Clinical psychodiagnostics is based on theory development of the complaints and problem behaviour (1), operationalization and measurement (2) and the application of relevant diagnostic methods (3).

There are five steps in the diagnostic process:

1. Converting the provisional theory into concrete hypotheses.
2. Selecting a specific set of research tools.
3. Making predictions about the results or outcomes from this set of tools.
4. Applying and processing instruments.
5. Give reasons for why the hypotheses have been accepted or rejected.

There are five basic questions that form the basis of most questions that are posed in diagnostic process:

1. Recognition
   These questions involve the question of what the problems are. It involves inventory and description (1), organization and categorization (2) and examination of the seriousness of the problems (3).
2. Explanation
   These questions involve the question of why the problems exist. It involves the main problem (1), the conditions that explains the problem’s occurrence (2) and the causal relationship between point one and two (3).
3. Prediction
   These questions involve the question of how the problems will develop. A prediction pertains to a relation between a predictor and a criterion.
4. Indication
   These questions involve the question of how the problems can be resolved. This step does not necessarily involve selection.
5. Evaluation
   These questions involve the question of whether the problems have been resolved as the result of an intervention. This establishes whether the therapy took account of the diagnosis and treatment proposal (1) and whether the treatment has brought about a change in the client’s behaviour (2).

Classification refers to assigning the clinical picture to a class of problems. Diagnostic formulation focuses on the individual and one’s unique individual clinical picture. Explanations can be classified according to different things:

1. Locus
   In these explanations, the explanatory factor lies within a person (i.e. person-focused explanations) or within the situation (i.e. situation-focused explanations).
2. Nature of control
   This determines whether the explanation is characterized by causes (i.e. objective facts) or reasons (i.e. voluntary actions). This is a continuum.
3. Synchronous and diachronous explanatory conditions
   The synchronous explanatory conditions (i.e. current problems) coincide with behaviour that is to be explained at the time. Diachronous explanatory conditions (i.e. past problems) precede this behaviour.
4. Induced and persistent conditions
   The induced conditions give rise to a behavioural problem while persistent conditions perpetuate the behavioural problem.

There are three elements of indication:

1. Knowledge of treatment and therapists
   There needs to be knowledge of treatment and therapists, although the eligibility requirements for treatments and therapists are often not clear.
2. Knowledge of the relative usefulness of treatments
   There needs to be knowledge of the relative usefulness of treatments in order to assess whether the client would benefit from it.
3. Knowledge of the client’s acceptance of indication
   There needs to be knowledge of

Psychological assessment can provide a catalog of an individual’s cognitive, emotional and psychological strengths, weaknesses, deficits and resources. It can also provide dynamic insights into the inner workings of an individual with invaluable information for diagnosis, potential intervention and prognosis. The goal of psychological assessment is determining what will be most valuable to the individual being assessed.

Psychological assessment consists of six steps:

1. Conducting a clinical interview
2. Choosing a battery of tests
3. Administering, scoring and interpreting tests
4. Integrating and conceptualizing information gathered from test results, the clinical interview, behavioural observations and other sources
5. Writing a psychological assessment report
6. Providing feedback to the individual assessed and/or the referral source

Psychological assessment only provides a picture of how a person is currently functioning and this cannot be projected on the future with 100% accuracy. The hypothesis testing model contains several steps:

1. Clinical assessment
   This step involves conducting a clinical interview and formulating hypotheses based on the interview and background information. The goals of this step are assessing impairment in functioning (1) and generating hypotheses (2).
2. Selecting tests
   This step involves selecting tests based on an established set of criteria. Multiple measures of the same constructs should be included (i.e. multiple tests for the same hypothesis).
3. Testing
   This step involves administering and scoring tests. The administering and scoring of tests need to be done with great care as it 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 which needs to be professional, while not too difficult to understand.
6. Providing feedback
   This step involves providing feedback to the client which is both professional and understandable. This step requires the person providing the feedback being flexible in the way it is provided.

Clinical assessment refers to the combination of the information gathered from the clinical interview and other sources of report.

