LECTURAS CLÍNICA - Evaluación e Intervención
LECTURA 1 - Psychological Intervention
1. What is psychological treatment or intervention? Does
psychotherapy work?
– Psychological treatment or intervention refers to the use of psychological
techniques and methods to alleviate mental health problems or improve
psychological well-being. These interventions can be conducted by trained
mental health professionals such as clinical psychologists, psychiatrists, or
counselors, and may include various modalities such as cognitive-behavioral
therapy, psychodynamic therapy, and humanistic therapy.
– The question of whether psychotherapy works is a complex one that has been
the subject of extensive research. While there is no doubt that some people
benefit greatly from psychotherapy, there is also considerable variability in
treatment outcomes, and not all individuals will experience the same degree of
improvement. That being said, meta-analyses of psychotherapy research have
consistently shown that psychological interventions are effective for a wide range
of mental health problems, including anxiety, depression, and post-traumatic
stress disorder (PTSD).
It is important to note that the effectiveness of psychotherapy can be influenced
by a number of factors, such as the quality of the therapeutic relationship, the
specific techniques used, and the client's motivation and engagement in the
therapeutic process. Additionally, certain types of psychotherapy may be more
effective for certain types of problems, and the appropriateness of a particular
treatment approach will depend on the individual's unique needs and
circumstances.
Overall, while psychotherapy may not be effective for everyone, it is an
important tool for treating mental health problems and improving psychological
well-being. It is recommended that individuals seeking psychological treatment
consult with a trained mental health professional to determine the best approach
for their particular needs.
2. What is the difference between evidence-based treatment (EBT) and
evidence-based practice (EBP)?
The terms evidence-based treatment (EBT) and evidence-based practice (EBP)
are often used interchangeably, but they actually refer to different concepts.
EBT refers to specific treatment approaches that have been rigorously tested in
clinical trials and demonstrated to be effective for specific mental health
problems. Examples of EBTs include cognitive-behavioral therapy (CBT) for
anxiety disorders and dialectical behavior therapy (DBT) for borderline
personality disorder. EBTs are typically manualized, meaning that the treatment
protocol is standardized and clearly defined, making it easier to replicate and
study.
EBP, on the other hand, refers to a broader concept that encompasses the use of
the best available scientific evidence, along with clinical expertise and patient
values and preferences, to inform clinical decision-making and treatment
planning. In addition to EBTs, EBP may also involve incorporating research
findings and clinical guidelines into practice, monitoring treatment outcomes,
and adapting treatment approaches to better fit the needs and characteristics of
individual clients.
While EBTs are an important component of EBP, they are not the only factor to
consider. EBP also recognizes the importance of clinical expertise and the unique
needs and circumstances of individual clients. The goal of EBP is to optimize
treatment outcomes by using the best available evidence to inform clinical
decision-making and treatment planning, while also considering the individual
client's preferences and characteristics.
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3. What patient or therapist variables have been shown to be related to
psychotherapy outcome?
Numerous patient and therapist variables have been shown to be related to
psychotherapy outcome. Some of the most commonly studied patient variables
include:
A. Severity of presenting problem: Generally, individuals with more severe
mental health problems tend to have poorer treatment outcomes than
those with milder symptoms.
B. Client motivation and engagement: Clients who are more motivated to
change and actively engaged in the therapeutic process tend to have
better treatment outcomes.
C. Client characteristics: Certain client characteristics, such as personality
traits and cognitive styles, may impact treatment outcomes. For example,
individuals with high levels of neuroticism may be less likely to benefit
from psychotherapy than those with lower levels.
D. Social support: Having a strong support system can be a protective factor
against mental health problems, and may also enhance treatment
outcomes.
Some of the most commonly studied therapist variables include:
A. Therapist experience and training: Therapists with more experience and
training tend to have better treatment outcomes.
B. Therapist characteristics: Certain therapist characteristics, such as
empathy and warmth, have been shown to be related to better treatment
outcomes.
C. Therapist techniques and adherence to treatment protocols: Therapists
who use evidence-based treatment techniques and adhere closely to
treatment protocols tend to have better treatment outcomes.
It is important to note that the relationship between these variables and treatment
outcomes is complex and may vary depending on the specific treatment approach
and individual client characteristics. Additionally, there may be other factors that
impact treatment outcomes that have not yet been identified or fully understood.
