Chapter 15: Clinical and Forensic Flashcards
(36 cards)
Neuropsychological Testing: Neuropsychological test batteries
Fixed neuropsychological test batteries are designed to
comprehensively sample the patient’s neuropsychological
functioning.
Neuropsychological Testing: Halstead–Reitan Neuropsychological Battery
Halstead and his student Reitan, developed a battery of tests designed specifically to assess the presence or absence of brain dysfunction.
The aim of the Halstead-Reitan is not simply to diagnose whether there is brain injury, but to determine the severity of such injury, the specific localization of the injury, the degree to which right or left hemisphere functioning is affected, and to provide some estimate of the effectiveness of rehabilitation.
- Purpose – to diagnose a brain injury
- A classic neuropsychological test battery.
- Requires a highly-trained examiner for administering the various subtests and a full workday to complete.
- Scoring yields a number referred to as the Halstead Impairment Index.
Neuropsychological Testing: Halstead–Reitan Neuropsychological Battery (three batteries)
- Ages 5 to 8
- Ages 9 – 14
- Adult
three separate batteries, one for young children (aged 5 to 8), one for older children (aged 9 to 14), and one for adults.
Many other known subtests are included (e.g., Wechsler, MMPI)
Shows validity in differentiating people with impaired brain functioning
versus intact brain functioning
Neuropsychological Testing: Criticisms
- Expensive equipment
- Administration
Long
Stressful
Costly
Not appropriate for all patients
Scoring is simplistic
Lack of standardization
Projective Techniques: Categories
- Associative Techniques: the subject responds to a particular stimulus, such as an inkblot or a word, by indicating what the stimulus suggests
- Construction Techniques: the subject con- structs a response, usually in the form of a story, to a stimulus, usually a picture, TAT
- Ordering Techniques: involve placing a set of stimuli in a particular order. Typically the stimuli are a set of pictures, like a comic strip that are random and need to be put in order
- Completion Techniques: the subject responds to a “partial” stimulus. Sentence completion tests are a prime example
- Expressive Techniques: the subject engages in some “creative” activity, such as drawing, finger painting, acting out certain feelings or situations (as in psychodrama). The Draw-A-Person test is a good example.
Projective Techniques: Clinical Usefulness
- Social responsibility
- Professional responsibility
- Teaching responsibility
- Advancement of knowledge
- Challenge to research skills
Projective Techniques: Basic assumptions
- A response reflects a person’s personality and/or psychodynamic functioning
- Behaviors can be influenced by transitory aspects
Reliability is difficult to measure because it doesn’t make sense with most methods
Are we evaluating the reliability of the test or the rater?
The projective viewpoint further assumes that perception is an active and selective process, and thus what is perceived is influenced not only by the person’s current needs and motivation, but by that person’s unique history and the person’s habitual ways of dealing with the world.
Projective Techniques: Sentence Completion Tests
A stem is presented to a person and they are asked to provide the first response that comes to mind
Many of these measures lack standardization, reliability, validity, and appropriate norms
Examples: Washington University Sentence Completion Test, Rotter Incomplete Sentence Blank
Value of these measures is that they may be used as a semi-structured interview, which provides a starting point for the clinician to ask questions
Projective Techniques: Drawings
Research doesn’t show very good reliability or validity
Examples: Draw-A-Man and the DAP
These may be useful to assess cognitive development in children
Not useful to assess a client’s functioning
Reliability and validity are moderate
Projective Techniques: Bender Visual Motor Gestalt Test
Purpose for Adults
* Measure of neuropsychological functioning
* Projective personality test
Purpose for Children
* Test of visual-motor development
* Projective personality test
The test consists of nine geometric designs
Each design is on an individual card and presented one at a time; the subject is asked to copy it on a piece of paper.
Bender (1938) believed that the quality of the reproduction of the designs varied according to the level of motivation of the subject and according to the pathological state of the subject, such a state being “organic” (i.e., the result of damage to the central nervous system) or “functional” (i.e., no actual brain damage but the abnormal behavior serving some psychological purpose).
Projective Techniques
Bender Visual Motor Gestalt Test
Widely used and very popular
Why use it?
- Brief and easy to administer
- Two purposes
- Useful for a screening device
- Clinician can obtain valuable information from observing a client’s
behavior
Not sure if it is useful to differentiate groups
Some Clinical Issues and Syndromes: Clinical versus Statistical Prediction
Research has found that statistical or mechanical prediction is as good as clinical prediction or better most of the time
Clinical methods involves looking at GPA, GRE, and LOR and predicting success
Statistical prediction would be putting said info in a regression equation
Some Clinical Issues and Syndromes: The Effective Therapist
White- horn and Betz (1960) identified effective therapists by comparing SVIB (strong) responses of therapists who were successful with schizophrenic patients and therapists whose improvement rates with their patients were low.
Looked at effective and less effective therapists and their responses
on the Strong (SVIB)
Some specific patterns were found
Maybe interactions? Some good with schizophrenics and others good
with neurotics
Some Clinical Issues and Syndromes: Alcoholism
what is the test used for?
