Chapter 6: The Assessment Interview pages 160-188

Assessment in Clinical Psychology

 1960’s and 1970’s—Decline in assessment measures and focus more on therapy.

 Clinical Assessment: Evaluation of an individual or family’s strengths and weaknesses,
conceptualization of the problem and prescription for alleviating it.
 Our capacity to understand a problem is based on our skill to diagnose it (diagnose before
treatment).
 Referral Question: Take into consideration what question was asked by the referral source
and what the referral source is seeking. (e.g. from parent, teacher, psychologist).
What Influences How the Clinician Addresses the Referral Question?
 The type of information asked is often based on the clinician’s theoretical approach (ex:
psychodynamic clinician may ask about childhood experiences but a behavioral clinician may
ask about daily life).
 Assessment Interview: Most basic and serviceable data gathering tools. It has a wide
range of application and adaptability, but this again depends on the clinician’s skills.
General Characteristics of Interview
An Interaction
 Interaction between at least 2 people in which each person contributes to the process and
influences the other’s response.
 Involves face-to-face interaction but the conversation is based on a specific set of goals in
mind.
 One characteristic that interviews have that conversation does not—the interexchange is
not based on personal satisfaction or prestige (used to gather data and information).
Interviews Versus Tests
 More purposeful but less formalized than standardized psychological tests.
 Psychological tests—collection of data under standardized conditions using structured
procedures.
 Interviews can use an individualized approach and are more flexible.

The Art of Interviewing

 Except for diagnostic interviews have a degree of freedom to their structure.

Clinician slowly learns to respond to patients cues over time
Computer Interviewing
 Asks all the questions that are assigned and has 100% reliability.
 May be less uncomfortable for patient to answer in private (dehumanizing to an extent).
 Clarification of interview questions is not possible and there is no flexibility room.
 Computers can’t assess non-verbal cues (ex: facial expression), can’t assess free-form
responses, can’t apply clinical judgment to patients.
Interview Essentials and Techniques
The Physical Arrangements
 The setting needs to consider privacy and protection from interruptions.
 Soundproofing may be necessary to ensure privacy (ex: remove hallway noise).
 Most clinicians prefer a neutral office setting.
Note Taking and Recording

 Few key note phrases will aid the clinician in recalling client’s responses.
 Most patients assume that some form of note-taking will occur, but may request note-
taking not occur for certain sensitive topics of discussion
 Verbatim notes; except during a structured interview as it prevents from noticing non-
verbal or subtle cues.
 Audio or videotaped interviews must be done with patient’s full consent.
Rapport
Definition and Functions
 Rapport: Characterize the relationship between patient and clinician, involving comfortable
atmosphere and mutual understanding of the purpose and goals of interview.
 Establishing a positive relationship will determine the type and amount of information the
clinician will acquire from the patient.
Characteristics
 Requires attitude of acceptance, understanding, respect for patient’s integrity.
 Does not require the clinician to like or be friends with the patient.
 Allows for probing and confrontation once rapport has been established.
Special Considerations
 Difficult in establishing rapport with multiple individuals during family or marriage
counseling.
 Similar situations may occur with child and adolescents where rapport must be
established with both patient and parent(s).
Communication
Beginning a Session
 Using general topics like the weather or difficulty about finding a parking space are good
starters.
 Establishes the clinician as a real person and removes them from being related to as a
“shrink”. Helps relax the patient.
Language
 Initial estimation of patients age, background and educational level to determine what
language to use.
 Using proper language to establish oneself as a professional but also being cognizant of
the client’s needs “not using teenager language like LOL”.
The Use of Questions + Silence
 Questions may become more structured over time—open ended, facilitative, confronting.
 Assess meaning and functions of the silence—organizing thought, deciding what to say.

Listening

 Listen and appreciate the emotions that the patient is conveying.

 If the clinician is concerned about impressing the client, or guided by other motivations
therapy will not be effective.
Gratification of Self
 Clinicians must resist temptations to think about their own problems and concerns; but
instead focus on the patient.
  Clinicians should avoid discussing their personal lives with the patient.

