UNIT 2 DIFFERENT STAGES IN

PSYCHODIAGNOSTICS
Structure·
2.0 Introduction
2.1 Objectives
2.2 Psychodiagnostics
2.3 Psychodiagnostics Assessment
2.4 Stages in Psychodiagnostics

2.5 Let Us Sum Up

2.6 Unit End Questions
2.7 Suggested Readings

2.0 INTRODUCTION
The practice of psychological assessment involves considerably and qualitatively
more than merely administering tests, questionnaires, or behaviour ratings in a
uniform way. Failure to adequately conceptualise the psychodiagnostic process,
from the statement of a problem to the final interpretation of results, has created
considerable confusion and contributed to psychometric inadequacies of the
professional practice years back. This unit shows a condensed summary process
of psychological assessment according to present day conceptualisation. In this
unit successive stages of an assessment procedure are described in detail.

2.1 OBJECTIVES
After reading this unit, you should be able to:

• Understand that there are different stages in the assessment process; and

• Discuss in detail the stages in psychological assessment.

2.2 PSYCHODIAGNOSTICS
This is a branch of psychology concerned with the use of tests in the evaluation
of personality and the determination of factors underlying human behaviour.

1) Any of various methods used to discover the factors that underlie behaviour,
especially maladjusted or abnormal behaviour.

2) The branch of clinical psychology that emphasises the use of psychological

tests and techniques for assessing mental illness.

• the science or art of making a personality evaluation.

• the diagnosis of a mental disorder.

Psychodiagnostic Assessment of Children: Dimensional and Categorical

Approaches provides comprehensive guidelines for assessing and diagnosing a 23
Psychodiagnostics in broad spectrum of childhood disorders. In this groundbreaking new text, Randy
Psychology Kamphaus (coauthor of the BASC and BASC-IT) and Jonathan Campbell discuss
both theoretical and practical aspects of the field. Their detailed coverage provides
students and professionals with important research fmdings and practical tools for
accurate assessment and informed diagnosis.

This monumental new work begins by explaining dimensional (e.g., classification

methods that emphasise quantitative assessment measures such as behaviour rating
scales) and categorical (e.g., classification methods that emphasise qualitative
assessment measures such as clinical observation and history-taking) methods of
·assessment and diagnosis. It then highlights assessment interpretation issues related
to psychological assessment and diagnosis. The remainder of the text covers
constructs and core symptoms of interest, diagnostic standards, assessment
methods, interpretations of fmdings, and case studies for all of the major childhood
disorders.

·The disorders include:

• Mental retardation

• Learning disability

• Autism spectrum disorders

• Depression

• Anxiety disorders

• Traumatic brain injuries

• Eating disorders

• Attention deficit hyperactivity disorder

• Conduct disorder

• Oppositional defiant disorder

• Substance abuse and dependence

·• Sub syndromal and hyper syndromal impairments

Psychodiagnostics is understood in two ways:

1) In the broadest sense it refers to moving closer to the psychological

measurement in general and may refer to any object, verifiable
psychodiagnostic analysis, speaking as the identification and measurement of
its properties;

2) In a narrow sense, a more widespread measuring of the individual-

psychodiagnostic personality traits.

In psychodiagnostic the data or information gathering can be divided into three

main phases:

1) Collection of data.

2) Processing and interpretation of data.

3) Decision making that is psychodiagnosis and prognosis.

24
Psychodiagnostics develops methods for detecting and measuring individual Different Stages in
psychological characteristics of personality. Psychodiagnostics

As a theoretical discipline, psychodiagnostics deals with variables and constants

that characterise the inner world of man.

Psychodiagnostics is a way to verify the theoretical constructions. It is a way

of moving from abstract theory, generalised to the particular facts.

Theoretical psychodiagnostic relies on the basic principles of psychology:

i) Principle of reflection -" an adequate reflection of the world provides a

person an effective regulation of its activities;

ii) Principle of development - orienting study of the conditions of psychic

phenomena,. their trends, qualitative and quantitative characteristics of these
changes;

iii) Principle of the dialectical relation of essence and phenomenon - allows

you to see the mutual conditioning of the philosophical categories of the
material of psychic reality as long as they non identical;

iv) principle of the unity of consciousness and activity - consciousness and

mind are formed in human activity, the activity is regulated by both
consciousness and psyche;

v) Personal principle - requires psychological analysis of individual to individual,

taking into account its specific situation in life, its ontogeny.