Test results may be used for:
* Individualized treatment – assessing needs, coping skills, strengths,
risk factors
* Better match of client and treatment options
* Monitor therapeutic progress
(1) The test information can result in individualized treatment to meet the patient’s needs, coping skills, psychodynamic strengths, risk factors, and so on
(2) The test information can allow a better match between client and available treatment options
(3) The test results can serve to monitor the course of therapeutic progress or lack of it
Some Clinical Issues and Syndromes: Alcoholism
Assessment instruments may be used for:
- Screening Tests
- Diagnostic Tests
- Triage Tests
(triage being a medical term referring to the assignments of patients to specific treatments)
whose results might be used to determine the appropriate setting, such as hospitalization vs. out-patient treatment, and the intensity of the treatment. - Treatment
- Monitoring
- Program Evaluation
- Family and Marital Functioning
- General Psychology Tests
Such as the MMPI, to assess general emotional adjustment, neuropsychological functioning, degree of psychopathology present, and so on - In-Process Measures
measures used to assess specific aspects of the treatment program and the client’s progress in that program, for example, the degree of acceptance that one has a drinking problem
Some Clinical Issues and Syndromes: Two testing strategies:
- Indirect scale
Items with no obvious relationship to drinking
Empirical approach - Direct scale
Items directly related to drinking
Has more face validity
indirect scale strategy
involves the administration of a large pool of items, such as the MMPI, items which have little or no obvious relationship to drinking behavior.
The responses of alcoholic and control samples are then statistically analyzed and a scale compiled of items whose responses are statistically different in the two groups
direct scale strategy
where the pool of items is directly relevant to drinking and related behaviors i.e., items have face validity
Eating Disorders
Eating Disorder Inventory-2 (EDI-2)
- 91 items
- Self-report to assess symptoms, behaviors, feelings related to anorexia and bulimia
- Assess patient symptoms
- Plan treatment
- Evaluate effectiveness of interventions
- Criterion-related, concurrent, and construct validity all explored
Health Psychology: primary focus
How behavioral factors affect physical health and illness
Related area – Occupational Health Psychology
Study of the process by which behavior is linked to physical disease, physiological effects of stressors that can influence susceptibility to disease
Primary focus
* How to keep people healthy
* Role of personality factors and coping styles in the development of illness
* The role of stress
* Benefits of social support
Health Psychology: Hardiness
Personal Orientation Inventory was based on Maslow’s ideas
Hardiness Test – developed by Suzanne Kobasa
* Some people are less vulnerable to illness
* Says that those who are more resistant is due to hardiness (a constellation of personality characteristics)
1. a hardy person is committed to his or her work and activities (i.e., has a sense of belief in himself or herself and the community)
2. A hardy person has a sense of control (i.e., the belief that he or she can influence the course of events)
3. A hardy person sees life as a challenge (that changes are an opportunity to grow rather than a threat to security)
Hardiness mediates or acts a buffer of stressful life events, or perhaps alters the way in which stressful life events are perceived
Health Psychology: Stress
The energy used to cope with life stressors is assumed to rob the body of resistance to disease, and thereby increase the probability of physical illness and interpersonal dysfunction.
- Stimulus-oriented theories view stress as being in selected aspects of the environment. (experiences such as divorce)
- Response-oriented theories define or focus on stress as the response of the individual. (mood and coping patterns)
- A third group of theories might be labeled as “interactionists.”
They see the person as being the major mediating link between the characteristics of the environment and the responses made. The approach here is that not only does the environment have an impact on the individual, but the individual can have an impact on the environment.
Health Psychology: Health Belief Model
Developed in the 1950s and 60s
Tried to assess why people were not using procedures to detect serious illnesses
Subjective beliefs about:
* Susceptibility to the disease
* Severity of the consequences
* Benefits of taking action
* Barriers related to action
Health Psychology: Schedule of Recent Experiences (SRE)
If a person experiences a significant life event, the readjustment required increases their risk of physical illness
Schedule of Recent Experiences (SRE)
* 43 items
* Designed to measure the occurrence of life events
Research has shown that the correlation is r = .12
Issues:
* Perception of the event is important
* Weighting of items – unitary or weighted scores
* Dimensionality – unidimensional or multidimensional
Health Psychology: Stability over time
and Criticisms
Stability over time
Research found that weights stayed stable in normal populations, but
wasn’t true for psychiatric patients
Criticisms
* Too few categories of life
* Focus too many categories around marriage
* Vague items
* Illness may cause the event
Health Psychology
Checklists have been developed as alternative method
key issues
Key issues with checklists
1. How does one define and select life events to be included?
2. Does it matter if the change is positive or negative?
3. Is the item an indicator or symptom of illness?
4. Internal reliability of the items which tend to be independent
5. Related problems may be related to one’s role
6. Is one year enough time for an illness to appear?
7. May need to assess time duration as well as occurrence of events
8. How to weight items?
9. Reliability should be considered at item level and not score level
