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• Demystify difficult experience
WK 7: Diagnosis and Classification Issues
• What defines abnormality?
Various theories have suggested:
– Personal distress
– Deviance from cultural norms
– Statistical infrequency
– Impaired social functioning
– Others
Harmful Dysfunction – a current theory
– Jerome Wakefield
– Considers both scientific data
(dysfunction) and social context
(harmful)
Can behaviors be culturally typical yet also
abnormal?
• Who defines Abnormality?
> Authors of DSM make official definitions of
disorders
> Leading researchers in psycho pathology
> Many of these authors have been
psychiatrists (DSM published by American
Psychiatric Association)
- Medical model of psychopathology
o Categorical definitions withspecific
symptoms
- Increasing cultural diversity among these
authors in more recent editions ofDSM
• Why is the definition of abnormality
important?
> Labeling an experience as a disorder can
affect professionals and clients
– Professionals
• Facilitate research, awareness, and treatment
– Clients
• Feel like “not the only one”
• Acknowledge significance of
problem
• Access treatment
Before the DSM
• Abnormal behavior was recognized and
studied in ancient civilizations
• In 19th century, asylums in Europe and U. S.
arose (see Chapter 2)
• Around 1900, Emil Kraepelin put forth some of
the first specific categories of mental illness
• Some early categorical systems were for
statistical/census purposes
DSM-I and DSM-II
• DSM-I published in 1952
• DSM-II published in 1968
– Similar to each other, but different from later
editions
– Not scientifically or empirically based
• Based on “clinical wisdom” of leading
psychiatrists
– Psychoanalytic/Freudian influence
– Contained three broad categories of
disorders
• Psychoses, neuroses, character
disorders
– No specific criteria; just paragraphs with
somewhat vague descriptions
DSM – More Recent Editions
• DSM-III
– Published in 1980
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– Very different from DSM-I and
DSM-II
• More reliant on empirical data
• Specific criteria defined disorders
• Atheoretical (no
psychoanalytic/Freudian influence)
• Multi-axial assessment (5 axes)-DSMIV-
TR
• Much longer—included many more
disorders
• DSM-III-R (minor changes from DSM-III) was
published in 1987
• PDD /ASD
• 1. AUTISTIC
DISORDER
• RETT’S
• CDD
• ASPERGER
• PDD-NOS
• DSM-IV was published in 1994
• DSM-IV-TR was published in 2000-16
BROAD CATEGORIES
– TR stands for “text revision”
– Only text, not diagnostic criteria, differ
between DSM-IV and DSM-IV-TR
• So, these two editions are essentially similar
• DSM-IV included significant cultural advances
– Text describing disorders often included
culturally specific information
– Culture-Bound Syndromes were listed
• Not official diagnostic categories, but
experiences common in some cultural groups
– Outline for Cultural Formulation
• Helped clinicians appreciate impact of cultureon
symptoms
DSM-5
• Current edition of the DSM
– Released in 2013
• Task Force led Work Groups, each focusingon a
particular area of mental disorders
• Attempted greater consistency between DSMand
International Classification of Diseases (ICD)
Changes DSM-5 Didn’t Make
• Paradigm shift to emphasize
neuropsychology/biological roots of mental
disorder
• Dimensional definition of all mental disorders
• Dimensional approach for personality
disorders
• Remove five of the 10 personality disorders
• Proposed disorders
– Attenuated psychosis syndrome
– Mixed anxiety-depressive disorder
– Internet gaming disorder
New Features in DSM-5
• Naming shift from Roman numerals (e.g.,
DSM-IV) to Arabic numerals (e.g., DSM-5)
– Minor updates will be denoted as new
versions
(e.g., DSM-5.1, DSM-5.2, etc.)
• Elimination of the multiaxial assessment
system -5
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New Disorders in DSM-5 – Covers separate learning disorders in
reading, writing, and math from DSM-IV
• Premenstrual dysphoric disorder
DSM-5 Controversy
• Disruptive mood dysregulation disorder
• Allen Frances’ criticisms
• Binge eating disorder
– DSM-5 features changes that “seem clearly
• Mild neurocognitive disorder unsafe and scientifically unsound”
• Somatic symptom disorder – DSM-5 “will mislabel normal people, promote
• Hoarding disorder diagnostic inflation, and encourage inappropriate
medication use”
Revised Disorders in DSM-5
• Key areas of criticism
• Major depressive episode
– Diagnostic overexpansion
– “Bereavement exclusion” dropped
– Questionable transparency of the revision
• Autism spectrum disorder (new scope in process
DSM-5)
– Work Groups predominantly composed of
– Encompasses autistic disorder, Asperger’s researchers, not clinicians
disorder, and related developmentaldisorders from
DSMIV, CDD, RETT’S, PDD- NOS
Criticisms of Recent DSMs
• Attention-Deficit/Hyperactivity Disorder
• Despite advances (e.g., empiricism, diagnostic
– Age at which symptoms must first
criteria), some have criticized recentDSMs:
appear raised from 7 to 12
– Breadth of coverage
• Bulimia nervosa
- Too many disorders? Some not actually
– Frequency of binge eating decreased from
forms of mental illness?
twice to once per week
- Too many people stigmatized?
• Anorexia nervosa - Concept of mental illness becoming
trivialized?
– Removed requirement that menstrual
periods stop – Controversial cutoffs