4. What are the typical phases or steps involved in clinical intervention?
Describe each phase.
Clinical intervention typically involves several phases or steps, which may vary
depending on the specific treatment approach and individual client needs.
However, some common phases of clinical intervention include:
1) Assessment and diagnosis: In this phase, the therapist gathers
information about the client's symptoms, history, and current life
circumstances, as well as any other relevant factors that may impact
treatment. The therapist may use various assessment tools, such as
standardized questionnaires or interviews, to help guide the assessment
process. The goal of this phase is to develop an accurate diagnosis and
treatment plan that is tailored to the client's unique needs.
2) Treatment planning: Once the assessment is complete, the therapist and
client work together to develop a treatment plan. This may involve
discussing treatment goals, selecting a treatment approach that is
appropriate for the client's needs, and identifying specific interventions
or techniques that will be used to address the client's symptoms.
3) Implementation of treatment: This phase involves implementing the
chosen treatment approach, which may involve individual or group
therapy sessions, medication management, or other interventions as
appropriate. The therapist and client work together to monitor progress
and make adjustments to the treatment plan as needed.
4) Maintenance and relapse prevention: Once the client has achieved their
treatment goals, the therapist may focus on helping the client maintain
their progress and prevent relapse. This may involve developing coping
strategies, strengthening social support, and addressing any residual
symptoms or underlying issues that may impact long-term recovery.
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5) Termination: The final phase of clinical intervention involves ending the
therapeutic relationship in a planned and intentional manner. This may
involve discussing the client's progress and future goals, reviewing
coping strategies and relapse prevention plans, and making referrals for
continued support if needed.
It is important to note that the specific steps and phases of clinical intervention
may vary depending on the treatment approach and individual client needs.
Additionally, some clients may require more intensive or longer-term treatment
than others, and the therapeutic relationship may need to be adapted accordingly.
5. What are the major issues to consider when designing a psychotherapy
research study?
When designing a psychotherapy research study, there are several major issues
that must be carefully considered in order to ensure that the study is valid and
produces meaningful results. Some of the key issues to consider include:
1) Sample selection: The study should include a representative sample of
individuals with the specific mental health problem being studied. It is
important to consider factors such as age, gender, ethnicity, and
socioeconomic status to ensure that the sample is diverse and reflects the
population being studied.
2) Control groups: In order to determine the effectiveness of a particular
psychotherapy intervention, it is important to include a control group that
receives a placebo or alternative treatment. This helps to rule out the
possibility that any observed changes in the treatment group are due to
factors other than the psychotherapy intervention.
3) Randomization: Participants should be randomly assigned to treatment
and control groups to minimize the effects of any individual differences
between the groups. This helps to ensure that any observed differences in
outcomes are due to the treatment intervention, rather than pre-existing
differences between the groups.
4) Standardization of treatment: In order to ensure that the study results are
comparable and reproducible, the psychotherapy intervention should be
standardized and clearly defined. This helps to ensure that the treatment
is delivered consistently across participants and across different
therapists.
5) Measurement of outcomes: The study should use reliable and valid
measures to assess treatment outcomes. This may include standardized
questionnaires or clinical assessments, as well as measures of treatment
adherence and client satisfaction.
6) Ethical considerations: The study must adhere to ethical guidelines for
research involving human subjects, including obtaining informed
consent, protecting participant privacy, and minimizing any potential
risks to participants.
Overall, designing a psychotherapy research study requires careful consideration
of a variety of factors in order to produce meaningful and valid results that can
contribute to our understanding of the effectiveness of psychotherapy
interventions.
6. What conclusions can be drawn from the major comparative studies of
different forms of psychotherapy?
Several major comparative studies have been conducted to evaluate the
effectiveness of different forms of psychotherapy. While the results of these
studies are complex and multifaceted, some general conclusions can be drawn.
● Different forms of psychotherapy are equally effective: Overall,
comparative studies suggest that different forms of psychotherapy are
equally effective in treating a wide range of mental health problems. This
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means that therapists and clients can choose the form of psychotherapy
that best fits their needs and preferences, without necessarily worrying
that one form is superior to others.

