Chap4

The reliability of the assessment interview may be enhanced by the use of

. rating scales.

Which of the following would be used to reveal a dysrhythmia in brain activity?

EEG

The number of disorders has _______from earlier versions of the DSM to the DSM-5.

Increased

Which of the following is a drawback of a structured interview?

Interviews may include questions about areas that are of no concern to the patient.

What is the goal of psychosocial assessment?

The goal of psychosocial assessment is to develop an understanding of how the client functions in his or her social environment. The focus is on how the client interacts with his or her social environment, as well as the elements that are present in that environment that might need to be addressed as part of treatment.

Which of the following is NOT a reason for using rating scales in clinical observation and self reports?

to decrease objectivity

Which approach to the classification of abnormal behavior uses statistical criteria to differentiate between normal and abnormal?

. Dimensional

Which of the following is a type of test that tries to find ways in which a person's personality and past experiences cause them to understand and perceive their world? a. Structured interviews b. Objective tests c. Neuropsychological tests d. Projective tests

. Projective tests

Discuss some of the ethical issues that must be kept in mind when evaluating assessment findings.

: In the assessment process, information is gathered about the client. A variety of testing procedures may be employed, addressing both the physical and psychosocial status of the client. Assessment data are then used to plan or alter treatment plans. Such data, however, must be interpreted and the limitations of both the test instruments and the clinician need to be considered during this process. Cultural bias, for example, may be introduced by either a testing instrument or the clinician. In addition, the clinician may tend to interpret information in a manner that is consistent with his or her theoretical orientation, as opposed to striving to take a more objective view of the information presented. There may also be a tendency to focus on the client, as opposed to recognizing that the presenting symptoms may be more of a reflection of environmental circumstances, as opposed to some internal process. It also must be recognized that not all assessment procedures have been validated and that, in the end, more data may be needed to truly understand the client and his or her condition. The evaluation of assessment data is ultimately a subjective process, requiring caution to limit potential errors. GRADING RUBRIC - 6 points total, 2 for each of 3 issues.

The projective test called the __________ is the inkblot test used in personality assessments.

: Rorschach

Which of the following would be an example of a projective technique? a. A troubled teen is asked to select statements that she feels describe her. b. An alcoholic is told to record the times at which she feels the greatest desire for a drink. c. An elderly woman is asked to recall the day her father died. d. A child is asked to draw her family.

A child is asked to draw her family.

Which statement about the Rorschach is accurate? a. The ambiguous stimuli it employs are pictures of people interacting in an unclear way. b. A considerable amount of training is required to administer and score it accurately. c. It assesses the kind of specific behavioral deficits that most mental health facilities require today. d. It is the quickest projective tests to administer and score.

A considerable amount of training is required to administer and score it accurately.

What is a projective test?

A projective test is a test designed to measure personal characteristics. Projective tests are intended to be an unstructured means of revealing what is on someone's mind. Examples of projective tests include the TAT and the Rorschach Test. Both ask the client to provide an interpretation of an ambiguous stimulus. It is assumed that the explanation provided will involve some "projection" of the client's own issues.

Why is it important to have an appropriate classification of the presenting problem? A formal diagnosis may be needed for insurance purposes. b. A determination of the range of presenting symptoms is needed to ensure proper placement in a treatment facility. c. A recognition of what type of disorder is present will aid in the development of an effective treatment plan. d. All of the above.

All of the above.

Which of the following statements regarding assessment is true? a. Assessment should focus only on the client's current level of functioning. b. An adequate assessment includes a determination of the amount of danger the client poses to himself and others. c. An adequate assessment should include as much information as possible. d. Assessment should focus on biological concerns rather than social concerns.

An adequate assessment should include as much information as possible.

What is an analogue situation?

An analogue situation is a controlled environmental setting in which a clinical observation is conducted. By creating such situations, the client's ability to function in specific types of interactions can be assessed. Examples of analogue situations include role playing, event re-enactment, and think-aloud procedures.

What role does the social context play in assessment?

An evaluation of the environment in which the client lives is necessary in

What role does the social context play in assessment?

An evaluation of the environment in which the client lives is necessary in order to understand the demands they face, as well as the supports that are present.

A clinician was in an assessment interview with a woman of Asian descent. The clinician realized there might be some cultural values and attitudes that could influence how questions were interpreted and answered. Which of the following would help the clinician obtain information about the potential impact of the woman's culture on her mental health care?

CFI

What does it mean if Carol scores high on the Schizophrenia scale of the MMPI?

