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Unformatted text preview: Cognitive and personality functioning Cognitive What are meaningful ways to integrate these two What pieces of information? pieces
– What interpretations might one make for high IQ What individuals relative to low IQ individuals re: personality? Overlap with maturity? Less complex presentations? Overlap What PD is associated with extremist thinking (splitting), inability What to recognize subtleties? to Other implications?
– Ease of use for clients, alternative test format, wider Ease range of responses (variability), alternative approach to detecting pathology, difficult for client to identify socially desirable or undesirable responding, theory based desirable – Defensiveness strategies (see MMPI-2)? Defensiveness Projective test/technique Projective MMPI/MMPI-2 is most frequently used test MMPI/MMPI-2 in inpatient settings in Rorschach & TAT are not too far behind Advantages of projectives? Disadvantages of projectives?
– Administration and scoring is generally less Administration standardized so reliability and validity are compromised compromised Minimal criteria for a test Minimal Standardized administration – Rorschach has numerous administration procedures Rorschach (Bleck, Klopfer, Exner, etc.) (Bleck, Standardized scoring – Rorschach has numerous scoring approaches (Bleck, Rorschach Klopfer, Exner, etc.) Klopfer, Standard of comparison for interpretations (norm group) – Minimal information with regard to representative norms Rorschach – Exner Rorschach Exner’s (1987) scoring system involves an attempt Exner’s to increase validity by objectifying the scoring, increasing the number of responses (14), and standardizing the administration standardizing This has resulted in significant improvements in This the test’s reliability and validity the In a meta-analysis, Hiller et al. (1999) found the In Rorschach (using Exner’s scoring) to have larger validity coefficients than the MMPI-2 for studies using objective criterion variables using Exner’s scoring system Exner’s Location – part of the blot Location
– W, D, d, S, (WS) – How common is the location (normative comparisons How from manual) from Determinant – what led to response
– – Form, Color, FC or CF, Movement, etc. Evaluate form quality (normative decision based on Evaluate manual of responses). Low F+% = psychosis/poor reality manual psychosis/poor contact contact Content – focus on what specifically
– Human or animal, whole or detail, nature, etc. Populars – determines normative responding Populars Other projective “tests” Other TAT (Thematic apperception test, Murray)
– Stimuli are less ambiguous than the ink blots – Tell a story, though little standardization re: which pictures to be used, Tell scoring (typically a content analysis), etc. scoring – Used extensively with less literate pops like children (CAT), geriatric pops Used (GAT), non-English speaking individuals, etc. (GAT), Draw-a-figure test (figure drawings)
– Person, family, house, tree, etc. – all are interpreted as you – Minimal standardization for scoring Sentence completion
– Sentence stems like “Mom is”, “Life”, etc. largely scored for a thematic Sentence standpoint standpoint Bender-Gestalt (the same test used for neuropsychological screens)
– Copying figures and making personality interpretations Test or technique? Test Review articles and come up with an Review opinion. Come ready to debate/discuss. opinion. On Tuesday/Thursday? Assessment of malingering Assessment What is malingering? What must it include?
