved as a result of the intervention?
Recognition ® The diagnostician identifies both the complaints and behavior of the client and/or his
environment. It includes:
• Inventory and description.
• Organization and categorization in dysfunctional behavior clusters or disorders.
• Examination of the seriousness of the problem behavior.
Recognition may occur as a result of:
Criterion-oriented measurement ® Comparison to a predefined standard.
Normative measurement ® Comparison to a representative comparison group.
Ipsative measurement ® Comparison to the individual himself, e.g. to the individual at a previous point in time.
Classification ® The clinical picture is assigned to a class of problems. This can be done according to an all-or-
nothing principle or a more-or-less principle.
Example: DSM categories (all-or-nothing: client is assigned to a category) and dimensions of complaints and
personality tests (more-or-less: client is given a profile with scores for a number of dimensions).
↳ Advantage = Classification facilitates communication between experts.
Disadvantage = Classification leads to labeling, which is limited and often forms the basis for establishing co-
morbidity.
Diagnostic formulation ® focuses on the individual and his own unique clinical picture.
Example: Holistic theory, such as that which is often used in behavioral therapy, in which functional,
theoretically explicit relationships between interdependent problem behaviors and the context play a central role.
3
, ↳ Advantage = Allows for the uniqueness of the individual, based on a description of the client and its context.
Helps therapy planning.
Disadvantage = Occasional lack of empirical support. Diagnostic formulation usually involves both recognition
and explanation.
Explanation ® Answers the question of why there is a problem or a behavioral problem.
It includes:
• The main problem or problem component.
• The conditions that explain the problem’s occurrence.
• The causal relationship between point 1 and 2.
Explanations may be classified according to:
1. The locus ® The person or situation.
Person-oriented: The explanatory factor lies in the person himself. This emerges when the behavior is
viewed separately from the context.
Situation-oriented: In the event of a well-known context. The explanatory events may (a) precede
(voorafgaan) the behavior that is to be explained or (b) follow it.
2. Nature of control ® We can explain behavior in two ways: cause and reason.
A cause is something that makes the behavior happen, like gravity causing someone to fall. A reason is
about choice or intention, like being careless while picking cherries. Causes tell us what made it
happen; reasons tell us why it happened in a meaningful way. Often, both apply at the same time. For
example, acting out of strong passion can cause the behavior and also give it meaning.
3. Synchronous and diachronous explanatory conditions ® Explanatory conditions can happen at the same
time as the behavior (synchronous) or before it (diachronous). For example, a weak ego explains
behavior now (synchronous), while early childhood problems explain behavior from the past
(diachronous).
4. Induced and persistent conditions ® Induced conditions: give rise to a behavioral problem. Persistent
conditions: perpetuate (in stand houden) the behavioral problem.
↳ Important to have this knowledge, to make allowances (rekening houden met) for more than 1 type of
explanation. And some are better suited to specific goals of diagnostics and therapy.
Central theory ® Should, together with the biological influences, simultaneously identify the situational
influences, personal characteristics, development and systemic patterns.
Eclectic theory ® different theories and concepts complement (aanvullen) each other and reveal each other’s
limitations.
Prediction ® Involves making a statement about the problem behavior in the future. It is a chance statement, e.g.
the chance of suicide or the chances of a certain treatment’s succes. Prediction determines the treatment
proposal, e.g. short-term or long-term treatment.
Prediction pertains to a relationship between a predictor and a criterion. The predictor is the present behavior.
The criterion is the future behavior.
Risk assessment ® preferrable term for prediction. Correlations are never perfect and we can only determine the
chance that behaviors will occur in a particular population (not in a certain client).
Indication ® Focuses on the question whether the client requires treatment and, if so, which caregiver and
assistance are the most suitable for this client and problem.
Before you can proceed to the indication, the steps for explanation and prediction must be completed. There are,
however, three additional elements:
1. Knowledge of treatments and therapists ® Eligibility requirements for treatments and therapists are not
clear. Exceptions: ambulant vs. residential, psychotherapeutic vs. pharmacological and individual vs.
group therapeutic treatment.
2. Knowledge of the relative usefulness of treatments ® There are many outcome studies, but these are
often not specific enough to support certain therapeutic interventions and types of clients.
3. Knowledge of the client’s acceptance of the indication ® There is a chance that the client will not
follow a recommendation if the proposed treatment deviates from his preference. There is an indication
4
Chapter 1: The diagnostic process
1.1 Introduction
History ® Psychodiagnostics was not popular. Perceived as being a tedious, time-consuming pursuit that labeled
people based on unreliable projective techniques and lengthy questionnaires.
Clinical psychodiagnostics is based on three elements:
• Theory development of the problems/complaints and problematic behavior.
• Operationalization and its subsequent measurement.
• The application of relevant diagnostic methods.