Carol's answers were comparable to those given by a group of people with schizophrenia.

In DSM-5, criteria for Persistent Depressive Disorder combines criteria from Dysthymic Disorder and which other disorder? a. Generalized Anxiety Disorder b. Chronic Major Depression c. Obsessive Compulsive Disorder d. Specific Phobia

Chronic Major Depression

Why is classification a necessary first step in developing an understanding about abnormal behavior?

Communication about abnormal behavior cannot be effective unless what is being discussed is clear.

What is comorbidity?

Comorbidity refers to the occurrence of two or more disorders in an individual simultaneously. Comorbid diagnoses are quite common.

Today, there are two major psychiatric classification systems in use: the ICD-10, and the ______.

DSM-5

Which of the following is an assumption of a categorical approach to abnormal behavior? a. Both normal and abnormal behavior lie on a continuum. b. Each disorder has unique symptoms. c. Disorders that share common symptoms have a common etiology. d. All behavior is the product of numerous interacting influences

Each disorder has unique symptoms.

In which of the following circumstances would a psychosocial assessment clearly need to be used?

Ever since the divorce, James has been sleeping less and less.

Dr. Bruce says "Its beneficial features are the ability to map ongoing psychological activities of the brain without injecting radioactive substances into the patient's body. In addition, they are much more widely available procedures than what was used before." What is Dr. Bruce describing?

Functional magnetic resonance imaging (fMRI)

What is validity?

In the context of diagnosis, validity refers to the extent with which a diagnosis, a classification, provides useful information. If a label provides no meaningful information, if it offers no information with clinical utility, it is not valid.

What is the difference between an unstructured and a structured diagnostic interview? Which is preferable?

Just as assessment interviews may be either unstructured or structured, so may diagnostic interviews. When an interview is unstructured, the clinician does not ask any standard set of questions, thus the information obtained with each client is likely to be very different. The clinician is free to take the questioning in whatever direction the responses lead. In a structured interview, the questions that are asked and the nature of the information obtained are predetermined. A structured diagnostic interview is preferable as its use is likely to improve diagnostic reliability.

Which of the following is an objective test? a. Rorschach Test b. Thematic Apperception Test c. Sentence-Completion Test d. MMPI-2

MMPI-2

Which of the following makes it possible to see all but the most minute abnormalities of brain structure?

MRI

What are two problems with diagnostic labeling?

People, including professionals, may just accept the label as a complete description of a person and not inquire further. They can keep people from evaluating the person with the label in an objective manner. They can unfairly influence clinical expectations and treatment choices. They may cause the labeled person to lose morale and self-esteem.

What are the pros and cons of projective and objective personality tests?

Projective tests have great strengths -- they focus on unique aspects of personality and allow for exploration of many issues. They are often hard to interpret and can be subjective and unreliable. Objective tests are very reliable and do not require subjective interpretation. But they are limited in what they cover, require the cooperation of the test-taker, and may require above average reading levels.

If a diagnosis is made by comparing subjects to a "model" of an illness, which type of classification scheme is being used?

Prototypal

Because his psychologist suspects he might have substantial brain damage, Tony was given a five-hour battery of tests that included listening to rhythmic beats presented by tape recorder and putting different shaped blocks into grooves while blindfolded. The procedure Tony experienced is called the

Rhythm Test

Several clinicians look at the TAT results of a hospitalized patient. The patient described the characters on the card as not speaking to each other. One clinician says this means the patient has a lot of unresolved anger. Another says it means the patient has a lot of social anxiety. The third says he thinks it means the patient is uninterested in people and prefers to be alone. This demonstrates the following problem with the TAT: a. Scoring and interpretation is very subjective. b. The pictures on the cards are new and updated. c. The amount of time it takes to score and interpret it. d. The lack of training of clinicians on using it.

Scoring and interpretation is very subjective.

A behaviorally oriented clinician tells her alcohol dependent client: "Here is a checklist I want you to fill out each day. Whenever you feel you need a drink, you should indicate what you were thinking, where you were, who you were with, and whether you went ahead and drank." What procedure is the clinician using?

Self-monitoring

Compare and contrast the following: MRIs, PET scans, and fMRI.