Mapping out personalities is useful for choosing a career (1), personnel selection (2) and clinical diagnostics (3). There are three psychometric issues with personality tests:

1. Reliability
   This can be checked by looking at the test-retest reliability (1), the correlations between items (2), inter-rater reliability (3) and the Cronbach’s alpha (4).
2. Validity
   Construct validity can be checked by investigating differences between groups (1), links with other tests (i.e. convergent validity) (2) and the internal structure of the test (3). The link between the measure and tests that measure other constructs is called discriminant validity. Criterion validity (i.e. predictive validity) is also important for the validity of a measure.
3. Standardization
   The scores often require standardization and comparison to an absolute norm (e.g. passing grade) or a relative norm (e.g. other people).

Cronbach’s alpha is the lower-limit for reliability.

Personality traits are relatively stable. The criterion refers to what one wants to predict. Postdictive validity refers to criterion validity with a criterion that lies in the past. Concurrent validity refers to criterion validity with a criterion that is measured at the same time as the predictor. Predictive validity refers to criterion validity with a criterion that lies in the future.

A good reliability is needed for good validity although good validity is not needed for good reliability. Tests are often assessed based on principles of test construction (1), quality of the test material (2), quality of the manual (3), norms (4), reliability (5), construct validity (6), criterion validity (7).

In projective tasks, the subject is presented with a fairly unstructured task and the idea is that everyone will tackle these tasks in their own way, revealing something about their personality traits and preferences. There are several projective techniques:

1. Association methods
   In this method, the subject has to state the first thing that comes to mind after

Objective methods of personality assessment typically contain short-answer items for which the person being assessed needs to select a response. The answers of questions is indicative for the presence or absence of a personality trait. However, these methods are prone to response biases and the content of the items can be guided by theory.

The sign approach states that test responses are deemed to be signs or clues to underlying personality or ability. The sample approach states that behaviour is to be interpreted in light of a trait of interest. An advantage of the sign approach is that the client might become aware of feelings that one was not previously aware of.

Behavioural assessment refers to what a person does in situations rather than on inferences about what attributes this person has. In traditional approaches to assessment, data is used to diagnose and classify, whereas in behavioural approaches to assessment, data is used to describe targeted behaviours and maintaining conditions usually for the purpose of selecting specific therapeutic conditions.

In traditional assessment, an individual’s behavioural history is afforded great weight (i.e. it is seen as predictive of future behaviour). In behavioural approaches, behavioural history provides a baseline information relevant to an individual’s learning history.

There are several questions that can be asked in behavioural assessment:

1. Who
   This refers to the question of who the assessee and who the assessor is. In behavioural assessment, the assessee can be the assessor (e.g. diaries).
2. What
   This refers to the question of what is being measured in the behavioural assessment. This typically constitutes of targeted behaviour which is measurable (e.g. amount of times face touched).
3. When
   This refers to the question of when the assessment of behaviour is made. Assessment of behaviour is typically made at times when the problem behaviour is most likely to be elicited (e.g. during lunch). It can also occur through frequency or event recording (i.e. each time the behaviour occurs) (1) or interval recording (i.e. assessment according to pre-defined schedules). The intensity of the behaviour may also be measured.
4. Where
   This refers to the question of where the assessment takes place. In behavioural assessment, this can be anywhere, preferably the environment in which the target behaviour is most likely to occur.
5. Why
   This refers to the question of why the assessment takes place. This can take place to provide behavioural baseline data (1), to provide a record of the assessee’s behavioural strengths and weaknesses across a variety of situations (2), to pinpoint environmental conditions that are acting to trigger, maintain or extinguish certain behaviours (3), to target specific behavioural patterns for modification (4) and to create graphic displays useful in stimulating innovative or more effective treatment approaches (5).
6. How
   This refers to the question of how the assessment is conducted. This depends on the goal of the assessment.

Timeline

On the test day, the test administrator needs to make sure the logistics are in order (1), needs to be sensitive to the client’s feelings and perceptions (2), needs to communicate clearly (3).

After scheduling the test, it is imperative to select the norm-groups with which to compare the client’s raw scores. Norm data provides important support for making good-quality decisions (e.g. generating the cut-off scores for personnel selection). It is impossible to have one individual do a test several times so the individual one-off scores is collected from the population in order to make comparisons.