The Impact of the Clinician

 The type of therapist that a patient has—tall, thin and muscular vs. very feminine female will
elicit different responses from their patients.
 The clinician must thus have a degree of self-insight to consider the possible impact they can
have.
T he Clinician’s Values and Background
 Clinicians must examine their own assumptions before making judgements about others;
some misconceptions may essentially be a part of the other person’s culture.
 Gender differences or different frame-of-references can sometimes elicit the same
response of disconnect from the patient.
The Patients and Clinicians Frame of Reference
 Being sensitive to the patient’s initial perceptions and expectations in necessary to
establish rapport.
 The clinician needs to be prepared and should know everything there is to know about
that patient before the first meeting.
o The clinicians should also be clear about the purpose of the interview, and clear
about the nature of what is required if it is for a referral.
Varieties of Interviews
 Interviews first differ in terms of purpose, and second in terms of whether it is
unstructured (clinical interview) or structured.
 Unstructured Interview: Clinicians are allowed to ask any questions that come to mind in any
order.
 Structured Interview: Verbatim set of standardized questions in a specific sequence.
The Intake-Admission Interview
 Helps determine why the patient has come to the hospital or clinic and judge whether the
facilities resources will meet the patients’ needs and expectations.
 Conducted by a psychiatric social worker.
 Can be done face to face or via phone.
 Informs patients of clinicians fees, policies, procedures.
The Case-History Interview
 A complete personal and social history is taken—concrete facts and dates and a patient’s
feelings about them.
 Broad history and context in which the patient and problem can be placed.
 Gathering historical-developmental context so that diagnostic significance and
implications can be determined.
Can also use outside sources (e.g. parents, teachers, peers)
The Mental Status Examination Interview
 Conducted to assess cognitive, emotional and behavioral problems.
 Very unreliable because they are unstructured in nature.
 One of the primary modes of assessment for a variety of mental health issues.
The Crisis Interview
 Hotline interviews for people fearful of abusing their children or abusing drugs.
 Rules of interviewing are blurred but the basics remain.
  Purpose is to meet the problem as it occurs and provide immediate resource of relief.
The Diagnostic Interview
 Evaluation against DSM-IV criteria; historically it used a free form unstructured
interview.
 Structured diagnostic interviews: Standard set of questions and follow up questions in a
specific sequence. Allows for greater inter-rater reliability.
 Very few clinicians used these structured interviews in daily life (only 15%).
Reliability and Validity of Interviews
 Interrater Reliability: Level of agreement between two raters who evaluate the same
patient. Quantified using the kappa coefficient or the intraclass correlation coefficient.
 Kappa Coefficient: To determine how reliable rater judge the presence or absence of a
feature of a diagnosis. Between .75 and 1.00 *best inter-rater agreement level.
 Validity concerns how well an interview measures what it intends to measure.
 Predictive validity: Scores from a measure, correlated (“predicted”) future events
relevant to that construct.
Reliability
 Structured interviews are more reliable than unstructured (reduce information and
criterion variance)
 Information Variance: Variation in the questions that clinicians ask, observations made and
the method integrating that information.
 Criterion Variance: Variation in the scoring threshold among clinicians. Clear cut scoring
criteria is better.
 DSM-III and structured interviews to assess DSM criteria made diagnostic interviews
more reliable.
 Test-Retest Reliability: Consistency of scores or diagnosis across time (retaken).
o Goes down over longer time periods—years or months.
Validity
 Content Validity: Measures comprehensiveness in assessing the variable of interest (does it
measure all areas of the construct of interest).
 Criterion-Related Validity: Ability of a measure to predict (correlate with) scores on
other relevant measures.
 Concurrent Validity: Type of criterion-related validity. Extent to which interview scores
correlate with scores on other relevant measures given at the same time.
 Predictive Validity: Type of criterion-related validity. Extent to which interview scores
correlate with scores on other relevant measures, at some point in the future.
 Discriminant Validity: Extent to which interview scores do not correlate with measures that
are not theoretically related to the construct being measured. E.g. no reason phobia of
spiders should relate to intelligence.
 Construct Validity: Extent to which interview scores demonstrates all aspects of validity.
Suggestions for Improving Reliability and Validity
 Use a structured interview, or consider developing one.
 Interview skills that are essential: establish rapport, being a good communicator, listener,
knowing when to remain silent and ask questions, observe verbal and non-verbal cues.
 Be aware of patients motives and expectations for the interview.
  Be aware of your own (clinicians) expectations, biases and cultural values.

Chapter 7—The Assessment of Intelligence (pg. 191-215)

Intelligence Testing: Yesterday and Today

 Due to under-education, and to measure mental abilities, intellectual tests were developed.
 Binet-Simon test looked at individual differences in mental functioning (focus academic ability).
 1971: Court Case Larry P. vs. Wilson Riles—California supreme court in 1975 placed a
moratorium on using IQ tests on African-Americans.
Review of Reliability
 Reliability—consistency with which individuals respond to test stimuli. The types are:
 Test-Retest: Consistency of responses to the same test stimuli on repeated occasions.
o May lead to “test-wiseness” that influences their scores the second time or
clients may show practice effects.
 Equivalent-Forms: Equivalent or parallel forms of a test are developed (ex: test forms A, B, C with
different colors for an exam).
 Split-Half: Test is divided into halves (or odd numbered items vs. even numbered items) &
participant’s scores on the two halves are compared (allows for internal-consistency reliability).
 Internal Consistency: Do the items on a test measure the same thing? Index of internal
consistency, average of split half correlations is made (Cronbach’s alpha).
 Inter-Rater: Independent observers agree about their ratings of an aspect of someone’s
behavior.
 Reliability needs to be consistent in all forms, otherwise it won’t be valid at all; and
reliability does not automatically equal validity.
Measures for Reliability

1. Test-Retest reliability: Pearson’s r and Interclass correlation

2. Equivalent forms reliability: Person’s r
3. Split-half reliability: Pearson’s r
4. Internal consistency reliability: Cronbach’s alpha and Kuder-Richardson-20
5. Inter-rater reliability: Person’s r and Interclass correlation Kappa
Review of Validity