The MRI measures variations in magnetic fields. It then computes and depicts cross sections of organs such as the brain with great clarity. It is noninvasive and allows for visualization of all but the tiniest brain structures. Its major problem is the claustrophobic reaction some people have to the procedure. PET scans track substances as they are metabolized by the brain. They can show how the brain is functioning. They can help identify areas that aren't functioning normally that might not be obvious anatomically. Their major problem is low-fidelity pictures that have so far limited their value. The fMRI measures changes in blood flow in the brain. It is possible to map ongoing psychological activity and show which areas of the brain are involved in different activities. However, like MRIs, these are very sensitive to movement, which can cause false results. Also fMRIs are often very hard to interpret. GRADING RUBRIC - 6 points, 2 for accurately describing each imaging technique

Which of the following is an example of a symptom? a. The client's hands would not stop shaking. b. The client reported hearing voices. c. A large lesion was visible on the CAT scan. d. Her children reported that she had not been sleeping well.

The client reported hearing voices.

A clinician is in an assessment interview with a new client. The clinician is having trouble determining an exact diagnosis, but must put something down before the client can receive treatment. What is one reason for this?

The clinician has to provide this information to the medical insurance agency.

Discuss the difference between symptoms and signs, and explain why both concepts are important in DSM-5 diagnosis.

The criteria that define the recognized categories of disorder consist for the most part of symptoms and signs. The term symptoms generally refers to the patient's subjective description, the complaints she or he presents about what is wrong. Signs, on the other hand, are objective observations that the diagnostician may make either directly (such as the patient's inability to look another person in the eye) or indirectly (such as the results of pertinent tests administered by a psychological examiner). To make any given diagnosis, the diagnostician must observe the particular critieria - the symptoms and signs that the DSM-5 indicates must be met. 6 point total. 2 for correctly identifying signs, 2 for correctly identifying symptoms, and 2 for correctly stating why both are important in diagnosis.

Describe the dimensional and the prototypical approaches to classification.

The dimensional approach assumes that a person's typical behavior is produced by a combination of differing strengths of behaviors along several definable dimensions. These include emotional stability, anxiousness, and social introversion, among many others. The dimensions are the same for everyone. People differ in terms of how much they have of each trait, not because of an underlying dysfunction that causes disordered behavior. Abnormality is determined through statistical criteria by comparison to people in general. The prototypal approach classifies types by describing the idealized combination of personality characteristics that occur regularly together, based on observation. It is likely that no member of a defined group will have all of the characteristics of the defined prototype. There also is often much overlap between categories. GRADING RUBRIC - 10 points, 5 points for each approach.

Which of the following is a true statement about assessment and professional orientation? a. Regardless of whether a therapist is behaviorally or psychodynamically oriented, the same basic assessment procedures are employed. b. The focus of the assessment will be largely determined by the professional orientation of the clinician. c. While some assessment procedures will vary, a biological screening and administration of a personality test are components of all assessments. d. The assessment techniques employed will serve to reveal the causal factors that are most consistent with the clinician's orientation.

The focus of the assessment will be largely determined by the professional orientation of the clinician.

Why was the MMPI-2 needed?

The original MMPI was created over 50 years ago.

Which of the following would be an important factor to keep in mind when assessing behaviors exhibited during an assessment and how those behaviors might be interpreted? a. validity of the instrument b. relevance of date to national sample c. not enough data about a person d. the theoretical orientation of the clinician

The theoretical orientation of the clinician

Which of the following statements about individually administered IQ tests is correct? a. They typically take less than an hour to give and interpret. b. They have low reliability. c. Many settings and cases don't require the kind of detailed knowledge they give. d. They are expensive

They are expensive.

In which of the following circumstances would a clinician be most likely to use self-monitoring? a. When other forms of clinical observation have yielded no evidence of abnormal behavior b. To find out what situations are likely to elicit problematic behavior c. To evaluate the quality of the social environment d. When analogue situations have not served to provoke a demonstration of the presenting problem

To find out what situations are likely to elicit problematic behavior

What are the purposes of the initial clinical assessment of a person?

To make a diagnosis, predict the course of the disorder, to decide on treatment, and for use in research.

Which of the following best explains why the Rorschach is less likely to be used today? a. Other projective approaches have been found to be more reliable. b. Treatment facilities often require other types of information than the Rorschach provides and insurance companies do not pay for it. c. It is inexpensive and time efficient in comparison to other projective techniques. d. The Rorschach is only useful as a means of aiding clients in self-discovery; it has no true clinical utility.

Treatment facilities often require other types of information than the Rorschach provides and insurance companies do not pay for it.