The accuracy of conclusions drawn depends on the reliability of the test. In order to compare scores of two different constructs, it is necessary to standardize them.

Coping refers to the thoughts and behaviours used to manage internal and external demands of situations that are appraised as stressful.

Coping is a process that unfolds in the context of a situation or condition that is appraised as personally significant and as taxing or exceeding the individual’s resources for coping. The coping process is initiated in response to the individual’s appraisal that important goals have been harmed, lost or threatened and these appraisals are often characterized by intense negative emotions. Emotions are essential in the coping process.

Coping is sensitive to the environment (1), its demands (2), resources (3) and personality dispositions that influence the appraisal of stress (4). Coping is strongly associated with the regulation of emotion and escapist coping techniques are associated with poor mental health outcomes.

Measurement (1), nomenclature (2) and determination of effectiveness (3) are criticized in the research on coping.

The first measurements of coping included retrospective reports. This allowed for multi-dimensional descriptions of situation-specific coping thoughts and behaviours. However, there are several limitations to the use of these inventories:

1. The length can be too long
2. It often uses inadequate sampling
3. It often has response keys that are difficult to interpret
4. There are variations in the recall period
5. The accuracy of recall is not always good
6. There are changes in meaning of a given coping strategy, depending on when it occurs
7. Some people are unable to recall the coping strategies, thoughts and behaviours
8. There is confounding with the outcomes

These problems were overcome using momentary assessment. However, this might lead to people focussing on concrete events and not mentioning more complex, abstract events (1), people not mentioning all the coping efforts (2) and people focusing on specific thoughts and actions rather than a broader conceptualization of coping (3).

Narrative approaches ask a person to recall a stressful event, what happened and the emotions associated with it. This could provide information in understanding what a person is coping with (1) and provide information on ways of coping not included in checklists (2).

One challenge to coping research is finding common terminology which allows for the diverse coping strategies to be compared and discussed in a meaningful manner across studies. The coping responses have been clustered according to a theory (1), according to factor analysis (2) or through a mixture of both (3).

Problem-focused coping refers to addressing the problem causing distress. Emotion-focused coping refers to ameliorating the negative emotions associated with the problem. This is one terminology that has been used. Meaning-focused coping refers to the use of cognitive strategies to manage the meaning of the situation. Social coping also exists. Problems of these categories are that it might mask differences within categories (1), the internal consistency might not be good (2) and the factors within the multifactorial scale are not independent of each other (3).

It is

Burnout refers to the exhaustion of employees’ capacity to maintain an intense involvement that has a meaningful impact at work. Later, burnout was defined as a state of exhaustion in which one is cynical about the value of one’s occupation and doubtful of one’s capacity to perform.

Burnout discussions began within human services because they were better able to give voice to issues of emotions, values and relationships with people. The roots of burnout are embedded within broad social, economic and cultural developments:

1. A large influx in the human services with the goal of eradicating poverty
   However, this was not possible due to the perpetuating factors of poverty, frustrating the idealists.
2. Professionalization of service industry
   This led organizations to have different values in the service industry than the values of the service providers (i.e. employees).
3. Cultural revolution
   This led to a decrease in prestige of most service jobs but an increase in demands of care, service and empathy from service recipients.
4. Flexible capitalism
   This is the replacement of traditional, rigid, homogeneous and predictable social institutions by heterogeneity and continuously changing social institutions. This led to social fragmentation which decreases community support and can foster burnout.
5. Development of narcistic culture
   This is the development of a culture where people demand immediate gratification of desires but remain perpetually unsatisfied.
6. Transformation from industrial society to service industry
   This led to an increase in psychological pressures.

It is possible that ideological communities prevent burnout from happening because it provides a collective identity that prevents burnout from occurring because of social commitment (1), a sense of communion (2), contact with the collective whole (3) and shared strong values (4).

The lack of reciprocity refers to the discrepancy between professionals’ efforts and the rewards they received in terms of recognition and gratitude. This fosters burnout. Naïve idealism magnifies one’s vulnerability to a burnout but it is not an essential prerequisite.