These principles underpin the development of psychodiagnostic methods -ways

of obtaining reliable data on the content of the variables of mental reality.

The emergence of psycho-diagnostics, as a science and basic stages of its

development.

psychodiagnosis modem history begins with the first quarter of the nineteenth
century, that is the beginning of a period of clinical development psychodiagnostic
knowledge. Doctor psychiatrists have begun to conduct clinics systematic
monitoring of patients, recording and analysing the results of their observations.

At this time there are psychodiagnostic methods such as observation, interviews,

analysis of documents. But these methods were qualitative; and therefore on the
same data different doctors often have different conclusions.

Modem methods of psycho diagnostics on the main psychodiagnostic processes,

properties and states rights have appear in the late nineteenth and early twentieth
century. At this time actively developing the theory probability and mathematical
statistics, which later became build scientific methods of quantitative
psychodiagnosis.

Psychological Assessment versus Psychological Testing

It is important to note the difference between psychological assessment and
psychological testing. Testing is a relatively straight forward process wherein a
particular test is administered to obtain a specific score. Subsequently, a descriptive
meaning can be applied to the score based on normative, nomothetic fmdings. For
example, when conducting psychological testing, an IQ of 100 indicates a person
possesses average intelligence. 25
Psychodiagnostics in Psychological assessment, however; is a quite different enterprise. The focus here
Psychology is not on obtaining a single score, or even a series of test scores. Rather, the focus
is on taking a variety of test derived pieces of information obtained from multiple
methods of assessment, and placing these data in the context of historical
information, referral information, and behavioural observations in order to generate
a cohesive and comprehensive understanding of the person being evaluated.
,
These activities are far from simple. They require a high degree of skill and
sophistication to be implemented prop~rly.
Thus, personality assessment is a complex clinical enterprise where the tools of
assessment are used in concert with data from referring providers, clients, families,
schools, courts, and other influential sources.
Although tests form the cornerstone of the work, personality assessment is the
comprehensive interpretation of a person given all relevant data. This is not an
easy enterprise and relies on substantial clinical skill, knowledge, and experience.
However, if done well, the results can be very fulfilling for both clinicians and
. clients alike.
Monitoring of Treatment
Personality assessment tests have shown to be sensitive to the changes that clients
experience in psychotherapy. Some measures, such as the Beck Depression
Inventory were specifically designed to be used as adjuncts to treatment by
measuring change.
Personality assessment results can be used as baseline measures, with changes
reflected in periodic retesting. Clinicians can use this information to modify or .
enhance their interventions based on test results.
Use of Personality Assessment as treatment
The Therapeutic Assessment model was developed to increase the utility of
personality assessment and feedback by making assessment and feedback a
therapeutic endeavor. Based on the principles of self and humanistic psychology,
the therapeutic Assessment model views assessment as a collaborative endeavour
in which both the client and the assessor work together to arrive at a deeper
understanding of the client's personality, interpersonal dynamics, and present
difficulties.
The client becomes an active collaborator in a mutual process to better understand
the nature of his or her concerns and the assessor discusses (rather than delivers)
test results in a manner that is comfortable and understandable to the client. This
approach stands in contrast to the more typical information gathering approach to
assessment often used in neuropsychological and/or forensic psychology practice,
where clients are less engaged in the process of assessment, and feedback may
be provided in only a brief summary or written format.

2.3 PSYCHODIAGNOSTIC ASSESSMENT

Assessment consists of evaluating the relative factors in a client's life to identify
themes for further exploration.
Diagnosis which is sometime a part of the assessment process consists of identifying
a specific mental disorder based on a pattern of symptoms that leads to a specific
26
 diagnosis found in the DSM N TR. Both assessment and diagnosis are intended Different Stages in
Psychodiagnostics
to provide direction from the treatment process. '

Psychodiagnostics (psychological diagnosis) is a general term covering the process

of identifying and emotional or behavioural problem and making a statement about
the current status of a client. Psychodiagnostics may also include identifying a
syndrome that conforms to a diagnostic system such as the DSM N TR. This
process involves identifying possible causes of the person's emotional, cognitive,
physiological and behavioural difficulties leading to some kind of treatment plan
designed to ameliorate the identified problem.