● The therapeutic relationship is key: Regardless of the specific form of

psychotherapy used, research consistently shows that the quality of the
therapeutic relationship is a crucial factor in predicting treatment
outcome. This highlights the importance of developing a strong and
trusting therapeutic relationship in order to achieve positive treatment
outcomes.

● Specific techniques may matter less than we think: While different forms
of psychotherapy may use different techniques or interventions, research
suggests that the specific techniques used may matter less than we think.
Instead, it may be the overall therapeutic approach or underlying
principles of the therapy that are most important.

● Matching treatment to individual needs is important: While different

forms of psychotherapy may be equally effective, research also suggests
that certain individuals may benefit more from one form of therapy than
another. Matching the treatment approach to individual needs,
preferences, and characteristics may therefore be an important factor in
maximizing treatment effectiveness.

● Comparative studies have limitations: It is important to note that

comparative studies of different forms of psychotherapy have limitations,
including variations in study design, measurement of outcomes, and
sample characteristics. Therefore, while these studies can provide
important insights into the effectiveness of different forms of
psychotherapy, they should be considered as one piece of evidence
among many when making treatment decisions.
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LECTURA 2 - The assessment Interview
1. What are major issues to consider when conducting an assessment
interview?
Here are some of the major issues to consider when conducting an assessment
interview:
1) Purpose and Goals: Before conducting the assessment interview, it is
important to have a clear understanding of the purpose and goals of the
interview. This will help the clinician to structure the interview and ask
relevant questions.
2) Preparation: The clinician should prepare for the assessment interview by
reviewing any available information about the client, such as medical
records, previous assessments, or referrals. This will help the clinician to
ask informed questions and avoid asking redundant or irrelevant
questions.
3) Rapport Building: Building rapport with the client is essential for a
successful assessment interview. The clinician should establish a warm
and friendly atmosphere, be empathetic, and show genuine interest in the
client's concerns.
4) Structuring the Interview: The clinician should structure the assessment
interview in a way that is clear and easy to follow. This may involve
using a structured interview protocol, using open-ended questions, or
allowing the client to lead the conversation.
5) Cultural Considerations: It is important to be aware of the client's
cultural background and to tailor the interview to their cultural norms
and expectations.
6) Ethics and Confidentiality: The clinician should adhere to ethical
guidelines when conducting the assessment interview, such as obtaining
informed consent, maintaining confidentiality, and avoiding dual
relationships.
7) Communication Skills: Effective communication skills are essential for
conducting an assessment interview. The clinician should be able to
listen actively, ask probing questions, and summarize and clarify
information.
8) Assessment Tools: The clinician may use various assessment tools
during the interview, such as questionnaires, rating scales, or cognitive
tests. It is important to choose appropriate tools based on the client's
needs and presenting concerns.
9) Documentation: The clinician should document the assessment interview
in a clear and concise manner. This may involve taking notes during the
interview, recording the session, or writing a report after the interview.
10) Feedback and Follow-up: The clinician should provide feedback to the
client after the assessment interview, including a summary of the results
and recommendations for treatment or further assessment. Follow-up
sessions may be necessary to monitor progress and adjust treatment
goals.
2. What are the most common types of assessment interviews? Briefly
describe each type.
does not specifically mention the most common types of assessment
interviews. However, there are different types of assessment interviews
that may be used depending on the client's needs and the clinician's
goals. Here are some examples:
- Diagnostic Interview: This type of interview is used to diagnose
mental health disorders. The clinician asks questions about the
client's symptoms, history, and behavior to determine whether
they meet the criteria for a particular disorder.
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- Clinical Interview: This type of interview is used to gather
information about the client's psychological functioning and
overall well-being. The clinician may ask questions about the
client's thoughts, emotions, behaviors, and relationships.
- Intake Interview: This type of interview is used to gather
information about the client's presenting concerns and to
determine whether they are a good fit for treatment at a
particular clinic or facility. The clinician may ask questions
about the client's history, symptoms, and goals for treatment.
- Neuropsychological Interview: This type of interview is used to
assess cognitive functioning, such as memory, attention, and
language skills. The clinician may use standardized tests and
questionnaires to evaluate the client's cognitive abilities.
- Forensic Interview: This type of interview is used in legal
settings, such as court cases or child custody evaluations. The
clinician may ask questions about the client's history, behavior,
and mental health in order to provide an opinion or
recommendation to the court.
Each type of assessment interview has its own specific goals and
techniques, and the clinician may use a combination of these types of
interviews to gather a comprehensive understanding of the client's needs
and concerns.
3. What are the similarities and differences between structured and
unstructured interviews?
Here are some similarities and differences between these two types of
interviews:
Similarities:
● Both structured and unstructured interviews are used to gather
information about the client's history, symptoms, and functioning.
● Both types of interviews can be used to diagnose mental health disorders
and to develop treatment plans.
