Clinical Psychology Exam 2

Chapter 6: The Assessment Interview

Reliability and Validity

1. What is reliability? What is validity?
 Reliability: the extent to which an assessment technique yields
consistent, repeatable results
 Validity: how well the assessment measures what it is intended to
measure
2. What are the different types of reliability and validity?
 Interrater reliability: consistency of results across different administrators
o Different people get consistent results
 Test-retest reliability: Consistency of results across multiple
administrations at different times
o Many people get consistent results time after time
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
 Content validity: the extent to which the assessment has content
appropriate for what is being measured
o Does it measure all aspects of the thing of interest?
o If an interview is designed to measure depression, it should have
many questions assessing various emotional, cognitive, and
physiological aspects of depression
 Criterion-related validity: the ability of a measure to predict (correlate
with) scores on other relevant measures
o Concurrent validity: is correlated with other measures of the
same thing
o Predictive validity: is correlated with a future event
 Discriminant validity: the extent to which the assessment does NOT
correlate with assessments that measure something else
o There is no reason a specific phobia should be correlated with
level of intelligence
 Construct validity: used to refer to all aspects of validity; involves a
demonstration of both convergent and discriminant validity
o Researchers describe the process of developing and validating a
measure as a process of construct validation
3. How are reliability and validity related?
 We conduct multiple validity studies using a variety of criterion measures
 Our confidence in the validity of our measure will increase as a function
of the number of times we find that the scores from our measure are
highly associated with scores of other measures of the same or similar
constructs (reliability)
The Assessment Interview
1. What is assessment in clinical psychology?
 Clinical assessment: involves an evaluation of an individual’s strengths
and weaknesses, a conceptualization of the problem at hand, and some
prescription for alleviating the problem
o Clinical assessment is usually an ongoing process, maybe even
every day
 Steps:
o Gather info
o Conceptualize problem
o Suggest solution
o Evaluate change and progress
 Our ability to treat a psychological problem depends on our ability to
define the problem
2. What is a referral, and how does it impact assessment?
 Someone—a parent, teacher, psychiatrist, judge, etc.—poses a question
about the patient (usually about his/her behavior, learning abilities,
abnormal things)
o Why have I been having problems lately?
o Why is Jane disobedient?
o Why can’t Charlie learn to read?
 A referral impacts assessment because it is what prompts a person to
seek treatment!
 Referral question: the question posed about the patient by the referral
source
o The reason the client is seeking treatment/testing
o The reason the client was referred by someone else
 How to address the referral
o Ways of addressing referral are heavily influenced by the
clinician’s theoretical views
o Assessment is not a completely standardized set of procedures
 Clients not given same tests or asked the same questions
3. What is an interview? What are the essentials and techniques that should be
kept in mind when conducting an interview?
 Assessment interview: one of the most basic techniques employed by
the clinical psychologist for the purpose of answering a referral question.
o If administered skillfully, it can provide insight into the problem
and inform clinical decision making
 Essentials & Techniques
o The physical arrangement
 Privacy and protection from interruptions
 Soundproof rooms
 Neutral and tasteful offices
 o Note taking & recording
 All contacts with clients need to be recorded
 Jot down a few key phrases, moderate note-taking
desirable
 Avoid taking verbatim notes
 Can detract from the understanding of what the
patient is saying
 Also prevents clinician from observing patient’s
expressions or body positions/movements
 Video/audio recording is also done, but only with the
patient’s consent
4. What is rapport and why is it important?
 Rapport: the relationship between the client and clinician
o Involves a comfortable atmosphere and a mutual understanding
of the purpose of the interview
o A relationship founded on respect, mutual confidence, trust, and a
certain degree of permissiveness
o The clinician does not always have to be “liked”