 Validity: An assessment technique measures what it is supposed to measure

 Content Validity: Measures comprehensiveness in assessing the variable of interest (does it
measure all areas of the construct of interest).
 Predictive Validity: Type of criterion-related validity. Extent to which test scores indicate some
behavior or event in the future.
 Concurrent Validity: Type of criterion-related validity. Extent to which test scores correlate with
scores on other relevant measures given at the same time.
 Construct Validity: Extent to which test scores demonstrates all aspects of validity in a consistent
manner (involves both convergence and discriminant validity demonstration).
Definitions of Intelligence—3 Classes Emphasize (are not mutually exclusive definitions):

1. Adjustment or adaptation to the environment—adapting to situations or dealing with

situations.
2. Ability to learn—educability in the broad sense of the term
3. Abstract thinking—ability to use a wide range of symbols and concepts, ability to use verbal and
numerical symbols.
Theories of Intelligence

Factor Analytic Approaches

 Spearman—general intelligence g (general tests) and specific intelligence s (unique test

aspects).
 Spearman viewed intelligence as a broad generalized entity. Used principal components.
 Thrustone—viewed intelligence as a series of “group factors” not the basic g. Used principal
factors.
o 7 factors (Thurstone’s Primary Mental Abilities)
 Spearman and Thurstone also used different data sets (broad range vs. academic institutions).

C attell’s Theory (Hierarchical Model of Intelligence)

 Emphasized g. He developed 17 ability concepts. Divided Spearman’s g into 2 components:
o Fluid Ability: Genetically based intellectual capacity
o Crystallized Ability: Capacities that are tapped by intelligence tests, (culture based
learning).
Guilford’s Classification (Viewed as a classification or taxonomy; not really a theory)
 Structure of Intellect Model (SOI)—used model as a guide in generating data.
 Intelligence components can be divided into 3 areas: operations, contents and products.
 Operations: Cognition, memory, constructing logic alternatives, arguments, evaluation.
 Content: Areas of information in which the operations are performed (figural, symbolic,
semantic and behavioral).
 Products: When a mental operation is applied to a context there are 6 types of products.
o Units, classes, systems, relations, transformations and implications.

G ardner’s Theory of Multiple Intelligences (Viewed as “Talents” not intelligences)

 Gardner—theory of multiple intelligences (8 intelligences):
Linguistic, Musical, Logical-Mathematical, Spatial, Bodily-Kinesthetic, Naturalistic, Interpersonal and
Intrapersonal
S ternberg’s Triarchic Theory of Intelligence
 People function on the basis of three aspects of intelligence: componential, experiential and
contextual.
 Emphasis on planning responses and monitoring them and de-emphasis on speed & accuracy.
 Componential: Analytical thinking (good test-taker)
 Experiential: Creative thinking (combine separate elements of experience
 Contextual: “street smart”—practical, can play the game and manipulate the environment.
T oday’s Focus—More on Spearman + Thurstone Contributions
 Focus is largely still on a single IQ or Spearman’s g.
 Current intelligence tests are made up of subtest scores (Thurstone factors).

T he IQ: It’s Meaning and It’s Correlates—The Intelligence Quotient (IQ)

Ratio IQ

 Mental Age (MA): Index of mental performance (X items passed)

 Chronological Age (CA): Individual’s given age
 IQ: Used to overcome differences cause by CA and MA to express deviance
 IQ= MA/CA x 100
 IQ measurement is not one of equal-interval measurement and we can’t add & subtract (so IQ
of 100 is not twice IQ of 50).
Deviation IQ

 Ratio IQ is limited and not fully applicable to older age groups.

 Compares an individual’s performance on IQ test with his/her same age peers .
 Same IQ has a different meaning for different ages (ex: same IQ for 22 year vs. 80 year old).
Correlates of the IQ: School Success, Occupational Status and Success, Demographic Group Differences

 School
o General IQ shows success in school and specific tests measure what area.
o IQ scores + grades correlation—.50
 Occupation
o Based on educational level acquired (income, race, prestige…)
o IQ also good predictors of job performance
 Demographic Group
o Differences between sexes for specific abilities; males on spatial and quantitative ability
and females on verbal ability.
o Hispanic & African Americans have lower IQ scores than North or European Americans.
Heredity and Stability of Intelligence
 Intelligence is influenced by genetic factors (behavioral genetics)
 Similarity in intelligence is a result of the amount of genetic material shared (monozygotic more
similar than dizygotic twins or siblings).
 IQ variance associated with genetics varies from 30% to 80%.
 Environment plays a role—biological relatives raised together are more similar.
 Heritability of intelligence is not stable; 20% in infancy and 60% in young adults, 80% in old age.
Stability of IQ Scores and the Flynn Effect

