Introduction to Clinical Psychology

What is clinical psychology

1).a subfield of the large discipline of psychology

2).conduct research on behavior and mental
processes
3).involvement in the assessment or measurement
of the abilities and characteristics of individual
human beings
4).effort to help people who are psychologically
distressed
Clinical attitude or clinical approach

The activities of clinical psychologist

Assessment
Treatment
Research
Teaching
Consultation
Administration

Distribution of clinical activities(Table 1.1)

Clients and their problems

Employment settings and salaries for

clinical psychologists (Table 1.2)

Sociocultural diversity among clinical

psychologists

The roots of clinical psychology

The research tradition in psychology

Attention to individual differences

Changing conceptions of behavior disorder

Clinical psychology in the 21st century

The challenges of health care reform

Trends toward integrated theories and

interdisciplinary work

Specialization of clinical activity

The challenge of cultural diversity

The scientist-practitioner issue

Assessment in Clinical Psychology

Definition

the process of collecting information to

be used as the basis for informed decision
by the assessor or by those to whom results
are communicated.

a process of solving problems (answering

questions) (Maloney, & Ward, 1976)

Reasons for Psychological Assessment

Help answer specific questions & aid in making
relevant decisions (Groth-Marnat, 2003)
Common reasons:
1). Diagnosis
2). Treatment planning
3). Identifying functional status
4). Self-control problems
5). History

A Model for the Assessment Process

Cushman & Scherer (1995)
1). Determine the information you need to
answer the referent questions
2). Identify who is to be involved
3). Obtain informed consent & releases
4). Collect & examine medical records
5). Identify what is to be measured

e.g. cognitive function, mood, personality

6). Identify & select your measures

7). Administer your assessment. Modify as
needed
8). Score measures; analyze & interpret
results
9). Seek consultation if you are unable to
make sense of the results
10). Write report
11). Provide feedback to client & other
appropriate parties

Phases in Clinical Assessment

Groth-Marnat (2003)
1). Evaluating the referral questions
2). Acquiring knowledge relating to the
content of the problem
3). Data collection
4). Interpreting the data

Conceptual Validity (Maloney &

Ward, 1976)

The Clinical Assessment Process

Nietzel, Bernstein, & Millich (2003)

A schematic view of the clinical assessment process

Planning
data
collection
procedure

Collecting
assessment
data

Data
Communicating
processing assessment data
and hypothesis
formation

Planning for Assessment

What do we want to know?

Assessment levels
1). Somatic
2). Physical
3). Demographic
4). Overt behavior
5). Cognitive/intellectual
6). Emotional/affective
7). environmental

Factors guiding assessment choices

Theoretical Model

Reliability & Validity

Clinician-specific factors
personal preferences, training experiences

Clinicians assessment strategy

bandwidth-fidelity issues

The goals of clinical assessment

Diagnostic classification

Psychodiagnosis; Differential Diagnosis

DSM-, ICD-10
Description

Person-environment interactions
Prediction

for Selection

Collecting assessment data

How should we go about learning it ?
Sources of assessment data
1). Interviews
2). Observations
3). Tests
4). Life records
The value of multiple assessment sources

Processing assessment data

Data Processing or Clinical Judgment

determine what their mean

transformed from raw data into interpretations

& conclusions
Levels & Types of clinical inference

1). Goal:

2). Underlying theoretical approach

3). Level of abstraction:

Lowest vs. Highest inference level

Three views of assessment data

1). Samples

2). Correlates

3). Signs
Approaches, Views, and Levels
The process of clinical inference

Clinical intuition

The Clinician as inference expert

Formal vs. informal inference

Communicating assessment data

1). Report clarity

2). Relevance to goals

3). Usefulness of reports

Clarity, Meaningful, Synthesis

Clinical interview

A conservation with a purpose or goal.

An interaction:
at least 2 persons(interviewer v.s. interviewee)
face to face
Interview v.s. Conservation
specific purpose
participants role
time &place

Interview structure

The degree to which the interviewer determines

the content and course of the conversation.
Nodirective
semistructured
structured

1). Goals of interview

2). Course of interview
3). Theoretical orientation
4). Personal preferences
Trends toward structured interview

Stage in the interview

Stage 1: Beginning the interview

establishment the rapport

Stage 2: The middle of the interview

informational gathering

a). nondirective techniques

b). directive techniques

c). combining interview tactics

Stage 3: Closing the interview

Communication in the interview

Verbal v.s. Nonverbal communication
Use of Language
Focus on the interviewee
Active listening
Response to silence
Channel of communication
The clinicians values & bacground

Rapport of interview

A comfortable atmosphere and a mutual understanding of

the purpose of the interview

Positive rapport:

1). be more receptive to the message being sent.