– Intentional? Awareness? Personal gain? Very complex phenomenon that may change over time
– e.g., A lie (or lies) that become “real/true” for the individual over time, or a e.g., truthful statement that becomes a lie. truthful – Most statements can’t be categorized as one or the other, and typically Most involve aspects of both involve – Berry et al (1995) suggest that faking good and faking bad are distinct Berry constructs (not opposite ends of the same continuum) constructs – Harder to detect specific faking vs. general faking – Content nonresponsivity (CNR) – random responding, all true or all false – Content response faking (CRF) – fake good or bad; research suggests that Content these may be independent dimensions (client may fake good on some parts and fake bad on others) parts Should always be considered (in some form) when there are Should contingencies for the patient contingencies Classifications of Misrepresentation Classifications Are symptoms under conscious control? Are physical/psychological Are symptoms motivated by internal or external gains? symptoms Factitious Disorders – intentional production of symptoms (feigning) Factitious intentional that are motivated by internal gains that
– Motivation is to assume the “sick role” as there are no external incentives Motivation no for the behavior (e.g., economic gain, avoiding legal responsibility, etc.) for Somatoform disorder – unintentional (i.e., unconscious) production of Somatoform unintentional symptoms for internal gains symptoms Malingering – intentional production or exaggeration of symptoms (i.e., Malingering intentional exaggeration conscious) motivated by external incentives external
– Lack of cooperation during the evaluation, presence of ASPD, discrepancy Lack between self-reported data and objective findings, medicolegal context for referral (e.g., attorney, police, etc.) referral – Note: Exaggeration rather than fabrication makes differential very difficult Note: Pros and Cons of Malingering Dx Pros What are the costs of labeling someone a “malingerer”
– Questions all present and future clinical presentations What are the limits of our measures to make this differential? After weighing the strength of any claim of malingering (relatively weak After given the limits of our measures) and the costs of making an erroneous judgment, we need to act very carefully judgment, Use converging, independent evidence to make any determinations
– e.g., objective inventories like the MMPI-2, strong contextual factors (i.e., to e.g., provide the motive and baserates), interview, low probability baserates for responding (e.g., incorrect on all options when this would be well below chance responding), and response to the evaluator’s feedback (e.g., “Actually, you’re doing quite well” – followed by decrements in performance) performance) Mind of a murderer – the Bianchi tapes Mind Identify the circumstances that could be seen as contingencies for Identify malingering (reinforcers for malingering) malingering Why would that particular malingering behavior be manifested? How could client have obtained the information necessary to provide How the malingering profile? Any evidence that this information was obtained? obtained? Any indications of malingering in his presentation? (Be objective) What are some reasons why he might not be malingering? Predict response sets in advance of testing (vs. scoring in hindsight) What pattern of responses do you predict for the Rorschach? What pattern of responses would you predict for the MMPI-2? What’s your call? Measures of malingering – Berry et al Measures The pasta strainer and photo copy machine “incident” MMPI-2: F, F-K (note: these two indices are not independent), VRIN MMPI-2: not (random), TRIN (all true or all false), and Fb (random), – Also look for discrepancies between some of your subtle and obvious Also supplemental scales (though this can also just assess sophistication in malingering) – The D scale has also been used with some success, as the items appear The to reflect a less sophisticated (popular) view of mental illness to MCMI – evaluates random responding, low frequency responding, MCMI willingness to disclose information, debasement (willingness to endorse psychological problems), and desirability (unwilling to endorse psychological problems). Also as with the D scale of the MMPI, the well-being scale can likewise assess psychopathology well-being Measures of malingering – 2 continued Measures CPI (Cough, 1957) – intended to assess personality in the normal CPI population population
– Has 3 validity scales: good impression (faking good), communality (items Has with either very high or very low endorsement frequency that assesses random responding), well-being (assesses fake bad) random Basic personality inventory (BPI: Jackson, 1989) contains 12 scales Basic each with 20 T/F items. Research is limited on its utility for this. each
– Deviation scale is comparable to the MMPI-2 F scale Personality assessment inventory (PAI: Morey, 1991) is a 344 items
– 4 validity scales: Inconsistency, infrequency, negative impression validity management and positive impression management management NEO-PI-R (Costa & McCrae, 1991) – no effective validity index, so NEO-PI-R should not be used in this context should 16 PF also lacks adequate validity measures and should not be used Measures to specifically detect malingering Measures These measures should be administered when the referral question These specifically implicates malingering and/or when there are substantial contingencies to suggest that malingering is likely Structured Interview of reported symptoms (SIRS) Structured
