INTRODUCTION TO CLINICAL PSYCHOLOGY, THIRD CANADIAN EDITION by John Hunsley and Catherine M. Lee Chapter 9.

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INTRODUCTION TO CLINICAL PSYCHOLOGY, THIRD CANADIAN EDITION by John Hunsley and Catherine M. Lee Chapter 9

Overview Questions Integrating Assessment Data Threats to the Validity of Assessments and Case Formulation Case example Psychological Assessment Reports and Treatment Plans For next class

Integrating Assessment Data The process of assessment Clarifying the question that will be the focus Generating hypotheses Gathering data Examining the data: looking at consistencies and contradictions Formulating conclusions and making recommendations

In reporting data, the psychologist begins with the broad picture and then presents specific findings

Case Formulation Integrates material Addresses diagnostic issues Hypotheses about development of problem Hypotheses about maintenance of problem Makes predictions about trajectory with and without treatment Informs the treatment plan Takes into account obstacles to implementing the treatment plan

What can we learn from TV about case formulation? Medical/emergency room series? Police/detective/crime scene investigation series? In these shows, how are hypotheses generated and evaluated? What happens when the professional/investigator believes too strongly in one hypothesis (i.e., confirmatory bias)? Think of examples from TV shows that provide good and bad examples of how to formulate a case

Case formulation 1. Symptoms and problems 2. Underlying vulnerabilities 3. Stressors Mechanism linking 1, 2, & 3 and maintaining the problem

Threats to the Validity of Assessments and Case Formulations Patient/client factors Retrospective recall Possible biases in self-presentation (as presented in Chapter 8)

Threats to the Validity of Assessments and Case Formulations Clinician factors Biases and heuristics Fundamental Attribution Error Inattention to Base Rates Belief in the Law of Small Numbers Regression to the Mean Inferring Causation from Correlation Hindsight Bias Confirmatory Bias Representativeness Heuristic Availability Heuristic Affect Heuristic Anchoring and Adjustment Heuristic

Improving the Accuracy of Clinical Judgment Use psychological tests that are directly relevant to the assessment task and that have strong psychometric qualities. Check for scoring errors when using test data. Use computers as aids in the collection, scoring, and interpretation of clinical data whenever possible. Use normative data and base rate information whenever available. Use established diagnostic criteria when making diagnostic decisions. Use evidence-based decision aids, such as decision trees or clinical guidelines.

Improving the Accuracy of Clinical Judgment In unstructured tasks, such as conducting interviews and reviewing assessment data, be as systematic, structured, and quantifiable as possible in order to obtain, consider, and use all relevant information. Be aware of relevant research in psychological assessment, psychopathology, and prevention/intervention. Be aware of personal biases and preconceptions. Be self-critical: search for alternative explanations for hypotheses and challenge evolving case formulations. Seek consultation from other professionals when unsure of the accuracy of conclusions. Don’t rely on memory and don’t rush any conclusion or decision.

Case example: Alejandro: Current context Age 11 lives with his mother (39) and his sisters Clara (15) and Anna (9). Mother and her three children have lived together in Canada since they moved to Canada from War-torn country last year Alejandro has just completed grade 5. Mother currently holds a part-time retail job that involves working four days a week from 3:00 to 7:00 p.m. Mother has requested psychological services for her son. Instructor can present Melissa from the text or another composite case (as has been done in these slides) and ask students to work in groups to generate hypotheses, identify sources of data, and after hearing summary information from instructor, to

Alejandro: Problems identified by adults in his life Mother Teacher Overactive; does not respect limits Hurts sisters when play fights get out of hand Only does homework with supervision When he does focus can get a lot done well Easily distracted Difficulty settling to work after recess Recently did 3 items on math test then played games on his phone Plays the ‘clown’ in class Has hit a boy who repeatedly teased him

Alejandro What is the major question the assessment will address? Hypotheses to explore? Diagnoses to consider? Types of assessment data that will help address the question?

Alejandro: Assessment results Cognitive assessment: Doing poorly on achievement tests Performance affected by poor English skills Observation: School—distractible; plays the clown Home—lack of supervision; extensive time watching TV Rating scales: borderline range for externalizing behaviours and attentional problems

Alejandro: Integrating data from Interviews Observations Intelligence & achievements tests Symptom checklists completed by different informants

Alejandro: Case formulation How do we understand the development of his problems? What is maintaining the problem? What is the likely trajectory if there is no intervention? What are the obstacles to treatment?

Psychological Assessment Reports and Treatment Plans Importance of knowing the “audiences” for the report Confidentiality and privacy considerations Separating (and identifying) facts, client opinion, and psychologist opinion Using computer-based interpretations of test results

Psychological Assessment Report Identifying patient/client information Reason for referral Background information (including, as relevant, developmental history, educational history, employment history, family history, relationship history, medical history, history of symptoms and disorders) Assessment methods (including tests administered) Interview data and behavioural observations Test results (including interpretation of test scores) Diagnostic impressions and case formulation Summary Recommendations

Treatment Plan Report Identifying patient/client information Reason for referral Evaluation of primary symptoms and problems Diagnosis Patient strengths Treatment-related goals and objectives Proposed treatment(s) Potential barriers to treatment Criteria for treatment termination or transfer to other service provider Service provider responsible for treatment implementation and evaluation of treatment

Providing Assessment Feedback Verify the general accuracy of the assessment results Correct any errors or misunderstanding that occurred during the assessment process Refine the interpretation of the results to ensure an optimal fi t with the individual’s life circumstances Put the individual’s symptoms, problems, and experiences in the context of his or her life history and current life circumstances Provide some psychological relief for the individual by presenting an integrated picture that helps make sense of the individual’s difficulties Provide concrete information about steps the individual can take to address personal difficulties Help the individual identify potentially stressful situations that can exacerbate difficulties Collaborate with the individual in creating therapeutic goals that build on personal strengths

For next class…

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