– “Low body weight” changed from • How many symptoms should be necessaryfor a
numeric definition to less specific description particular disorder?

• Substance use disorder (new scope in DSM-5) • What constitutes “significant distress and
impairment?”
– Encompasses substance abuse and
substance dependence disorders from DSM-IV – Cultural issues

• Intellectual disability disorder • Some progress, but still dominated by non-

minority authors and traditional Western values?
– Mental retardation from DSM-IV
• Specific learning disorder/LD
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– Gender bias
• Do some diagnostic categories pathologizeone
gender more than the other?
• Consider premenstrual dysphoric disorder
– Nonempirical influences
• Despite increased empiricism, do other non-
empirical factors (e.g., politics, finances)
influence decisions about abnormality?
– Limitations on objectivity
• Even with increased empiricism, do opinionand
judgment still play significant roles in decisions
about abnormality?
Alternate Directions in Diagnosis and
Classification
• Categorical approach
– The DSM’s approach
– An individual falls in the “yes” or “no”
category for having a particular disorder
– “Black and white” approach—no “shades of
gray”
– May correspond well with human tendency to
think categorically
– Facilitates communication
• Dimensional approach
– “Shades of gray” rather than “black and
white”
– Place clients’ symptoms on a continuum rather
than into discrete diagnostic categories
– Five-factor model of personality could providethe
dimensions
• Neuroticism, extraversion, openness,
conscientiousness, and agreeableness
– More difficult to efficiently communicate, but
more thorough description of clients?
– May be better suited for some disorders (e.g.,
personality disorders)
Attention to Culture, Racism, and
Discrimination in DSM 5-TR
- Racialized
- Ethno racial
- Latinx
DSM 5-TR and Diagnoses for Children
• More Precise Criteria Existing criteria have
been updated in DSM-5-TR to provide more
precise descriptions and reflect the scientific
advances and clinical experience of the last
decade
• Autism Spectrum Disorder
• Disruptive Mood Dysregulation Disorder
• Posttraumatic Stress Disorder
• Prolonged Grief Disorder
WK 8 The Clinical Interview
Interviewing is a lot like talking, but you have to
guide the conversation. You have to know whatyou
want and go about getting it.
• Assessment is closely linked with the identityof
clinical psychologists
– No other mental health profession
incorporates assessment into their work as
clinical psychologists do
• Clinical interviews are the most frequent
assessment tool
– More than any specific test
– Vast majority of practicing clinical
psychologists use
Interviews
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Essential Qualities of Assessment Techniques ➢ Vocal qualities
➢ Verbal tracking referring to
• All assessment techniques (including client by proper name
interviews) should have adequate:
COMPONENTS OF THE INTERVIEW
– Validity—measures what it claims to measure
• Rapport
– Reliability—yields consistent, repeatable
– Positive, comfortable relationship between
results
interviewer and client
– Clinical utility—benefits the clinician and
ultimately the client – How an interviewer is with clients

