APA Style Sheet 1

The Use and Misuse of Psychometrics in Clinical Settings

To be published in Psychometric Testing: Critical Perspectives by Wiley & Sons, London

This chapter raises the philosophical and ethical dilemmas, which inevitably arise from

being in clinical practice and in particular with using psychometrics with a potentially vulnerable

population within these clinical settings. Before I come to the use of psychometrics I will discuss

the widespread use of diagnosis in order to explore how this medical construction is inextricably

linked with the use of psychometrics. I will discuss why this should be borne in the mind of any

clinician considering the use of psychometrics as part of an assessment or treatment process. I

will then explore a collaborative approach to the use of psychometrics in clinical settings and

why this approach might be considered the gold standard approach to assessment and treatment

planning. All of my shared thoughts and observations arise out of my own practice experience.

Are diagnostic categories social constructions?

In my view, any discussion of psychometric use has to be preceded by a discussion of the

use of diagnosis in clinical settings. For most people who seek assistance within the mental

health system a diagnosis is required in order to obtain treatment. People are usually assessed

and then coded within a medical system which chooses to categorise people into a diagnostic

category. Mental distress is conceptualised in the same way as medical illness and physical

injury. The most widely used diagnostic systems are the International Classification of Diseases-

10 (ICD-10) and Diagnostic and Statistical Manual version 5 (DSM-5). Each present a list of

symptoms required to be diagnosed with a particular disorder. Such a list of symptoms is

presented as components of a distinct disorder akin to that one might expect in the diagnosis of

physical illness.
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This approach to the categorisation of human suffering has been criticised extensively.

Gergen, Hoffman and Anderson (1996) have suggested that the need to use diagnosis is more to

satisfy the psychologist than the client. Gergen does not hold back when stating:

Diagnostic systems give a sense of legitimacy, confidence and predictability both to the

professional and to the client. In both psychotherapy and the broader culture, a diagnosis

implies that the object of inquiry and the method of inquiry are based on stable assumptions like

those in the biomedical realm. It operates as a professional code which has the function of

gathering, analyzing and ordering waiting-to-be-discovered data. As similarities and patterns

are found, problems are then fitted into a deficit-based system of categories. In a larger sense,

this framework is based on the assumption that language is representational and can accurately

depict "reality." (Gergen, Hoffman and Anderson, 2006, p104)

More recently David Pilgrim has written extensively on the underlying difficulties with

such a diagnostic model (Pilgrim, 2007; 2009). Major points of criticism are the ontological and

epistemological assumptions that mental abnormality simply exists ‘out there’ awaiting

verification during an assessment by the expert psychologist and that these categories of mental

abnormality are inherently pathological in nature rather than variations on ‘normal.’ Such

assumptions, argue Pilgrim, imply and justify a further assumption that professionals then have a

resulting ‘duty of care’ and ‘right to treat’ even when the person identified with ‘the disorder’

objects to treatment.

The history of the ICD and the DSM adds fuel to this debate. In 1952 the DSM-I was

published and featured descriptions of 106 disorders, referred to at the time as reactions of the

personality to psychological, social and biological factors. In 1980 the DSM-III changed from

the original psychodynamic based perspective to that of empiricism and this resulted in 265
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research based diagnostic categories. Since 1980 each new edition of the DSM has increased the

number of formal diagnoses by approximately ten per cent. Depending upon one’s view, this is

evidence of the social construction of diagnostic categories or our improving ability to identify as

yet, unidentified disorders waiting to be discovered.

Such philosophical consideration of the meaning of diagnosis and its uses over human

history is important for the clinician to hold in mind and was explored extensively by Foucault in

his classic work History of Madness. Careful consideration of these issues assists when

considering what might be in the best interests of the client, avoiding the dogmatism which can

come from strict adherence to a medically based formal diagnostic model. It assists in

consideration of whether the distress described by the client is caused more by economic or

social hardship than a disorder of the psyche. Such philosophical awareness also assists in

decision making regarding psychometric use. But it raises its own dilemmas. For example how

do we, as clinicians act, in the best interests of our clients when aware of the debates regarding

the classification of mental distress as ‘illness’?

One attempt to counter this dilemma has been to encourage psychologists to use

formulation rather than the medically conceptualised use of diagnosis. Strawbridge goes as far as

stating “Formulation is a key element of psychological practice, and one that is often seen as

distinguishing a psychological from a medical approach to distress.” (Strawbridge, 2010, pxxx).