– Has shown some promise, though it is susceptible to acquiescence and Has false positives (claiming malingering when it is not) false The M test is a 33 item T/F test with three scales: genuine symptoms The of schizophrenia, atypical attitudes not characteristic of mental illness, and bizarre and unusual symptoms rarely found in mental illness and
– Showed some ability to differentiate patients from directed malingerers and Showed from suspected malingerers (Note: The problem with using the latter criterion group as there is no definitive knowledge about those individuals) criterion Measures to specifically detect malinger. - 2 Measures Test battery approach including WAIS-III and the MMPI-2 – the more Test tests administered, the harder it is to present a consistent profile tests This approach should use baserates for incorrect responses as the This primary means of classifying primary
– Provide response options (typically no more than two) such that a chance Provide correct criterion can be calculated (e.g., 50% for a two item version) – this should be no lower than 30% to avoid floor effects should – Track responses over at least 30 trials (the more the better as this Track minimizes chance outcomes). minimizes – Calculate the probabilities for deviations from .50 correct and apply it to Calculate client’s correct response rate (i.e., what are the odds that they would have missed as many as they did if they were truly guessing) missed – Evaluate responsiveness to your feedback (e.g., “You’re actually not doing Evaluate that bad” vs. “Most people with your type of injury do better”) that – If less sophisticated malingering there will be an immediate and relatively If large response to your comments large Who is your client? Who Why is this question important in addressing the malingering issue? If the suspected malingerer is your client who is undergoing therapy If with you (or someone else) to whom is your obligation and what are the costs/benefits of undertaking an evaluation of malingering? the
– Does it help the therapeutic process? Focus on why one might be Does why deceptive to better understand client’s behavior deceptive If the “client” is the court, then to whom is your obligation and what are If the costs/benefits of undertaking an evaluation of malingering? the
– Question now is to determine if client is being deceptive/evasive. Assessing psychopathic personality Assessing Psychopathic personality = behavior characterized by remorseful and Psychopathic callous disregard for others and a chronic antisocial lifestyle. Thus, most ASPDs are not necessarily psychopathic. not Drawing data from various sources (at least three)
– – – In person interview Testing Independent historical information (anything that is not self report – it is Independent not important to note that other official records are not necessarily based on anything other than self-report) anything Although all three of the above are important in order to provide Although converging evidence, the test data will be the strongest tool in court (due to its psychometric strengths) (due Assessment (Meloy & Gacono, 1995) Assessment The Psychopathy checklist – revised (Hare, 1991) – 20 item test with a The 4-point Likert scale response format. Largely intended for males (little data on females) data
– To be completed by the clinician after a clinical interview and review of To historical data (includes descriptors falling under a single dimension of psychopathy) e.g., impulsive, irresponsible, shallow emotions, etc. psychopathy) – Items must be scored in a particular sequence, with more structured items Items first, followed by the least structured items (with the former contributing to the latter) – Cutoff score of 30 or greater to define psychopathy, with higher scores Cutoff denoting more extreme presentations denoting – Adequate reliability and validity, though note the overlap between some of Adequate the validity criteria and the info used to determine the score (e.g., extent of criminal record is used for both) criminal Assessment (Meloy & Gacono, 1995) – p. 2 Assessment The Rorschach – should still pursue the minimum number of The responses (14 or more) as suggested by Exner (1986) responses
– Include an assessment of defenses and object relations (both of which Include appear to have modest reliability) that suggest more narcissism (selfappear references), violations of boundaries, etc. in the psychopathic personality references), (specific ratios from Exner’s scoring system are described) (specific MMPI-2 – primary focus is on scale 4 (also content subscales drawn MMPI-2 from 4 – be cautious with the latter) from
– If administering scale 4 alone, note that you will not have the benefit of the If k correction. Thus, scores will be suppressed. correction. – L and F will also predict psychopathy (tendency to be untruthful) Cognitive abilities (e.g., WAIS-III) are unrelated to the presence of Cognitive psychopathy, but may be informative as to the nature of the presentation (e.g., level of sophistication, concordance with traditional/ presentation normative concepts of intelligence, etc.) Integrity testing Integrity Evaluating integrity as a trait, whereas such behavior may be situation Evaluating specific (e.g., someone who would not lie in interpersonal settings might not hesitate to cheat on their taxes). might