 Good rapport can be a primary instrument by which the clinician achieves
the purpose of the interview
 Important in making the patient feel comfortable
o Good rapport allows the patient to realize that the clinician is
trying to understand their problems in order to help them
5. In what ways do interviews differ?
 Have different purposes
o Example: the purpose of one interview may to be evaluate a client
who is presenting to an outpatient clinic for the first time
o Purpose of another interview may be to arrive at a DSM-IV
diagnostic formulation
 Structure
o Unstructured
o Structured
o Semi-structured
6. Know about the (5) different types of interviews.
 Intake-Admission Interview
o Determine why the client is seeking services
o Judge whether the agency can meet the patient’s needs
o Also informs the client about the clinic’s functions, fees, policies,
procedures, and personnel
 Case-History Interview
o Gather complete personal and social history of patient
  Meant to provide a broad background and context in
which the patient and the problem can be placed
o Provides context of…
 Family
 Medical/prior treatment
 Education
 Employment
 Social network/relationships
 Religion/culture
 Mental Status Exam
o Conducted to evaluate the patient for the presence of cognitive,
emotional, or behavioral problems
o The clinician assesses…
 General presentation
 Orientation (to person, place, and time)
 Attention and calculation
 Recall
 Language
 Complex commands
 Crisis Interview
o Purpose is to meet problems as they occur and to provide
immediate resource
 Prevent potential disasters
 Encourage person to enter a relationship with a clinician
o Walk in clinics
o Telephone hotlines
 1-800-273-TALK
 211 Big Bend
 Diagnostic Interview
o Clinicians evaluate patients according to DSM-IV criteria
 Sometimes required by insurance companies, research
protocols, or court proceedings
o Used to use unstructured interviews, but results proved unreliable
o Switched to structured interviews, which increase Interrater
reliability
7. What are the differences between structured and unstructured interviews?
 Unstructured interview: an interview in which the clinician asks any
questions that come to mind in any order
 Structured interview: clinicians ask, verbatim, a set of standardized
questions in a specific sequence

Chapter 7: The Assessment of Intelligence

1. What were the first intelligence tests for children and adults?
1. 1908 – Binet-Simon Scale
1. Test to identify individual differences in mental functioning
2. They created a test that was standardized and would allow for the
measurement of a child’s intelligence in the present.
3. This scale was originally created with the intent of classifying children as a
means for them to receive special education
1. Assessed cognitive limitations among children
2. 1939 – Wechsler-Bellevue Test
1. Wechsler Bellevue Intelligence Scale (WBIS): a general test of
intelligence, which Wechsler defined as, "... the global capacity of the
individual to act purposefully, to think rationally, and to deal effectively
with his environment."
2. The WBIS consists of 11 subtests divided into two parts, verbal and
performance.
3. First measure of adult intelligence
2. How has intelligence been defined?
1. There is no universally accepted definition of intelligence
2. Definitions of intelligence fall into one of three classes
1. Emphasize adjustment or adaptation
2. Focus on the ability to learn
3. Emphasize abstract thinking
3. Examples
1. Intelligence is the global capacity of the individual to act purposefully, to
think rationally, and to deal effectively with his environment (Wechsler)
2. The whole class of behaviors which reflect one’s ability to solve problems
with insight, adapt to new situations, think abstractly, and to profit from
hid experience (Robinson & Robinson)
3. How did Spearman and Thurstone differ in their conceptualizations of
intelligence? How are their ideas reflected in current IQ tests?
1. Spearman (1927) Factor Analysis approach
1. g factor: general intelligence
2. s factors: specific intelligence
1. The elements that tests have in common are represented by g, while
the elements unique to a given test are s factors
2. Thurstone (1938)
1. Not just one g factor, but several group factors
1. Numerical facility
2. Word fluency
3. Verbal comprehension
4. Perceptual speed
5. Spatial visualization
6. Reasoning
7. Associative memory
 3. How Spearman and Thurston’s ideas reflected in current IQ tests
1. IQ tests still cover Spearman’s g factor and Thurstone’s group factors
1. The whole notion of a single IQ score that can represent someone’s
intelligence strongly implies that we are trying to discover how much
g that person has (Spearman)
2. Current intelligent tests are composed of subtests (Thurstone’s group
factors)