A persistent imbalance of demands over resources leads to increased burnout as an increase of demands leads to insufficient opportunities to regenerate depleted energy. There are also value conflicts between the employee and organization and this misfit can lead to increased burnout.

Globalization, privatization and liberalization cause rapid changes in modern working life. Burnout occurs globally. The meaning of the term burnout differs per country, however. The medicalization of burnout is intertwined with debates of whether burnout is not mere exhaustion. Most burnout research uses a definition that includes exhaustion (1), inefficacy (2) and cynicism (3) (i.e. multidimensional view). The one-dimensional view of burnout is that it is exhaustion (e.g. psychological exhaustion, emotional exhaustion).

The definition of burnout is sometimes treated as being context-independent, although this is not possible for the multi-dimensional approach of burnout research. The definition of burnout is also dependent on medical practice as medical practitioners favour dichotomous diagnoses. The dichotomy of

Sexual recidivism is associated with deviant sexual interests (1) and antisocial orientation / lifestyle instability (2). Deviant sexual interests refer to enduring attractions to sexual acts that are illegal or highly unusual. Antisocial orientation refers to antisocial personality, antisocial traits and a history of rule violation.  

Antisocial orientation facilitates sexual offending because individuals will not commit sexual crimes unless they are willing to hurt others (1), can convince themselves that they are not harming the victims (2) or feel unable to stop themselves (3).

Risk factors of the development of sexual offending are adverse family environments (1), lacking nurturance and guidance (2) and beliefs that permit non-consensual sex (3). Persistent sexual offenders may be characterized by a negative family background (1), problems forming affectionate bonds with friends and lovers (2) and attitudes tolerant of sexual assault (3).

The observed sexual recidivism rate is 13.7%. The violent non-sexual recidivism rate is 14.3%. General recidivism rate is 36.2%. Anti-social orientation is the major predictor of violent non-sexual recidivism and any recidivism. General problems with self-regulation (1), a history of non-violent crime (2), a history of non-sexual crime (3) and psychopathy (4) are predictors of recidivism.

For adolescent sex-offenders, recidivism was predicted by sexual deviancy (1) and anti-social orientation (2).

Most sexual offenders were more likely to recidivate with non-sexual offenses. Sexual deviancy and anti-social orientation are the major predictors of sexual recidivism. The factors that initiate sexual offending may not be the same as the factors associated with persistence. Sexual offenders are more likely to respond to stress through sexual acts and fantasies, thereby creating discrete time periods where they are at increased risk of sexual recidivism.

According to Mofitt, life-course persistent offenders have behaviour problems in childhood (1), engage in interpersonal violence (2) and have many sexual partners (3). Sexual offenders who attend treatment are less likely to recidivate than any comparison group.

For general offenders, treatment is effective only when it targets criminogenic needs (i.e. characteristics associated with offending).

The Dutch association of psychologists has made ethical guidelines based on responsibility (1), integrity (2), respect (3) and expertise (4). There are several important points of the guidelines for use of tests (AST):

1. The initiator relationship
   The psychologist needs to determine who initiated the request for psychodiagnostic examination. The psychologist initially carries out the examination for the benefit of the initiator. The psychologist attempts to ask the questions of the initiator or if that is not possible, seeks contact with the initiator to rephrase the questions.
2. The psychologist’s expertise
   A client has the right to a psychologist’s expertise. The psychologist’s expertise must be up-to-date and maintained. It also means that the psychologist knows his own boundaries and limitations. Expertise also refers to the fact that the psychologist must make sure that the quality of the assessment is high.
3. Confidentiality
   The things a client say must be handled in a confidential way and the client’s dossier also needs to be confidential. The retention period of a dossier is one year or as long as necessary for the purpose it was created for or as long as required by law. The content can be used for a longer period of time in scientific research if the data has been anonymized.
4. Voluntary participation and information provision
   Participation in an psychological examination is always voluntary. A client is entitled to information during each phase of the psychological examination. The client also has the right to correct, supplement or omit any data from the report for which he can convincingly argue that the data are incorrect, incomplete or irrelevant. This does not apply to test results and conclusions. The client also has the right to stop the psychologist from reporting to an external initiator, unless the external initiator is a court order.