● Both types of interviews require the clinician to establish rapport with
the client and to communicate effectively.
Differences:
● Structured interviews use a standardized set of questions, while
unstructured interviews are more flexible and allow for spontaneous
discussion.
● Structured interviews are often used to assess specific symptoms or
disorders, while unstructured interviews may be used to explore a wider
range of issues.
● Structured interviews may be more reliable and valid because they are
based on established criteria, while unstructured interviews may be
subject to bias or inconsistency.
● Structured interviews may be more time-efficient because they follow a
set format, while unstructured interviews may require more time to
explore various topics.
● Structured interviews may be less personalized because they do not
allow for individual variation or unique experiences, while unstructured
interviews may be more tailored to the client's needs and concerns.
Ultimately, the choice between using a structured or unstructured interview will
depend on the clinician's goals, the client's needs, and the specific context of the
assessment. Both types of interviews have their advantages and limitations, and
the clinician should consider which approach is most appropriate for each
individual client.
4. What types of reliability and validity are relevant to an evaluation of
a structured interview?
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Several types of reliability and validity are relevant to the evaluation of a
structured interview. Here are some examples:
Reliability:
➢ Test-retest reliability: This refers to the consistency of scores obtained
from the same test administered on different occasions. In the case of a
structured interview, this would mean administering the same interview
to the same client at different times to determine whether the results are
consistent.
➢ Inter-rater reliability: This refers to the degree of agreement among
different raters or interviewers who administer the same structured
interview. In the case of a structured interview, this would mean
comparing the results obtained by different clinicians to determine
whether they agree on the client's diagnosis or symptoms.
➢ Internal consistency: This refers to the degree of correlation among
different items or questions on the structured interview. In the case of a
structured interview, this would mean examining whether the questions
are measuring the same underlying construct.
Validity:
➢ Content validity: This refers to the extent to which the structured
interview measures the intended construct or domain of interest. In the
case of a structured interview, this would mean ensuring that the
questions are relevant to the client's symptoms, history, and diagnosis.
➢ Criterion validity: This refers to the degree to which the structured
interview correlates with other measures of the same construct or domain
of interest. In the case of a structured interview, this would mean
comparing the results to other measures of the client's symptoms or
functioning.
➢ Construct validity: This refers to the degree to which the structured
interview measures the underlying construct or psychological concept of
interest. In the case of a structured interview, this would mean ensuring
that the questions are measuring the intended construct, such as
depression or anxiety.
Overall, evaluating the reliability and validity of a structured interview is
essential to ensure that it is a valid and reliable tool for assessing the client's
symptoms, history, and functioning.
5. Why is the validity of a structured diagnostic interview difficult to
assess?
the validity of a structured diagnostic interview is noted as difficult to assess due
to several factors. Here are some reasons why:
Heterogeneity of disorders: Mental health disorders can present in
different ways across individuals, making it difficult to develop questions
that accurately capture the range of symptoms and behaviors associated
with a particular disorder.
Comorbidity: Many individuals with mental health disorders have
multiple diagnoses, which can complicate the diagnostic process and
make it difficult to assess the validity of a single diagnostic interview.
Subjectivity of symptoms: Mental health symptoms are often subjective
and difficult to quantify, making it challenging to develop questions that
accurately measure the severity and impact of these symptoms.
Limited gold-standard diagnostic measures: There are limited
gold-standard diagnostic measures for many mental health disorders,
making it difficult to assess the validity of structured diagnostic
interviews.
Lack of diversity in samples: Many structured diagnostic interviews have
been developed and validated using samples that are not representative
of the diversity of individuals who may seek mental health services.
Overall, the validity of a structured diagnostic interview is difficult to assess due
to the complex nature of mental health disorders and the limitations of current
diagnostic measures. However, ongoing research and refinement of diagnostic
tools may improve the validity and accuracy of structured diagnostic interviews
in the future.
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LECTURA 3 - Evidence-based Practice in Clinical Psychology
1. Rationale for Evidence-based Practice
Firstly, the authors argue that EBP is essential for improving healthcare quality, ensuring
accountability and promoting healthcare policy. By integrating research evidence with
clinical expertise and patient values, EBP helps to optimize patient outcomes and reduce
healthcare costs.
Secondly, the growth of the evidence base about psychological treatments has made EBP
increasingly important. The authors discuss how advances in research methodology have
enabled the development of rigorous treatment guidelines and outcome monitoring tools.
This has allowed clinicians to make evidence-based decisions about treatment selection
and to track treatment progress over time.
Thirdly, the authors emphasize the importance of transdisciplinary collaboration in
promoting EBP. By working with colleagues from other disciplines, such as medicine and
public health, clinical psychologists can gain a broader understanding of the patient's
health and develop more effective treatment plans.
Finally, the authors argue that EBP requires lifelong learning. They highlight the
importance of ongoing training and professional development to ensure that clinicians
remain up-to-date with the latest research and treatment guidelines. This commitment to
