lectures – clinical assessment and
decision making
lecture 1 – introduction & roadmap part 1
Definitions
Clinical assessment
Synonyms of clinical assessment in mental health care
- Psychological assessment
- Psychodiagnostics
It entails solving the problem of someone’s psychological disorder by making decisions
about its presentations, by formulating and testing hypotheses about what it is and how it
is caused, by gathering and integrating information form many sources
Psychological assessment
“A shared decision-making process in which a clinician iteratively defines a diagnostic
question, formulates and tests hypotheses about the client’s cognitive functions and
behaviour, and integrates the information thus collected from a number of sources and
using different methods based on scientific psychology in a dynamic fashion, resulting in
a representation and understanding of the problem that is shared with the client in such a
way that it is relevant indications for treatment or care ensue”
The underlined words illustrate what defines psychological assessment. They
distinguished psychological assessment approach from the kind of ‘problem
solution’ approach
This is a scientist-practitioner approach using an evidence-based way of thinking
Four basic questions
1. Classification – e.g., does this person have PTSD?
2. Explanation – e.g., why does he refuse to eat?
3. Prediction and indication: what can you predict when it comes to the indication to
treatment or treatment outcome – e.g., will cognitive behavioural therapy help
this person?
4. Evaluation – e.g., was the intervention successful?
Knowledge and skills
Psychological assessment
- Required knowledge: textbook knowledge
- Psychopathology and psychological theory
- Instruments and their psychometrics qualities
- Treatment protocols
- Required skills
- (self) reflection
- Building therapeutic alliance: there should be motivation in the client
otherwise the psychological cycle will not work. There should be a click at
the level of the expectations from the client and the psychologist. This is
not very necessary when:
- When you work in a multidisciplinary team and you are one of the
many professionals that engage with the client
- When you have short encounters with the client
- Conversational skills
- Test skills
1
,Roadmap
If you have the needed
knowledge and skills, you can
start this roadmap, which
shows the whole
psychological process. You
first need to accept the
referral, then conclude if
there is an emergency (if yes,
you won’t follow the whole
process), and decide if it is
useful to include an
explanatory analysis
Using instruments
Psychological assessment
- Observation: from the psychologist, people in the client’s circle, or the staff
- Interview
- Tests
- Why do you want to administer a test or questionnaire?
- Which questionnaire or test do you pick?
- How to interpret the results?
Consult the COTAN database
The COTAN database
Dutch Committee on Tests and Testing
Criteria:
- Availability: is the test or questionnaire available to everybody or do you have to
email a researcher to use it?
- Adaptation/translation for the Netherlands
- Validity (construct and criterion)
- Construct validity: does the test measure what it is supposed to measure?
- Criterion validity: does the test predict a certain outcome?
- Standardisation: is the standardisation described or are there loose ends when you
administer the test?
- Reliability: if you administer the test twice, does it come to the same conclusion?
- Norms: normative data e.g., size of norm groups, date of norms
Cotan rating
Wechsler Intelligence Test for Children – 5th ED. (WISC-V-NL)
- Basis of test construction: Good
- Quality of test materials: Good
- Quality of manual Good
- Norms: Sufficient
- Reliability: Good
- Construct validity: Sufficient
- Criterion validity: Insufficient (because of lack of research)
Beck Depression Inventory – 2ND ED. (BDI-II-NL)
- Basis of test construction: Good
- Quality of test materials: Good
- Quality of manual Good
- Norms: Insufficient (outdated)
- Reliability: Good
- Construct validity: Sufficient
- Criterion validity: Insufficient
2
, Rorschach Test (1921)
- Basis of test construction: Insufficient
- Quality of test materials: Insufficient
- Quality of manual Insufficient
- Norms: Insufficient
- Reliability: Insufficient
- Construct validity: Insufficient
- Criterion validity: Insufficient
Defining (ab)normality
Your (cultural) reference frame is
important in determining what is
(ab)normal
What is normal changes over time.
E.g., in the DSM-III homosexuality
was a disorder
Cultural differences may also frame
the classification system of mental
disorders
This normal curve determines what
is normal or abnormal in statistics
The result depends always on
‘compared to the rest of the
population’. +/- 2 standard
deviations from the average are
seen as extreme
Personality
Disorders and personality
- Vulnerability hypothesis: certain personality traits make
an individual vulnerable for the development of disorders
- Scar hypothesis: a disorder affects ones personality
- Spectrum hypothesis: personality and consequent
disorders to be considered a continuum (see picture)
Referral
- My child needs help
- My parent(s) need help
- I need help
- You need help
- My patient needs help
Can I accept this referral?
Questions
- Is it a proper referral? If the referral is not properly
formulated, you ask more information from the person who sent the referral
- Is it a question that can be answered?
- Is it a mental health issue?
- Does it need treatment or care?
- Am I the right person to take it up?
- Do I have the right qualifications? (e.g., to give the specific treatment)
- Do I have the time?