Which of the following best illustrates high reliability? a. An interviewer modifies the way she asks questions to fit the style of the client. b. Two interviewers diagnose the same disorder after talking to the same client. c. A clinician accurately predicts that a client will become violent when reunited with this family. d. A clinician uses both medical (e.g., MRI) and psychological (e.g., MMPI-2) information to decide a diagnosis.

Two interviewers diagnose the same disorder after talking to the same client.

Which of the following would best address recent criticisms of the TAT? a. Make the images less ambiguous b. Allow more time for the client to respond c. Use more modern pictures d. Rely only on manuals for interpretation

Use more modern pictures

Which of the following statements about reliability and validity is true? a. Reliable tests are usually valid. b. Valid tests are usually reliable. c. There is no relationship between reliability and validity. d. In order for a test to be reliable, it must be valid.

Valid tests are usually reliable.

What does a diagnostic label describe?

When a diagnosis is given, an attempt is being made to classify the current behavioral pattern and level of functioning that is observed. Diagnosis of a psychiatric condition is made based on the information that is obtained during the assessment process, thus a label serves to summarize what has been observed. Diagnostic labels do not describe people or underlying pathological conditions, as is often presumed.

Which of the following demonstrates reliability? a. An IQ test is effective in predicting the academic performance of both males and females. b. Scores on an IQ test are not affected by mood. c. Scores on two different intelligence tests are highly correlated. d. When an IQ test is administered to the same person repeatedly, the results do not differ.

When an IQ test is administered to the same person repeatedly, the results do not differ.

Why is the establishment of trust important when conducting a psychological assessment?

When conducting an assessment, a clinician wants to develop as clear of a picture of the client's situation as possible. The client needs to understand that the information gained in the assessment process will aid the clinician in determining how best to address his or her problem. Providing feedback to the client during the assessment process may even lead to some improvement as the client's self understanding increases. By establishing a trusting relationship with the client, the clinician increases the likelihood of eliciting useful information.

Under what circumstances is a structured interview most likely to be used?

When consistent information is needed for research purposes

The DSM acknowledges that

a DSM diagnosis is only the first step, much more is needed to determine treatment.

Shondra is in fourth grade and has been having trouble sitting still and remaining focused on her schoolwork. Her teacher speaks with her parents about this, and suggests they see a clinician for an assessment. What is one problem with the DSM system that would make her parents reluctant to send her for an assessment?

a The diagnosis would become a label that would stick with Shondra.

Danielle is having problems with drinking. She goes to a psychologist who gives her a form to fill out. It has a list of statements about drinking and problems associated with drinking. She is to rate each item between 1 and 3 - 1 meaning it is not a problem for her, 3 meaning it is a very big problem for her and 2 is in between. This is an example of

a rating scale.

The MMPI is a. a structured approach to personality assessment. b. the most commonly used test of intelligence. c. a rating scale used to determine how comparable one is to individuals with various psychiatric diagnoses. d. a recently developed objective approach to personality assessment.

a structured approach to personality assessment

Computers are excellent devices for storing information on large numbers of people's characteristics and test score patterns. Whenever a person turns up with a specific test score pattern, the computer can print out an appropriate description. This illustrates

actuarial procedures.

Dr. Lo asks Julie to pretend that he is her father as part of his psychosocial assessment of Julie. Which of the following would this be an example of?

an analogue situation

A psychosocial assessment typically begins with

an interview.

Psychological tests a. are extremely reliable and valid. b. are dependent on the competence of the clinician who interprets them. c. are far superior to clinical observation for making diagnoses. d. can arrive at a person's diagnosis without the need for an interview.

are dependent on the competence of the clinician who interprets them.

The aim of a projective test is to

assess the way a patient perceives ambiguous stimuli.

A person comes to a mental health professional with a certain complaint. The professional attempts to understand the nature and extent of the problem. This process is called

assessment.

Since it was first published, the DSM has

become more objective.

Research by Exner and others has shown that the Rorschach

can be scored by computer, thereby increasing its reliability.

While neurological assessment procedures evaluate the brain's physical properties, neuropsychological assessment focuses on

client performance.

A clinician sits down with an individual and conducts an assessment interview. The clinician arrives at a diagnosis of schizophrenia. While writing up the notes on this interview, the clinician is mindful of preferred terminology by mental health professionals. What is the preferred way to refer to the individual in the assessment?

client with schizophrenia

A clinical psychologist notes that a client wears his clothes inside out, that his hair is matted, and there is dirt under his fingernails. This information is known as

clinical observation.