learning also helps to ensure that patients receive the best possible care.
2. Framework for Evidence-based Practice
PRACTICE: The three circles represent three domains of knowledge that are essential
for EBP: research evidence, clinical expertise, and patient values. The intersection of
these three circles represents the point at which all three domains overlap and inform
clinical decision-making.
- The first circle represents research evidence. This includes empirical studies,
clinical trials, systematic reviews, and meta-analyses. The authors emphasize the
importance of accessing high-quality research evidence, and they provide
resources for locating such evidence, including databases and search engines.
- The second circle represents clinical expertise. This includes the clinician's
knowledge and experience with particular populations, disorders, and
treatments. The authors stress the importance of ongoing professional
development to enhance clinical expertise, including attending workshops and
conferences, seeking supervision and consultation, and participating in peer
review.
- The third circle represents patient values. This includes the patient's preferences,
goals, and cultural context. The authors emphasize the importance of
collaborating with patients to develop treatment plans that align with their
values and goals.
In addition to these three circles, the authors highlight four categories of skills that are
essential for EBP:
(1) Formulating a clinical question: The first category of skills involves developing
a clear and focused clinical question that can be answered with research
evidence. Clinicians need to be able to identify the key components of a clinical
problem and develop a question that is specific and answerable. This skill
requires knowledge of research methodology, including the ability to identify
appropriate study designs, outcome measures, and statistical analyses.
(2) Locating and appraising research evidence: The second category of skills
involves the ability to locate and critically appraise relevant research evidence.
Clinicians need to be able to access databases and search engines to find
high-quality research evidence, and they need to be able to critically evaluate
the quality of the evidence. This skill requires knowledge of research design,
methodology, and statistical analysis, as well as the ability to evaluate the
credibility and validity of research studies.
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One key role of psychologists in EBP is to engage in transdisciplinary collaboration with
(3) Integrating research evidence with clinical expertise and patient values: The other healthcare professionals. By collaborating with physicians, nurses, social workers,
third category of skills involves integrating research evidence with clinical and other healthcare professionals, psychologists can contribute their unique expertise in
expertise and patient values to inform clinical decision-making. Clinicians need behavioral and mental health to enhance patient care and improve outcomes.
to be able to interpret research evidence in the context of the patient's unique
clinical situation, taking into account their values and preferences. This skill Psychologists also play a critical role in lifelong learning and professional development.
requires the ability to synthesize and apply research evidence, as well as This includes seeking out opportunities for continuing education, attending workshops
effective communication and collaboration with patients. and conferences, seeking supervision and consultation, and participating in peer review.
By staying current with the latest research evidence and clinical practice guidelines,
(4) Evaluating the effectiveness of the treatment: The fourth category of skills psychologists can continually improve their clinical skills and provide the best possible
involves the ability to evaluate the effectiveness of the treatment. Clinicians care for their patients.
need to be able to monitor and evaluate the patient's progress over time, using
appropriate outcome measures and tracking tools. This skill requires the ability Finally, the authors stress the importance of psychologists taking an active role in
to collect and analyze data, as well as the ability to make evidence-based healthcare policy and advocating for the integration of EBP into clinical practice. By
decisions about the need for modifications to the treatment plan. promoting the use of evidence-based interventions, psychologists can help to improve the
quality of care for patients and enhance the overall healthcare system.
Overall, these four categories of skills are essential for EBP in clinical psychology. By
developing these skills, clinicians can effectively integrate research evidence, clinical In summary, psychologists
expertise, and patient values to optimize patient outcomes and improve the quality of play a critical role in
care. implementing
evidence-based practice in
The authors provide guidance on how to develop these skills and provide resources for clinical psychology. By
ongoing learning and professional development. staying up-to-date with the
latest research evidence,
Overall, the three circles model emphasizes the importance of integrating research collaborating with other
evidence, clinical expertise, and patient values to inform clinical decision-making in a healthcare professionals,
collaborative and patient-centered manner. engaging in lifelong
learning and professional
3. Psychologists’ Roles in Evidence-based Practice development, and
Psychologists play an important role in implementing EBP by applying research evidence advocating for EBP,
to inform clinical decision-making and enhance the quality of care for patients. psychologists can contribute
to the improvement of
The authors emphasize that psychologists have a responsibility to stay up-to-date with the patient care and the overall
latest research evidence, clinical practice guidelines, and professional standards. healthcare system.
Psychologists need to be able to critically evaluate the quality of the evidence and apply
it to their clinical practice in a way that is relevant and effective for their patients.
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4. Training for Evidence-based Practice 5. Evidence-based Practice Process
The authors emphasize that training in EBP is essential for preparing clinicians to
integrate research evidence, clinical expertise, and patient values in their clinical
decision-making.

