INTEGRATING ASSESSMENT

DATA
Overview

! Interpretation of psychological data proceeds by

considering various and sometimes conflicting
interpretive possibilities suggested by data
! Weighing and deciding among competing
interpretations
! Integrating may separate conclusions suggested by
data in meaningful theoretically consistent
description of patient’s
! current symptoms,
! problems in psychological adaptation and
! need for psychological treatment
Overview

! Consensus on:
! After data gathered and scored generate preliminary
hypotheses from careful review of all test data
! Decide which hypotheses to retain and which to discard
! Then integrate various findings into a comprehensive formulation
to describe
! patient’s personality organization
!Assist in differential diagnosis
!Identify characteristic patterns of interpersonal functioning
!Assess self concept
!Highlight issues for treatment planning
Overview

!Test interpretation will be more accurate and

meaningful if it is data driven rather than theory
driven
!Eg. Clinician’s understanding of individual based on
results of WISC-V, WIAT or Rorschach does not rely
primarily on what client says about self, observation of
behavior, intuitive reactions
!Instead use psychological data to develop
conceptualization of functioning based on specific test
findings found to be empirically assoc with relevant extra test
behavior (symptoms, interpersonal relationships, organization
of thinking, emotional control, self concept, defenses
Overview

! In situations that have been adequately

researched, clinical inferences are quite justified in
the many situations
! for which empirically derived decision rules have not yet
been articulated and validated
! Highly unique circumstances
! Decisions that are not readily translated into statistical
formulae
!In real world, most effective to utilize both approaches in a
thoughtful manner
Preliminary Hypotheses

!First stage in interpretative process

!Involves generating initial hypotheses about
individual’s psychological functioning based on
review of each discrete test score
!Goal is to identify meaningful findings about an
individual grounded in the results of the empirical
literature rather than developing a theoretically
based explanation about person’s presentation
!All interpretative hypotheses should be entertained and none
discarded lest the examiner prematurely dismiss a potentially
meaningful finding
!Initial stage data driven rather than theory driven
Overview

! Importance of systematically reviewing all interpretations

!Avoid biased interpretation of test data
!Confirmatory bias – tendency for individual to
prematurely make decision and then maintain that
conclusion without considering evidence
contradicting initial impressions
!Danger of confirmatory bias clear for clinical
personality evaluations because it is rare for
clinicians to interpret data blindly
Overview

!Bias toward accepting information that confirms

initial impressions can influence how clinicians
approach and organize data
!Antidote for confirmatory bias
!Deliberately review test data in systematic impartial manner
to develop hypotheses using test data alone
!Systematically check whether data confirms or contradicts
initial impression based on non-test data
!Clinician deliberately thinks about alternative interpretations
after initial hypotheses are formulated
Evaluate and Refine Hypotheses

! Second stage of interpretative process

! Clinician identified points of agreement and disagreement
among initial interpretative findings to determine if preliminary
hypotheses should be accepted, modified, or discarded
!Generally, clinician can have considerable confidence that a
particular interpretation is correct it is confirmed by several pieces of
data, particularly if same conclusion is suggested by independent
sources
!Ideally, all findings related to specific hypothesis will mesh and
agree – in practice should expect both agreement and
disagreement among related test variables in nearly every case
! No justification to responding to between test differences as sign that
one must decide between WISC and WIAT
! Should be treated as common occurrence to be resolved in a
thoughtful, meaningful, and clinically useful manner
Integration

!At this stage, organize, refine, and integrate

hypotheses generated from test data to
describe psychological functioning as fully and
completely as possible
!Do not simply list discrete, independent signs and
symptoms suggested by individual test scores as in 1st
two stages (piecemeal)
!Instead in-depth theoretically coherent description of current
psychological make-up based on integration of findings,
history, current clinical presentation, knowledge of
psychopathology, human behavior, and clinical theory
Integration

!Conclusions should address various aspects of

psychological functioning
!Symptoms, self-concept, organization of thought
processes, contact with reality, self-control, defenses,
potential for acting out, and interpersonal functioning
!Many tests are not linked to a specific theory
!Clinician’s theoretical frame can help organize and integrate
diverse test findings and allow clinician to generate additional
inferences not contained specifically in test data
Integration

!Neither WISV-V nor WIAT results translate directly

into many of the behavioral and symptom
criteria needed to make DSM-V diagnosis
!Used to describe patient’s psychological
organization, personality structure and the symptoms
characteristics, and behaviors associated with
particular configurations of test data
!Can confirm presence or absence of certain symptoms by
patients
!Some cases can rule out a specific diagnosis
Integration

!Awareness of “mind set” has important

implications for the integrative stage
!Psychologist who routinely interprets test data using a
particular theoretical perspective is likely to interpret
other cases accordingly – not because theory fits
clinical data, but because that framework is most
accessible
!Hindsight bias – tendency of people who know a
specific outcome has already occurred to have
unrealistic confidence they could have accurately
predicted that outcome before it occurred
Integration

!Knowing that an outcome has happened

affects how people organize, integrate, weigh
information related to outcome so as to create
impression that outcome was inevitable
!May explain how clinician explains person’s
current psychological functioning based on
knowledge of past history
STEP 1 – ACCUMULATING THE DATA