When a psychologist is informed of the issues involved in multicultural assessment, this is known as __________ .

cultural competence

Dr. Hunter is studying personality. He decides that he will classify his subjects into varying levels of intensity on personality traits based on how far they statistically fall above the average score of a "normal person." He is using a

dimensional approach.

Dr. Vera says, "It may only provide a limited view of a person's problems, but it is important for planning appropriate treatment. Administratively, it is essential so that a facility can know what kinds of problems clients need help with. Even if we don't want to do it, insurance claims require it." What is Dr. Vera is referring to?

formal diagnosis

Intelligence and personality tests can best be described as

indirect means of assessing psychological characteristics.

There are two general categories of psychological tests used in clinical practice. They are a. intelligence tests and personality tests. b. projective tests and sentence completion tests. c. neuropsychological tests and standardized tests. d. intelligence tests and rating scales.

intelligence tests and personality tests.

The Thematic Apperception Test (TAT) has been used to assess all of the following EXCEPT a. needs. b. intelligence. c. perception of reality. d. fantasies

intelligence.

The fMRI technique cannot currently be used as a diagnostic tool. This is because

it is very difficult to interpret the results.

The term MRI in assessment of the brain means __________ .

magnetic resonance imaging

A valid test

measures what it is designed to measure.

Dr. Kim is a psychologist who uses a number of tests to measure a person's cognitive, perceptual, and motor performance to detect brain damage. Dr. Kim is probably a specialist in using

neuropsychological assessment.

Ed has suffered a head injury in a car accident. He is referred to a psychologist to see what types of impairment now exist and to get some suggestions for treatment. The best assessment strategy would be

neuropsychological tests.

The use of standardized psychological tests

permits the clinician to determine how a client's behavior compares to some reference group.

"Projective" and "objective" are two types of ________ tests.

personality

Dr. Smith believes that a decrease in frontal lobe function underlies the cognitive deficits seen in schizophrenia. He has hypothesized that effective drug therapy serves to selectively increase metabolic activity in this part of the brain. Which of the following is Dr. Smith most likely to use to test his hypothesis?

positron emission tomography (PET) scans

Psychological assessment refers to the

procedures used to summarize a client's problem.

One advantage of magnetic resonance imaging (MRI) over the CAT scan is that the MRI

provides better differentiation and clarity.

Shanna goes to Dr. Henderson for a first interview. He diagnoses her with a depressive disorder. She then goes to Dr. Smithson, because her friend recommended her. Dr. Smithson diagnoses Shanna with an anxiety disorder. This demonstrates a problem with

reliability.

One limitation of the MMPI-2 is that it

requires an individual to be literate.

Joanne says that she cannot say "no" to her intrusive mother. Her therapist has her pretend to engage in such an interaction to assess how weak Joanne's assertiveness skills really are. This illustrates the use of

role-playing.

Psychological test results are often compared to each other to determine a mid-range, or normal point. In order to accomplish this, test administration must be completely consistent from one person to the next. What is this process called?

standardization

Dr. White is doing research in which she must diagnose clients at a mental health clinic. Because diagnostic reliability is of great concern in research, she will most likely establish diagnoses by using

standardized structured interviews.

As in assessment, diagnostic interviews can be

structured or unstructured.

Symptoms are to signs as ________ is to ________.

subjective; objective

Which of the following is a projective testing method that has been adapted for computer interpretation? a. The Rorschach Test b. The MMPI c. The Thematic Apperception Test d. The sentence completion test

the Rorschach Test

Which of the following is an unstructured approach to studying personality? a. WISC-III b. the BPRS c. the Stanford-Binet d. the TAT

the TAT

The need for rapport between a clinician and a client means

the client must feel comfortable with the clinician and the assessment.

A key feature of the MMPI-2 is that

the clinical scales measure the same properties of personality organization as they always have

While the DSM is designed to be a categorical classification scheme,

the existing criteria tend to lead to a prototypal approach.

One of the problems with actuarial data for an instrument like the MMPI is that

the profiles of many subjects do not "fit" the profile types for which actuarial data are available.

The text presented the case study of Andrea C, a twenty-one-year-old student from Colombia. The MMPI-2 computer-based report was typical of such reports because

the report provided diagnostic and treatment considerations

One criticism of diagnostic labels is that

they can influence both other people's and the diagnosed person's perception of themselves in negative ways.

Mike decides he is going to try to look mentally ill when he goes for his disability evaluation. He takes the MMPI-2. He most likely

will be caught by specialized scales on the test.