The authors suggest that training in EBP should be incorporated into graduate programs
in clinical psychology and should include both didactic and experiential components.
Didactic components may include courses in research methods, statistics, and critical
appraisal of research evidence. Experiential components may include supervised clinical
practica, in which students can learn to apply EBP principles in clinical practice.

The authors also suggest that training in EBP should continue throughout a psychologist's
career, with opportunities for continuing education, professional development, and
supervision. This can include attending workshops and conferences, seeking supervision
and consultation, participating in peer review, and engaging in ongoing self-reflection
and evaluation of clinical practice.

The evidence-based practice (EBP) process involves framing clinical questions to address
The authors suggest that training in EBP should focus on developing the four categories
areas of uncertainty in the assessment, treatment, etiology, prognosis, harm, and
of skills that are essential for EBP: formulating a clinical question, locating and
cost-effectiveness of psychological interventions. These areas of uncertainty can be
appraising research evidence, integrating research evidence with clinical expertise and
framed as questions in order to guide the search for relevant research evidence and to
patient values, and evaluating the effectiveness of the treatment. By developing these
inform clinical decision-making.
skills, clinicians can effectively integrate research evidence, clinical expertise, and patient
values to optimize patient outcomes and improve the quality of care.
1) Assessment: Questions about assessment may focus on the most accurate and
reliable methods for identifying and measuring symptoms, disorders, or other
In summary, training in EBP is essential for preparing clinicians to integrate research
clinical phenomena. For example, a clinician might ask, "What is the most
evidence, clinical expertise, and patient values in their clinical decision-making. Training
effective way to assess anxiety in children?"
should be incorporated into graduate programs in clinical psychology and should
continue throughout a psychologist's career. Training should focus on developing the four
2) Treatment: Questions about treatment may focus on the effectiveness and safety
categories of skills that are essential for EBP, including formulating a clinical question,
of psychological interventions for a specific disorder or clinical problem. For
locating and appraising research evidence, integrating research evidence with clinical
example, a clinician might ask, "What is the most effective treatment for
expertise and patient values, and evaluating the effectiveness of the treatment.
depression in older adults?"