• All assessment techniques (including • Technique

interviews) should have adequate:
– Validity—measures what it claims to measure
– Reliability—yields consistent, repeatable
results
– Clinical utility—benefits the clinician and
ultimately the client
FEEDBACK
Common to all kinds of psychological
assessment
• Provide results of tests or interviews
• May be face-to-face, a report, etc.
THE INTERVIEWER
• General skills
- Quieting yourself (modulation of the voice
of the interviewer. Do not interruptyour
client when they are answering, because
you will interrupt their flow of thoughts)
- Being self-aware > know how you tendto
affect other interpersonally, and howothers
tend to relate to you
- Develop positive working relationships
- Listen through your ears & eyes
• Specific behaviors
- Listening – the primary task of the
interviewer, consisting of numerous
building blocks
➢ Eye contact
➢ Body language
– What an interviewer does with clients
– Directive vs. nondirective styles
SPECIFIC INTERVIEWER RESPONSES
• Open-ended and close-ended questions
- Allow individualized and spontaneous
responses from clients
- • Elicit long answers that may or may not
provide necessary info
• Close-ended questions
- Allow less elaboration and self-
expression by the client
- Yield quick and precise answers.
• Clarification
– Question to make sure the interviewer
accurately understands the client’s
comments
• Confrontation
– For discrepancies or inconsistencies in a
client’s comments
• Paraphrasing
– Restatement of client’s comments to
show they have been heard
• Reflection of feeling
– Echo client’s emotions, even if not
explicitly mentioned
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• Summarizing
– Tie together various topics, connect
statements that may have been made at
different points, and identify themes
PRAGMATICS OF THE INTERVIEW
• Note-taking
– Little consensus about note-taking
– Provide a reliable written record, but can be
distracting to client and interviewer
• Audio- and Video-recording
– Also provide a reliable record, but can be
inhibiting to clients
– Must obtain permission
• The Interview Room
– Professional yet comfortable
• Confidentiality
– Explain confidentiality and its limits to clients
(e.g., child abuse, intention to harm)
TYPES OF INTERVIEWS
• Intake interviews
– To determine whether to “intake” the client
into the agency or refer elsewhere
• Diagnostic interviews
– To provide DSM diagnosis-DSM5-TR
– Structured interviews often used
• Minimize subjectivity, enhance reliability
• SCID is an example
– Currently being revised for DSM-5-TR
• Semi-structured interviews include some
structure but also some flexibility or
opportunities to improvise
• Mental status exam
– Typically used in medical settings
– To quickly assess how a client is functioningat
that time
• Crisis interviews
– Assess problem and provide immediate
intervention
– Clients are often considering suicide or other
harmful act
CULTURAL COMPONENTS
• Appreciating the cultural context
– Knowledge of the client’s culture, as well asthe
interviewer’s own culture
– For behavior described or exhibited during
interview
• Acknowledging cultural differences
– Wise to discuss cultural differences ratherthan
ignore
– Sensitive inquiry about a client’s cultural
experiences can be helpful
WK 9: INTELLECTUAL AND
NEUROPSYCHOLOGICAL ASSESSMENT
Assessing Intelligence
Assessment Overview
• Tests described in this chapter are related to
cognitive functioning in some way
– Intelligence tests measure intellectual
abilities
– Achievement tests measure
accomplishments in academic areas
– Neuropsychological tests focus on cognitive
dysfunction, often from brain injury or illness
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Intelligence Testing
Advantages
- In general, intelligence tests measure a
wide variety of human behaviors better
than any other measure that has been
developed.
- They allow professionals to have a
uniform way of comparing a person's
performance with that of other people
who are similar in age.
- These tests also provide information on
cultural and biological differences among
people.
Intelligence tests are excellent predictors of
academic achievement and provide an outlineof a
person's mental strengths and weaknesses.
Many times the scores have revealed talents inmany
people, which have led to an improvement in their
educational opportunities.
Teachers, parents, and psychologists are ableto
devise individual curricula that matches a person's
level of development and expectations.
Theories of intelligence
– Is intelligence one thing or many things?
• Charles Spearman —” g” for general (single)
intelligence
• Louis Thurstone — intelligence is plural
abilities that may not relate to each other
More contemporary theories of intelligence:
• James Cattell — two separate intelligences
o Fluid intelligence — ability to
reason when faced with novel
problems
o Crystallized intelligence — bodyof
knowledge accumulated through
life experiences
• John Carroll — three-stratum theory
• “g,” 8 broad factors, 60 specific abilities
Wechsler Intelligence Tests
- Originally created by David Wechsler in
early 1900s
"The global capacity of a person to act purposefully,
to think rationally, and to dealeffectively with his/her
environment. “
Currently, there are three Wechsler IQ tests
–Wechsler Adult Intelligence Scale—Fourth
Edition (WAIS-IV) – age 16-89.
– Wechsler Intelligence Scale for Children—
Fourth
Edition (WISC-V) – age 6.0-16.11
– Wechsler Preschool and Primary Scale of
Intelligence
—Third Edition (WPPSI-III) – age 2.6-7
• Similarities among the three Wechsler IQ
tests:
– Yield a single full-scale intelligence score
• Also yield 4 index scores: Verbal
Comprehension, Perceptual Reasoning,
Working Memory, Processing Speed
• Also yield about a dozen specific
subtests scores
– One-to-one, face-to-face administration
– Share a core of subtests:
• Vocabulary
• Similarities
• Information
• Comprehension
• Block Design
• Picture Completion
• Matrix Reasoning
• Coding
• Symbol Search
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– Mean of 100 for full scale and index scores,and – Entirely language free
10 for subtests – No speaking necessary for test administratoror
– Large sets of normative data test taker