External initiators refer to initiators that do not have direct contact with the client in a personal manner (e.g. insurance companies, court). Non-external initiators refer to initiators who have direct contact with the client in a personal manner (e.g. client himself). Expertise refers to the psychologist’s theoretical and practical knowledge and skills.

If there is little psychological information about a client, the following steps will follow:

1. The psychologist will begin a comprehensive anamnestic and biographical interview or begin treatment if possible.
2. The psychologist will plan the examination.
3. The psychologist carries out the examination.
4. The testing assistant will score (and potentially interpret) the tests.
5. The psychologist will interpret all of the information and examine which insights and hypotheses can be supported or rejected by the results.

The reporting of diagnostics involves written and oral reports. The purpose of the reports is to communicate the findings and results of the psychological examination as well as suggestions and recommendations on which these are based.

A written report is mandatory in all cases except for communication with the client.

Basic knowledge of neuropsychological is required for the diagnostician because proper referral is necessary. Clinical neuropsychology refers to the scientific area that involves the study of the relationship between the brain and behaviour in patient-oriented research. In clinical neuropsychology, the focus on organic holism tends to change with lateralization and localization and vice versa.

The idea currently is that brain dysfunctions may have consequences that stem from both selective, localization-related disorders as well as more general consequences.

There are several misconceptions about neuropsychology:

1. Neuropsychological diagnostics only involves the examination of functional cognitive disorders and intellectual deterioration
   Neuropsychology also focuses on emotional factors (1), personality factors (2), coping skills (3), the client’s experiences (4), limitations in everyday life (5) and consequences for social roles and relationships (6). Establishing which of the patient’s functions are intact is important in establishing the patient’s independence and his compensation options.
2. The explanation question should require an answer in terms of a medical diagnosis and/or the localization of the lesion.
   The conclusions should be drawn on the basis of cognitive functional domains and their influence on behaviour. This does not necessarily lead to a medical diagnosis. Behavioural information can sometimes offer information for the localization of brain lesions and can be conclusive for medical diagnoses.
3. The psychologist should limit himself to the question originally formulated by the initiator
   The original question is usually vague and is rarely based on knowledge of the capabilities and limitations of clinical neuropsychology. Therefore, other questions should also be addressed.

There are three type of neuropsychological questions:

1. What is the cognitive profile of the patient
   This involves identifying the behavioural, cognitive and emotional disorders. There is no link yet between strengths and weaknesses with certain brain diseases or lesions.
2. Which behavioural consequences can be identified as a result of brain injury
3. What is the cause of the behavioural changes?
   It is important to establish what practical significance this question has for the patient.

Test-retest reliability is important in neuropsychological tests because sometimes tests need to be made in a short span of each other to indicate improvement after treatment or surgery. There are four groups of neuropsychological tests:

1. Level tests and screening tests
   Level tests can be used to indicate general level of cognitive functioning (e.g. intelligence test) Screening tests are presumed to give an indication of a potential deficit. The screener tests should have a low cut-off score (i.e. very sensitive). Examples of screener tests are the NLV and the IQCODE-N (i.e. asking a friend of the client about the client’s cognitive functioning).
2. Cognitive tests
   In order to examine the cognitive functions of a person, cognitive tests can be administered. Attention (1), information processing speed (2), perception (3), memory and learning (4), language (5), spatial functions and executive functions (6), social cognition (7) and targeted action (i.e.

A treatment plan should be based on the best science available. This means that the therapist must be well-informed regarding recent scientific findings. The clinical hermeneutics error refers to the therapist losing track of the actual degree of pathology due to adopting the patient’s perspective. This means that high-level depth of processing or interpreting and explaining the behaviour leads to a loss of normative judgement.

The Neo-Kraepelinian diagnostic rubrics consist of ascertainment of facts to determine the presence or absence of relatively explicit diagnostic criteria (1), the making of differential and multi-axis diagnoses using the DSM (2) and the differential selection of treatment guided by differential diagnosis (3).

