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Chapter 9: Clinical Assessment

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1 Chapter 9: Clinical Assessment
Objective Personality Tests Projective Personality Tests

2 Defining Clinical Assessment
The process of assessing the client through multiple methods, including: the clinical interview (see Chapter 12), the administration of informal assessment techniques (Chapter 10), and the administration of objective and projective tests (this chapter).

3 Defining Clinical Assessment (Cont’d)
Clinical assessment can do the following: Helps client gain greater insight. Aid in case conceptualization and diagnostic formulations. Assist in the decision-making concerning psychotropic medications. Assist in treatment planning. Assist in court decisions (e.g., custody decisions; testing a defendant in a child molestation case). Assist in job placement decisions (e.g., high security jobs), Aid in diagnostic decisions for health related problems (e.g., Alzheimer’s), and Identify individuals at risk (e.g., to identify students at risk for suicide or students with low self-esteem).

4 Objective Personality Testing
Definition: A type of paper and pencil personality assessment, often in multiple choice or true/false formats, that assesses personality. Often used to: increase client insight identify psychopathology assist in treatment planning Each objective personality test measures different aspects of personality based on the specific constructs defined by the test developer.

5 Common Objective Personality Tests
Many of the tests we will examine were identified by Camara, Nathan and Puente (2000) as one of the eleven most frequently used tests (see Table 1, Intro to Section III, p. 103). For a list of the tests we will review, and their general purpose, see Table 9.1, p. 170.

6 Common Objective Personality Tests: Minnesota Multiphasic Personality Inventory - 2
Most widely used personality test. Developed in 1942, revised last in 1989. 90 minutes to take the 527 items. To interpret requires grad level course in psychological testing and a grad level course in psychopathology Provides six validity scales, ten basic (clinical) scales, and fifteen content scales. Commonly used scales: three validity scales and ten basic scales (see Figures 9.1 and Table 9.1, p. 171). Adolescent version also exists: MMPI-A

7 MMPI-2 (Cont’d) It is important to understand the meaning of each scale. A high L (Lie) means the client is having trouble admitting to his or her faults– makes entire test results suspect. The Basic Scales are useful in diagnosis and treatment planning Look at patterns of responses. “Clinical significance” is a T score of 65 or greater. Content Scales, identify 15 specific traits such as anxiety, fears, anger, cynicism, low self-esteem. Reliability estimates on the different scales (.37 to .92) Some high intercorrelations in scales, probably because scales share some items.

8 Common Objective Personality Tests: Millon Clinical Multiaxial Inventory, 3rd Ed. (MCMI-III)
Second most used objective personality test. Designed to assess DSM-IV-TR personality disorders and clinical symptomatology. Adolescent version also exists. 175 true/false items take 25 minutes. Has six different major scales (Table 9.3, p. 174): Clinical Personality Pattern Scales Severe Personality Pathology Scales Clinical Syndrome Scales Severe Clinical Syndrome Scales Modifying Indices Validity Index

9 MCMI-III (Cont’d) Uses Base Rate (BR): Converts raw score to a more meaningful standardized score Sets median for non-psychiatric individuals at 35, and 60 for psychiatric population. A BR of 75 indicates that some of the features are present while a BR of 85 indicates that the trait is clearly present. Reliability ranges from .67 to .90 Scales have been correlated with several other scales such as the MMPI and the BDI. Other studies demonstrated predictive validity for the instrument with DSM-IV-TR diagnoses.

10 Common Objective Personality Tests: The Beck Depression Inventory—II (BDI-II)
BDI-II developed in 1996 21 questions on 0 to 3 scale to measure depressive symptoms. Takes 10 minutes to take. Cut-off scores are given to measure depression (see Table 9.4, p. 175). Scores related to groups of depressed and non-depressed individuals. High reliability estimates (in .90s). Convergent validity with original BDI and discriminant validity with other disorders.

11 Common Objective Personality Tests: The Myers-Briggs Type Indicator
Most widely used personality assessment for normal functioning (for adolescent through adults). Based on Jung’s work, following characteristics derived: extroverted or introverted, sensing or intuiting, thinking or feeling. Myers and Briggs added judging or perceiving. See Figures 9.2, p. 177 and 9.3, pp Some have questioned the reliability of results Most agree with results and they seem to correlate with scores on other tests (e.g., CPI).

12 Common Objective Personality Tests: The California Personality Inventory (CPI)
Describe basic personality characteristics. Used with normal clients; helpful to further client insight. Twenty folks scales, 3 vectors (see Table 9.5, p. 181) 13 “special scales” available with computer scoring, usually used for career and business-related activities. Uses T scores. Generally, the higher the better, but some argue that low scores fit their personality better (see Fig. 9.4, p. 182) Reliability: Some scales correlate too highly with one another (questionable factor purity).

13 Common Objective Personality Tests: The Coopersmith Self-Esteem Inventory
Measures self-esteem for children 8 – 15, in four areas: general self (24 items), self in relation to peers (8 items), self in relation to parents (8 items), and self in relation to school (8 items). Total score: Multiply by two the total number of positive self-esteem items chosen by the child. Reliability ranges from .87 to .90, but information dates back to early 1970s. Validity studies are dated and some are questionable. Authors gave the instrument to students in a number of different settings, and thus have broad ethnic comparisons. Generally, mean scores ranged from the mid-50s to the mid-70s, and standard deviations were between 12 and 20.