 IQ Scores tend to be less stable for children and more stable for adults and more influenced
at a younger age for children than for adults (i.e. environment).
 Flynn Effect: From 1972 onwards Americans IQ scores on average have increased 3 points each
decade.
The Clinical Assessment of Intelligence Scale 1: The Stanford-Binet Scales
Stanford-Binet 1972 revised test kit version followed a fourth revision in 1986 and the most recent revision
 in 2003—Stanford-Binet Fifth Edition (SB-5)
Description:

 Hierarchical Model of Intelligence; 5 factors that tap non-verbal & verbal abilities.
1. Fluid Reasoning: Ability to solve new problems. Measured by sub-tests
a. Quantitative Reasoning, Visual-Spatial Processing, Working Memory and Knowledge
 Each sub-test is made up of items of varying difficulty (age 2-adulthood)
 Multistage Testing: Two routing subtests the Object-Series Matrices and Vocabulary subtest
o Routing: Examinee’s performance on these two sub-tests determine which item to start
with for each remaining subtest.
Standardization and Reliability and Validity:

 Included 4,800 participants aged 2-96 years old; participants were tested using various areas.
 SB-5 administered to individuals with disability, mental retardation to ensure utility of scores.
 Comparing Stanford-Binet to other scales like Wechsler Scales; the scale has strong validity.

The Clinical Assessment of Intelligence Scale 2: The Wechsler Scales

 Wechsler-Bellevue Intelligence Scale; developed to correct flaws in Stanford-Binet Scale.

 Test was designed for adults and items were groups into subtests not according to age level.
 Used a deviation IQ concept; intelligence is normally distributed, compare with same-age peers.
Description:

 1955—Wechsler-Adult Intelligence Scale (WAIS); revised version 1981 (WAIS-R).

 1997—(WAIS-III); and most recent version 2008 (WAIS-IV)
 Inclusion of reversal items in the subtests introduced first in WAIS-III
o Two examinee’s both begin with the same base items then based on performance
subsequent items are presented in reverse sequence until a perfect score on two
consecutive items is obtained.
 WAIS-IV—provided Index scores in addition to the Full Scale IQ Scores.

Obtaining the Full Scale IQ Score and Index Scores + Standardization:

 Raw scores converted to standardized scores for a given age group.

 Full IQ Score and Index score—adding scale scores of each subtest and converting sums to IQ
equivalents.
Reliability and Validity

 Scores from previous WAIS-III and WISC-IV are strongly correlated with WAIS-IV scores (good).
 Over relying on global IQ scores can thus be misleading (Full Scale IQ)
The Wechsler Intelligence Scale for Children (WISC-IV)—Description and Standardization

 1949—WIC; multiple revisions since then and the latest version WISC-IV was published in 2003.
 Used to test children age 6-16 years old; has 10 core and 5 sub-tests. A reduced version of WAIS.
 Individual subtests define 4 major indices and make up the Full Scale IQ (*see pg. 212).
o Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PCI), Working Memory Index
(WCI), The Processing Speed Index (PSI)
The Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III)

 1967—WPPSCI developed; a revised version since then and the latest WPPSI-III in 2002.
 Similar to the WISC-IV but targeted towards youth; so children below the age of 6.
 Only 3 indices—Full Scale IQ, Verbal IQ and Performance IQ; addition of PSI for age 4+; but also
has several subset scales specific for children only.
Clinical Use of Intelligence Tests
Estimating General Intelligence Level

 Determining the person’s g level—what is the patient’s intellectual potential?

 Intellectual ability level can also assist with helping individuals recover cognitive abilities
following head trauma, injury.
 IQ scores need to be interpreted and placed in an appropriate context.

Prediction of Academic Success and Appraisal of Style

 Intelligent tests should predict academic success in school.

 Intelligence tests allow us to observe patient at work (observations; help with interpretation).
 Some clinicians made diagnosis of mental disorders from intelligence tests (intertest scatter) but
this is not at all reliable.
Final Observations and Conclusions—IQ is an Abstraction
 Look at IQ as “present functioning” not innate potential; it is an abstraction that allows us to
predict specific behaviors.
 Most believe that there is a “true IQ” and intelligence tests assess these.
Final Observations and Conclusions—Generality Versus Specificity of Measurement
 Intelligence tests can provide broad general index of intellectual functioning across a range of
situations. Can thus be used to compare similar individuals in same situations.
Chapter 8—Personality Assessment (pg. 218-251)
Objective Tests
Objective Personality Measures: Administer standard set of questions and the examinee responds using a
fixed set of option choices (ex: T/F or Y/N response).
Advantages of Objective Tests or Self-Report Inventories
 Economical—large groups can be tested after only brief instructions.
 Administration and scoring is also very simple thus making interpretation easier (e.g. functional-
dysfunctional). But it is very objective and reliable.
Disadvantages of Objective Tests or Self-Report Inventories
 Questions are behavioral in nature and so may not characterize the respondent (can’t tell why
different people gave same response).
 A single score is provided to look at both cognitions and emotions, but individuals who receive
the same overall score may have different cognitions and emotions.
 Option choice prevents respondents from providing answer reasons, so information may be lost.
Methods of Construction for Objective Tests
Content Validation
 Best for clinicians to decide what they wish to test and then ask the patient that information.
 Content validation focuses on:
 o A. defining relevant aspects of the variable looking to be measured
o B. consulting experts before generating items
o C. Using judges to assess each potential items relevance to the variable of interest
o D. Using psychometric analysis to assess each item before it is included in the measure.

