Issues in Assessment, Part I PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. September 24, 2013

Announcements Response paper due Exams handed back

Response Paper Questions for Hunsley, Lee, & Wood (2003) Article (due next Thursday) Questions 1. Why do you think these tests are so commonly used by practicing psychologists? 2. Should these tests be taught to clinical psychology graduate students? 3. Is there sufficient justification for using the Rorschach, TAT, projective drawings, or anatomically detailed dolls in forensic settings?

In the News Science and psychotherapy One patient’s perspective Equine therapy for veterans with PTSD in Wyoming Prediction in the NCAA: mental disorders in student-athletes

From Last Class Prediction Factors that affect predictive accuracy Base rates Clinician biases Clinical vs. statistical method for combining observations

Response Paper Questions for Garb & Boyle (2003) Article (due this Thursday) Questions 1, 2, and 3: Describe three factors that make it difficult for therapists to learn from their own clinical experience

On Clinical Judgment “We (psychologists) of all people, ought to be highly suspicious of ourselves…[and] have no right to assume that entering the clinic has resulted in some miraculous mutations and made us singularly free from the ordinary human errors which characterized our psychological ancestors.” -Psychologist Paul Meehl

Questions for Garb & Boyle (2003) Chapter, due this Thursday 9/23 Questions 1, 2, and 3: Describe three factors that can prevent clinicians from learning from their own clinical experience.

Biases in Clinical Judgment Assessment data is interpreted in context of one’s own preconceived notions (theoretical model, biases, prejudices, etc.) Information is made to fit the model, rather than vice versa Example: bias to perceive psychopathology, labeling anger and aggression as childhood bipolar disorder

Biases in Clinical Judgment Real-world clinical examples “Ellen's phobic anxieties focused on ‘fear of being bitten by a dog’ and ‘nighttime monsters’ impress me as directly related to displacements of her feelings about her older sister's aggression. Ellen's explicit statement, ‘my sister acts like a monster’ is balanced with equal sincerity by Ellen's assertion, ‘I like being around Sarah, if she is nice.’” – psychiatrist “He has tolerated ECT well apart from a gradual decline in immediate recall and short-term memory functions (sufficient that he now questions his ability to learn new job skills if he were to succeed in obtaining employment). His increased concern about short-term memory loss prompts him to now consider filing for short-term Social Security medical disability benefits and doing volunteer work until more fully recovered from his mental illness.” – psychiatrist

Biases in Clinical Judgment Confirmation bias Initial opinions are formed quickly Selective attention to confirmatory evidence Counting the hits and forgetting the misses

Biases in Clinical Judgment Overconfidence “Virtually every available study shows that the amount of clinical training and expertise are unrelated to judgmental accuracy” (Faust & Ziskin, 1988) Overconfidence interacts with confirmation bias (i.e., the more confident you are, the less need to look for disconfirmatory information)

Biases in Clinical Judgment Availability bias – relying on information that most easily comes to mind We vividly recall instances of accurate judgment (the “hits”) and overestimate their frequency

Experience and Clinical Judgment Experience creates the “illusion of learning” We draw conclusions about a group by examining only members of that group (e.g., alcoholism is a chronic disease because all the alcoholics in my clinic keep relapsing)

Experience and Clinical Judgment We see an unrepresentative sample of patients We create contexts in which our judgments cannot be wrong Hospitalizing an ambiguously suicidal patient Awarding custody to one parent over the other

On Clinical Judgment We rarely get accurate, objective feedback about our judgments Feedback for psychologists: In clinical practice vs. research Nature of feedback (client self-reports) Comparison with physician feedback (lab tests, autopsies, etc.)