3) Etiology: Questions about etiology may focus on the causes or risk factors for a
specific disorder or clinical problem. For example, a clinician might ask, "What
are the risk factors for developing PTSD after a traumatic event?"
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4) Prognosis: Questions about prognosis may focus on the likely course or
outcome of a specific disorder or clinical problem. For example, a clinician
might ask, "What is the long-term prognosis for individuals with borderline
personality disorder?"
5) Harm: Questions about harm may focus on the potential adverse effects of a
specific psychological intervention. For example, a clinician might ask, "What
are the potential risks associated with the use of benzodiazepines for anxiety?"
6) Cost-effectiveness: Questions about cost-effectiveness may focus on the
economic impact of a specific psychological intervention. For example, a
clinician might ask, "What is the cost-effectiveness of cognitive-behavioral
therapy compared to medication for treating depression?"
By framing these areas of uncertainty as questions, clinicians can identify relevant
research evidence, critically evaluate its quality, and integrate it with their clinical
expertise and patient values to inform their clinical decision-making.
6. Acquisition of Evidence:
In this step, clinicians search for and gather research evidence related to the clinical
question(s) they have framed. This may involve using databases such as PubMed or
PsycINFO to find relevant studies.
7. Decision-making and Action:
After gathering evidence, clinicians must integrate this evidence with their clinical
expertise and patient values to make informed decisions about assessment, treatment, and
other aspects of care. This step involves considering the strengths and limitations of the
available evidence and determining the best course of action for the patient.
8. Analyze and Adjust
- Evaluation:
Once a treatment plan has been implemented, clinicians must continually evaluate its
effectiveness and adjust it as necessary. This may involve monitoring patient progress,
identifying any barriers to treatment adherence or effectiveness, and making changes to
the treatment plan as needed.
- Dissemination: EBP also involves sharing the knowledge and insights gained through
the process with other clinicians, researchers, and stakeholders. This may involve
publishing research findings, presenting at conferences, or engaging in other forms of
knowledge dissemination.
- Follow-up: Finally, EBP requires ongoing follow-up with patients to monitor their
progress and ensure that treatment goals are being met. This may involve regular
check-ins, reassessment of symptoms, and adjustments to the treatment plan as necessary.
In summary, the EBP process involves acquiring evidence, making informed decisions
based on that evidence, continually evaluating and adjusting treatment plans,
disseminating knowledge gained through the process, and following up with patients to
ensure treatment goals are being met.
9. Conclusion
In conclusion, the chapter "Evidence-based Practice in Clinical Psychology" highlights
the importance of evidence-based practice (EBP) in clinical psychology. It discusses the
rationale for EBP, including the need for healthcare quality, accountability, and policy,
and the growth of the evidence base about psychological treatments. The chapter presents
a framework for EBP, which includes the three circles of research evidence, clinical
expertise, and patient values. It also discusses the four categories of skills that are
essential for EBP, including research skills, critical thinking and decision-making skills,
communication and collaboration skills, and lifelong learning skills.
The chapter further outlines the EBP process, which involves framing clinical questions
to address areas of uncertainty in the assessment, treatment, etiology, prognosis, harm,
and cost-effectiveness of psychological interventions. It also discusses the steps involved
in the EBP process, including acquisition of evidence, decision-making and action,
evaluation, dissemination, and follow-up.
Overall, the chapter highlights the importance of incorporating research evidence, clinical
expertise, and patient values in clinical decision-making and treatment planning. It
emphasizes the need for ongoing evaluation and adjustment of treatment plans, as well as
the importance of lifelong learning and skill development in the field of clinical
psychology.
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LECTURA 4 - Chapter 5 Evidence-based Assessment John Hunsley and
Eric J. Mash
Chapter 5 of "A Guide to Assessments That Work" by John Hunsley and Eric J.
Mash is focused on evidence-based assessment. The chapter highlights the
importance of using scientific evidence to guide clinical decision-making in
psychological assessment. The authors outline the steps involved in
evidence-based assessment, which include identifying the problem, formulating a
research question, searching for evidence, evaluating the quality of evidence, and
integrating the evidence into clinical decision-making.
The authors also discuss the different types of evidence that can be used in
evidence-based assessment, including empirical evidence from research studies,
clinical expertise, and patient values and preferences. They explain how to
evaluate the quality of evidence, including considerations such as the study
design, sample size, and the relevance of the findings to the specific assessment
question.
The chapter also covers the role of clinical expertise in evidence-based
assessment, including how to integrate clinical judgment with empirical
evidence. The authors emphasize the importance of considering patient values
and preferences when making clinical decisions and provide guidance on how to
do so.
Finally, the authors address some of the challenges and limitations of
evidence-based assessment, including the limited availability of high-quality
research evidence for some assessment questions and the potential for bias in the
research literature. They also discuss the importance of ongoing evaluation and
refinement of evidence-based assessment practices.
Sure, here's a deep and extensive summary of Chapter 5 of "A Guide to
Assessments That Work" by John Hunsley and Eric J. Mash:
1. Some Current Problems and Limitations in Clinical Assessment:
The authors begin the chapter by highlighting some of the problems and
limitations of clinical assessment, such as the over-reliance on subjective clinical
judgment, the lack of standardization in assessment practices, and the potential
for bias in assessment methods. They argue that evidence-based assessment is a
way to address these issues by using scientific evidence to guide clinical
decision-making.
2. Scientific Limitations of Some Commonly Used Clinical
Instruments:
The authors point out that some commonly used clinical instruments may have
scientific limitations, such as low reliability and validity, limited generalizability,
and a lack of sensitivity to change over time. They suggest that evidence-based
assessment can help identify which instruments are most effective for specific
assessment questions.
3. Problems with Instrument Selection and Interpretation:
The authors note that there are challenges associated with selecting and
interpreting clinical instruments, such as the need to consider the population
being assessed, the nature of the problem, and the validity of the instrument.
They argue that evidence-based assessment can help clinicians make informed
decisions about which instruments to use and how to interpret the results.
4. Limited Evidence for Clinical Utility of Commonly Used
Instruments:
The authors acknowledge that there is limited evidence to support the clinical
utility of some commonly used assessment instruments. They suggest that
evidence-based assessment can help identify which instruments are most
effective for specific assessment questions and improve the overall quality of
assessment practices.
5. Conceptualizing and Evaluating Evidence-based Assessment:
The authors provide a framework for conceptualizing and evaluating
evidence-based assessment. They suggest that evidence-based assessment
involves identifying the problem, formulating a research question, searching for
 LECTURAS CLÍNICA - Evaluación e Intervención
evidence, evaluating the quality of evidence, and integrating the evidence into
clinical decision-making.