– Characterological view of integrity downplays situational factors – Integrity is a very broad concept that can include diverse responses (e.g., Integrity passive vs. active lying, cheating vs. theft, etc.) passive Early paper and pencil tests were validated with the polygraph Employed in low end entry jobs when people have to interact with Employed money (retail, financial services, etc.) money Today, such tests attempt to predict a wide range of behaviors Today, including violations of work rules, fraud, absenteeism, etc. including Integrity testing – p. 2 Integrity Overt integrity tests – evaluate beliefs about the incidence of theft and Overt other counterproductive behaviors, punitive attitudes towards theft, endorsement of common rationalizations for theft, and direct questions about one’s own involvement in such activities. about Personality oriented measures – much broader than integrity tests and Personality tend to have lower face validity (e.g., high conscientiousness on the NEO) NEO) Clinical measures like the MMPI – validity scales All are difficult to validate because the behavior we are trying to predict All goes largely undetected. So if a test score does not predict it could just mean that this is a false positive or someone who was not caught mean The polygraph test The Measures physiological arousal that is presumed to be associated with Measures lying. e.g., perspiration as indicated by galvanic skin response, brain activity suggesting arousal, etc. to the question (not answer) to
– Is this assumption reasonable? Is – Confounds? Confounds? – Under what circumstances can lying not be associated with arousal? Habituation effect from repeated lying? Lack of awareness of the lying? (issue of conscious vs. unconscious) What is the best way to quantify arousal? Should we evaluate this What normatively or ipsatively? normatively Control Question Test (CQT) – compares relevant questions to control Control questions which are intended to elicit a strong physiological response from innocent subjects (e.g., “Prior to 1993, did you ever do anything that was illegal or dishonest?”) that
– While innocent people know they didn’t commit the crime, they are either While uncertain or lying about the CQ. Guilty persons should not respond as much to the CQ much The polygraph test – p. 2 The Criticisms of the CQT
– Difficult to develop good control questions that will produce similar Difficult responses relative to relevant questions for innocent people. This results in many false positives (Note: Bias for positive outcome is why most of these tests have artificially high success rates in forensic settings – most are guilty) guilty) – CQ are designed for each individual, so standardization is compromised Direct Lie Control Test (DLCT) – if person answers truthfully to a Direct question they are asked the question again and told to lie about it when asked again (a known lie for comparison) when
– Can be standardized and the power of the DLCT is from the instruction Can (which is standardized) not the content of the question (which – Can reduce the rate of false positives and generally does better than the Can CQT CQT Initially employed absolute standards for arousal = lying and this was Initially not at all effective not The polygraph test – p. 3 The The guilty knowledge test (GKT) – not designed to detect deception, The rather it tries to differentiate between those who have knowledge about a particular event (crime) and those who do not (the innocent) particular The concealed information test (CIT) – is similar to the above approach The and likewise tries to assess familiarity with specific information as opposed to lying opposed Both of these approaches have the advantage of asking the exact Both same questions of all individuals and comparing responses both within and between subjects and Minimal data on these approaches, as the bulk of the research is on Minimal the CQT the Does it work? Does Honts (1994) reviewed the literature on the effectiveness of the Honts polygraph and found that it does about as well as chance in experimental settings. Most of the reviewed research uses the DLCT experimental In real life and experimental settings, the majority of errors are false In negatives (saying someone is innocent when they are guilty) negatives Most deceptive individuals (up to 95%) are misclassified Because the cost of a false positive (saying someone is guilty when Because really they are innocent) is deemed to be higher in our legal system. Therefore, the cutoff scores (criteria) have been altered so as to make false negatives more likely false Why does it fail?
– If high arousal to control questions, then more difficult to discriminate – Idiosyncratic responses to lying Admissibility of the polygraph (Saxe & Ben-Shakhar, 1999) 1999) Courts have almost universally rejected the polygraph, though this Courts question has been and continues to be litigated extensively question Courts are increasingly being made responsible for evaluating the Courts merits of test data, despite lacking the expertise to do so. merits
– Note: The literature has become increasingly discrepant in its view on the Note: polygraph (disagreement on its validity even in the scientific community) polygraph What criteria should be used to evaluate this information and what What should we tell the courts? should History
– Marston (1917) used a blood pressure cuff to determine truthfulness Marston (arousal) in a defendant (Frye), based on the assumption that while truth required little or no energy, lies do – rejected by the courts required History of the Polygraph History Note the courts use of the term “experimental” as “not well established Note evidence” evidence” The Frye ruling adequately reflects the courts treatment of the The polygraph even today, though now based on the Federal Rules of Evidence (FRE) which require that the evidence (polygraph or otherwise) be relevant and that it aid the jury (i.e., be valid). otherwise) Daubert (1993) was based on the FRE and highlights 4 considerations Daubert when ruling on evidence: when