The clinician must carefully assess the client's presenting symptoms and think
critically about how this particular conglomeration of symptoms impair the client's
ability to function in his daily life. Practitioners often use multiple tools to assist
them in this process, including clinical interviewing, observation, psychometric.
tests and rating scales.

Differential diagnosis is the process of distinguishing one form of mental disorder

from another by 'determining which of two (or more) disorders with similar
symptoms the person is suffering from. The DSM N TR is the standard reference
for distinguishing one form of mental disorder from another. It provides specific
criteria for classifying emotional and behavioural disorders and shows the differences
among various disorders. In addition to describing cognitive, affective, personality
disorders this also deals with a variety of disorders pertaining to developmental
stages, substance abuse, moods, sexual and gender identity, eating, sleep, impulse
control ana adjustment.

Unless a thorough picture of the client's past and present functioning is formed,
specific counseling goals cannot be formulated. Furthermore, evaluation of
progress, change, improvement or success may be difficult without an initial
assessment.

Assessment, Diagnosis and Contemporary Theories of Counselling

Psychoanalytic theory: Some psychoanalytically oriented therapists favour

psychodiagnostics. This is partly due to the fact that for a long time in the United
States psychoanalytic practice was largely limited to practitioners of medi~ine.
Some of these psychodynamically oriented therapies note that in its effort to be
theory neutral the DSMN TR eliminated terminology linked to psychoanalytical
perspective.

Adlerian theory: Assessment is basic part of Adlerian therapy. The initial

sessions focus on developing a relationship based on a deeper understanding of
the individual's presentingproblem. A comprehensiveassessmentinvolvesexamining
the client's life style. The therapist seeks to ascertain the faulty, self defeating
beliefs and assumptions about self, others and life that maintains the problematic
behavioural patterns the client brings to therapy.
N
"""
I

W Existential theory: The main purpose of existent clinical assessment is to

U
c, understand the personal meanings and assumptions clients use in structuring their
::E existence. This approach is different from the traditional diagnostic framework
because it focuses on understanding the client's inner world and not on understanding
individual from an external perspective. 27
Psychodiagnostics in Person centered theory: The best vantage point to understand another person
Psychology is through his subjective world. They believe that the traditional assessment and
diagnosis are detrimental because they are external ways of understanding client.
Gestalt theory: Gestalt theory gathers certain types of information about their
client's perceptions to supplement the assessment and diagnostic work done in
the present moment. Gestalt therapists attend to interruptions in the client's
contacting functions and the result is a functional diagnosis of how individuals
experience satisfaction or blocks in their relationship with the environment.
Behaviour theory: This begins with a comprehensive assessment of the client's
present functioning with questions directed to past learning that is related to
current behaviour. Practitioners with a behavioural orientation generally favour a
diagnostic stance valuing observation and other objective means of appraising
both a client's specific symptoms and the factors that have led up to the client's
malfunctioning.

11lUsevery theory requires that there is a thorough psychodiagnostic assessment

before one could plan any kind of intervention.

2.4 STAGES IN PSYCHODIAGNOSTICS

Sundberg and Tyler (1962) described the course of clinical assessment as a flow
through four major stages:
1) Preparation: In which the clinician learns of the patient's problem, 'negotiates'
the referral questions, and plans further steps in assessment;
2) Input: during which data about the patient and his situation are collected;
3) Processing: during which the material collected is organised, analysed and
interpreted; and
4) Output: during which the resulting study of the person is communicated and
decisions as to further clinical actions made.
Depending on whether the clinician favours a psychometric or clinical orientation
there will be greater or lesser use of statistical prediction or of clinical interpretation.
Below is the general outline of the stages or phases of clinical assessment found
in books of psychological testing and which can provide both a conceptual
framework for approaching an evaluation and a summary of some of the point'S
already discussed in blocks. Although the steps in assessment are isolated for
conceptual convenience, in actuality, they often occur simultaneously and interact
with one another. Through out these phases, the clinician should integrate data and
serve as an expert on human behaviour rather than merely an interpreter of test
scores. This is consistent with the belief that a psychological assessment can be
most useful when it addresses specific individual problems and provides guidelines
for decision making regarding these problems. The stages are as follows:
Application of Psychodiagnotic Evaluations
This includes the following areas in which psychodiagnostic assessment is applied.
• psychological and emotional injury
.• psychosomatic disorders
28
• Workers compensation Different Stages in
Psychodiagnostics
• Industrial injury