Formulation is described as “a concept that organizes, explains, or makes clinical sense out of

large amounts of data and influences the treatment decisions” (Lazare, 1976, p97). It is

hypothesis driven, should be continually revised and allows for a fluidity of thinking which

avoids the concreteness of a fixed diagnosis which has a tendency to resist being revised. The

formulation approach allows for the consideration of hidden materials not apparent to the client
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or the clinician (not yet discovered) but are held in mind as present and future possibilities. In my

practice, it is this search for as yet unidentified and hidden information which encourages me to

use psychometric testing. My intention is to integrate the science-based practice with the focus

upon the shared, collaborative understanding with my client. As a practitioner, I also often have

to provide a diagnosis in order to enable my client to have access to certain ‘treatments’ for a

‘mental illness.’ A refusal to provide a diagnosis can result in my client having no access to

otherwise available support. These are the dilemmas faced by psychologists in practice even

before consideration of the use of psychometric measures within their assessment and ongoing

evaluation of a client.

How might providing a diagnosis assist with treatment in clinical settings?

As stated previously, the provision of a formal diagnosis within mental health settings is

usually the required first step towards access to treatment. For example, an individual who has

not been formally assessed and diagnosed with depression is unlikely to be able to access

ongoing psychological and psychiatric services. Without a formal assessment and diagnosis of a

learning disability an individual with a learning disability will not have access to support within

the community. Access to services and funding for treatment, whether within the NHS or via

medical insurance is often what is being sought by the client so diagnosis, to all intents and

purposes, provides the access which would otherwise be denied in a system which at present has

a medically based way of seeing ‘disorders.’

Improving the reliability of assessment and diagnosis

Indeed as a scientist practitioner I am aware research has indicated that where particular

symptoms are required to be observed by clinicians, making diagnostic decisions has increased

the agreement between clinicians when making a formal diagnosis (Spitzer, Endicott, & Robins,
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1978; American Psychiatric Association, 1994, pxi). This is the strongest evidence-based

argument for the use of standardized assessment methods, including psychometrics, as a

contribution to standardized methods of determining diagnosis. Research evidence shows use of

formal diagnostic categories allows clinicians, even those from different professional group or

training backgrounds, to clearly communicate with each other using a shared, common language

and understanding of diagnosis which in turn benefits their clients.

Research studies have already indicated the imprecision and unreliability of traditional

clinic interviews. Such unreliability and lack of correlation between the subjective (if clinically

experienced) judgement of psychologists and psychiatrists can result in confusion for the client

and confuse the selection of the most appropriate treatment plan. Structured interviews have been

shown to provide a far higher level of reliability and correlation between professionals (Miller,

2001). Obtaining a high level of reliability and correlation between professionals benefits clients

as it allows for the selection of an evidence based treatment plan. Indeed, guidelines on the

selections of evidence based treatments, such as What Works for Whom? (Roth & Fonagy, 2005)

or the National Institute for Health and Care Excellence (NICE) Guidelines

https://www.nice.org.uk/guidance have an underlying assumption of carefully completed

assessment and formally made diagnosis using accepted, agreed criteria. In turn the monitoring

and appraisal of outcomes and thus the perceived measure of the success of any particular

treatment approach is a part of this rather circular process of validation, i.e. we confirm diagnosis

by using psychometric measures and the psychometric measures confirm the usefulness of both

the diagnosis and the treatment provided.

The use of psychometrics adds further to this sense of reliability and correlation between

professional judgements by allowing for the rapid yet in depth exploration of presenting
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difficulties. Most interestingly, the use of psychometrics has the advantage of exploring issues

the psychologist may not be able to directly observe and the client has not presented for

assessment despite being significant in understanding the bigger picture.

In my own practice I use a three stage model of assessment for the purpose of diagnosis

as well as clinical formulation and treatment planning. This three stage process allows for the

integration of evidence-based practice with collaborative working with the client so that both

they as the client and I, as the clinician, are working together learning as we jointly collaborate

along the path of diagnosis, treatment and recovery. Such a three stage assessment, using free

flowing narrative, the use of a semi structured interview (for identifying specific difficulties,

symptoms and matching categories required for a diagnosis) and the use of psychometric

measures might be described as the ‘gold standard’ method of clinical assessment. Three stage

assessment has long been recognised as particularly important in the context of psychological

assessments in the court arena (Scott & Sembi, 2002) where reliability is paramount.

