Chapter 2. Assessment

Slide 1. Assessment is easier said than done…

Slide 2. When assessments?

To identify:

Goals for therapy

Needs for school or programmatic services

Whether a person is competent/sane for use in legal system

Who should gain custody of a child

Whether a person qualifies for disability

Slide 3. Assessing possible psychological problems...

Slide 4. Test must be...

Reliable

• Test-retest
• Split-half

Valid

• Face
• Predictive
• Construct

Slide 5. Types of assessment tools

a. Clinical interview

• Structured
•  Unstructured

b. Observations

c. Psychological testing

• Objective
• Intelligence (WAIS, WISC, WPPSI)
• Personality (MMPI-II, BDI-2)
• Projective (Rorschach, TAT)

Slide 6.Wechsler (1939)

• Intelligence is a multifaceted concept. Intelligence tests measure "the aggregate or global capacity of the individual to act purposively, to think rationally and to deal effectively with his environment"

Slide 7. WAIS

• Verbal
• Information
• Similarities
• Arithmetic
• Vocabulary
• Comprehension
• Digit Span
• Performance
• Picture completion
• Picture arrangement
• Block design
• Object assembly
• Coding

Slide 8. Sample questions from WAIS-R

• How many ears do you have? (Information)
• Define: Knife (Vocabulary)
• How are Wheel and Ball alike? (Similarities)
• If I cut an apple in half, how many pieces will I have? (Arithmetic)
• What's missing from this picture? (Nose on girl's face; Picture completion)

Slide 9. What do scores mean?

Slide 10. Minnesota Multiphasic Personality Inventory (MMPI-2)

• 550 T/F questions
  • I cry easily.
  • I am happy most of the time
  • I believe I am being followed.
  • Someone has been trying to poison me.
• Compared to known groups with clinical symptoms
• 10 Clinical scales
  • Hypochondriasis, Depression, Hysteria, Paranoia, Schizophrenia, Hypomania, Social introversion, etc.
• 3 Validity scales
  • Faking good? Faking bad? Overwhelmed?

  Slide 11. A Rorschach-like picture

  Slide 12. A TAT-like picture

  Slide 13. One response

  Advice
  "The woman is a young professional who has been given charge of a project. An older colleague has questioned her  methods. He called her into his office and is giving her advice that she knows is incorrect and not pertinent to the  project. She resents the intrusion but can't say so because she feels sorry for him. She will leave his office and do things her own way anyway and the project will be succesful."

  Slide 14. Time to think...

  If you were forced to see a therapist against your will, how would you handle this?  How might someone else see your behavior in this setting?

  Slide 15. Why diagnose?

  • Ease of communication
  • Standardization
  • Assistance in identifying:
  • Therapy
  • Prognosis
  • Suspected etiology
  • Third party reimbursement
  • Ability to access services

  Slide 16. DSM-IV diagnoses

  Axis I -- Clinical syndromes
  Axis II -- Personality disorders and mental retardation
  Axis III -- Medical conditions affecting psychological condition
  Axis IV -- Psychosocial and environmental problems
  Axis V -- Global Assessment of Functioning.
                  Highest in last year
                  At Intake
                  Current

  Slide 17. Example I

  Axis I: Major Depressive Disorder, Single Episode, Severe without  Psychotic Features
              Alcohol Abuse
              Rule out: Alcohol Dependence
  Axis II: Dependent Personality Disorder
  Axis III: Cirrhosis of Liver
  Axis IV: Threat of Job Loss, Recent Separation from Spouse,
  Axis V: GAF = 35 (current)

  Slide 18. Example 2

  Axis I: Major Depressive Disorder, Recurrent, Mild (provisional)
              Rule out: Dysthymic Disorder
              Reading Disorder
  Axis II: No diagnosis
  Axis III: Recurrent ear infections
  Axis IV: Victim of Child Neglect
  Axis V: GAF = 53 (current)

  Slide 19. Example 3

  Axis I: Partner Relational Problem
  Axis II: No diagnosis
  Axis III: Stomach ulcer
  Axis IV: Unemployment; probable loss of family home
  Axis V: GAF = 80 (highest level within last year)
  GAF = 65 (current)

  Slide 20. Disadvantages of diagnoses

  • If wrong, poor treatment.
  • Often people only see the label.
  • A person with schizophrenia.
  • We begin to see label as real rather than as a construct which summarizes behavior
  • Some people will attribute problems to a disease & not see it as changeable, relinquishing responsibility
  • Label sticks and expectations for person’s behavior changes to match label

  
  Page by jms
  URL= http://psy1.clarion.edu/jms/Abn2assess.html

  Last modified September 13, 2001.

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