• Occupational stress

• Sexual harassment and discrimination suits

• Disability determinations

• Maritime stress claims

• Workplace violence

• Fitness for duty

• Competence to stand trial

• Criminal responsibility

Evaluating the Referral Question

Many of the practical limitations of psychological evaluations result from an

inadequate clarification of the problem. Because clinicians are aware of the assets
and limitations of psychological tests, and because clinicians are responsible for
providing useful information, it is their duty to clarify the requests they receive.
Furthermore, they cannot assume that initial requests for an evaluation are
adequately stated. Clinicians may need to uncover hidden agendas, unspoken
expectations, and complex interpersonal relationships, as well as explain the specific
limitations of psychological tests. One of the most important general requirements
is that clinicians understand the vocabulary, conceptual model, dynamics, and
expectations of the referral setting in which they will be working (Turner et aI.,
2001).

Clinicians rarely are asked to give a general or global assessment, but instead are
asked to answer specific questions. To address these questions, it is sometimes
helpful to contact the referral source at different stages in the assessment process.
For example, it is often important in an educational evaluation to observe the
student in the classroom environment. The information derived from such an
observation might be relayed back to the referral source for further clarification
or modification of the referral question. Likewise, an attorney may wish to
somewhat alter his or her referral question based on preliminary information
derived from the clinician's initial interview with the client.

Psychodiagnostic testing enhances diagnostic accuracy by controlling for subjective

opinion because it uses highly reliable, standardized tests that have been validated
in clinical trials. For example: the reliability of the Wechsler Adult Intelligence
Scale, which measures cognitive abilities and determines intelligence quotients,
ranges from impressive .93 to .97. Because it is able to provide both accurate
diagnostics and to grade the severity of impairment, psychodiagnostic testing
helps the physician or psychiatrist to make pharmacological or psychotherapeutic
treatment recommendations that have the highest likelihood of success. "Differential
therapeutics", the prescription of effective treatments and proscription of ineffective
ones, is the standard of care in contemporary medicine. Psychodiagnostic testing,
because of its standardized and objective qualities, aids the practitioner in
developing differential treatment recommendations. 29
Psychodiagnostics in Patients sometimes present confusing clinical pictures. They require sophisticated
Psychology ann extensive work-ups to distinguish the psychological contributions that confound
accurate diagnoses and/or treatment of their conditions. Referral for
psychodiagnostic testing is a cost-effective and valuable tool in the diagnostic
decision-tree.

Examples of appropriate referrals for psychological testing include:

• Patients whom you suspect have substance abuse problems

.• Patients with possible learning disabilities

• Patients with suspected mental retardation or poor intellectual functioning

• Patients with mood disorders

• Patients with anxiety and panic disorders

• Patients who have experienced trauma

• Children and adolescents who are "acting-out"

• Patients with suspected personality disorders

The psychodiagnostic report is designed to answer specific referral questions.

These may include questions regarding diagnostic clarification, differentiation
between transient "state" disorders and long-standing "trait" disorders (DSM Axis
I versus Axis IT disorders),intellectualfunctioning,learning style, current psychosocial
stressors, and adaptive ability. Reports also include treatment recommendations
that are based on the synthesized results of the clinical interview, mental status
exam, patient's personal, family and cultural history, and findings from the
standardized tests. Clinicians can use these objective recommendations to develop
interventions with the highest likelihood of success

The information to be gathered in psychodiagnostics step by step are given below.

Step by step procedure in psychodiagnostics

1) State the client's name, age, date of evaluation and examiner. Document the
. reason for referral. This section captures why a professional psychological
assessment was requested and the expected outcome recominendation type
such as special education placement, diagnosis, need for therapeutic
intervention and competence.

2) Summarize background information on the client. This report section should

be broken up into categories of related information such as medical conditions,
test, and medications; clinical history, developmental milestones, education,
behaviour, social situation and family. Each subsection should be presented
in chronological order.

3) Provide client information details extracted from interviews with parents or

family members that were part of the evaluation procedure. Include facts and
professional impressions.

