Psychological Assessment – Lecture 1, interim exam 1 summary [UNIVERSITY OF AMSTERDAM].

Psychological assessment refers to the collection and integration of psychological data to make a diagnosis in the field of psychology. This employs tools such as tests, interviews, observation and specifically designed equipment.

Physiognomy states that it is possible to judge the inner character of people from their appearance (e.g. face). Phrenology states that the bumps on the skull are an indicator of personality.

A single aptitude test measures one ability domain and a multiple-aptitude test measures several distinct ability domains. The development of aptitude tests lagged behind the development of intelligence tests because of a lack of statistical techniques (1) and the absence of practical application of these tests (2).

Ipsative tests compare the relative strength of interests within an individual instead of comparing it to professional groups (e.g. interest inventories). There is a world-wide trend of evidence-based testing; the idea that treatments and interventions require proof that they are effective.

In the first world war, there was group testing of intelligence on recruits. This was not very successful because of the large number of recruits (1), the difficulty comparing verbal and non-verbal tests (2) and the lack of validation of the test (3).

The Bernreuter personality inventory was one of the first personality tests. The Rorschach test was developed to reveal the inner workings of an abnormal subject. The Thematic Apperception Test was developed as an instrument to study normal personality.

Projective testing made use of free association (1), sentence completion (2), and interpretation (3).

There are several pitfalls in psychological assessment:

1. Fundamental attribution error
   This is the tendency to overestimate the influence of dispositions and underestimate the influence of situational factors. A solution to this error is to pay attention to the circumstances.
2. Confirmation bias
   This is the tendency to search and pay attention to information that is consistent with one’s conclusion. This includes ignoring and selectively interpreting hypotheses, beliefs and conflicting information. A solution to this error is to actively look for conflicting information.
3. Salience effect
   This is the tendency to give more weight to striking information than to non-striking information. A solution to this error is to be aware of the existence of the error or to use objective measurements.
4. Contrast error
   This is the tendency to judge others in a manner opposite from how one perceives oneself or a previous client due to a perceived discrepancy between self (or previous client) and others. A solution to this error is to be aware of the existence of the error or to use objective measurements.
5. Illusory correlation
   This is the tendency to perceive links between tests and one’s conclusion which does not exist empirically. A solution to this error is to employ the scientific approach.
6. Blindspot bias
   This is the tendency to see oneself as less biased than others and to be less able to recognize bias in oneself than in others. A solution to this error is to be aware of the existence of the error or to employ the scientific approach.

The scientific evidence for the existence of these errors in the diagnostic process comes from differences between raters and methods. The general solutions to error in psychological assessment are awareness of the limitations (1), including circumstances (2), thinking about verification and falsification (3), use specific instruments that are as valid and reliable as possible (4), think about whether one instrument is sufficient (5), remain critical (6) and follow the hypothesis-testing model (7).

The diagnostic process consists of several steps:

1. Clinical assessment
   This step involves conducting a clinical interview and formulating hypotheses based on the interview and the background information. The goals are assessing impairment in functioning (1) and generating hypotheses (2).
2. Test selection
   This step involves selecting tests based on an established set of criteria and multiple measures of the same construct should be included.
3. Testing
   This step involves administering and scoring tests. Mistakes here can greatly skew interpretations.
4. Integration of all data
   This step involves combining test results and behavioural observations with clinical assessment data to address each of the hypotheses.
5. Writing the assessment report
   This step involves writing the assessment report.
6. Providing feedback
   This step involves providing feedback to the client which needs to be professional and flexible

There are five basic questions for psychological assessment:

1. Recognition
   This is the question of what the problems are. It includes making an inventory of the problems (1), description of the problems(2), organization of the problems (3), classification of the problems (4) and indicating severity of the problems. (5).
2. Explanation
   This is the question of why do the problems exist and what perpetuates the problems. It involves establishing the locus (i.e. is the explanatory factor within a person or a situation) (1), nature of control (i.e. determining whether the action is characterized by causes or reasons) (2), synchronous and diachronous explanatory conditions (i.e. explaining behaviour now or explaining conditions that precede the behaviour) (3) and establishing induced and persistent conditions (4).
3. Prediction
   This is the question of what will the development of problem behaviour be in the future. This links the predictor to research and experience.
4. Indication
   This is the question of how the problems can be resolved. This depends on the answers to the previous questions and requires knowledge of practitioners and treatments (1), relative usefulness of treatments (2) and acceptance of advice by the client (3).
5. Evaluation
   This is the question of what the result of psychological assessment is. This establishes whether the therapy helped the client (1) and whether the therapy took the results of the psychological assessment into account (3).

The nature of control determines whether the explanation of the problems is characterized by causes (i.e. objective facts) or reasons (i.e. voluntary actions). Synchronous explanatory conditions explain conditions that coincide with the current problems and diachronous explanatory conditions explain conditions that precede the problem.

Psychological assessment only provides a picture of how a person is currently functioning. Classification refers to assigning the clinical picture to a class of problems. Diagnostic formulation focuses on the individual and the unique clinical picture.

Analysis of the request for diagnosis contains information about the referrer which can provide information about the seriousness and the setting. This analysis is followed by a reflection phase in which weight is given to each piece of information.

The diagnostician organizes all of the requester’s and the client’s questions from the application phase in a diagnostic scenario. This is used to propose an initial, tentative theory about the problematic behaviour to determine which information should be assigned to the recognition question and what should be examined as explanation.

Diagnosis and treatment combination (DTC) states that once a patient is diagnosed this diagnosis is accompanied by an evidence-based treatment. This has several points of criticism:

• It is difficult to select one treatment as many clients experience comorbidity.
• It is not a solution for clients with poorly defined complaints.
• It leads to the possibility that other disorders are overlooked during treatment in a particular department.
• It assumes an interaction between a specific diagnosis and a type of treatment which is not always empirically supported.
• It is not always possible to do a comprehensive diagnostic examination which makes selecting the right treatment difficult.

There are several basic ethical principles for during psychological assessment:

• Responsibility
  This states that psychologists must be aware of their responsibility to prevent harm (e.g. do not make statements about a patient in the media, regardless of consent).
• Integrity
  This states that psychologists must not mix professional and non-professional roles in a way that does not allow the psychologist to maintain a professional distance.
• Respect
  This states that psychologists must be aware of the knowledge, insight and experience of the person involved and psychologists must respect the mental and physical integrity of the person involved and must not harm one’s dignity.
• Expertise
  This states that psychologists must be aware of the limits of their expertise in their professional activities.