– Impressive psychometric data to support • All instructions are hand gestures

reliability and validity • All responses are manual, not verbal
– Approach to interpretation: full scale IQ first, – Some drawbacks: only for kids age 5-17,
followed by increasingly specific scores and limited psychometric data, more limited range
patterns
Achievement Testing
Stanford-Binet Intelligence Scales – 5th
• Intelligence is what a person can accomplish
Edition (SB5)
intellectually
• Dominated in early 1900s until Wechsler’s
• Achievement is what a person has
tests began to compete
accomplished, especially reading, spelling,
• Like Wechsler tests in many ways writing, or math
– Face-to-face, one-tone administration • Achievement tests typically produce standard
scores that can be easily compared to scores from
– Single overall IQ score, 5 factor scores, many
intelligence tests (e.g., mean = 100)
more subtest scores
– A significant discrepancy between a person’s
– Mean score is 100
achievement and expected levels of achievement is
– 2-85 the basis for specific learning disorder
• Unlike Wechsler tests in some ways: • They also typically produce age- or grade
equivalency scores
– One test covers whole lifespan (ages 2-85+)
– Subtests include extensions at high and lowend • Some achievement tests are specific to
(useful for assessing giftedness or mental
math, reading, or other abilities
retardation)
• Others are more global
– Different subtests and factors
– Wechsler Individual Achievement Test—
– Has become less commonly used than
Third
Wechsler tests, but still highly regarded andused
Edition (WIAT-III)
Cultural Fairness in Intelligence Tests
• For ages 4-50:11
• Some subtests may place people from
minority cultural groups at a disadvantage • Administered face-to-face and one-on-
one
– Verbal subtests especially
• Reading, math, written language, oral
– Both Wechsler tests and Stanford-Binet have
language
made improvements in recent editions
Neuropsychological Testing
• Universal Nonverbal Intelligence Test
• Measure cognitive functioning or impairmentof
(UNIT)
the brain and its specific components or structures
– Recently created (1996)
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• Additional purposes: to make prognosis, plan
rehab, determine eligibility for accommodations,
etc.
Halstead-Reitan Neuropsychological
Battery (HRB)
• Comprehensive battery of 8
neuropsychological tests
• Primary purpose is to identify people with
brain damage and, to the extent possible,
provide detailed information or hypotheses
about any brain damage identified
• 15-above
• Some of 8 tests involve sight, hearing, touch,
motor skills, and pencil & paper tasks
• A similar comprehensive battery of tests is the
Luria-Nebraska Neuropsychological Battery
(LNNB)
– Similarly long and comprehensive
– Emphasizes qualitative data in addition to
quantitative data
Brief Neuropsychological Measures
• Bender Visual-Motor Gestalt Test
– Second Edition
– Most commonly used
neuropsychological screen among
clinical psychologists
– ~6 minutes to administer
– Simple copying test using 9 geometric
designs
– A quick “check,” followed by more
tests as necessary
– Can suggest brain damage in a
diffuse, but not specific, way
• Rey-Osterrieth Complex Figure Test
– Brief pencil-and-paper drawing task, but
unlike Bender-Gestalt, involves just a single,
more complex figure
– Also includes a memory component (recall
figure and draw it again from memory)
– Copy, Recall (immediate or delayed)
• Repeatable Battery for the Assessment of
Neuropsychological Status (RBANS)
– Neuropsych screen focusing on a broader
range of abilities than Bender-Gestalt or Rey
Osterrieth
– 12.0-89.11
– 12 subtests in less than half hour
• Wechsler Memory Scale
– Fourth Edition (WMS-IV)
– Assesses memory problems due to brain
injury, dementia, substance abuse, etc.
– Ages 16-90
– Assesses visual and auditory memory,
immediate and delayed recall
--
WEEK 10-11
Personality Assessment and Behavioral
Assessment
Multimethod Assessment
• No measure of personality or behavior is
perfect
• It is best to use multiple methods
– Tests
– Interviews
– Observations
– Other sources
• Convergent conclusions can be made with
more confidence
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Evidence-Based Assessment