4) Report on your observations of the client during testing and interviewing. If

evaluating a young child, include data on free-play behaviour and interactions
30 with parents or siblings.
 5) List tests used. Because your report may be read by non-professionals, it is Different Stages in
helpful to provide a brief description of what each test measures. Report test Psychodiagnostics
results. List test and scoring by section, subtest or total score.
6) Interpret the test results. This critical section of the report can be approached
in several ways: you can report the meaning of the results of each test, tie
the results to the initial reasons for evaluation, or integrate the results by
category such as intellectual ability, competence, interpersonal skills,
neuropsychological factors and mentalstatus.
7) Write a summary and recommendations. For this section, integrate information
from all sections of the report into a capsule of your diagnosis using the
DSM IV, your conclusions relative to the reason for evaluation, key findings
about the client and recommendations.
8) Acknowledge the confidentiality of the report information on each page.
Print the report on letterhead stationery, sign your name and provide your
professional credentials including license number and licensing authority.
Mental Status Examination
The history and Mental Status Examination (MSE) are the most important diagnostic
tools a a clinical psychologist or a psychiatrist has to,obtain information to make
an accurate diagnosis. Although these important tools have been standardized in
their own right, they remain primarily subjective measures that begin the moment
the patient enters the office. The clinician must pay close attention to the patient's
presentation, including personal appearance, social interaction Withoffice staff and
others in the waiting area, and whether the patient is accompanied by someone
(i.e., to help determine if the patient has social support). These first few observations
can provide important information about the patient that may not otherwise be
revealed through interviewing or one-on-one conversation.
When patients enter the office, pay close 'attention to their personal grooming.
One should always note things as obvious as hygiene, but, on a deeperlevel, also
, ' note things such as whether the patient is dressed appropriately according to the
" ..
season. Other behaviours to note may include patients talking to themselves in the
waiting area or perhaps pacing outside the office door. Record all observations.
The next step for the interviewer is to establish adequate rapport with the patient
by introducing himself or herself. Speak directly to the patient during this
introduction, and pay attention to whether the patient is maintaining eye contact.
Mental notes such as these may aid in guiding the interview later. If patients
appear uneasy as they enter the office, attempt to ease the situation by offering
small talk or even a cup of water. Many people feel more at ease if they can have
something in their hands. This reflects an image of genuine concern to patients and
may make the interview process much more relaxing for them.
Beginning with open ended questions is desirable in order to put the patient
further at ease and to observe the patient's stream of thought (content) and
thought process, Begin with questions such as "What brings you here today?" or
''Tell me about yourself." These types of questions elicit responses that provide
the basis of the interview. Keep in mind throughout the interview to look for
nonverbal cues from patients. As they speak, for example, note if they are avoiding
eye contact, acting nervous, playing with their hair, or tapping their foot repeatedly.
In addition to the patient's responses to questions, all of these observations should
be noted during the interview process. 31
Psychodiagnostics in. As the interview progresses, more specific or close ended questions can be asked
Psychology in order to obtain specific information needed to complete the interview.

At some point during the initial interview, a detailed patient history should be
taken. Every component of the patient history is crucial to the treatment and care
of the patient it identifies. The patient history should begin with identifying patient
data and the patient's chief complaint or reason for coming to the clinic. The
patient's chief complaint should be a quote recorded just as it was spoken, in
quotation marks, in the patient's record. This also is where all history of illness
is recorded, including psychiatric history, medical history, surgical history, and
. medications and allergies. Of interest, it is important to make direct inquiry to
items such a family history of members being murdered etc.

Obtain a complete social history. This addition to the patient history can be most
crucial when discharge planning begins. Inquire if the patient has a home. Also ask
if the patient has a family, and, if so, if the patient maintains contact with them .
. This also is the area in which any history of drug and alcohol abuse, legal problems,
and history of abuse should be recorded.

Following completion of the patient's history, perform the MSE in order to test
specific areas of the patient's spheres of consciousness. To begin the MSE, once
again evaluate the patient's appearance. Document if eye contact has been
maintained throughout the interview and how the patient's attitude has been toward
the interviewer. Next, in order to describe the mood aspect of the examination,
ask patients how they feel. Normally, this is a one-word response, such as "good"
or "sad."

Next, the interviewer's task is to defme the patient's affect, which will range from
expansive (fully animated) to flat (no variation). The patient's speech then is
evaluated. Note if the patient is speaking at a fast pace or is talking very quietly,
almost in a whisper. Thought process and content are evaluated next, including
any hallucinations or delusions, obsessions or compulsions, phobias, and suicidal
or homicidal ideation or intent.