Free Flowing Narrative

Although not the focus of this chapter the importance of hearing the client’s own

description of their life, their current difficulties and their own understanding of what is

happening cannot be overemphasised. There is always a danger in using psychometrics as one

part of an assessment of the clinician losing sight of the human being before them. There is a

danger of becoming increasingly focused upon having the client complete the test in order to

‘discover’ the results, believing these represent the client more accurately than the client

themselves. Listening to and sharing the understandings is the essential first step to any

collaborative assessment where the clinician and client work together to form a shared, agreed
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understanding of the presenting issues even when the client is attempting to present themselves

in an pleasing or negative light..

Semi-Structured Interviews

The second stage of the three stage assessment process in clinical practice is the semi-

structured interview, where appropriate. Semi-structured interviews are used as a means to

standardize the questions used in an initial therapeutic or diagnostic assessment. The aim of the

semi-structured interview is to standardize the information gathered and to standardize the way

in which that information is considered. They explore the issues or symptoms in a way that

assists make decisions on classification or categorization of disorders. Commonly used semi-

structured interviews include the Structured Clinical Interviews for DSM-5 (SCID-5) (First,

2015); the Clinician-Administered PTSD Scale (CAPS) originally developed by Turner & Lee

(Turner & Lee, 1998) and now replaced by CAPS-5 (Weathers et al. 2014) and the Hare

Psychopathy Checklist -Revised (PCL-R) (Hare 2003) often used in clinical forensic settings.

Research has shown the use of such semi-structured and structured interviews improves

the reliability of data collection and increases inter-rater reliability regarding diagnostic decisions

above when compared with free flowing narrative and clinician ‘experience’ (Falloon et al.,

2005; Miller et al., 2001; Miller, 2001; Miller, 2002). Considered carefully this finding is not

surprising. The semi-structured interview questions are created using the currently existing

diagnostic criteria ‘checklists,’ which assist in preventing the overlooking of pertinent

information. However, such highly structured questions may also prevent the gathering of

information which falls outside the usual ‘diagnostic criteria.’ Hence the importance of the free

narrative as the first stage of the assessment, when the clinician uses their training and
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experience to listen carefully for issues relevant to classification and most importantly, to the

client themselves.

Tests Used in Clinical Practice

The third and final stage of a thorough assessment is to use psychometric tests, where and

only where appropriate. Choosing to use what is routine or simply available in one’s practice

setting is not a sufficient reason to use a psychometric test. Consideration must be given to

whether the client’s own personal history, ethnicity, culture and educational opportunity

(amongst others) matches the population on which the proposed test to be used was standardised.

Without such consideration the client’s psychometric results are likely to be misrepresentative of

their true condition and thus clinical decisions made likely to be fundamentally flawed. For

example, using a mood measure such as the Beck Depression Inventory, standardised on

Western European or North American populations is unlikely to be appropriate for a Chinese

male who has only recently arrived in the West. Understanding of mood, of the acceptable

expression of emotion and the recognition of the need of the individual self rather than the

collective community vary in different cultures. Using any psychometric measures whilst having

to engage the use of an interpreter for the client must also raise a high degree of concern as to

whether the answers obtained reflect the true answers of the client and whether the results have

any meaning because of translation difficulties as well as cultural difficulties. The clinician has

to ensure they take care to include the crucial but often neglected step of carefully selecting the

most appropriate test measure for their client. For the selection of any test measure the

practitioner should consider a number of key questions:

1. Does the client meet the norm population on which the test was developed?

2. Is the client able to engage in the test process directly or do they need assistance?
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3. To what extent will this assistance influence possible responses to questions, making

them less reliable.

4. Will the possible results of the test cause potential harm to the client rather than

assist?

Whilst it is beyond the remit of this chapter to describe and review all test measures used

within clinical practice, I provide consideration of a number of widely used measures for adults

along with concerns about their use. Assessment of children, older adults and other special

populations such those as forensic settings require their own specialist measures.