Empirical Criterion Keying

 No assumption is made as to whether a patient is really telling the truth about feelings.
 Assumes that members of a certain diagnostic group will respond in the same way
 Utility of an item is based on its ability to discriminate between groups.
 Difficulty with interpreting the meaning of a

score. Factor Analysis or Internal Consistency Approach

 Seeks to reduce or “purify” the scales to reflect basic personality dimensions.

 Exploratory Approach: Taking various items and then reducing these items to basic elements—
(ex: personality, adjustment) to arrive at core traits of personality.
 Confirmatory Factor Approach: Seek to confirm a hypothesized factor structure (based on
predictions) for test items. Largely used by clinicians because it is empirical.
Construct Validity Approach
 Scales are developed to measure specific constructs from a theory (personality). Validation is
obtained when the scale measures the theoretical construct.
 The most desirable and labor-intensive approach
Description of MMPI
 Uses the Keying Approach; Hathaway & McKinley wanted to identify psychiatric diagnoses of
individuals. Originally designed for ages 16+, but was also used with younger individuals.
 Given to both clinical and non-clinical population.
 550 items that were answered T/F or “can’t say”. Only items that differentiated clinical
from non-clinical individuals (ex: depressed individuals vs. non-clinical individuals) were
included.
Description of MMPI-2
 MMPI originally overemphasized the U.S. population and lacked diversity; this was changed.
 Language was changed to be modern, & 154 new items were added bringing total to 704
items.
 Lower age range—can be used with at least 13 year olds or those with 8th grade education
level.
 Versions in multiple languages are available & an adolescent version MMPI-A is also available.
Validity Scales
 As MMPI & MMPI-2 as self-report measures they are susceptible to distortion due to attitudes.
 To detect “faking-bad” behavior the MMPI & MMPI-2 incorporates 4 validity scales:
o Cannot Say Scale—items left unanswered
o F(Infrequency) Scale—tendency to exaggerate one’s problems/ symptoms
o L (Lie) Scale—attempts to present oneself favorably
o K (Defensiveness) Scale—attempts to present oneself favorably
 “Added” MMPI-2:
o Fb (Back-page Infrequency) Scale—tendency to exaggerate one’s problem’s/symptoms
o VRIN (Variable Response Inconsistency) Scale—random responding or T/F to most items
o TRIN (True Response Inconsistency) Scale—random responding or T/F to most items
Short Forms and Interpretation Through Patterns (Profile Analysis)
 Shortened versions of the MMPI & MMPI-2; but loss of interpretation is present and intense
scrutiny should be present in terms of whether these and reliable and valid measures.
 MMPI—interpretation on elevated scale scores (ex: high Sc score schizophrenia).
 MMPI-2—interpretation of “pattern or profile” test scores
Interpretation Through Content and Supplementary Scales
 Shift from clinical use of MMPI & MMPI-2—away from use of differential psychiatric diagnosis
based on a single score to a more sophisticated profile analysis of scale scores.
 MMPI-2: Content scales have been developed (ex: identify health concerns, identity fears…)
 Supplementary Scales: 450 MMPI scales ranging from Dominance to Success in Basketball!
MMPI-2 there are 20 supplementary scales (ex: Anxiety, Strength, Social Responsibility).
A Summary Evaluation of the MMPI and MMPI-2
Screening and The Question of Personality Traits
 MMPI-2 useful for information about mental disorder diagnosis in terms of severity and
hypothesis generator.
 Not useful for a screening specific disorders (ex: depression) as very long + time intensive.
 Atheoretical: MMPI measures symptoms of psychopathology. Not useful for understanding
general personality traits and situational determinants.
Reliability and Validity of MMPI-2
 Lacks internal consistency but do show good test-retest reliability.
 Strong validity with external correlates—emotional states, stress reactivity.
 2 aspects of validity for MMPI-2 (Butcher et al., 1995)—incremental validity & cut-off scores.
o Incremental Validity: If a scale’s score provides information about a person’s personality
features, behavior or psychopathology that is not provided by other measures
 All psychological tests including MMPI-2 lack incremental validity.
o Cut-off scores validity: Varies on the nature of the sample population (which patients
have or don’t have the disorder).
 MMPI-2 cut off T score of 65+ may or may not be

appropriate. Personnel Selection and Bias

 Empirical Criterion Keying approach limits usage of MMPI-2 to those that understand it.
 May not be appropriate to use MMPI-2 to screen candidates for employment hiring (invasion of
privacy into religious beliefs, sexual orientation).
 MMPI original—may be biased against ethnic groups. Test Bias means that different predictions
are made for two groups even when they receive the same score.
Concerns about the MMPI-2
 The normative sample is too education; individuals without college degrees not represented.
 Criteria for inclusion of “normal respondents” is confusing.
 Those who are administered both versions of the MMPI show different results on each version.
 Scores on MMPI-2 are lower than the MMPI
 Internal consistency of the MMPI-2 Scale is low
The Revised NEO-Personality Inventory (NEO-PI-R)
Description
 Self-report personality inventory that is made up of the Five-Factor Model (FFM)
 OCEAN (Openness to Experience, Consciousness, Extraversion, Agreeableness, Neuroticism).
 o There are 6 subscales/facet scales for each FFM
 The 240 items are rated on a scale (strongly disagree, disagree, neural, agree, strongly agree)
 Original Version (Costa & McCrae) looked at only Neuroticism, Extraversion and Openness.
 Half of the items are reverse scored—lower scores are more indicative of a trait.

