Theme 1: What is psychological assessment?
Ch. 1: Diagnostic process (pp. 15 - 32) + Ch. 12.2: Descriptive diagnostics vs. structural diagnostics
(pp. 248 - 250)
1.1 Introduction
Clinical psychodiagnostics is a core professional activity of clinical psychologists. Historically,
diagnostics had a poor reputation due to unreliable projective methods, but modern
psychodiagnostics is evidence-based, structured, and crucial for adequate treatment.
Clinical diagnostics relies on three pillars:
1. Theory development of complaints, strengths, and problematic behavior
2. Operationalization and measurement
3. Application of diagnostic methods
The diagnostic process provides a systematic, step-by-step framework to analyze complex problems
and answer the client’s and referrer’s questions.
1.2 steps in the diagnostics process
A diagnostic examination starts with the client’s
request for help and/or the referrer’s request. Both
sets of questions guide the diagnostic scenario.
Steps include:
1. Constructing provisional hypotheses
about the client
2. Selecting tools to test these hypotheses
3. Predicting expected results if hypotheses
are correct
4. Administering and processing diagnostic
tools
5. Accepting/rejecting hypotheses and
forming diagnostic conclusions
This corresponds to the diagnostic cycle:
Exploration → Induction → Deduction →
Testing → Evaluation → Integration →
Reporting
,1.3 Five basic questions in clinical psychodiagnostics
Clinical psychodiagnostics revolves around five basic questions, which structure most diagnostic
requests:
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 develop in the future?
4. Indication – How can the problems be resolved?
5. Evaluation – Have the problems been adequately resolved?
These questions ensure that diagnostics is conducted in a scientific and professional manner.
1.3.1 Recognition
Recognition means understanding and structuring the client’s problems. It includes:
Inventory/description
Classification (DSM categories)
Comparison to norms or personal baseline
Distinguishing clusters of dysfunctional behaviors
Two approaches:
Classification (DSM): all-or-nothing assignment to categories
Diagnostic formulation: person-oriented, dimensional, integrates context and uniqueness,
useful for therapy planning
1.3.2 Explanation
Explanation answers why a behavioral problem occurs.
It includes:
1. The main problem or problem component
2. Conditions that explain the problem’s occurrence
3. Causal relations between problem and conditions
Types of explanations
1. Locus
Person-oriented: causes lie in the person
Situation-oriented: causes lie in the environment
Explanatory events may precede or follow the behavior.
2. Nature of control
Causes can be deterministic (past conditions) or reason-based (intentional
actions).
Cause and reason form a continuum.
, 3. Synchronous vs. diachronous conditions
Synchronous: occur at the same time as behavior (e.g., structural personality
organization)
Diachronous: precede behavior (e.g., early childhood problems)
4. Induced and persistent conditions
Induced → rise to behavioral problem
Persistent → perpetuate the problem
The diagnostician must consider multiple possible explanations, their hierarchy, and which are
influential in the current situation, since these affect treatment options. Some diagnosticians create
a central theory integrating biological, situational, personal, and systemic factors.
1.3.3 Prediction
Prediction involves estimating future behavior or the expected development of symptoms. It
connects a predictor (current features) to a criterion (future behavior). Useful for decisions such as
treatment intensity, admission, or risk.
1.3.4. Indication
Indication answers which treatment, caregiver, or assistance is appropriate.
It is an orientation process, not merely a selection process.
Three essential types of knowledge are required:
1. Knowledge of treatments and therapists
o Distinguish: ambulant vs. residential, psychotherapeutic vs. pharmacological,
individual vs. group treatment.
2. Knowledge of treatment usefulness
o Outcome studies vary in specificity; protocol-based therapies (e.g., anxiety, mood
disorders) show modest effect sizes.
3. Knowledge of the client’s acceptance of the indication
Clients may reject recommendations if they differ from their preferences.
Indication strategy:
1. Examine client perspective
2. Provide information about treatment options
3. Compare client expectations with therapist recommendations
4. Jointly select treatment and therapist
Indication integrates prior steps: recognition, explanation, and prediction.
, 1.3.5 Evaluation
Evaluation determines:
1. Whether therapy used the diagnostic proposal (if not, diagnostics was unnecessary).
2. Whether therapy and diagnostic process caused change in behavior or experience.
Two approaches:
Establishing whether complaints decreased (regardless of cause)
Demonstrating that therapy caused the improvement (e.g., with n=1 designs)
1.4 The diagnostic cycle
The diagnostic cycle is based on De Groot’s empirical cycle, adapted for psychodiagnostics.
It consists of:
1. Observation – collecting/classifying empirical material
2. Induction – forming theory/hypotheses about behavior
3. Deduction – deriving testable predictions
4. Testing – using new data to confirm/disconfirm predictions
5. Evaluation – integrating findings into a justified conclusion
Although originally intended for scientific research, the cycle provides a structured and disciplined
model for psychodiagnostic reasoning.
1.5 The diagnostic process: from the application to the report
The diagnostic process consists of five main phases:
1. Application
2. The diagnostician’s reflections
3. Diagnostic scenario
4. The diagnostic examination
5. The report
1.5.1 Application
The diagnostician evaluates the referrer’s request and the client’s request for help, which may differ.