4. What are the differences between Ratio IQ and Deviation IQ?
1. Ratio IQ: using the ratio of one’s “mental age” score to their “chronological
age.” MA/CA x 100 = IQ (William Stern)
1. If one’s mental age stays the same, but their chronological changes, their
IQ would change as well
2. Using ratio IQ scores better reflect the reality of more rapid intellectual
growth at younger ages
2. Deviation IQ: introduced by Wechsler to address problems observed when
applying the ratio IQ to older individuals. An individual’s performance on an
IQ test is compared to that of his peers
1. Involves a comparison of one’s score on an IQ test with that of his/her
same age peers
5. What are the correlates of IQ? Do gender differences in IQ exist?
1. School success
1. Correlation between IQ and grades is (.50)
2. However, any behavior is complexly determined by many variable other
than just intelligence
2. Occupational status
1. Amount of education/school success usually leads to better job options
1. IQ and occupational status are related
2. This relationship is true whether occupational status is defined in terms of
income, rated prestige, or social prestige. Regardless of gender or
ethnicity
3. Job performance
1. Once entry to a profession has been gained, the degree of intelligence
may not make much of a difference
2. Degree of success may be more a function of nonintellectual factors
4. Gender differences in IQ
1. No difference in overall IQ
2. Males score higher on spatial and quantitative ability
3. Females score higher on verbal ability
6. What is the evidence that IQ is heritable? Is IQ fixed?
1. IQ is heritable
1. Heritability: proportion of differences between individuals that is due to
genetic differences
1. Empirical evidence from behavioral genetics studies
2. Estimates of heritability range from 30%-80%
 2. Behavioral genetics: a research specialty that evaluates both genetic and
environmental influences on the development of behavior
1. Dizygotic (DZ) twins share 50% of their genes (identical twins)
2. Monozygotic (MZ) twins share 100% of their genes (fraternal twins)
1. Twins also have genetically similar intelligence when reared apart
2. Is IQ fixed?
1. No
1. Environment also plays an important role in the development of
intelligence
2. Heritability of intelligence is not stable across the lifespan
1. 20% in infancy
2. 60% in young adulthood
3. 80% in old age
4. Environment plays greatest role in the intelligence development
during childhood
7. What is the Flynn Effect?
1. Flynn Effect: the empirical finding that Americans’ IQ scores have on average
increased 3 points each decade since 1972
1. Explanations for this effect?
1. People getting smarter
2. Contemporary humans exposed to/more familiar with IQ tests or
similar types of tasks
8. What are the common IQ assessments? What do they have in common? How
are they different?
1. Stanford-Binet Fifth Edition (SB-5): Intelligence test based on a hierarchical
model of intelligence
2. Ages 2-85+
1. Measures 5 general cognitive factors:
1. Fluid reasoning: ability to solve new problems
2. Knowledge: ability to absorb general info that is accumulated over
time
3. Quantitative reasoning: ability to solve numerical and word problems
as well as to understand fundamental number concepts
4. Visual-spatial processing: ability to see relationships among objects,
recognize spatial orientation, and conduct pattern analysis
5. Working memory: ability to process and hold both verbal and non-
verbal information and then interpret it
2. Each factor includes 10 both verbal and non-verbal subtests
3. Wechsler Scales
1. Wechsler-Bellevue Intelligence Scale was designed for adults – one that
would offer items whose content was more appropriate and motivating to
adults than the school oriented S-B
4. WAIS-IV (Wechsler Adult Intelligence Scale – 4th ed.): an adult intelligence
test compromised of subtests that tap four areas of cognitive functioning.
