II.

ASSESSMENT IN CLINICAL PSYCHOLOGY

Clinical Psychology is…

- Large field of research and practice, within the psychological sciences, where the principles of
Psychology (especially differential and experimental psychology) are applied to:
o Prevention
o Assessment
o Treatment
o Health promotion

What is Clinical Assessment?

= Set of procedures aimed at:
- Describing the individual’s problem/s
- Identifying the possible causes of the problem/s
- Formulating a diagnosis (NOT THE MAIN GOAL)
- Developing a treatment strategy (+proper tools)
- Monitoring the course of treatment
- Conducting valid research
What is a diagnosis?
Classification of disorders based on symptoms (subjectively reported experiences) and signs (an
objective pathological manifestation).
Advantages:
- Facilitating communication among professionals
- Promotes research on the causes of disorders and on the most effective treatments
Clinical assessment is an active process that involves:
- Gathering
- Analyzing
- Processing
Information
- It is structured and organized hierarchically (consecutive in-depth analyses)
Clinical assessment should integrate information collected through different instruments and
methods:
o Clinical interview
o Interviews
o Questionnaires
o Intelligence Tests
o Diaries (logs)
o Behavioral observations
o Psychophysiological recordings
 - Which characteristics are important when selecting an instrument or a procedure?
o Validity and reliability are extremely important
- Why integrating several instruments/methods/measures in clinical assessment? The concept of
multidimensional assessment
- Which characteristics are important when selecting an instrument or procedure?
o Reliability = stability, consistency of measurement
o Validity = the degree to which an instrument (questionnaire/test,…) or a procedure actually
measures what it is supposed to measure

The clinical interview

- Verbal exchange between a clinician and a client
- Not just passive listening
- Goal: examine the problem in the context of the individual’s life (life history personality
characteristics, family, social environment)
- The clinician is interested not only in gathering information (what?), but also in the way information
is given by the client (how?)
- The clinician chooses the type and order of questions flexibly
- More specific aspects are related to the clinician’s theoretical viewpoint (type of information, how
it’s obtained and interpreted)
- The clinical interview allows establishing mutual trust, acceptance and collaboration (working
alliance)

INTERVIEWS:

 STRUCTURED:
o Any clinician using a given structured interview asks the same set of
questions, in a predeterminant order
o Structured interviews assess specific constructs and provide a score
 Structured Clinical Interview for DSM-5 (SCID-5)
 Anxiety and related Disorders Interview Schedule for DSM-5 9ADIS-
5)
 …
o Inter-rater reliability is high for most diagnostic categories
o Appropriate training is required
 SEMI-STRUCTURED:
o The content and number of questions is predetermined and obligatory, but
the order is selected by the interviewer

Integrating several instruments/methods/measures in clinical assessment:

What kind of information is collected in multidimensional assessment?

 Self-report measures
 Behavioral measures
 Psychophysiological measures
 Self-reports:
- Standardized instruments (questionnaires, scales, etc.) that require an individual to provide
information about him/herself (personality characteristics, behavior, mood, etc.)
- Advantages:
o Quantification
o Easily administered
o Many instruments are available to measure many different characteristics
- Disadvantages:
o Limited reliability: simulation, social desirability, hello-goodbye effect

Minnesota Multiphasic Personality Inventory 2-Restructured Form (MMPI-2 RP)

Beck Depression Inventory-II
Projective personality tests:
Presentation of standardized unstructured or ambiguous stimuli that have to be
interpreted by the client.
- Projective hypothesis: because stimuli are ambiguous, the individual will try to structure/interpret
them by projecting (mainly unconscious) wishes, motives, conflicts, etc.
- Often provide indications that must be interpreted by the clinician, rather than scores
Rorschach inkblot test – 10 inkblot pictures (5 black/white, 2 black/red, 3 multicolored), the person is
required to say what he/she sees in each blot
Thematic Apperception Test – series of black/white pictures with different contents, the person is required
to make up a story related to each picture content (what happened before and after the event)
Intelligence tests:
- Measure different functions/abilities that are considered as components of intelligence (e.g.,
abstract thinking, linguistic abilities, attention, visual-spatial abilities, non-verbal reasoning)
- Debate on what is intelligence – includes such components as abstract thinking, linguistic abilities,
spatial abilities…
o Wechsler Scales
 Wechsler Adult Intelligence Scale, 4th ed. (WAIS-IV)
 Wechsler Intelligence Scale for Children, 5th ed. (WISC-V)
 Wechsler Preschool and Primary Scale for Children, 4th ed. (WPPSI-IV)
o Stanford-Binet, 5th ed. (SB5) – 2 to 85+ years
- IQ tests are standardized instruments: Mean = 100, SD = 15 (Wechsler) or SD = 16 (Stanford-Binet)
- Intelligence tests are used:
o To predict school performance
o To diagnose learning disabilities or intellectual development disorders (mental retardation)
o To identify gifted children
o As part of neuropsychological assessment
- NB: Lower IQ is associated with higher incidence of psychopathology and higher mortality risk (not
a causal relation)
- IQ tests are characterized by:
o High reliability
o Good capacity to predict professional and school performance (but explained variance is not
very high…)
 - Construct validity – what is intelligence?