• Assessment based on “what works”
empirically
• Similar to movement regarding “what
works” in therapy, but data is not quite as
abundant yet
• Typically tied to particular disorders
– Ex. SCID and BDI-II for assessing
depression
Culturally Competent Assessment
• Every culture has its own definitions of
“normal” and “abnormal”
• Culturally competent clinical
psychologists are aware of this, and of the
influence of their own cultural perspective
• Especially important not to
overpathologize
– View as abnormal what is culturally
normal
Objective Personality Tests
• Include unambiguous test items, offer
clients a limited range of responses, and
are objectively scored
• Typically self-report questionnaires
Minnesota Multiphasic Personality
Inventory-2 (MMPI-2)
Minnesota Multiphasic Personality
Inventory-2 (MMPI-2) (cont.)
• Original MMPI was published in 1943
– Primary authors were Starke
Hathaway and J. C. McKinley
– Empirical criterion keying was used as
test construction method
• Revised edition, MMPI-2, was
published in 1989
– Better norms
– Less outdated wording of items
Minnesota Multiphasic Personality
Inventory-2 (MMPI-2) (cont.)
• MMPI and MMPI-2 feature 10 clinical
scales
– 1—Hypochondriasis
– 2—Depression
– 3—Hysteria
– 4—Psychopathic Deviate
– 5—Masculinity/femininity
– 6—Paranoia
– 7—Psychasthenia
– 8—Schizophrenia
– 9—Mania
– 0—Social Introversion
• Also feature supplemental scales and
content scales for additional clinical
information
Minnesota Multiphasic Personality
Inventory-2 (MMPI-2) (cont.)
• MMPI and MMPI-2 also feature validity
scales
– To measure test-taking attitudes
– Can identify clients who “fake good” or
“fake bad,” or clients who respond
randomly
• MMPI-A (for adolescents, age 14-18) was
published in 1992
– Similar clinical scales, validity scales, and
administration
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• MMPI-2-RF—most recent edition—
briefer, less overlap between clinical scales
• Strengths include psychometrics
(established reliability and validity) and
comprehensiveness
• Limitations include length, reading
requirement, attention requirement, and
emphasis on pathology/abnormality
• Therapeutic Assessment
– Interesting use of MMPI-2, developed by
Stephen Finn and colleagues
– MMPI-2 feedback used as a brief
therapeutic intervention
Millon Clinical Multiaxial Inventory
(MCMI- III)
• Originally created by Theodore Millon
• Like the MMPI-2 in some ways
– Comprehensive objective personality test
– Self-report, pencil & paper format- 175
items
NEO Personality Inventory—Revised
(NEO- PI-R)
• Originally created by Paul Costa and
Robert McCrae
• Another objective personality test
– Pencil & paper, self-report format
• Main distinction: measures “normal”
personality traits (not pathologies)
California Psychological Inventory-III
(CPI- III)
• Another objective personality test
– Pencil & paper, self-report
• Like NEO-PI-R, doesn’t emphasize
pathology
• Emphasizes positive attributes of
personality— strengths, assets, internal
resources
• Consistent with recent positive
psychology movement
• Also goes by name CPI-434 (434 items)
• 20 scales
Beck Depression Inventory-II (BDI-II)
• Not a comprehensive test of personality,
but a brief, targeted measure of one
characteristic (depression symptoms)
• 21 items; takes 5-10 minutes to complete
• Pencil & paper, self-report format
• Lacks validity scales, and much more
limited scope than other tests discussed to
this point
Projective Personality Tests
• Based on the assumption that clients will
“project” their personalities when presented
with unstructured, ambiguous stimuli and an
unrestricted opportunity to respond
• Lack of objectivity in scoring and
interpretation
– Considered by many to be empirically
inferior to objective tests
– Usage has declined in recent decades
• Advocates claim they are less “fake-able”
Rorschach Inkblot Method
• Created in 1921 by Hermann Rorschach
• 10 inkblots (5 in color, 5 black & white)
are presented
• Scoring emphasizes how the client
perceives the blot as well as what the client
sees
• Scoring variables include:
– Location (Whole blot, large part, or small
detail?)
– Determinants (Form, color, or shading of
blot?)
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– Form Quality (Conventional? Distorted?) Behavioral Assessment