Yields a Full-Scale IQ, in addition to Index scores for these 4 areas
1. Ages 16-90
2. 4 Index scores
1. Verbal comprehension
2. Perceptual reasoning
3. Working memory
4. Processing speed
3. 10 subtests
1. Included reversal items
2. 5 supplemental
5. WISC-IV (Wechsler Intelligence Scale for Children – 4th ed.): Intelligence test
designed for children between 6-16 years old. It is a more child-based
extension of the adult intelligence scales
1. 5 supplementary subtests
1. Verbal comprehension index (VCI)
1. Similarities
2. Vocabulary
3. Comprehension
4. Information and word reasoning subtest
2. Perceptual reasoning index (PRI)
1. Block design
2. Picture concepts
3. Matrix reasoning
4. Picture completion subtest
3. Working memory index (WMI)
1. Digit span
2. Letter-Number sequencing
3. Arithmetic subtest
4. Processing speed index (PSI)
1. Coding
2. Symbol search
3. Cancellation subtest
5. All used to make up the Full Scale IQ
6. WPPSI-III (Wechsler Preschool and Primary Scale of Intelligence – 3 rd ed.):
Intelligence test designed for children between the ages of 2 years, 6 months
and 7 years, 3 months. Geared toward the assessment of intellectual ability
among the much younger youth
1. Two sets of subscales used
1. Ages 2 years, 6 months to 3 years, 11 months
1. 4 core subtests
2. 1 supplemental subtest
3. Supplemental score
 2. Ages 4-7 years, 3 months
1. 7 core subtests
2. 5 supplemental subtests
3. 2 optional subtests
4. Optional scores
9. Why are intelligence tests used?
1. For the estimation of general intellectual level
1. Diagnosis of intellectual disability
2. Part of assessment for:
1. Learning disability
2. Other psychoeducational difficulties
3. Neurological problems
2. For prediction of academic success
1. Ex: gifted evaluation

Chapter 8: Personality Assessment

1. What is personality?
 Personality: distinct, enduring pattern of thoughts, feelings, and behaviors
o How an individual thinks, feels, and behaves… most of the time, or in
most situations
o People differ from each other in these patterns
o But your own pattern tends to be stable across various situations
 Ex: extravert will likely be more social than introverts in various
situations
2. What are the common characteristics of projective tests?
 Projective test: a procedure for discovering a person’s characteristic modes
of behavior by observing his behavior in response to a situation that does
not elicit or compel a particular response.
o Characteristics
 Stimulus is unstructured
 Participants are asked to describe an ambiguous stimulus
or answer ambiguous questions
 Ex: “Tell what is happening in this picture”
 Examinees forced to impose their own structure
 Shown an ambiguous stimulus
 Indirect
 Examinees not aware of the purpose of the test
 Freedom of response
 Infinite range of responses
 Interpretation of many variables
 Because clients can offer an infinite range of responses,
there are many interpretations that can be made, across
many dimensions
3. Describe the Rorschach and how it is administered and scored.
 The Rorschach: (1921) Psychodiagnostik, published by Hermann Rorschach.
Use of inkblots to assess personality, emotional functioning, and diagnoses.
o 10 cards with symmetrical inkblots
o 5 black and white
o 5 colored
 Administered
o Free association phase:
 Clinician says “tell me what you see, what it might be for you.
There are no right or wrong answers, just tell me what it looks
like to you”
 Clinician notes everything the patient says
 Sometimes notes length of time to make first response, total
time for each card, position of card
o Inquiry phase:
 Patient is reminded of all previous responses
 Asked what prompted that response
 Asked to identify the exact location of the responses
 Scoring (techniques vary)
o Employ at least three determinants:
 Location – the area of the card that the client responded to
(whole blot, small detail, big detail, white space)
 Content – the nature of the object seen (animal, person, rock,
clothing, etc.)
 Determinants – aspects of the image that prompted the
response (form of blot, color, texture, shading, movement)
o Exner’s Comprehensive System
 Most frequently used scoring system
 Scoring based mostly on determinants, not content
4. Describe the Thematic Apperception Test and how it is administered and
scored.