Measures of Affect (mood state)

In mental health services the most widely used psychometric measures are self-report

measures of affect: questionnaires which ask the client to rate how they have been feeling during

the past two weeks. These measures of state give an indication of the emotional state (rather than

a long lasting trait) and the two week period is chosen as the questions used then correlate

closely to the requirements of a diagnosis from DSM. Such measures are developed and

validated within clinical populations in order to determine cut off scores indicating the likelihood

of the presence of particular mood states likely to be problematic and likely to respond to

treatment. Widely used measures of mood include the Beck Depression Inventory-II, the Beck

Anxiety Inventory-II, the Generalised Anxiety Disorder-7 and the Patient Health Questionnaire-

9. These measures of affect also include Clinical Outcomes Routine Evaluation (CORE).

These measures of affect are frequently used to track the client’s current mood state and

thus to evaluate the effectiveness of treatment as it progresses within therapeutic treatment

settings. In the UK one of the most widely used measures of psychological distress is CORE,

usually used to measure distress or symptoms and then provide reliable outcome measures
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(CORE-OM) (Barkham et al., 1998). Detailed information on this is available from

www.coreims.co.uk. However, whilst CORE is a widely used means of measuring mood state,

progress of therapy and outcomes within the NHS there is widespread criticism of how this has

been implemented. Even those involved in the development of such measures have expressed

concerns. Chris Evans describes use of a self-report outcome measure used weekly as “power

steering for psychotherapy” and suggests, rather like Gergen speaking of diagnosis, that it is

“merely an anxiety reducing device” for the clinician. He also considers the outcome measures

as possibly distracting from the other, rich levels of communication available within the

therapeutic relationship, (Evans, 2013) using what might be described as qualitative rather than

quantitative information. Other criticisms of the use of self-report mood measures as a means of

case management have been their use to pre-screen clients in order to decide who receives

treatment (how do we know who completed the mood measure form); the reliability of such

measures when the client is likely to wish to please the therapist; the reliability of such measures

when the therapist is under scrutiny for payment by results and the assumption that no

‘improvement’ in scores means the therapist is not working hard enough.

Ability assessments

Measures of ability are used to assess an individual’s ability, compared with others in the

same age range. Ability measures are described as measures of maximum performance as they

are designed to take the client through various tasks until it becomes clear they are no longer able

to complete them correctly. Ability measures are used to assess intelligence and memory as well

as achievement in areas such as reading, writing and mathematical ability. The most widely used

ability and achievement scales remain the Wechsler Scales but in the UK the Ravens Progressive

Matrices and the British Ability Scales are also widely used.
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Within clinical practice the usual reason for measuring ability is when it is suspected the

client suffers from a learning disability, a particular learning difficulty or has a suspected

neuropsychological difficulty. For the assessment of a learning disability the British

Psychological Society have published guidelines (British Psychological Society, 2000) which

emphasise the importance of considering adaptive, social functioning alongside intellectual

functioning. This inclusion of adaptive social functioning encourages the consideration of how

the client copes on a day-to-day basis with the demands of their daily environment. Measures of

adaptive behaviour include the Adaptive Behaviour Assessment System (ABAS-3) and the

Vineland Adaptive Behaviour Scales (Vineland-II). As always the clinician has many ethical

issues to consider, such as the educational, social and economic influences on an individual’s

cognitive test results, their daily life and the potential impact on the client of being recognised as

learning disabled.

Neuropsychology

Neuropsychological assessment is regarded as a highly specialist area of psychological

assessment although in practice many applied psychologists do practice using

neuropsychological skills. Neuropsychological measures such as the Repeatable Battery for the

Assessment of Neuropsychological Status Update (RBANS™ Update), the Delis-Kaplan

Executive Function System (D-KEFS), The California Verbal Learning Test (CVLT-II) and

others are widely used in addition to the usual ability and achievement measures. Often such

neuropsychological assessment can provide a more in depth, detailed interpretation of presenting

difficulties which may have resulted from brain injury or illness. Commonly neuropsychological

results are considered in terms of domains (such as language ability, visual-spatial ability,

impulse control, emotional lability), rather than individual test score results, allowing for a
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clearer picture to be presented of the client being assessed. However, there has been some

criticism of the usefulness of many neuropsychological assessments in that the results are often

not made available to fellow professionals or, perhaps most importantly, to the client, in a useful,

meaningful manner. It is argued by Tad Gorske and others that neurospcyhology needs to move

towards a humanistic, collaborative method of assessment and feedback to make its true

contribution (Gorske, 2008; Gorske & Smith, 2008)

Personality assessments (trait)

Personality measures are probably the least used measures within general clinical practice

and yet can provide rich materials with which to work collaboratively in a therapeutic setting.