– – – – Testability or falsifiability (see Popper and the method of science) Error rate Peer review and publication General acceptance This basically requires juries & judges to evaluate scientific issues This History of the Polygraph – p. 2 History In trials like Daubert, scientists with opposing views on the polygraph In present their views and the jury must decide on the merits of their arguments arguments Generally there has been no legal distinction between the concepts of Generally reliability and validity (you can see where this is go, since, from a scientific standpoint, reliability limits validity) scientific An additional problem with these concepts is that the data is collected An as a series of discrepancy scores and these are then summed to reflect a qualitative assessment of truthful, deceptive, and inconclusive. Thus, very different discrepancy readings might still result in similar qualitative assessments. qualitative Two accepted approaches for reliability are:
– Test the same person twice on the same issue using the same polygraph Test technique with 2 different testers technique – Test the person once, but have the chart scored by two different people History of the Polygraph – p. 3 History The latter approach deals on with the error involved in chart scoring The and ignores (or equates) administration error and The real issue is whether the procedure as a whole is reliable (e.g., the The creation and administration of control questions), thereby getting at internal reliability (do different parts of the test agree), test retest reliability (different administrations of the test agree), inter-rater reliability (different test administrators agree as to the outcome) reliability
– Note: There are practical limitations to how often the “same” test could be Note: given to the same individual What little data exists on reliability focuses only on the between What examiners approach (inter-rater reliability), though this reliability is reasonable (not high). Thus, this remains an unevaluated component of the polygraph (major limitation) of History of the Polygraph – p. 4 History Because the courts do not distinguish between reliability and validity, Because the minimal reliability that does exist carries far more weight than it should. Modern views of validity highlight the integrative component of validity Modern (recall Messick, 1995), though to evaluate it, it is necessary to consider different aspects separately Different types of validity are more relevant depending on the question Different at hand
– e.g., predictive validity for integrity testing in job placement/hiring, vs. e.g., criterion validity being more relevant for determining truth/lying Construct validity gets at the theoretical issue of what is a lie. Is it a Construct situational phenomenon or a trait? Can it be represented by physiological responding? Etc. physiological
– No theory to explain why a stronger response should occur for lies vs. truth History of the Polygraph – p. 5 History Similar physiological responses to lying appear to occur for Similar experiences such as surprise/novelty experiences
– Note: For the CQT, questions about the crime are expected to be well Note: rehearsed for the criminal rehearsed Thus, they have questionable construct validity (not necessarily Thus, measuring what they propose to measure) measuring
– Under-represents the construct of interest and over-represents irrelevant Under-represents constructs (surprise, stress, etc.) constructs What criterion can be used?
– Outcome of a trial? If the case is dismissed? – Do either of these assure that we know the client’s status re: lying? Note also that a true evaluation of the polygraph would mean that the Note examiner only has access to the polygraph data (that s never the case). History of the Polygraph – p. 6 History The criterion and predictor are rarely independent.
– e.g., if the polygraph is used to get a confession and the confession helps e.g., get a conviction, then by definition, the polygraph is part of the criterion (polygraphs are frequently used to get confessions) (polygraphs Experimental criteria for the polygraph generally lack external validity Experimental (is lying in an experiment = to lying in a crime involving yourself? That is, are all types of deception equal?), while real life evaluations of the polygraph lack experimental rigor and control (e.g., only a subset of them will ultimately have a clear outcome regarding deception and this may not be representative of all respondents). may The CQT assumes that you can create similar “control” questions. Do deceptions involving different types of crime result in the same Do physiological response? physiological Issues in assessing alcohol/substance abuse Issues Recognition of dual diagnosis (vs. assuming all other problems are merely Recognition secondary to the addiction) – How can we address this? How Timing of assessment remains an important concern as this can dramatically Timing alter the outcome- When is the optimal time to assess? When Patterns of use/abuse and general categories (e.g., stimulants, sedatives, Patterns etc.) of use may be important to assessment and intervention etc.)
– Also some drugs may be used to offset the deleterious effects of other drugs Context in which use typically occurs may help in identifying triggers and high Context risk settings for potential relapse – Examples of assess & tx? Examples Motivation for seeking treatment is likewise a critical component to evaluating Motivation the patient – Why? How would you assess and tx differently? Why?