Diagnosis in the current practice misses the point that symptoms of presenting complaints and targets of treatment plan may be manifestations of personality traits. The features the diagnostician focuses on may be consequences of extreme levels of personality traits (1), problematic configurations of trait levels (2) or extreme adaptations to personality traits (3). A high degree of comorbidity may be the result of manifestations of the same few maladaptive personality traits (e.g. negative emotionality) which are interpreted as symptoms.

Personality traits influence how individuals interpret and construe life events. Science does not fully support the claim that major mental disorders are separate from personality. Constructive realism makes several statements:

1. Personality traits are real
   A trait refers to a psychological structure underlying a relatively enduring behavioural disposition.
2. Traits are separate from constructs and measures
   Constructs refer to elements in psychologists’ theories of traits. Traits become known through their behavioural implications but the manifest behaviours are not the traits.
3. Traits exist in individuals but lead to population concepts
   The different trait levels lead to trait dimensions which leads to population concepts (e.g. height in individuals leads to tallness as a concept in the population).

Trait levels refer to an individual’s specific dispositions. There are major replicable trait dimensions and they are organized hierarchically. There are three trait dimensions:

1. Extraversion
   This is an aspect of the broader dimension of positive emotionality (PE).
2. Neuroticism
   This is an aspect of the broader dimension of negative emotionality (NE).
3. Constraint
   This is related to reversed psychoticism and reversed sensation seeking.

Environmental effects consist of shared environmental factors and unshared environmental factors. Treatment planners should know about four things:

1. Heritability of personality traits
   This is the proportion of variance in a trait that is attributable to genetic influences. It is a population concept.
2. Initial findings on the source of personality trait stability
   A lot of stability of personality traits stems from genetic factors whereas change arises primarily from unshared environmental factors. Individuals with certain genotypes select environments that provide stability for their personality traits.
3. Gene-environment correlations
   It is through the agency of the person that environments are selected or created that are

Observation in clinical psychology refers to perception with the intention to draw conclusions. It can be used to gather information about others with whom a person communicates directly or indirectly (1), relationships and situations in which a person is either involved or not involved (2) and the person himself (3).

There is a distinction between every day observation and professional observation. Professional observation refers to goal-oriented observation on the basis of an observation question which leads to an informed decision to act. The method is first perception and then interpretation.

A rating scale refers to a written behavioural examination that draws on psychological knowledge (e.g. intake interview). An observation scale refers to a written behavioural examination that draws on observation. Subscales refer to components of the observation scale.  

Behavioural aspects can be accurately observed in a test situation. Observation during an interview can be useful for generating hypotheses about a client’s problems. The leniency effect (1), the halo effect (2), the logic error (3), the contrast error (4), the primacy effect (5), the recency effect (6) and the tendency to mostly give average scores and to avoid making extreme judgments (7).

The logic error refers to the tendency to pass similar judgements on traits that seem to be logically linked instead of an isolated impression. The psychologist’s theoretical background may also influence the fundamental attribution error.

Heuristics refer to information processing strategies that people use to reduce complex assessment tasks to simpler operations. There are two heuristics that influence observation in a clinical context:

1. Availability heuristic
   This refers to the tendency to give greater weight to more available or recent information.
2. First impression heuristic
   This refers to the tendency to hold on to one’s first impression even when there is additional information that contradicts the initial impression.

Standardized observation is generally selective (i.e. not everything is observed). The level at which the observation is observed needs to be determined. The molar level refers to larger, meaningful units. The molecular level refers to smaller behaviour units. The validity is high but the reliability is low at the molar level. The reliability is high but the validity is lower at the molecular level.

There are several potential settings for observation:

1. Natural surroundings
   This is observation in the setting in which behaviour normally occurs (e.g. school) The problems of observation in natural surroundings are the investment of time (1) and the information is not necessarily comparable (2).
2. Observation in simulated settings
   This is observation in a natural setting with a predefined task. The validity is high but the comparability with other clients is partially possible due to the semi-structured nature of the situation.
3. Laboratory observation
   This is observation in a setting which is artificial. The advantages are that there is a high degree of standardization (1) and the reliability and interrater reliability can be determined