ASSESSING BEHAVIOR:

Behavior assessment requires an operational definition of the constructs being assessed in terms of the
individual’s observable behavior, in daily life or in specially arranged situations, as similar as possible to real-life
situations

- An operational definition makes the concept observable by stating what it is done to measure it
o E.g., anxiety could be defined as a state of being uneasy, apprehensive, or worried. An operational
definition of anxiety could include observable measures, such as sweating palms (observable as
sweat gland activity), increased heart rate (observable with heartbeat recording), dilated pupils, and
other observable physiological changes; it could also be a self-rating scale or a paper-and-pencil
questionnaire. We could in each case specify the precise amounts of each measure necessary for our
operational definition of anxiety.
- Behavioral assessment also includes specific aspects of the environment (e.g., workplace, classroom) that
may contribute to the manifestation of dysfunctional behaviors
- Behevior assessment allows identifying the type and frequency of an individual’s problematic behaviors, and
their consequences

DIRECT OBSERVATION:

- Behavior is observed in structured laboratory situations or in a natural environment (e.g., parent-child

interaction; public speaking)
o Behavior is divided into segments
o Antecedents and consequences are identified

SELF-OBSERVATION:

Self-monitoring:

Observing and recording one’s own behavior, thoughts, and feelings (e.g., mood fluctuations, stressful
events, thoughts, etc) using a diary (log)
 Ecological Momentary Assessment (EMA):

Collecting data in real time by using electronic devices (smartphones)

- Substance abuse
- Self-injury
- Stress and pain in oncologic patients
- Physical activity
- …

Reactivity Effect → Just observing one’s own behavior may change it (desirable behaviors tend to become more
frequent, and undesirable behavior tend to become less frequent).

Advantages:

- Behavior assessment allows to examine behavior directly, and is more reliable than self-reports

Disadvantages:

- Behavioral samples are not necessarily representative of target behavior

- Simulated situations cannot be identical to real-life situations

PSYCHOPHYSIOLOGICAL INDICES:

- Activity of the central nervous system (e.g., electrocortical activity)

- Activity of the peripheral nervous systems:
o Somatomotor (e.g., muscle tone)
o Vegetative (e.g., heart rate, electrodermal activity)
- Hormonal-immune system (cortisol, catecholamines, immunoglobulins)

Recording modality:

- Electrophysiological recordings
o Bioelectric (e.g., electroencephalogram, electrocardiogram, electromyogram)
o Biophysical (e.g., blood pressure, temperature measures)
- Bio-imaging (e.g., Positron Emission Tomography, functional Magnetic Resonance Imaging)
- Biochemical assays (urinary, salivary, blood draws)

Why recording psychophysiological data in clinical assessment?

- Assessing specific symptoms in disorders where psychophysiological symptoms are definitionally a part of
the disorder (e.g., Panic Disorder, PTSD)
- Identifying individuals at rick for psychological disorders (e.g., P3 & electrodermal activity & substance
abuse)
- Addressing applied clinical questions, such as assessing malingering (exaggerating psychological or
physiological symptoms in order to obtain something), predicting the emergence from coma, assessing
amnesia
- Predicting or assessing response to treatment
 - Identifying the ethology of various disorders, for example serving as indicators of mechanics thought to
underlie the expression of psychopathology (e.g., oddball P3 & psychopathology) oddball tasks = very simple
tasks, you have to pay attention to a specific tone and its variations → having to response to something that
changes, you have to pay attention
- Refining the diagnostic criteria for a mental disorder or assist with differential diagnosis (dissociative identity
disorder vs malingering)

Relationships among self-report, behavioral, and physiological indices

Are the different indices highly correlated?

- Several constructs are multidimensional, and the different components are not interchangeable,
overlapping, or redundant; they do not co-occur and do not co-vary necessarily
o E.g., high fear/anxiety
 Subjective experience
 Physiological activation
 Behavior
o Low-absent fear/anxiety
 Subjective experience
 Physiological activation
 Behavior

Co-variation

- Everything that stands in-between the extremes is not necessarily indicating consistency

Why multidimensional assessment?

- Because subjective, behavioral and physiological measures complement one another and may reflect
different aspects of the same construct
- Because many constructs in Clinical Psychology involve different variables, have multiple components that
are not isomorphic and therefore cannot be captured through a single measure
- Because there are many important individual differences in response modality