↳ The quality of these three elements is grounded in conceptual and empirical research. This means that
hypotheses about behavior, cognition and emotion/motivation are formulated based on a theory, and are
operationalized, measured and tested using a step-by-step diagnostic process. This is a scientifically regulated
thought to action process that results in responsible statements about the client’s behavior or problems.
Goal of psychodiagnostics:
1. Collecting information about the client and his or her environment:
2. To design the best approach to interests and problems
3. To evaluate the approach to interests and problems (during and after treatment)
A clinician’s capacity to help a client is directly related to the skills in defining symptoms and strengths
1.2 Steps in the diagnostic process
The diagnostic process has five steps:
1. Application
2. Diagnostic reflections
3. Diagnostic scenario
4. Diagnostic research/examination
5. Reporting
Exploration ® Request, request for help and exploration of
the problem (interview).
The diagnostic process usually begins with the client’s
referral to the diagnostician, but it may also begin with the
direct question to the diagnostician.
Analyze both the client’s request for help and the referrer’s
request.
Example:
Request for help = Client wants to be cured of his compulsive
behavior.
Referrer’s request = Referrer would like to know whether
there is evidence of OCD.
Induction ® Diagnostic scenario: subdivision of basic
questions, formulation of theory and converting into concrete
hypotheses.
Based on the questions from the exploration phase, the
diagnostician will construct a diagnostic scenario that
contains a provisional theory about the client, which
describes what the problems are and how they can be
explained.
Deduction ® Selection a specific set of research tools, which
can either support or reject the formulated hypotheses. And
1
,making predictions about the results or outcomes from this set of tools, to give a clear indication as to when the
hypotheses should be accepted or rejected.
Testing ® Applying and processing instruments.
Evaluation ® Based on the results that have been obtained, giving reasons for why the hypotheses have either
been accepted or rejected. This results in the conclusion.
1.3 The diagnostic cycle
Empirical cycle ® A model for answering questions in a scientifically justified manner. It is a basic diagram for
scientific research and not for psychodiagnostics practice. That’s why the five stages can only be found in
rudimentary form (niet volledig) in psychodiagnostics.
Consists of:
• Observation: collecting and classifying empirical materials.
• Induction: includes formulation of theory and hypotheses.
• Deduction: testable predictions are derived from hypotheses.
• Testing: new materials are used to determine whether predictions are correct.
• Evaluation: finally results in the evaluation.
1.4 The diagnostic process: from application to the report
Application
The diagnostician’s first task is to analyze the request and request for help. He will also consult file data (such as
reports from previous examinations). This analysis results in:
• Information about the referrer.
• Details about the type and content of the request.
• Referrer’s knowledge about the client.
1. The information about the referrer includes several elements:
a) Important to understand the referrer’s frame of reference. It contains his vision of the client’s
behavior and performance.
b) The analysis of the request results in clarification of the relationship between the diagnostician and
referrer. The referrer might be part of a team to which the diagnostician also belongs, and sometimes he
may not. And information about the nature of setting provides insight into the content and seriousness
of the problems.
c) Important to make a distinction between the referrer in name and the actual referrer. Referrer in name
® requires an examination to be carried out (e.g. psychiatrist).
Actual referrer ® takes the initiative (e.g. court or insurance company).
d) Referrer’s differ from each other in terms of the nature and extent of the powers which are available
to them.
2. Analysis of request also aims to understand the type and content of the request:
a) The referrer’s request may adhere to an open-ended format (no hypotheses) or closed format
(hypotheses).
b) Contents of a request are connected to the setting from which the request originates. E.g. ambulant
services/primary care centers ® specific requests.
Residential psychiatric centers ® more complex, exploring underlying factors.
c) Requests can be classified according to the five basic questions. They may also exist as a
combination (what’s going on, how to understand and what should be done?)
3. The analysis is supported by:
a) What the referrer already knows about the client (information client functioning).
b) Helps to determine whether the client presented himself to the referrer and whether he consents to the
examination.
2
,The analysis of request includes exploration of the client’s mindset. During the first meeting, the client’s attitude
to the examination is evaluated: Is the client there on his own initiative? Does he consent? Does he have a well-
defined request for help? What is the main problem?
The diagnostician’s reflections
The diagnostician’s reflection ® A reflection phase:
• Studying file data
• Weight is given the pieces of information. Will partly be influenced by the diagnostician’s character. He
won’t be entirely impartial towards the requester and the client.
• Be aware of own bias, knowledge, preferences.
• Reflection involves any new questions about the problem that may have occurred.
↳ Attaching different degrees of importance to sources of information rarely leads to better predictions. Adding a
large volume of information doesn’t improve prediction either.
Diagnostic scenario
Diagnostic scenario ® The diagnostician organizes:
• All of the requester’s and client’s questions from the application phase.
• All of the questions that have occurred to him.
• His knowledge of the problem
↳ Based on this information, he proposes an initial, tentative (voorlopig) theory about the client’s problematic
behavior.