Then, the patient's sensorium and cognition are examined, most commonly using
the Mini-Mental State Examination. The interviewer should ask patients if they
know the current date and their current location to determine their level of
orientation. Patients' concentration is tested by spelling the word "world" forward
and backward. Reading and writing are evaluated, as is visuospatial ability. To
examine patients' abstract thought process, have them identify similarities between
2 objects and give the meaning of proverbs, such as "Don't cry over spilled milk."
Once this is completed, perform the physical examination and needed laboratory
tests to help exclude medical causes of presenting symptoms.

A compilation of all information gathered throughout the interview and MSE leads
to the differential diagnosis of the patient. Once this diagnosis is established, a
treatment plan is formulated. At this point, involving the treatment team (e.g.,
social workers, nurses, others) is important to help carefully explain to patients
what their treatment will entail.

Once the history and MSE are complete, documenting this event accurately and
efficiently is important.

32
 DitTerent Stages in
Specifically the Mental Status Examination should cover the following: Psychodiagnostics

Appearance, attitude and motor activity - dress, grooming, signs of illness and
behaviour
Mood and affect - range, lability appropriateness

Speech - quality .
Thought - Content (Delusion, suicidal & homicidal ideations, obsessions)
Thought - Form (Circumstantiality, tangentiality, loosening of associations, flight
of ideas, derealisation, depersonalisation, dissociative events, concreteness,
grandiosity)
Perception - Hallucinations and illusions

• Alertness
• Orientation to time, place, and person

• Concentration
• Recent and remote memory
• Language (e.g., naming objects, repeating phrases, performance of commands)

• Calculations
• Construction
• Insight and judgment
Hallucinations and illusions
Onset of illness
Symptoms of Depression

Sleep (hypersomnia or insomnia)

Interest (loss of interest in activities once enjoyed)
Guilt (inappropriate guilt, feelings of worthlessness)

Energy (decreased)
Concentration (decreased)
Appetite (increased or decreased)
Psychomotor agitation/retardation
Suicidal ideation
Acquiring Knowledge Relating to the Content of the Problem

Before beginning the actual testing procedure, examiners should carefully consider
the problem, the adequacy of the tests they will use, and the specific applicability
of that test to an individual's unique situation. This preparation may require referring
both to the test manual and to additional outside sources. Clinicians should be
familiar with operational definitions for problems such as anxiety disorders,
33
psychoses, personality disorders, or organic impairment so that they can be alert
Psychodiagnostics in to their possible expression during the assessment procedure. Competence in
Psychology merely administering and scoring tests is insufficientto conduct effective assessment
For example, the development of an IQ score does not necessarily indicate that
an examiner is aware of differing cultural expressions of intelligence or of the
limitations of the assessment device. It is essential that clinicians have in depth
knowledge about the variables they are measuring or their evaluations are likely
to be extremely limited.

Related to this is the relative adequacy of the test in measuring the variable being
considered. This includes evaluating certain practical considerations, the
standardization sample, and reliability and validity. It is important that the examiner
also consider the problem in relation to the adequacy of the test and decide
whether a specific test or tests can be appropriately used on an individual or
group. This demands knowledge in such areas as the client's age, sex, ethnicity,
race, and educational background, motivation for testing, anticipated level of
resistance, social environment, and interpersonal relationships. Finally, clinicians
need to assess the effectiveness or utility of the test in aiding the treatment process.

Data Collection

After clarifying the referral question and obtaining knowledge relating to the
problem, clinicians can then proceed with the actual collection of information. This
may come from a wide variety of sources, the most frequent of which are test
scores, personal history, behavioural observations, and interview data. Clini-ians
may also find it useful to obtain school records, previous psychological observations,
medical records, police reports, or discuss the client with parents or teachers. It
is important to realise that the tests themselves are merely a single tool, or source,
for obtaining data. .

The case history is of equal importance because it provides a context for

understanding the client's current problems and, through this understanding, renders
the test scores meaningful. In many cases, a client's history is of even more
significance in making predictions and in assessing the seriousness of his or her
condition than his or her test scores. For example, a high score on depression on
the MMPI-2 is not as helpful in assessing suicide risk as are historical factors such
as the number of previous attempts, age, sex, details regarding any previous
attempts, and length of time the client has been depressed. Of equal importance
is that the test scores themselves are usually not sufficient to answer the referral
question.

For specific problem solving and decision making, clinicians must rely on multiple
sources and, using these sources, check to assess the consistency of the
observations they make.