2). be characterized by feelings such as trust, relaxation,
comfort, respect, warmth, safety

Negative rapport:

1). Less desire to share oneself and less readiness to

believe whats being said
2). be characterized by feelings such as hostility,
defensiveness, unease, mistrust, disrespect, dagerous

Techniques of interview
Interviewer attitude:

acceptance, understanding, sincerity

Five types of interview questions

1). Open-ended

2). Facilitative

3). Clarifying

4). Confronting

5). Direct

Attending

S O
L

E
R

Listening

Experiences VS. Behaviors

VS. Feelings
Overt VS. Covert

Contents VS. Processes

Understanding

Empathic understanding

Probing

Clarify
Concrete

Focusing

Severity
Urgency
Importance Timing
Complexity

 ( )

1).

2).

3).

4).

 The physical setting arrangement

Note taking & recording
The patients frame of reference
The clinicians frame of reference

Reliability of interview

Reliability
1). information variance:
refer to the variation in the questions the clinicians ask,
the observations that are made during the interview, and
the method of integrating the information that is obtained.

2). Criterion variance:

refer to the variation in scoring thresholds among

clinicians
Two types of reliability:

1). Interrater or interjudge reliability

2). Test-retest reliability

Validity of interview

Content validity

Criterion-related validity

Discriminant validity

Construct validity

Suggestions for improving

reliability & validity
Whenever possible, use a structured
interview
If a structured interview does not exist for
you purpose, consider developing one
Certain interviewing skills are essential
Be aware of the patients motives &
expectancies with regard to the interview
Be aware of your own expectations, biases,
and cultural values

Varieties of interview

The intake-admission interview

The case-history interview

Mental status examination interview

The crisis interview

The diagnostic interview

Mental status examination(MSE)

General appearance and behavior

Speech & thought

Consciousness

Mood & affect

Perception

Obsessions and compulsions

Orientation

Memory

Attention & concentration

Fund of general information

Intelligence

Insight & judgment

Higher intellectual functioning

The diagnostic interview

Structured diagnostic interview

1).Careful history-taking

2).Clinical examination:

eliciting clinical sign

Clinical Observational Assessment

Goals:

1). Collect informational that is not

available in any other way

2). Supplement other data as part of a

multiple assessment approach

Benefits of observational assessment

Supplementing self-reports

Highlighting situational determinants of behavior

signs v.s. samples

Minimizing inference

Enhancing ecological validity

Observational method

1). Selection:
people, classes of behavior, events, situations, time

2). Provocation:

provoke or wait

3). Recording:

observer memory, record sheet, audio- or videotape,

physiological monitoring system, timers, counters
4). Encording: most difficult

a system for encoding raw observations into usable form

must be developed

Approach to observational assessment

Naturalistic v.s. controlled observation

Participants v.s. nonparticipants

1). Complete observer

2). Observer as participant

3). Participant as observer

4). Complete participant

Naturalistic observation

Hospital observations

School observations

Home observations

Observations by insiders

Self-observation(self-mnitoring)

Controlled observation

Also referred to as analogue behavior

observation (ABO), situation tests, and
contrived observation

Performance measures

Role-playing tests

Reliability & Validity of observation

Reliability of observation:

1). Complexity of target behavior

2). Training observers

Validity of observation

1). Mechanics of rating

2). Observer error

3). Reactivity

4). Ecological validity

Behavioral Assessment

SORC Model (Kanfer & Phillips, 1970)

Stimulus(S)
Organism(O)
Response(R)
Consequence(C)
Functional analysis(ABC Model)(Skinner, 1953)
Antecedent event(A)
Behavior(B)
Consequence(C)

Two broad categories of behavior

1). Respondents: are the antecedent-controlled behaviors

which function in a reflexive manner

a). Somatic reflexes
b). Emotional reactions & other responses of the smooth
muscles, gland & heart
c). Sensations

2). Operants: are consequence-controlled

a). Actions
b). Instrumental responses of the smooth muscles, gland
c). Cognitions

Assessment task

1). Identify:
respondent, operant, consequence of operant,
setting event
2). Classify:
behavioral excesses, behavioral deficits,
behavioral anomalies, behavioral assets
3). Prophesy:
theoretical orientation:

4). Specify: recommendations

precise goals, methods of interventions,

therapeutic agents

5). Evaluation: what changes are occurring

in behavior treatment

processes evaluation,

outcome evaluation

follow-up evaluation

Methods of behavioral assessment

Behavioral interview

Direct observation

Psycho-physiological measures

Behavioral Inventories & Checklist

BDI, CBCL

Behavioral Sampling

Event sampling

Duration sampling

Time sampling

Interval sampling

Subject sampling

Situation sampling

(incremental validity)
(conceptual validity)


WAIS -
WISC
B-G Test
Rorschach Test
TAT
Projective drawing
Self-Report: MMPI, CPI, KMHQ, HPH.

(Theoretical Orientation)

(Practical Considerations)

(Standardization)

(Reliability)

(Validity)