3
decision making
lecture 1 – introduction & roadmap part 1
Definitions
Clinical assessment
Synonyms of clinical assessment in mental health care
- Psychological assessment
- Psychodiagnostics
It entails solving the problem of someone’s psychological disorder by making decisions
about its presentations, by formulating and testing hypotheses about what it is and how it
is caused, by gathering and integrating information form many sources
Psychological assessment
“A shared decision-making process in which a clinician iteratively defines a diagnostic
question, formulates and tests hypotheses about the client’s cognitive functions and
behaviour, and integrates the information thus collected from a number of sources and
using different methods based on scientific psychology in a dynamic fashion, resulting in
a representation and understanding of the problem that is shared with the client in such a
way that it is relevant indications for treatment or care ensue”
The underlined words illustrate what defines psychological assessment. They
distinguished psychological assessment approach from the kind of ‘problem
solution’ approach
This is a scientist-practitioner approach using an evidence-based way of thinking
Four basic questions
1. Classification – e.g., does this person have PTSD?
2. Explanation – e.g., why does he refuse to eat?
3. Prediction and indication: what can you predict when it comes to the indication to
treatment or treatment outcome – e.g., will cognitive behavioural therapy help
this person?
4. Evaluation – e.g., was the intervention successful?
Knowledge and skills
Psychological assessment
- Required knowledge: textbook knowledge
- Psychopathology and psychological theory
- Instruments and their psychometrics qualities
- Treatment protocols
- Required skills
- (self) reflection
- Building therapeutic alliance: there should be motivation in the client
otherwise the psychological cycle will not work. There should be a click at
the level of the expectations from the client and the psychologist. This is
not very necessary when:
- When you work in a multidisciplinary team and you are one of the
many professionals that engage with the client
- When you have short encounters with the client
- Conversational skills
- Test skills
1
,Roadmap
If you have the needed
knowledge and skills, you can
start this roadmap, which
shows the whole
psychological process. You
first need to accept the
referral, then conclude if
there is an emergency (if yes,
you won’t follow the whole
process), and decide if it is
useful to include an
explanatory analysis
Using instruments
Psychological assessment
- Observation: from the psychologist, people in the client’s circle, or the staff
- Interview
- Tests
- Why do you want to administer a test or questionnaire?
- Which questionnaire or test do you pick?
- How to interpret the results?
Consult the COTAN database
The COTAN database
Dutch Committee on Tests and Testing
Criteria:
- Availability: is the test or questionnaire available to everybody or do you have to
email a researcher to use it?
- Adaptation/translation for the Netherlands
- Validity (construct and criterion)
- Construct validity: does the test measure what it is supposed to measure?
- Criterion validity: does the test predict a certain outcome?
- Standardisation: is the standardisation described or are there loose ends when you
administer the test?
- Reliability: if you administer the test twice, does it come to the same conclusion?
- Norms: normative data e.g., size of norm groups, date of norms
Cotan rating
Wechsler Intelligence Test for Children – 5th ED. (WISC-V-NL)
- Basis of test construction: Good
- Quality of test materials: Good
- Quality of manual Good
- Norms: Sufficient
- Reliability: Good
- Construct validity: Sufficient
- Criterion validity: Insufficient (because of lack of research)
Beck Depression Inventory – 2ND ED. (BDI-II-NL)
- Basis of test construction: Good
- Quality of test materials: Good
- Quality of manual Good
- Norms: Insufficient (outdated)
- Reliability: Good
- Construct validity: Sufficient
- Criterion validity: Insufficient
2
, Rorschach Test (1921)
- Basis of test construction: Insufficient
- Quality of test materials: Insufficient
- Quality of manual Insufficient
- Norms: Insufficient
- Reliability: Insufficient
- Construct validity: Insufficient
- Criterion validity: Insufficient
Defining (ab)normality
Your (cultural) reference frame is
important in determining what is
(ab)normal
What is normal changes over time.
E.g., in the DSM-III homosexuality
was a disorder
Cultural differences may also frame
the classification system of mental
disorders
This normal curve determines what
is normal or abnormal in statistics
The result depends always on
‘compared to the rest of the
population’. +/- 2 standard
deviations from the average are
seen as extreme
Personality
Disorders and personality
- Vulnerability hypothesis: certain personality traits make
an individual vulnerable for the development of disorders
- Scar hypothesis: a disorder affects ones personality
- Spectrum hypothesis: personality and consequent
disorders to be considered a continuum (see picture)
Referral
- My child needs help
- My parent(s) need help
- I need help
- You need help
- My patient needs help
Can I accept this referral?
Questions
- Is it a proper referral? If the referral is not properly
formulated, you ask more information from the person who sent the referral
- Is it a question that can be answered?
- Is it a mental health issue?
- Does it need treatment or care?
- Am I the right person to take it up?
- Do I have the right qualifications? (e.g., to give the specific treatment)
- Do I have the time?
3