Commonly used personality measures are the Myers Briggs Type Indicator (MBTI), Millon

Clinical Multiaxial Inventory-III (MCMI-III) (with version IV now available which relates to

requirements of DSM-5), the NEO Personality Inventory Revised (NEO PI-R), the Personality

Assessment Inventory (PAI) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

Discussion of the results along with the meaning of the findings to the client should be made a

core part of any collaborative assessment. The MBTI, the Millon and the NEO PI-R are probably

the most client friendly and therefore the most supportive of such collaborate working. The in

depth information available personality tests can be used to confirm what the client already

knows about themselves but also reveal to the client how others might interpret their attitudes

and behaviours in a way not previously unavailable to them. This may help provide an insight

into, for example, present relationship conflicts which are part of their presenting difficulties and

so become the focus of therapy.

The usual cautions apply to personality tests regarding the matching of the client to the

population upon which the test was developed and normed. In particular, the clinician should
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consider cultural and social issues which may influence how someone’s personality is measured

against the dominant cultural norms. For psychologists, consideration of the evidence base for

the personality tests must be considered. There is strong criticism of older tests such as the MBTI

and MMPI, in particular for their early lack of a science base and for not being based upon the

Big Five personality theory (Lewin, 1984; McCrae and Costa, 1989; Furnham, 1996). It is

generally accepted that there is strong theoretical and research support for those personality tests

based upon the Big Five personality theory. This would suggest clinicians should therefore

carefully consider the use of the Big Five based measures in preference to older, less evidence

based measures.

Weighing the information

Most test manuals contain the following standard warning:

“The interpretive information contained in this report should be viewed as only one

source of hypotheses about the individual being evaluated. No decisions should be based solely

on the information contained in this report. This material should be integrated with all other

sources of information in reaching professional decisions about this individual.”

This is a vital reminder to all clinicians to not prioritise test results over information

gained from the client, from other sources of information and from the semi-structured interview.

The clinician’s training and experience is important in assisting them to weigh all the

information as a whole before drawing any conclusions to assist with diagnosis, formulation or

both. In my experience the collaborative approach to assessment and feedback encourages this

weighing of information and allows the client to feel fully participant in the process even if the

clinician and client agree to disagree on some matters. This collaborative working is counter to

the other usual warning placed at the beginning of most psychometric reports
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“This report is confidential and intended for use by qualified professionals only. It

should not be released to the individual being evaluated.”

Conclusions

I have written previously:

“The basis of any psychometric assessment is the measure of individual difference. Each

individual is viewed as unique and from this comes the conclusion that each individual has a

combination of abilities and traits which, if described accurately, would describe this

uniqueness.” (Van Scoyoc, 2010 p613).

The clinician is seeking to understand and then work therapeutically with a unique

individual who has sought assistance. The use of tests can help with this process only when the

client feels the tests are a useful tool they too can benefit from, rather than a test with is being

‘done to’ them. American Psychologists such as Stephen E. Finn and Constance T. Fischer have

pioneered an approach to psychometric assessment within therapeutic practice which emphasises

the humanistic, collaborative way of working (Finn, Fischer, & Handler, 2012). Such an

approach encourages both the clinician and the client to make the best of their clinical encounters

and avoids losing the human being seeking therapeutic help to a simplistic diagnostic label. This

approach to the use of psychometric measures within clinical setting should be our goal even

when pressured within the workplace to forget the unique human being before us.

References

American Psychiatric Association, (1994). Diagnostic Criteria From DSM-IV.

Washington: American Psychiatric Association.

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Barkham, M., Evans, C., Margison, F., & Mcgrath, G. (1998). The rationale for

developing and implementing core outcome batteries for routine use in service settings and

psychotherapy outcome research. Journal of Mental Health, 7(1), 35.

British Psychological Society, (2000). Learning Disability: Definitions and Contexts.

Leicester: British Psychological Society.