– Popular (What others see? • Assumes that client behaviors are not
Idiosyncratic?) signs of underlying issues or problems;
instead, those behaviors are the problems
– Content (What kinds of objects appear
frequently?) Techniques of Behavioral Assessment

Thematic Apperception Test (TAT) • Behavioral observation is the most

• Published in 1943 by Henry Murray and
Christiana Morgan
• Like Rorschach in that it involves a •
When naturalistic observation is not
possible, analogue observation is used
– Replicate situation in clinic
• Recording of behaviors is crucial
– This functionality is key concept in
behavioral assessmentseries of cards with
ambiguous stimuli
essential technique
– Direct, systematic observation of a
client’s behavior in the natural environment
– Also known as naturalistic observation
Technology in Behavioral Assessment
• Laptop computers or handheld devices
can be used to record observed behaviors
• Numerous software programs have been
created for this purpose

• Cards feature interpersonal scenes rather Created by: Jona&Bea <3

than inkblots BS PSYCH 3YB-1
PADAYON!
Tell-Me-a-Story (TEMAS)
• Recent TAT-style apperception test
• Greater emphasis on cultural sensitivity
(via portrayal of diverse individuals in
cards)

Sentence Completion Tests

• The ambiguous stimuli are not inkblots
or interpersonal scenes, but beginnings of
sentences

• Rotter Incomplete Sentence Blank

(RISB) is most widely used

• Simulated examples:
– I enjoy .

– It makes me furious .
– My greatest weakness .
• Not often formally or empirically scored

• Reliability and validity are questionable