Norms and Reliability & Stability, Factor Structure

 U.S. Census for distribution of age and racial groups as well as college students.
 Excellent internal consistency and test-retest reliability (for periods as long as 6 years later).
 Factor analysis have supported the NEO-PI-R five-factor-model structure.

Clinical Applications, Alternative Forms of the NEO-PI-R

 Axis II (Personality Problems), application to the NEO-PI-R makes sense.

 The NEO-PI-R and related FFM can be used for clinical assessment related to Axis I & II disorders.
 60 question NEO Five Factor Inventory (NEO-FFI); but has no facet scales. There is also Form R.

Limitations of the NEO-PI-R

 Lack of validity scales, has no items to assess response patterns and test taking approach.
 May not be good for clinical diagnosis because it was based of a “normal” personality
Nature of Projective Tests
 Projective techniques: First developed by Rorschach in 1921, uses inkblots as a method of
differential diagnosis for psychopathology. Characterized as a person’s modes of behavior by
observing their behavior in response to a situation that does not elicit a particular
response.
 Characteristics include:
1. Examinees are forced to impose their own structure and reveal something of themselves when
responding to ambiguous stimuli
2. Stimulus material is unstructured (supposed to be ambiguous without a clear answer).
3. Method is indirect—examinees are not aware of the purpose of the test.
4. There is freedom in response—allows a range of responses
5. Response interpretation deals with more variables—allows for interpretation along multiple
dimensions.
Standardization of Projective Tests, Reliability and Validity
 If they were standardized it would allow for communication & checks against biases.
 Other’s ague that project tests can’t be standardized because each person is unique.
 Test-retest reliability may change with participants over time, but even split-half reliability is
difficult to demonstrate in projective tests.
 Validity needs to ask specific questions: Does the TAT predict aggression in situation A?
The Rorschach Inkblot Test

Description and Administration of Rorschach

 Consists of 10 cards on which inkblot images are printed. 5 black & white and 5 colored
 “Tell me what you see, there are no right or wrong answers, tell me what it looks like to you”
 Cards are administered in order and clinician notes down patient’s responses word for word.
 Other recorded aspects: lengths of time to make response, total time spent on card, position of
the card, all spontaneous remarks (um, uh…).
  Inquiry: At the end patient is reminded of their responses to each card and asked
what prompted that response.
Scoring
 Location: Area of the card that the patient responds to (whole, blot, large detail, white space…)
 Content: What is the object that is being viewed (animal, rock, clothing, person…)
 Determinants: What aspect of the card prompted patient’s response (form of the blot, color,
texture, shading…)
o Some tests also score Popular responses and Original responses
o Exner’s Comprehensive System of scoring is the most used.
 Most clinicians do not formally score the Rorschach but simply rely on determinants.
 Exner’s Scoring System—strong for test-retest reliability and construct validity.
Reliability and Validity of Rorschach
 Many argue that reliability across time or test conditions does not exist for the Rorschach, while
others counter-argue this statement.
 Clinicians who haven’t been trained together & that use free-wheeling interpretation of the
Rorschach makes interpreting the test difficult.
 Rorschach may be valid only under certain conditions; with the average validity being .41 (this
has not been steady as another clinician found a value of .29).
Rorschach Inkblot Method
 Best viewed as a method of data collection and not a “test”, as it is subject to interpretation.
 Viewing it as a method allows clinicians to use all aspects of the data output.

The Thematic Apperception Test (TAT)

Description
 31 TAT cards (of that 20 is recommended to be given to an examinee). Not as ambiguous as the
Rorschach but not clear cut either.
o Other versions: Roberts Apperception Test and Children’s Apperception Test]
 Reveal patient’s basic personality characteristics by their interpretation of their responses to a
series of pictures.
 Used as a method inferring psychological needs (ex: for achievement, sex, power…) and how the
patient interacts with the environment. Used to infer content of personality & mode of social
interaction.
Administration and Scoring
 6-12 cards are administered and patient’s responses and noted down word-for-word.
 “Make up a story for each of these pictures, who are these people, what are they doing…”
 Not much emphasis is placed on scoring TAT’s as the types of responses are so varied.
Reliability and Validity
 Very difficult to assess validity and reliability (as a result of personality changes—test-retest).
 Broadly looks at reliability of interpretations—when there is explicit scoring instructs interjudge
reliability can be achieved.
 Comparing TAT data with case data and patient evaluations, matching techniques with no prior
patient knowledge and general principles interpretation include ways of establishing validity.
 There are no adequate norms for TAT and typically clinicians interpret responses (no scores).