Evans, C. (2013). The danger of trading measures but not meeting distressed minds:

“outcome” measurement in MH and psychological therapies. Proceedings from Royal College of

Psychiatry Psychotherapy Faculty Conference, Stratford. Available from

http://www.psyctc.org/talks/2013/20130417_RCPsych_Faculty_talk.pdf

Falloon, I. R. H., Mizuno, M., Murakami, M., Roncone, R., Unoka, Z., Harangozo, J. et

al. (2005). Structured assessment of current mental state in clinical practice: an international

study of the reliability and validity of the Current Psychiatric State interview, CPS 50. Acta

Psychiatrica Scandinavica, 111(1), 44-50.

First, M.B. (2014). Structured Clinical Interview for DSM-5 (SCID-5) Research Version.

Washington: American Psychiatric Association.

Finn, S. E., Fischer, C. T., & Handler, L. (2012). Collaborative/therapeutic assessment:

A casebook and guide. John Wiley & Sons.

Foucault, M. (2013). History of madness. London: Routledge.

Furnham, A. (1996). The big five versus the big four: the relationship between the

Myers-Briggs Type Indicator (MBTI) and NEO-PI five factor model of personality. Personality

and Individual Differences, 21(2), 303-307.

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Gergen, K. J., Hoffman, L., & Anderson, H. (1996). Is diagnosis a disaster? A

constructionist trialogue. Handbook of relational diagnosis and dysfunctional family patterns,

102-118.

Gorske, T. T. (2008). Therapeutic neuropsychological assessment: A humanistic model

and case example. Journal of Humanistic Psychology, 48(3), 320-339.

Gorske, T. T., & Smith, S. R. (2008). Collaborative therapeutic neuropsychological

assessment. New York: Springer.

Lazare, A. (1976). The psychiatric examination in the walk-in clinic: Hypothesis

generation and hypothesis testing. Archives of General Psychiatry, 33(1), 96-102.

Lewin, M. (1984). Psychology measures femininity and masculinity: From ‘13 gay men’

to the instrumental-expressive distinction. In M. Lewin (Ed.), In the shadow of the past:

Psychology portrays the sexes: A social and intellectual history (pp. 179-204). New York:

Columbia University Press.

McCrae, R. R., & Costa, P. T. (1989). Reinterpreting the Myers Briggs type indicator

from the perspective of the five factor model of personality. Journal of Personality, 57(1), 17-40.

Miller, P. R. (2001). Inpatient diagnostic assessments:2. Interrater reliability and

outcomes of structured vs. unstructured interviews. Psychiatry Research, 105(3), 265-271.

Miller, P. R. (2002). Inpatient diagnostic assessments: 3. Causes and effects of diagnostic

imprecision. Psychiatry Research, 111(2), 191-197.

Pilgrim, D. (2007). The survival of psychiatric diagnosis. Social Science and Medicine,

65(3), 536-544.

Pilgrim, D. (2009). Abnormal psychology: unresolved ontological and epistemological

contestation. History and Philosophy of Psychology, 10(2), 11-21.

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Roth, A., & Fonagy, P. (2005). What Works for Whom? A Critical Review of

Psychotherapy Research (2nd ed.). New York: The Guilford Press.

Scott, M. J., & Sembi, S. (2002). Unreliable assessment in civil litigation. The

Psychologist, 15(2), 80-81.

Spitzer, R. L., Endicott, J., & Robins, E. (1978). Research Diagnostic Criteria: Rationale

and Reliability. Arch Gen Psychiatry, 35(6), 773-782.

Strawbridge, S. (2010). Prologue: Teling Stories. In S. Corrie & D. Lane (Eds.),

Constructing stories, telling tales: A guide to formulation in applied psychology (pp. i-xxx).

London: Karnac.

Turner, S., & Lee, D. (1998). Measures in Post Traumatic Stress Disorder: A

Practitioner’s Guide. London: NFER-Nelson.

Van Scoyoc, S. (2010). The Collaborative Use of Psychometric Testing. In S.

Strawbridge, R. Woolfe, B. Douglas, & W. Dryden (Eds.), Handbook of counselling psychology

(3rd ed., pp. 611-629). SAGE Publications.

Weathers, F. W., Marx, B. P., Friedman, M. J., & Schnurr, P. P. (2014). Posttraumatic

stress disorder in DSM-5: New criteria, new measures, and implications for assessment.

Psychological Injury and Law, 7(2), 93-107.