CLINICAL ASSESSMENT & DECISION MAKING
Lecture 1 Introduction & Roadmap
Knowledge:
- Psychopathology & Psychological theory
- Instruments & their psychometric qualities
- Treatment protocols
Skills:
- (Self) reflection
- Building therapeutic alliance
- Conversational skills
- Test skills
Roadmap:
The Toolkit:
- Observation
- Interview
- Tests Consult the COTAN (Dutch Committee on Tests & Testing) for interpreting
results
Abnormality:
- In psychological tests normality/abnormality is described in statistics (deviation from
the mean) usually indicated by Sd (-2z & + 2z)
Vulnerability hypothesis: certain personality traits make one vulnerable for the development
of disorders
1
,Scar hypothesis: a disorder affects one’s personality
Spectrum hypothesis: personality & disorders to be considered a continuum
Presenting complaints:
- Find out what complains are
- Find out what the client’s question is
- Shape relationship
o Be authentic, show empathy, unconditional positive regard
- Share expectations & provide information
- Transference: difficult position from client (e.g., doesn’t want to take advice of
women, falls in love with you)
- Countertransference: personal-opinion stronger than unconditional regard (especially
in forensic setting)
The Compulsory Mental Healthcare Act:
- If there is a serious emergency with the client (self-harm/harm to others) you can force
the patient to cooperate to eliminate serious harm
- Only imposed if:
o Only way of eliminating serious harm
o Proportionate (not excessive for the serious harm that needs to be resolved)
o Effective (yielding results)
Procedure: 2 possibilities that can result in compulsory medical care
o A care authorisation via a judge
o A crisis-measure via the mayor
Classification:
Criteria-based Models:
- DSM-5-TR
- ICD-10
You can avoid wrong classifications & quick prototypes by using the structured clinical
interview for DSM-5 to ensure all possible disorders are systematically evaluated
o Shorter version: Mini International Neuropsychiatric interview (15-20 minutes
compared to 45min-2hrs)
2
, Chapter 1: Psychological Assessment: Definition & Introduction
Question categories:
- Classification
- Explanation
- Prediction
- Indication
The empirical cycle:
- Observation = Collection of data
- Induction = formulating a hypothesis / what might happen
- Deduction = deriving testable predictions
- Testing of prediction
- Evaluation = process & outcomes are evaluated
1.2 Using assessment instruments
Self-registration: enables observation of behaviour such as feelings / thoughts – often used in
behavioural therapy not possible for everyone (young/old people)
Cons of observation:
- interpretations can be tainted by observer’s prejudices / stereotypes & easily result in
judgemental errors
- observing person in natural setting is labour-expensive & people usually change their
behaviour as soon as they are aware of being observed
Standardised Observations:
- have evaluative scale
- reduce probabilities of judgment errors
- often insufficient psychometric data, no suitable scales for every behaviour
Non-standardised observation:
- actor-observer effect: own problematic behaviour is attributed to external factors, for
others it is attributed to internal factors fundamental attribution error
Time sampling: how often certain behaviour occurs in a specific period of time
Event sampling: how often certain behaviour occurs – better for infrequent / problematic
behaviour
Clinical interviews:
Ideographic approach:
- person-oriented approach – uniqueness of an individual is key
- Closely related to clinical judgment
Nomothetic approach:
- norm-oriented approach – emphasis on general laws, person = understood trough
analytical thinking, theory formation, empirical testing
3
Lecture 1 Introduction & Roadmap
Knowledge:
- Psychopathology & Psychological theory
- Instruments & their psychometric qualities
- Treatment protocols
Skills:
- (Self) reflection
- Building therapeutic alliance
- Conversational skills
- Test skills
Roadmap:
The Toolkit:
- Observation
- Interview
- Tests Consult the COTAN (Dutch Committee on Tests & Testing) for interpreting
results
Abnormality:
- In psychological tests normality/abnormality is described in statistics (deviation from
the mean) usually indicated by Sd (-2z & + 2z)
Vulnerability hypothesis: certain personality traits make one vulnerable for the development
of disorders
1
,Scar hypothesis: a disorder affects one’s personality
Spectrum hypothesis: personality & disorders to be considered a continuum
Presenting complaints:
- Find out what complains are
- Find out what the client’s question is
- Shape relationship
o Be authentic, show empathy, unconditional positive regard
- Share expectations & provide information
- Transference: difficult position from client (e.g., doesn’t want to take advice of
women, falls in love with you)
- Countertransference: personal-opinion stronger than unconditional regard (especially
in forensic setting)
The Compulsory Mental Healthcare Act:
- If there is a serious emergency with the client (self-harm/harm to others) you can force
the patient to cooperate to eliminate serious harm
- Only imposed if:
o Only way of eliminating serious harm
o Proportionate (not excessive for the serious harm that needs to be resolved)
o Effective (yielding results)
Procedure: 2 possibilities that can result in compulsory medical care
o A care authorisation via a judge
o A crisis-measure via the mayor
Classification:
Criteria-based Models:
- DSM-5-TR
- ICD-10
You can avoid wrong classifications & quick prototypes by using the structured clinical
interview for DSM-5 to ensure all possible disorders are systematically evaluated
o Shorter version: Mini International Neuropsychiatric interview (15-20 minutes
compared to 45min-2hrs)
2
, Chapter 1: Psychological Assessment: Definition & Introduction
Question categories:
- Classification
- Explanation
- Prediction
- Indication
The empirical cycle:
- Observation = Collection of data
- Induction = formulating a hypothesis / what might happen
- Deduction = deriving testable predictions
- Testing of prediction
- Evaluation = process & outcomes are evaluated
1.2 Using assessment instruments
Self-registration: enables observation of behaviour such as feelings / thoughts – often used in
behavioural therapy not possible for everyone (young/old people)
Cons of observation:
- interpretations can be tainted by observer’s prejudices / stereotypes & easily result in
judgemental errors
- observing person in natural setting is labour-expensive & people usually change their
behaviour as soon as they are aware of being observed
Standardised Observations:
- have evaluative scale
- reduce probabilities of judgment errors
- often insufficient psychometric data, no suitable scales for every behaviour
Non-standardised observation:
- actor-observer effect: own problematic behaviour is attributed to external factors, for
others it is attributed to internal factors fundamental attribution error
Time sampling: how often certain behaviour occurs in a specific period of time
Event sampling: how often certain behaviour occurs – better for infrequent / problematic
behaviour
Clinical interviews:
Ideographic approach:
- person-oriented approach – uniqueness of an individual is key
- Closely related to clinical judgment
Nomothetic approach:
- norm-oriented approach – emphasis on general laws, person = understood trough
analytical thinking, theory formation, empirical testing
3