1.5 Five basic questions in clinical psychodiagnostics
There are five basic questions that form the basis for most of the questions that are posed by clients, referrers and
diagnosticians:
1. Recognition ® What are the problems; what works and what doesn’t?
2. Explanation ® Why do certain problems exist and what perpetuates them?
3. Prediction ® How will the client’s problems subsequently develop in the future?
4. Indication ® How can the problems be resolved?
5. Evaluation ® Have the problems been resolved as a result of the intervention?
Recognition ® The diagnostician identifies both the complaints and behavior of the client and/or his
environment. It includes:
• Inventory and description.
• Organization and categorization in dysfunctional behavior clusters or disorders.
• Examination of the seriousness of the problem behavior.
Recognition may occur as a result of:
Criterion-oriented measurement ® Comparison to a predefined standard.
Normative measurement ® Comparison to a representative comparison group.
Ipsative measurement ® Comparison to the individual himself, e.g. to the individual at a previous point in time.
Classification ® The clinical picture is assigned to a class of problems. This can be done according to an all-or-
nothing principle or a more-or-less principle.
Example: DSM categories (all-or-nothing: client is assigned to a category) and dimensions of complaints and
personality tests (more-or-less: client is given a profile with scores for a number of dimensions).
↳ Advantage = Classification facilitates communication between experts.
Disadvantage = Classification leads to labeling, which is limited and often forms the basis for establishing co-
morbidity.
Diagnostic formulation ® focuses on the individual and his own unique clinical picture.
Example: Holistic theory, such as that which is often used in behavioral therapy, in which functional,
theoretically explicit relationships between interdependent problem behaviors and the context play a central role.
3
, ↳ Advantage = Allows for the uniqueness of the individual, based on a description of the client and its context.
Helps therapy planning.
Disadvantage = Occasional lack of empirical support. Diagnostic formulation usually involves both recognition
and explanation.
Explanation ® Answers the question of why there is a problem or a behavioral problem.
It includes:
• The main problem or problem component.
• The conditions that explain the problem’s occurrence.
• The causal relationship between point 1 and 2.
Explanations may be classified according to:
1. The locus ® The person or situation.
Person-oriented: The explanatory factor lies in the person himself. This emerges when the behavior is
viewed separately from the context.
Situation-oriented: In the event of a well-known context. The explanatory events may (a) precede
(voorafgaan) the behavior that is to be explained or (b) follow it.
2. Nature of control ® We can explain behavior in two ways: cause and reason.
A cause is something that makes the behavior happen, like gravity causing someone to fall. A reason is
about choice or intention, like being careless while picking cherries. Causes tell us what made it
happen; reasons tell us why it happened in a meaningful way. Often, both apply at the same time. For
example, acting out of strong passion can cause the behavior and also give it meaning.
3. Synchronous and diachronous explanatory conditions ® Explanatory conditions can happen at the same
time as the behavior (synchronous) or before it (diachronous). For example, a weak ego explains
behavior now (synchronous), while early childhood problems explain behavior from the past
(diachronous).
4. Induced and persistent conditions ® Induced conditions: give rise to a behavioral problem. Persistent
conditions: perpetuate (in stand houden) the behavioral problem.
↳ Important to have this knowledge, to make allowances (rekening houden met) for more than 1 type of
explanation. And some are better suited to specific goals of diagnostics and therapy.
Central theory ® Should, together with the biological influences, simultaneously identify the situational
influences, personal characteristics, development and systemic patterns.
Eclectic theory ® different theories and concepts complement (aanvullen) each other and reveal each other’s
limitations.
Prediction ® Involves making a statement about the problem behavior in the future. It is a chance statement, e.g.
the chance of suicide or the chances of a certain treatment’s succes. Prediction determines the treatment
proposal, e.g. short-term or long-term treatment.
Prediction pertains to a relationship between a predictor and a criterion. The predictor is the present behavior.
The criterion is the future behavior.
Risk assessment ® preferrable term for prediction. Correlations are never perfect and we can only determine the
chance that behaviors will occur in a particular population (not in a certain client).
Indication ® Focuses on the question whether the client requires treatment and, if so, which caregiver and
assistance are the most suitable for this client and problem.
Before you can proceed to the indication, the steps for explanation and prediction must be completed. There are,
however, three additional elements:
1. Knowledge of treatments and therapists ® Eligibility requirements for treatments and therapists are not
clear. Exceptions: ambulant vs. residential, psychotherapeutic vs. pharmacological and individual vs.
group therapeutic treatment.
2. Knowledge of the relative usefulness of treatments ® There are many outcome studies, but these are
often not specific enough to support certain therapeutic interventions and types of clients.
3. Knowledge of the client’s acceptance of the indication ® There is a chance that the client will not
follow a recommendation if the proposed treatment deviates from his preference. There is an indication
4
