What is the purpose of psychopathology assessment? `
it depends but it may be too:
- To determine if psychopathology is present, and if so, the
type - To help characterise (or feed into a formulation) - build
understanding of the ‘problem’ - To inform treatment planning/priorities
- To establish a baseline against which ‘change’ might be monitored
- To establish a shared language from which to progress
- A diagnosis may be “required” because of contextual factors (e.g., to gain access to the health system)
What are some principles that guide diagnostic
assessments
Psychologists may consider the reliability & validity of:
- diagnostic entities (DSM categories)
- the underpinning information (e.g., method of assessment [self report, test, other]), and its reliability validity)
- verification of information (e.g., corroborated, converging, or gaps?)
- how the data are combined (e.g., checked for biases, plausible given other the known facts, resolving discrepancies).
When making assessments, we join information together - how do we do this?
The combination of the information relies on cognitive processes. This is known as diagnostic reasoning. The process can be modelled; for example, using the steps articulated by Nurcombe and Fitzhenry-Coor. The
hypothetico-deductive method asks us to “test” if there is sufficient evidence for a possible (hypothesised) diagnosis.
What is reliability (in assessment)?
measurement consistency (e.g., interrater reliability or diagnostic agreement, kappa)
What is validity (in assessment)?
degree to which a test / system measures what it is intended to measure (e.g., convergent validity, predictive validity)
What is standardisation (in assessment)?
a fixed procedure (or prescription) for application of methods ensuring/increasing measurement consistency (affects how tests are administered, scored, and reported).
What is the nature and source of info (in assessment)
(e.g., qualitative vs quantitative; interviews vs behavioural observations vs tests; structured versus unstructured methods
What are the methods of assessment?
- clinical interview
- psychological test
- physical/medical assessment
What is a clinical interview?
*involves client (and if consent permits, may include significant others)
Interviews allows a collection of:
* A wide variety of information (client’s view of problem/symptoms; subjective distress/impairment)
- Different types of information (clinical observations, signs, mental status – mental status exam - may involve role playing.
- May include Family history / genogram
- May include Strengths, resources, supports
What is a psychological test?
Many of these tests have standardisation & normative data; have known psychometric properties, including reliability.
Tests with normative data can be useful for assessing severity relative to “normal” (normative comparisons)
Tests with known psychometric can be used to evaluate for statistically significant change overtime (ipsative comparisons)
What is a physical/medical exam?
- Assessing for psychopathology can include (or recommend) “physical” or “medical” tests
- These tests are not typically performed by psychologists,
but a psychologist would take the results into consideration. - May include neuroimaging, EEGs, genetic tests
- Important to exclude pathology due to medical condition for correct diagnosis/treatment (so if someone is fatigued it is important to know whether that is fatigue due to depression or a pathological infection)
What can affect the Assessment process
- Human cognitive biases, personal biases, including
cultural biases - Procedural/process/interpersonal aspects (e.g.,
time, space, organisational priority; client willingness to be “assessed”, confidentiality, rapport) - The nature of the beast - no (or very few) pathognomonic tests for psychopathology, and the DSM’s polythetic approach, means that there can be different symptoms for the same diagnosis
What is a treatment?
The application of techniques to relieve the symptoms associated with the disorder and provide better adaptive functioning in the individual.
What are serendipitous treatment discoveries?
Some ‘treatments’ are accidental discoveries – serendipitous, incl. some medications e.g.,
* drug ‘repurposing’
* some ‘psychosurgeries’
* electroconvulsive therapy, ECT
How would a psychodynamic approach view psychopathology?
GOAL: increase awareness of the unconscious mind
METHOD: free association, dream analysis, focus on childhood
THERAPIST ROLE: passive, non-directive, interpreter
How would a biological approach view psychopathology?
GOAL: treat physical or brain disease processes that underpin the disorder; deliver benefits by altering biology
METHOD: diagnosis, medications, psychosurgery
TREATMENT LENGTH: brief with follow up visits
ROLE OF THERPIST: active, directive, diagnostician
How would a humanist/existential approach view psychopathology?
GOAL: increase emotional awareness through techniques
such as reflective listening
METHOD: empathy, support, opportunities for exploration of emotions
LENGTH: variable, length not typically structured
THERAPIST ROLE : passive, non- directive supporte
How would a cognitive/behavioural approach view psychopathology?
GOAL: Change contingencies & teach more adaptive cognitions & skills (behaviours/responses)
METHODS: skills training, guided learning, behavioural rehearsal (role playing), teaching of new cognition, problem solving
LENGTH: short term with booster sessions
THERAPIST ROLE active, directive, non-judgemental, teacher.
What is Combined therapy
Combination of biological and psychological therapy
- E.g., medication and psychotherapy for depression or
schizophrenia. - Consistent with a biopsychosocial approach (treating multiple possible drivers?)
- Extent of “integration” with this approach
What is Eclectic therapy
Combined across psychological paradigms (most commonly)
- E.g., Interpersonal therapy or multimodal therapy.
- Employs techniques from different paradigms rather than from one perspective only; considered more client-centric.’
- A ‘common’ answer given by psychologists to the question:
What therapy do you use?
example - uses both humanistic and behavioural approach together
How can therpaies be harmful?
- side effects
- Breach of trust issues - E.g., boundary violations, breaches of confidentiality, errors of professional judgement, power dynamics
- Loss of liberties - E.g., treatment ‘against one’s will
What are the Harmful “Psychological” therapies
- Critical incident stress debriefing
- Scared straight
- Recovered memories
- Boot camp
what is Critical incident stress debriefing (harmful therapy)
Processing’ trauma too soon
leads to Increased risk for PTSD
what is Scared straight (harmful therapy)
Seasoned inmates scare youth about consequences of
criminality
leads to conduct problems