6. Evidence-based Assessment Initiatives and Criteria:

The authors discuss various initiatives and criteria for evidence-based
assessment, such as the Society for Clinical Psychology's Task Force on
Psychological Assessment Guidelines and the Cochrane Collaboration's
systematic reviews. They suggest that these initiatives can help improve the
quality of assessment practices and increase the availability of evidence-based
instruments.

7. Evidence-based Instruments: Current Status and Issues:

The authors examine the current status and issues related to evidence-based
assessment instruments. They note that there is a growing number of
evidence-based instruments available but also highlight the need for ongoing
evaluation and refinement of these instruments.

8. Building a Truly Evidence-based Psychological Assessment:

The authors outline the steps involved in building a truly evidence-based
psychological assessment, such as identifying the problem, conducting a
systematic review of the literature, selecting the most appropriate instruments,
and evaluating the results. They emphasize the importance of ongoing evaluation
and refinement of assessment practices.

9. Conclusions:
The authors conclude the chapter by reiterating the importance of evidence-based
assessment in improving the quality of clinical assessment practices. They
suggest that evidence-based assessment can help clinicians make informed
decisions about which instruments to use and how to interpret the results,
ultimately leading to better outcomes for patients.
 LECTURAS CLÍNICA - Evaluación e Intervención
LECTURA 5 - Interviewing and Case Formulation
Naomi Koerner, Heather K. Hood, and Martin M. Antony
Interviewing and case formulation are important aspects of the assessment process in
clinical psychology. During an interview, the clinician gathers information about the
client's presenting problem, their history, and other relevant factors that may be
contributing to their current difficulties. This information is then used to formulate a case
conceptualization, which is a comprehensive understanding of the client's problems,
strengths, and needs.
Case formulation is important because it guides the selection of appropriate interventions
and helps to ensure that treatment is tailored to the client's specific needs. It may also
help the client to understand their difficulties in a more comprehensive way and to feel
more engaged in the therapeutic process.
The process of case formulation typically involves gathering information about the
client's presenting problem, their history, and their current context. This information is
then organized into a coherent understanding of the client's difficulties and needs, which
may be conceptualized using various theoretical models or frameworks. The clinician
may also consider the client's strengths and resources, as well as any potential barriers to
treatment.
Overall, interviewing and case formulation are critical components of the assessment
process in clinical psychology, and they play an important role in guiding the
development of effective and tailored treatments for individuals with mental health
concerns.
Interview Structure:
The interview structure in psychology typically consists of four main parts: initial steps,
opening, body, and closing.
● Initial steps: This involves introducing yourself, explaining the purpose of the
interview, obtaining informed consent from the client, and discussing any
relevant administrative matters.
● Opening: This is the beginning of the interview, and it typically involves
establishing rapport with the client, setting a comfortable tone, and providing an
opportunity for the client to share their concerns.
● Body: This is the main part of the interview where the clinician gathers
information about the client's presenting problem, their history, and other
relevant factors. The body of the interview may be structured or semi-structured,
depending on the clinician's approach.
● Closing: This involves summarizing key points from the interview, discussing
any next steps or referrals, and providing an opportunity for the client to ask
questions.
Content of the Interview:
The content of the interview may vary depending on the purpose of the assessment, but it
typically includes information about the client's presenting problem, their history, and
other relevant factors such as family background, medical history, and social context.
Structured and Semi-structured Interviews for Assessment of Axis I Disorders:
Structured and semi-structured interviews are commonly used in the assessment of Axis I
disorders, such as mood and anxiety disorders. These interviews typically involve a
standardized set of questions that are designed to assess the client's symptoms and
severity. Examples of structured interviews for Axis I disorders include the Structured
Clinical Interview for DSM-5 (SCID-5) and the Mini International Neuropsychiatric
Interview (MINI).
Structured and Semi-structured Interviews for Assessment of Axis II Disorders:
Structured and semi-structured interviews are also commonly used in the assessment of
Axis II disorders, such as personality disorders. These interviews typically involve a
standardized set of questions that are designed to assess the client's personality traits and
patterns of behavior. Examples of structured interviews for Axis II disorders include the
Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) and the
Personality Assessment Inventory (PAI).
Strategies and Skills for the Interview:
Effective interviewing in psychology requires a range of strategies and skills, including
active listening, empathy, and the ability to establish rapport with clients. Other important
skills include the ability to ask open-ended questions, provide validation and support, and
maintain a non-judgmental stance. It is also important for clinicians to be aware of their
own biases and to remain objective throughout the interview process. Additionally,
clinicians may use various strategies to help clients feel more comfortable, such as
providing breaks or allowing the client to choose the location of the interview.