– e.g., legal motivation, social/family pressure, work requirement, etc. May require different test features to identify those still using as opposed to May those who have used before but are not now using those The outcome of research in this area varies greatly as a function of how use is The defined (any use, quantity/freq, problem behaviors, combos., etc.) defined
– May identify different pops (e.g., those with liver damage vs. those losing jobs) Specific measures to assess alcohol and drug abuse Specific The MMPI-2 has 2 items (264 “I have used alcohol excessively” & 489 The “I have a drug or alcohol problem”) that directly assess use, but the small number of items limits their psychometric properties. These items each appear to identify very different groups
– Sensitivity (how well the test identifies those who abuse alcohol) of approx. Sensitivity 80% for males and 75% for women – Specificity (how well the test identifies those who do not abuse alcohol) Specificity do ranges from 53% to 95% for men and from 76% to 97% for women (varying on the item and race of the respondent) Because the lifetime prevalence base rates for use in the population Because are 8% for women and 16% for men, it is difficult to improve on the base rate of non-use (84% or more) base Other measures include the MAST and the CAGE – what do you Other know about these? know
– Both have problems identifying female substance abusers (they were Both developed for and validated on, men) developed Specific measures to assess alcohol and drug abuse: MMPI-2 scales – p. 2 abuse: MacAndrew Alcoholism scale – (from the MMPI-2) is best for identifying white MacAndrew males who have a propensity for polydrug abuse. It has a sensitivity of approx. 70-75% and 20% false negatives.
– Very high false positive rate for black males, little data on females and adolescents, Very and lower hit rates for psychiatric patients and Addiction Admission scale (also from the MMPI-2) – acknowledgment or denial Addiction of substance abuse problems of
– Low reliability Addiction Potential scale (also from the MMPI-2) – personality features Addiction associated with use associated
– Low reliability MMPI-2 profiles associated with use: 2/4, 4/2, 2/7, 7/2, 9/4, 4/9, MMPI-2
– – – Just males: 1/2, 2/1 Just females: 3/4, 4/3, 6/4, 4/6, 8/4, 4/8 Code types account for 25-35% of alcoholics & they don’t differ on tx success Issues in alcohol/drug assessment Issues Is there any utility in identify substance abusers who are doing Is so covertly or who don’t believe they have a problem? so
– Drawbacks: Treatment generally requires the clients willing consent, so Drawbacks: why bother identifying anyone other than those who acknowledge use? This is consistent with the most widely used model, AA. – Some benefits: Accuracy of other diagnoses, as use can alter Some presentation of other symptoms, it can make some medication treatments undesirable due to interaction effects, it could bring a problem to a higher level of awareness for the client, etc. level Utility in administering a measure for some clients as it can serve as Utility a standard (vs. an opinion) to the lay person, that allows for a normative evaluation normative
– * Research suggests that exposure to norms can not only help with Research assessment, but also recognition of problem drinking assessment, Use, in and of itself is considered problem use for an alcoholic Use, from an AA perspective. What factors are relevant from a CD perspective? perspective? Legal/ethical issues in assessing children Legal/ethical Three components of “consent” for testing
– Knowledge – what will be done, why, and how – Voluntariness – absence of coercion; a child alone can’t do this, but they Voluntariness are usually asked for assent – Competence – parents must be legally competent and guardians to give Competence consent for child consent Also you are ethically (though not legally) bound to tell the parents of Also potential risks from testing (e.g., what test scores can be used for – potential such as being grounds to deny entry to a special education program) such Child is not likely to be the one who asked for testing. So are they the Child client? If not, who is? client? Legal issues abound for intelligence testing, but there have been few Legal precedents for personality assessment. Why? Why? Demers (1986) on testing Demers Although there are few legal challenges of personality tests, these Although measures do tend to have more problems with reliability and validity measures Little to no evidence for gender or racial bias in personality testing Also, most personality tests are administered in a voluntary context Test validation issues: – Tests must be validated for the purpose for which they are being Tests used used – Tests must be reliable for the pop being used, and appropriate Tests norms must exist for that pop. norms – The tests must be capable of generating appropriate decisions for The that pop (i.e., validity) that Providing feedback to clients Providing APA requires that feedback be provided after testing, but it must be in APA a form that they can understand (varies depending on the client) form
– This can be best accomplished through an overview of the findings and This then a Q & A session. then The feedback should provide a clear path to treatment goals Consider anything that is assessed as representing a continuum, such Consider that any characteristic will be shared by some portion of the population that Terminology such as unique and different can be substituted for Terminology “abnormal”, “deviant”, or “pathological” “abnormal”, Client need not agree with your feedback. Objections can be used to Client clarify findings and as a starting point for the intervention clarify Have client summarize info. Back to you Providing feedback to clients - p.2 Providing Feedback should also include information on the tests themselves Feedback (validity and reliability) in language that can be understood by the client
– General psychometrics can be used to enhance the credibility of the test General e.g., “The MMPI has been used for over 50 years by clinicians and it is one of the most widely used tests. Many research studies have been done to show that it is pretty consistent in the scores it produces and that it works pretty well at predicting behaviors.” pretty This issue may be further complicated when giving feedback to those This with limited cognitive abilities, but a more detailed account can be provided to those who have legal guardianship provided Providing MMPI-2 feedback to clients Providing Empirical evaluation of getting MMPI-2 feedback Compared MMPI-2 feedback of college students relative to attention Compared with no feedback with The former showed increased self-esteem, immediately & after 2 The weeks weeks Decreased symptomatic distress, immediately and after 2 weeks Why would this occur?