Sentence Completion Techniques
 Most used is the Rotter Incomplete Sentences Blank.
 Incomplete Sentences Blank—uses 40 sentence stems (ex: I like…., What annoys me….)
 Completions are scored along a 7-point scale for adjustment-maladjustment.
 Very versatile and has a strong scoring system that is objective and reliable (but also has
freedom of response), it can be used economically and is a good screening device.
Illusory Correlation
 Not a lot of evidence backing these “signs” associated with certain personalities.
 Poor correlation between making valid statement about patients on the basis of their
responses—illusory correlation can lead to error.
Incremental Validity and Utility
 Refers to the degree to which a procedure adds to the prediction obtainable from other
sources.
Assessment must inform the clinicians of something that the base rate/prevalence rate can’t
Use and Abuse of Testing: Protections, The Question of Privacy
 Clinicians should use only assessments that lie within their competence (only then can they
acquire tests).
 The examinee or individual has a right to full explanation of how their responses & results
will be used. Informed consent must thus be obtained.
 Must only be given tests relevant to the evaluation and reason for test must be provided.
Use and Abuse of Testing: The Question of Confidentiality & The Question of Discrimination
 There are cases in which confidential matters must be disclosed (i.e. Tarasoff case). If the person
is going to harm themselves or others, then information can’t be privileged.
 Tests might discriminate against minorities (only include White-middle class populations) or
include only certain population members (ex: TAT only white members in cards)
Use and Abuse of Testing: Test Bias
 This is a validity issue (i.e. criterion or performance varies significantly across groups). That it is
more accurate for one group than another.
o Using traits characteristic for one group (ex: men) but not the other group (ex:
women).
 Differences in mean scores does not mean bias, and bias can be overcome.
The Use and Abuse of Testing: Computer-Based Assessment
 Used to standardize tests, interpret responses, cut costs, increase clients attention.
 Internet based psychological testing may lack qualities of traditional testing—less reliable, valid,
lack of control over testing situation, technological issues, cultural differences in test
interpretation.
 Computer Based Test Interpretation (CBTI’s): Generate quick responses and processing complex
scores, but they must result in inaccurate interpretations of results.
 CBTI’s must be clinically useful (should aid in clinical understanding and treatment), valid
(accurate interpretations) and reliable (interpretations should be similar for similar scores).

Chapter 9: Behavioral Assessment pages 255-282

The Behavioral Tradition

Sample vs. Sign

  Behavioral Assessment: Assessment that focuses on the interaction between situations
and behaviors for the purposes of creating behavioral change.
 Focus on how well assessment device samples the behaviors and situations
 Sample orientation: Parallels how a person behaves in a situation; as in a test.
 Sign orientation: Inference about performance is indicative of some other characteristic.
 Traditional research has used a sign as opposed to sample orientation. But behavioral
research sample approach is used.
Functional Analysis
 Exact analysis is made of the stimuli that precede a behavior and the consequences that
occur from it.
 Behaviors are learnt and maintained as a result of consequences that follow them.
Identify stimulus that occurs beforehand and determine reinforcements that follow, to
elicit change.
 Behaviors that are monitored must be recorded in observable, measurable terms.
 Antecedent Conditions: Stimulus conditions that lead up to the behavior of interest.
 Consequent Events: Outcomes or events that follow the behavior of interest
o E.g. lack of attention (stimulus) taking pencil from another child (behavior)
attention (consequence).
 Organismic Variables: Physical, physiological or cognitive factors of the individual that
are important to determine the client’s problem.
 SORC Model—Used to conceptualize a client’s problem
o S—Stimulus or antecedent conditions that bring on a problem
o O—organic variables related to the problem
o R—response or problematic behavior
o C—consequences of the problematic behavior

Behavioral Assessment as an Ongoing Process

 Behavioral assessment is an ongoing process that occurs before, during and after
treatment.
 Diagnostic formulations—potential targets for intervention
 Patients context or environment—social support, physical environment, evaluation of
skills.
 Initial understand of client’s behaviors, resources will lead to a treatment plan.
 Treatment includes collaboration between therapist and client and feedback will lead to
adjustment of treatment.
Behavioral Interviews
Behavioral interview allows therapist to assess the client’s “hope” for end results.
 Ultimate Outcomes: Happiness, life satisfaction, making the world better.
 Behavioral Interviews: Clinician attempts to make sense of the problem and of the
variables that seem to maintain the problem.
 Basic goal is to identify the problem behaviors, situational factors that maintain those
behaviors and consequences that result from the problem.
Naturalistic Observation
 Observing individuals in their natural environment, will enable a clinician to better
 understand the problem.
 Observation in a natural environment has limitations and is easier for children than adults
who may be outpatients.
 Clinicians need to ensure that clients are not observed without their knowledge or that
family members are not drawn into the observation net—do not compromise privacy.
 Due to the cumbersome nature of it, clinicians prefer to use traditional assessment.
 Examples:
o Home Observation (Family mealtime routines)
o School Observation (school classroom, playground). Rate frequency, duration and
intensity.
o Hospital Observation (mental retardation; open environments)
 Unfiltered observation not contaminated by extraneous variables.
Controlled Observation or Analogue Behavioral Observation
 Clinicians can exert certain amount of control over the events being observed, may be
better in situations where behavior does not occur very often on its own.
 The environment is “designed” for the clinician to observe the behavior occurring.
 Situational Tests: Place individuals in situations similar to real life and observe how
people behave.
Controlled Performance Techniques
 Assessment procedure in which the clinician palces individuals in a controlled
performance situation and collects data on their reaction, performance and behavior.
 Approaches include:
o Behavioral Avoidance Tasks (Total number of steps/tasks completed)
o Fear Arousal Accompanying Responses (Total fear or distress ratings)