Interpreting the Data

The end product of assessment should be a description of the client's present

level of functioning, considerations relating to etiology, prognosis, and treatment
recommendations. Etiologic descriptions should avoid simplistic formulas and should
instead focus on the influence exerted by several interacting factors. These factors
. can be divided into primary, predisposing, precipitating, and reinforcing causes,
and a complete description of etiology should take all of these into account.
Further elaborations may also attempt to assess the person from a systems
34
 perspective in which the clinician evaluates patterns of interaction, mutual two way Different Stages in
influences, and the specifics of circular information feedback. An additional crucial Psychodiagnostics

area is to use the data to develop an effective plan for intervention.

Clinicians should also pay careful attention to research on, and the implications of,
incremental validity and continually be aware of the limitations and possible
inaccuracies involved in clinical judgment. If actuarial formulas are available, they
should be used when possible. These considerations indicate that the description
of a client should not be a mere labeling or classification, but should rather
provide a deeper and more accurate understanding of the person. This understanding
should allow the examiner to perceive new facets of the person in terms of both
his or her internal experience and his or her relationships with others.

To develop these descriptions, clinicians must make inferences from their test
data. Although. such data is objective and empirical, the process of developing
hypotheses, obtaining support for these hypotheses, and integrating the conclusions
is dependent on the experience and training of the clinician. This process generally
follows a sequence of developing impressions, identifying relevant facts, making
inferences, and 'supporting these inferences with relevant and consistent data.
Maloney and Ward (1976) have conceptualised a seven phase approach to
evaluating data.

They note that.in actual practice, these phases are not as clearly defmed but often
-occur simultaneously. For example, when a clinician reads a referral question or
initially observes a client, he or she is already developing hypotheses about that
person and checking to assess the validity of these observations.

Phase 1

The first phase involves collecting data about the client. It begins with the referral
question and is followed by a review of the client's previous history and records.
At this point, the clinician is already beginning to develop tentative hypotheses and
to clarify questions for investigation in more detail. The next step is actual client
contact, in which the clinician conducts an interview and administers a variety of
psychological tests.

The client's behaviour during the interview, as well as the content or factual data,
is noted. Outof this data, the clinician begins to make his or her inferences.

Phase 2

Phase 2 focuses on the development of a wide variety of inferences about the

client. These inferences serve both a summary and explanatory function. For'
example, an examiner may infer that a client is depressed, which also may explain
his or her slow performance, distractibility,flattened affect, and withdrawn behaviour.
The examiner may then wish to evaluate whether this depression is a deeply
ingrained trait or more a reaction to a current situational difficulty. This may be
_.- determined by referring to test scores, interview data, or any additional sources
of available information. The emphasis in the' second phase is on developing
multiple inferences that should initially be tentative. They serve the purpose of
guiding future investigation to obtain additional information that is then'used to
confirm, modify, or negate later hypotheses.

35

I
 Psychodiagnostics in Phase 3
Psychology
Because the third phase is concerned with either accepting or rejecting the inferences
developed in Phase 2, there is constant and active interaction between these
phases. Often, in investigating the validity of an inference, a clinician alters either
the meaning or the emphasis of an inference, or develops entirely new ones.
Rarely is an inference entirely substantiated, but rather the validity of that inference
is progressively strengthened as the clinician evaluates the degree of consistency
and the strength of data that support a particular inference. For example, the
inference that a client is anxious may be supported by WAIS-lII subscale
performance, MMPI-2 scores, and behavioural observations, or it may only be
suggested by one of these sources. The amount of evidence to support an inference
directly affects the amount of confidence a clinician can place in this inference.

Phase 4

'. As a result of inferences developed in the previous three phases, the clinician can
move in Phase 4 from specific inferences to general statements about the client.
This involves elaborating each inference to describe trends or patterns of the
client. For example, the inference that a client is depressed may result from self
verbalizationsin which the client continuallycriticizesandjudges his or her behaviour.
This may also be expanded to give information regarding the ease or frequency
with which a person might enter into the depressive state.' The central task in
Phase 4 is to develop and begin to elaborate on statements relating to the"rlient.

Phases 5, 6, 7
..
The fifth phase involves a further elaboration of a wide variety of the personality
traits of the individual. It represents an integration and correlation of the client's
characteristics. This may include describing and discussing general factors such as
cognitive functioning, affect and mood, and interpersonal-intrapersonal level of
functioning.