– Nature of the client population? (higher functioning, therefore feedback is Nature likely to be generally positive?) likely – Selective sampling? (Those seeking out personality evaluations are Selective wanting feedback and are more likely to construe it positively?) wanting When initially meeting with clients and discussing the testing and the When eventual feedback you will be able to differentiate those who will be most/least receptive to the feedback most/least
– Highlights the importance of having the client arrive at the decision to test Legal precedents Legal Griggs v Duke Power Company (1971) – job testing Hobson v Hansen (1967) – racial disparity (problems with standardization & Hobson norms; assessed present skills rather than innate ability) Larry P. V Riles (1972) – culturally biased IQ tests for EMR determination PASE v. Hannon (1980) – reversed the Larry P. decision based on the fact that PASE EMR determinations were based on more than just IQ testing (any thoughts on the item by item review by the judge?) the Lora v Board of Education City of New York – use of TAT, Rorschach, & BenderGestalt to label minority children as emotionally disturbed (vague def. for latter) Gestalt emotionally Note: Most personality tests are administered voluntarily. Test validation issues: – Tests must be validated for the purpose for which they are being used – Tests must be reliable for the pop being used, and appropriate norms must Tests exist for that pop. exist – The tests must be capable of generating appropriate decisions for that pop The (i.e., validity) (i.e., Note: many personality tests were developed for adults and co-opted for Note: children. Which of the above issues is most affected? children. Example DSM-IV codes: Review Example The parenthetical term “(provisional)” may follow a diagnosis to indicate The a significant degree of diagnostic uncertainty significant The phrase “rule out” is used to denote other diagnoses that should be The considered and that are still to be ruled out. The numeric code should follow the AXIS number and then the formal The name of the disorder should be listed.
– e.g., AXIS I: 295.40 e.g., Schizophreniform disorder (Provisional, rule out Organic Delusional Disorder), with(out) good prognostic features. Numeric codes from the DSM are matched to the ICD (International Numeric Classification of Diseases) codes to allow for international compatibility. Classification Recording procedures: e.g., Major Depressive Disorder
– AXIS I: 296.34 - 4th digit is either 2 (single episode) or 3 (multiple) -5th digit is severity: 1 = mild, 2= moderate, 3 = severe without psychotic features, 4= severe with psychotic features, 5= partial remission, 6= full remission 5= – 4th and 5th digits typically apply to most recent or current episode DSM-IV codes - continued DSM-IV Recording procedures: e.g., Bipolar I disorder
– AXIS I: 296.34 - 4th digit is 0 (single episode). For recurrent episodes, it’s 4 if current or most recent episode is hypomanic or manic, 5 if depressive, 6 if mixed, 7 if unspecified. -5th digit is severity: 1 = mild, 2= moderate, 3 = severe -5 without psychotic features, 4= severe with psychotic features, 5= partial remission, 6= full remission, 0 = unspecified (except for hypomanic where 5th digit is unspecified always a 0, and unspecified, where there is no 5th digit). always For Bipolar II, the 4th digit coding is the same, but do not use the 5th digit code as is already specified as 9. ...
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