 Behavior in this type of situation may not reflect real-life behavior.

 Psychophysiological measures: To assess CNS, autonomic nervous system, skeletal
motor activity.
o Complement other traditional assessments, can assess a process (e.g. emotional
response). E.g.—Event Related Potentials (ERP’s), Electroencephalographic activity
(EEG).
Self-Monitoring
 Individuals observe and record their own behaviors, thoughts and emotions.
 Keep diaries, logs for some period of time—usually in terms of how often the behavior
occurs (frequency, duration and intensity).
 May lead to distortion or wrongful recordings, resistance.
 Most effective in relation to other larger forms of therapy.
 Other monitoring devices include personal digital assistants (PDA’s), palmtop computers,
phones
Variables Affecting Reliability of Observation
Complexity of Target Behavior
 More complex behaviors, greater unreliability of observation so focus is usually on less-
complex behaviors.
Training Observers
 Training observer by bringing them into an inpatient facility and training them to look for
 specific signs of a disorder is most helpful. The goal should not be to please the supervisor or
agree.
 Observer Drift: Observers that work closely with each other began to subtly drift away
from other observers in their ratings. To prevent this regularly scheduled reliability checks
by an independent rater should be performed.
Variables Affecting Validity of Observations
 Content Validity—Behavioral observation schema should include behaviors that are
important/pertaining to the research or clinical purpose being measured.
 Concurrent Validity—Whether one’s obtained results of rating correspond to that found
by other people (teachers, spouse, friends).
 Construct Validity—Degree to which a test measures what it claims to measure.
 Mechanics of Rating:
Unit of Analysis: Length of time observations will be made along with the type and number of
responses made
o Scoring procedures must also be developed (ex: checklist, timers, laptop
computers).
 Observer Error: Observers need to be monitored and double checked to ensure that their
work is not subject to bias, flattering or misidentification/attribution.
 Reactivity: Patients or participants react to the fact that they are being observed and may
change the way they behave. Can impact the validity of a study; and prevents the data from
being generalizable.
 Ecological Validity: In the context of behavior assessment, the extent to which behavior
analyzed or observed are representative of a person’s typical behavior. Is the sample large
enough for the behavior to be truly representative?
Contemporary Trends in Data Acquisition
 The use of laptops and handheld devices can be used to code observational data.
 Devices like audio-recordings, diaries and logs can assist patients in self-monitoring by
providing them questions at specific time-points.
 Ecological Momentary Assessment (EMA): Devices for data collection in an individual’s
natural environment. E.g. electronic diaries.
 EMA’s have the potential to be ecological and moods of patients can be studied in their
“natural habitat”.
 Completing data entries using paper diaries—subjects neglect, threat to validity,
forgetting, self-presentation bias.
Role Playing or Behavioral Rehearsal Methods
 Can be used as a means of training new response patterns to get people to respond in a
way they would typically respond in a given situation.
 They have been used as therapeutic devices for many years in which the participant or
patient responds out loud to a scenario.
Inventories and Checklists
 Behavioral checklists like the Fear Questionnaire and the Fear Survey Schedule is used to
assess a patients fear about specific situations.
 Inventories asses a range of the patient’s behaviors—physical activity, binge eating,
alcohol use and other behaviors.
  Behavioral assessors focused on specific deficits and behavioral assets and not
psychiatric diagnostic criteria.
Cognitive-Behavioral Assessment
 Cognitions relate to the development of pathological situation, its maintenance and
changes.
 Notion that client’s thoughts play a vital role in behavior.
 Cognitive Functional Approach: Functional analysis of the client’s thinking process must be
made to plan an intervention strategy. What underlying cognitions are aiding with lack of
performance, and under what circumstances?
 E.g.-think out loud, verbalize thoughts.

Strengths and Weaknesses of Behavioral Assessments

 Behavioral assessors specify the behaviors targeted for intervention, treatments are
provided before, after and during treatment and on this basis are modified as such.
 Behavioral assessment like natural observation is time intensive and expensive.
 Behavioral assessors now widely use DSM criteria to diagnose disorders.