 Thematic Apperception Test (TAT): (Morgan & Murray, 1935) reveals
patients’ personality characteristics by interpreting the stories they produce
in response to a series of pictures
o Description
 31 TAT cards (one is blank)
 Depict people in a variety of situations
 Not always clear what the peoples’ genders are, who they are,
what they are doing, or what they are thinking
 Administered
o Clinicians show 6-12 TAT cards to patient
o Patients asked to make up a story about the pictures
 o Responses transcribed or recorded verbatim
 Scoring
o Many scoring techniques imposed, but none are widely used
o Clinicians usually rely on their own impressions
5. What is an illusory correlation?
 Illusory correlation: in projective testing, the phenomenon by which certain
test responses become associated with specific personality characteristics
o These responses come to be viewed signs of the trait in questions and
may be given undue weight when interpretation the test
 Example: Clinician gives hundreds of Rorschach tests. You
notice that every time a woman says card 2 looks like vomit,
she ends up having eating pathology
 You start to associate that response as a sign of eating disorder
 Truth is, there is actually no relationship because people with
and without ED say that
6. What are the advantages and disadvantages of projective tests?
 Advantages
o Indirect
o Infinite number of responses and interpretations
o Interesting for the examinee
 Disadvantages
o Must be administered, scored, and interpreted by a person
o Unstandardized scoring and administration
o Difficult to assess reliability and validity
7. What is an objective test? How does it differ from projective tests?
 Objective test: personality assessment tools in which the examinee
responds to a standard set of questions or statements using a fixed set of
options
o True/false, yes/no, dimensional scale
o Difference between projective and objective is that objective tests are
standardized
8. What are the advantages and disadvantages of objective tests?
 Advantages
o Economical
o Simple scoring and administration
 Can be administered to large groups and scored by computer
 Responses not ambiguous, clear way to interpret them
o Objective and reliable
 Not influenced by personal feelings, interpretations, or
prejudice; unbiased
 Disadvantages
 o Two people may choose the same behavioral item for entirely
different reasons
o Score may be obtained differently
 Get the same total score, but get it by endorsing different items
o May facilitate faking
 People may want to present themselves in a positive light, or
“fake bad”
o Some information may be lost
 Clients can’t elaborate on their responses
 Ex: I feel sad vs. I do not feel sad (no in between)
o Misinterpretation
 Clients may misinterpret questions
9. Explain the two methods of objective test construction discussed in class
(content validation approach, empirical criterion keying approach).
 Content Validation Approach
o 1) Carefully define all aspects of the variable you are attempting to
measure
o 2) Consult the experts before generating items
o 3) Use judges to assess each item’s relevance
o 4) Use psychometric analyses to evaluate each item
o Limitations to this approach
 Can clinicians assume every patient interprets each item the
same way?
 Can patients accurately report their own behavior and
emotions?
 Will the patients be honest?
 Empirical Criterion Keying Approach
o 1) Identify distinct groups of people
o 2) Ask them all to respond to the same test questions
o 3) Compare responses between groups
 Assumes that members of a particular diagnostic group will
tend to respond the same way
 Items are chosen if they discriminate between known groups
 Content is irrelevant
o Limitations to this approach
 Hard to interpret the meaning of the results
 There may be confounding variables in groups, such as a large
portion of schizophrenia that are also poor
10. Describe the MMPI-2 and how it is administered and scored.
 Minnesota Multiphasic Personality Inventory (MMPI-2)
o Used to assess personality and identify psychiatric diagnoses
o Created with empirical criterion keying approach
 o More than 10,000 published studies
o Updated and re-standardized (MMPI-2)
 Administered
o 567 items (true/false/cannot say)
o 13 years or older
o Can be taken individually or in groups
 Scoring
o Validity scales – used to detect malingering (faking bad), other test-
taking attitudes, and carelessness or misunderstanding
o Content scales
 Ex: certain items can help identify fears, health concerns,
cynicism, etc.
o Supplementary scales
 Such as anxiety, repression, ego strength, dominance, and
social responsibility
o Interpretation of results is an examination of patterns, or “profiles”
11. What is the point of having Validity Scales on the MMPI-2? What information
can they provide?