Although Phases 4 and 5 are similar, Phase 5 provides a more comprehensive

and integrated description of the client than Phase 4. Finally, Phase 6 places this
comprehensive description of the person into a situational context and Phase 7
makes specific predictions regarding his or her behaviour. Phase 7 is the most
crucial element involved in decision making and requires that the clinician take into
account the interaction between personal and situational variables.

Establishingthe validity of these inferencespresents a difficultchallengefor clinicians,

because, unlike many medical diagnoses, psychological inferences cannot usually
be physically documented. Furthermore, clinicians are rarely confronted with
feedback about the validity of these inferences. Despite these difficulties,
psychological descriptions should strive to be reliable, have adequate descriptive
breadth, and possess both descriptive and predictive validity. Reliability of
descriptions refers to whether the description or classification can be replicated
by other clinicians (inter-diagnostician agreement) as well as by the same clinician
on different occasions (intra-diagnostician agreement).

The next criterion is the breadth of coverage encompassed in the classification.

Any classificationshould be broad enough to encompass a wide range of individuals,
yet specific enough to provide useful information regarding the individual being
36 evaluated.
 Different Stages in
Psycho<Hagnostics

Phase 1 I Initial Data Collection

I
1 ,

Phase 2
I Development of Inferences
"I'
I
J,
," ~
Rejects. Modify Accept
Phase 3
Inferences Inferences Inferences

I
Develop and Integreate
T
Phase 4
Hypothesis

Phase 5
1
Dynamic Model of the Person

+
Phase 6
[ Situational Variables
I
;

!
Phase 7 Predictopm ofBehavior
J

-
Fig.2.1: Conceptual Model for Interpreting Assessment Data

Adapted from Maloney and Ward, 1976, p. 161

Descriptive validity involves the degree to which individuals who are classified are
similar on variables external to the classificationsystem. For example, are individuals
with similar MMPI-2 profiles also similar on other relevant attributes such as
family history, demographic variables, legal difficulties, or alcohol abuse?

Finally, predictive validity refers to the confidence with which test inferences can
be used to evaluate future outcomes. These may include academic achievement,
job performance, or the outcome of treatment. This is one of the most crucial
functions of testing. Unless inferences can be made that effectively enhance decision
making, the scope and relevance of testing are significantly reduced. Although
these criteria are difficult to achieve and to evaluate, they represent the ideal
standard for which assessments should strive.

2.5 LET US SUM UP

•
Sundberg and Tyler (1%2) have described the course of clinical assessment as
a flow through four major stages: preparation, input, processing and output. A
typical assessment process involves evaluating the referral question, acquiring
knowledge relating to the content of the problem, data collection and interpreting
37

I
Psychodiagnostics in the data. Maloney and Ward (1976) have conceptualised a seven phase approach
Psychology to evaluating data. According to them these phases often occur simultaneously.
Clinical interpretation does not appear at one moment, e.g., after data are collected,
as a basis for final judgement; wise and thoughtful decisions are required in all
stages. In fact, assessment requires statistical and clinical prediction throughout.
While improved techniques and better modes of statistical analysis and prediction
should be sought in continuing assessment research, they have ultimately to be
utilised by thinking and decision-making clinicians.

2.6 UNIT END QUESTIONS

1) During input the material collected is organised, analysed and interpreted.
True or False?
2) Many of the practical limitations of psychological evaluations result from an
inadequate clarification of the problem. True or False?
3) Competence in administering and scoring tests is sufficient to conduct effective
assessment. True or False?
4) The end product of assessment should be a description of the client's present
level of functioning, considerationsrelating to etiology,prognosis, and treatment
recommendations. True or False?
5) Descriptive validity involves the degree to which individuals who are classified
are similar on variables external to the classification system. True or False?
6) Write about the stages in assessment process as described by Sundberg and
Tyler?
7) Describe in detail the different stages of psychological assessment?

2.7 SUGGESTED-READINGS
Kaplan, R. M., &Saccuzzo, D. (2001). Psychological Testing: Principles,
Applications, and Issues(5th Ed.), Pacific Grove, CA: Wadsworth.

Korchin, S.l. (2004). Modern Clinical Psychology: Principles of Intervention

in the Clinic and Community. New Delhi: CBS Publishers & Distributers.

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