14 Common Objective Personality Tests: Name Recognition
There are dozens of common objective personality tests. Some others, include: 16 PF: Measures 16 personality factors identified by Raymond Cattell. Taylor-Johnson Temperament Analysis: Assesses personality variables that effect social, family, marital, work, and other environments. The Marital Satisfaction Inventory: Assesses the severity and nature of conflict in a relationship. Miller Marriage Satisfaction Rating Scale: Reports how a couples’ satisfaction compares to another couples’. (On-line—lack of validity data).

15 Projective Testing Defined:
Type of personality assessment where a client is presented a stimuli and personality factors are interpreted. Often used to identify psychopathology and to assist in treatment planning. Much more difficult to measure validity when one is dealing with abstract responses to vague stimuli, such as those in projective tests.

16 Common Projective Tests: Thematic Apperception Test (TAT)
Developed in 1938 Henry Murray Series of 31 cards with vague pictures on them (see Fig. 9.5, p. 185) 8 to 12 cards generally used during an assessment Examiner asks the client to create and describe a story that has a beginning, middle and end. Based on Murray's need-press theory: People driven by internal desires, such as attitudes, values, goals, etc. (needs), or external stimuli (press) from the environment. No universally agreed upon scoring and interpretation method.

17 Common Projective Tests: TAT (Cont’d)
Most clinicians use qualitative process of interpreting responses. Controversy over reliability and validity of instrument. Controlled setting interscorer reliability: .82. Due to age of cards and because figures are almost exclusively white, many cards seem biased and dated. To counter some of TAT problems: Southern Mississippi’s TAT (SM-TAT), and Apperceptive Personality Test (APT). Also, CAT (animals) and CAT-H (humans) developed for children. Many still use TAT– argue that cross-cultural issues not as critical (you’ll project yourself onto whatever you see).

18 Common Projective Tests: Rorschach Inblot Test
Herman Rorschach developed inkblot test in 1921 by splattering ink on paper and folding them in half (See Fig. 9.6, p. 186). Chose 10 final cards that have become the Rorschach inkblot test still used today. When giving the Rorschach, clinicians show clients cards, one at a time, and ask them to tell them what they see on the card. Rorschach believed images on the inkblots allowed one to express his or her unconscious. Difficulty showing adequate validity. Requires extensive training and practice to use.

19 Common Projective Tests: Rorschach (Cont’d)
Exner scoring system uses three components: Location: where on blot response occurred (e.g.,): 1. whole blot (w), 3. unusual details (Dd), 2. common details (D), 4. white space details (S) Determinants: how examinee understood what was seen: form (“that looks just like a bat”) color (e.g., “it’s blood, because it’s red”) shading (“it looks like smoke because it’s grayish-white”). Content: 22 categories, e.g.,: whole human, human detail, animal, art, blood, clouds, fire, household items, sex, etc. Specific content can hold meaning.

20 Common Projective Tests: The Bender Visual-Motor Gestalt (2nd ed.)
Lauretta Bender originally published test in 1938. Takes 5-10 minutes and measures developmental level, psychological functioning, as well as neurological deficits after a traumatic brain injury. Children, 4 – 7 and individuals 8 – 85+ replicate the original nine cards shown in Figure 9.7. p. 188. In 2nd ed., children 4 –7 have four additional cards and individuals 8 – 85+ have three additional cards. 5-point scoring system. 0 represents no resemblance and 4 represents a nearly perfect drawing. Reliability in .80s and .90s.

21 Common Projective Tests: House-Tree-Person and Other Drawing Tests
Drawing tests try to tap into unconscious. Focus might vary depending on content of test. Some popular ones: House-Tree-Person Kinetic-House-Tree-Person (Table 9.8, p. 190) Draw-A-Man Draw-A-Woman Kinetic Family Drawing: Draw a picture of your family all doing something together.

22 Common Projective Tests: Sentence Completion Tests
A sentence stem is given to client for client to respond to. Gather important content information and possible unconscious issues. Some common tests: The Sentence Completion Series EPS Sentence Completion Technique. Questions about the validity and reliability of sentence completion tests remain, but can be quick and useful way of gathering info.

23 Role of Helpers in Clinical Assessment
Helpers should conduct clinical assessment. E.g.: Elementary school counselor uses self-esteem inventory when working with young children. High school counselor might use objective personality measures to identify concerns and aid in treatment planning. College counselors, agency clinicians, social workers, and private practice professionals use clinical assessment tools to help identify issues and devise strategies for problem solving. All clinicians should consider clinical assessment tools and whether they have the appropriate training to administer and interpret instruments.

24 Final Thoughts on Clinical Assessment
Clinical assessment results in making decisions for clients that will critically affect their lives. Such decisions can result in a person being labeled, institutionalized, incarcerated, stigmatized, placed on medication, lose or gain a job, have access to their children, and more. Examiners must remember the impact that their decisions will have on clients and monitor: the quality of the tests they use their level of competence to administer tests, their ability at making accurate interpretations of client material.

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