The application phase includes:
Clarifying the referrer’s frame of reference
Understanding context (school, court, medical setting)
Determining the type and content of the request
Evaluating client’s functioning, motivation, and main complaints
Consulting existing file data
Ch. 1: Diagnostic process (pp. 15 - 32) + Ch. 12.2: Descriptive diagnostics vs. structural diagnostics
(pp. 248 - 250)
1.1 Introduction
Clinical psychodiagnostics is a core professional activity of clinical psychologists. Historically,
diagnostics had a poor reputation due to unreliable projective methods, but modern
psychodiagnostics is evidence-based, structured, and crucial for adequate treatment.
Clinical diagnostics relies on three pillars:
1. Theory development of complaints, strengths, and problematic behavior
2. Operationalization and measurement
3. Application of diagnostic methods
The diagnostic process provides a systematic, step-by-step framework to analyze complex problems
and answer the client’s and referrer’s questions.
1.2 steps in the diagnostics process
A diagnostic examination starts with the client’s
request for help and/or the referrer’s request. Both
sets of questions guide the diagnostic scenario.
Steps include:
1. Constructing provisional hypotheses
about the client
2. Selecting tools to test these hypotheses
3. Predicting expected results if hypotheses
are correct
4. Administering and processing diagnostic
tools
5. Accepting/rejecting hypotheses and
forming diagnostic conclusions
This corresponds to the diagnostic cycle:
Exploration → Induction → Deduction →
Testing → Evaluation → Integration →
Reporting
,1.3 Five basic questions in clinical psychodiagnostics
Clinical psychodiagnostics revolves around five basic questions, which structure most diagnostic
requests:
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 develop in the future?
4. Indication – How can the problems be resolved?
5. Evaluation – Have the problems been adequately resolved?
These questions ensure that diagnostics is conducted in a scientific and professional manner.
1.3.1 Recognition
Recognition means understanding and structuring the client’s problems. It includes:
Inventory/description
Classification (DSM categories)
Comparison to norms or personal baseline
Distinguishing clusters of dysfunctional behaviors
Two approaches:
Classification (DSM): all-or-nothing assignment to categories
Diagnostic formulation: person-oriented, dimensional, integrates context and uniqueness,
useful for therapy planning
1.3.2 Explanation
Explanation answers why a behavioral problem occurs.
It includes:
1. The main problem or problem component
2. Conditions that explain the problem’s occurrence
3. Causal relations between problem and conditions
Types of explanations
1. Locus
Person-oriented: causes lie in the person
Situation-oriented: causes lie in the environment
Explanatory events may precede or follow the behavior.
2. Nature of control
Causes can be deterministic (past conditions) or reason-based (intentional
actions).
Cause and reason form a continuum.
, 3. Synchronous vs. diachronous conditions
Synchronous: occur at the same time as behavior (e.g., structural personality
organization)
Diachronous: precede behavior (e.g., early childhood problems)
4. Induced and persistent conditions
Induced → rise to behavioral problem
Persistent → perpetuate the problem
The diagnostician must consider multiple possible explanations, their hierarchy, and which are
influential in the current situation, since these affect treatment options. Some diagnosticians create
a central theory integrating biological, situational, personal, and systemic factors.
1.3.3 Prediction
Prediction involves estimating future behavior or the expected development of symptoms. It
connects a predictor (current features) to a criterion (future behavior). Useful for decisions such as
treatment intensity, admission, or risk.
1.3.4. Indication
Indication answers which treatment, caregiver, or assistance is appropriate.
It is an orientation process, not merely a selection process.
Three essential types of knowledge are required:
1. Knowledge of treatments and therapists
o Distinguish: ambulant vs. residential, psychotherapeutic vs. pharmacological,
individual vs. group treatment.
2. Knowledge of treatment usefulness
o Outcome studies vary in specificity; protocol-based therapies (e.g., anxiety, mood
disorders) show modest effect sizes.
3. Knowledge of the client’s acceptance of the indication
Clients may reject recommendations if they differ from their preferences.
Indication strategy:
1. Examine client perspective
2. Provide information about treatment options
3. Compare client expectations with therapist recommendations
4. Jointly select treatment and therapist
Indication integrates prior steps: recognition, explanation, and prediction.
, 1.3.5 Evaluation
Evaluation determines:
1. Whether therapy used the diagnostic proposal (if not, diagnostics was unnecessary).
2. Whether therapy and diagnostic process caused change in behavior or experience.
Two approaches:
Establishing whether complaints decreased (regardless of cause)
Demonstrating that therapy caused the improvement (e.g., with n=1 designs)
1.4 The diagnostic cycle
The diagnostic cycle is based on De Groot’s empirical cycle, adapted for psychodiagnostics.
It consists of:
1. Observation – collecting/classifying empirical material
2. Induction – forming theory/hypotheses about behavior
3. Deduction – deriving testable predictions
4. Testing – using new data to confirm/disconfirm predictions
5. Evaluation – integrating findings into a justified conclusion
Although originally intended for scientific research, the cycle provides a structured and disciplined
model for psychodiagnostic reasoning.
1.5 The diagnostic process: from the application to the report
The diagnostic process consists of five main phases:
1. Application
2. The diagnostician’s reflections
3. Diagnostic scenario
4. The diagnostic examination
5. The report
1.5.1 Application
The diagnostician evaluates the referrer’s request and the client’s request for help, which may differ.
The application phase includes:
Clarifying the referrer’s frame of reference
Understanding context (school, court, medical setting)
Determining the type and content of the request
Evaluating client’s functioning, motivation, and main complaints
Consulting existing file data