!Put your data in a single place

!Create a list, by test, of all the results – cognitive,
academic, emotional, and personality tests –
regardless of their apparent usefulness or
importance
!Include any symptoms or issues that came from
interview and behavioral observations
STEP 1 – ACCUMULATING THE DATA

! Assessment is like a puzzle – the data are the

individual puzzle pieces
! This step allows you to lay out all the pieces of the
puzzle on table before you put them together to
form a picture
! Makes the ultimate step of writing the report easier –
all evidence from tests in single place for easy
reference
! Sets up the next step – identifying the themes
Example of Step 1- Write out results
from each test individually
WISC-V WIAT CAT Rorschach

FSIQ = 102 Total Composite = 111 - Anger Situational Stress

Average
VCI = 108 Mathematics = 110 - Self Doubt Feelings of loss
Average
PRI = 108 Oral Language = 114 – Frustration Needs closeness
high average
WMI = 97 Written Language = 113 Fear Painful internalized
– high average feelings

PSI = 83 Below Average

STEP 2 – IDENTIFYING THEMES

!Categorize the data and results into coherent

themes – often difficult to begin to categorize all
the results into themes that are meaningful
!Themes can include specific symptoms – low
self-esteem or feelings of worthlessness
!Themes can include environmental factors –
lack of support from family and others
!Cognitive skills/weaknesses
STEP 2 – IDENTIFYING THEMES

!Themes can include personality or character

styles or characteristics – tendency to hold in
emotions or bias toward negatively interpreting
ambiguous stimuli
!Good themes – clearly and straightforwardly
described by the data
!Make sure the data are explaining the theme –
not just related to it
STEP 2 – IDENTIFYING THEMES

!If themes do not emerge naturally or easily from

data – try to identify (a) emotional and (b)
thought process of individual
!Other domains that commonly help themes to
emerge include information about the
interpersonal world of the individual – how
person feels about self, coping strategies, etc
STEP 2 – IDENTIFYING THEMES

! Identifying themes may take several iterations

! Do not discount contradictory evidence
immediately
! Not every single piece of evidence has to be
incorporated into the theme – should fit as much of
the evidence into the theme as possible
! No rule as to the number of themes
! Best guideline is to have the fewest possible themes
that comprehensively account for all (or most) of
the test evidence
STEP 2 EXAMPLE
THEME LABELLING THEMES
WISC
Average FSIQ 102
Average VCI 108
Average PRI 108
WIAT
High Average Total Composite 111
High Average Math Composite 110
High Average Oral Language Composite 114
Rorschach
Stress Current adaptive capacities compromised; situational
Emotion Painful internalized
STEP 3 – ORGANIZING THE DATA

!Provides a visual means to identify the strongest

arguments from the themes you have identified
!Extremely important to take into account how
much data, across different tests and measures,
support each theme
!Themes from only a single test, or not much
evidence at all, should be reconsidered
STEP 3 – ORGANIZING THE DATA

!If there are additional data that do not fit, try to

combine them to create an additional theme
!Scan each of the themes individually to make
sure all of the evidence you have categorized
holds together conceptually – extremely
important to make sure that all of the individual
pieces of data together truly describe the
theme that you have identified
STEP 3 – ORGANIZING THE DATA

! Step 3 is simply a matter of reformatting the results in

Step 2
! Table created lists the themes in the first column and
individual measures (including self-report from
interview, behavioral observations, mental status
information, background information) in the top row
! Each box within the table will contain individual
pieces of evidence from each of the tests that
support the themes
STEP 3 – ORGANIZING THE DATA

!This step is like taking all the blue pieces of the

puzzle and assembling them in a way that they
naturally fit, so that you have a full blue puzzle
section
!Given that no test is perfect, it is important to
take into account results that are revealed
across multiple measures when thinking about
how confident you can be about the themes
that emerge
STEP 3 EXAMPLE

Concept
Theme
Very low Significant
overall strengths and
intellectual weaknesses
functioning
Poor Verbal Very poor
reasoning – verbal
Skills unevenly abstract
developed reasoning
Knowledge of
word meaning
barely
adequate
Concentration Attention for
and attention two items
(Working Attention for
Memory pictures good
STEP 4 – CONCEPTUALIZING

! Data pieces are put together to create a larger

picture
! Integration of the themes into a narrative describing
what is occurring for the individual assessed
! Narrative aims to make the results clearer, more
coherent, and more understandable to the person
being assessed (in additional to the referral parties
or anyone else receiving the feedback)
STEP 4 – CONCEPTUALIZING

!The more easily the results can be understood,

the more likely the individual will follow up on
the recommendations made as a result of the
assessment
!Although several different narratives can be
created for the same set of themes, each one is
as valid as the others as long as they proceed
logically from the data
STEP 4 – CONCEPTUALIZING

!It is the themes that support the conclusions,

diagnosis, and recommendations, while the
narrative simply organizes these data in a more
accessible way
!Multiple narratives can emerge from the same
theme
SUMMARY

!After completing the process, you will have a

clear conceptualization that incorporates all the
data you receive from the tests as well as your
clinical observations
!The clearer this conceptualization is to you, the
easier it will be both to write up and to convey
to others