2Defining 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), andthe administration of objective and projective tests (this chapter).
3Defining 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), andIdentify individuals at risk (e.g., to identify students at risk for suicide or students with low self-esteem).
4Objective 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 insightidentify psychopathologyassist in treatment planningEach objective personality test measures different aspects of personality based on the specific constructs defined by the test developer.
5Common 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.
6Common 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 psychopathologyProvides 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
7MMPI-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 planningLook 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.
8Common 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 ScalesSevere Personality Pathology ScalesClinical Syndrome ScalesSevere Clinical Syndrome ScalesModifying IndicesValidity Index
9MCMI-III (Cont’d)Uses Base Rate (BR): Converts raw score to a more meaningful standardized scoreSets 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 .90Scales 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.
10Common Objective Personality Tests: The Beck Depression Inventory—II (BDI-II) BDI-II developed in 199621 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.
11Common 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, ppSome have questioned the reliability of resultsMost agree with results and they seem to correlate with scores on other tests (e.g., CPI).
12Common 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).
13Common 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), andself 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.
14Common 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).
15Projective 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.
16Common Projective Tests: Thematic Apperception Test (TAT) Developed in 1938 Henry MurraySeries of 31 cards with vague pictures on them (see Fig. 9.5, p. 185)8 to 12 cards generally used during an assessmentExaminer 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.
17Common 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).
18Common 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.
19Common 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.
20Common 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.
21Common 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-PersonKinetic-House-Tree-Person (Table 9.8, p. 190)Draw-A-ManDraw-A-WomanKinetic Family Drawing: Draw a picture of your family all doing something together.
22Common 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 SeriesEPS Sentence Completion Technique.Questions about the validity and reliability of sentence completion tests remain, but can be quick and useful way of gathering info.
23Role 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.
24Final 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 usetheir level of competence to administer tests,their ability at making accurate interpretations of client material.