 Validity scales – used to detect malingering (faking bad), other test-taking
attitudes, and carelessness or misunderstanding
o ? (Cannot Say) Scale: number of items left unanswered
o F (Infrequency) Scale and Fb (Back-page Infrequency) Scale: not
frequently endorsed items
 High F score may suggest deviant response sets, abnormal
behavior, etc.
o L (Lie) Scale: questions that place respondent in a positive light
 Unlikely that the items would be truthfully endorsed
 Ex: “I like everyone I meet”
o K (Defensiveness) Scale: items that suggest defensiveness in admitting
certain problems
 Detect subtle faking good
 Ex: “Criticism never bothers me”
o VRIN (Variable Response Inconsistency) Scale: pairs of questions with
similar or opposite content
 Detect random responses
o TRIN (True Response Inconsistency) Scale: Pairs of items that are
opposite in content
 High TRIN scores suggest a tendency to give true responses
 Low scores suggest tendency to give false responses
12. How is the MMPI-2 typically used?
 Screening capabilities
 Determine severity of a patient’s diagnostic status
  Help clinician develop hypotheses about diagnosis
13. Are the Rorschach, TAT, and MMPI-2 reliable measures? Valid?
 Rorschach
o Reliability
 Interrater reliability for scoring responses (at the most basic
level)
 Some evidence supports, other evidence does not
 Test-retest
 Only limited evidence of stability of summary scores
 Interrater for interpretations
 Unknown; difficult to calculate
o Validity
 Controversy in literature
 Apparent that the test is not equally valid for all purposes
 May be valid for predicting thought disorder
 Because of lack of evidence, graduate programs have offered
less training
 TAT
o Reliability & Validity
 Difficult to examine
 Lack of a scoring system
 Lack of standardization
 Basically impossible to evaluate reliability and validity
 Little evidence supporting use of TAT
 MMPI-2
o Reliability
 Good test-retest support
 Low internal consistency for clinical scales, because items were
selected only to discriminate between groups
o Validity
 Predicts many external correlates
 Emotional states, antisocial behaviors, stress reactivity,
worry, paranoia, and introversion
 Cut-off scores valid for normal population

Chapter 9: Behavioral Assessment

1. When is behavioral assessment used in the context of treatment, when is it
assessed?
 Behavioral View of Personality: focuses on the interactions between
situations and behaviors for the purpose of effecting behavioral change
o The behavior is not a sign of a problem, the behavior is the problem
 Behavioral assessment most relevant for youth and children
 o They have not yet developed a set of stable personality traits
o Children may show important constellations of observable behaviors
that are important when diagnosing and treating psychological
symptoms
 When is behavior assessed?
o Initial assessment
 Assist with diagnosis and treatment planning
o Throughout treatment
 Monitor treatment progress
o Upon treatment completion
 Measure end-state functioning
o Post treatment
 Assess maintenance of treatment gains/relapse
2. How is behavior assessed? Know about interviews, naturalistic observation,
controlled observation, and self-monitoring. What are the advantages and
disadvantages of each of these?
 Interviews: clinician attempts to gain a general impression of the presenting
problem and the variables that seem to be maintaining the problem
o Relevant historical data
o Assessment of patient’s strengths and of past attempts to cope with
the problem
o Note relevant behaviors during interview
o Advantages
 Simple, straight-forward
o Disadvantages
 Can client identify antecedents and consequences of the
behavior?
 Malingering
 Naturalistic Observation: clinician directly observes client in their natural
environment – home, school, hospital
o Used to determine the frequency, strength, and pervasiveness of the
problem or the factors that are maintaining it
o Advantages
 Real behavior
 Unfiltered from self-reports and inferences
o Disadvantages
 Sometimes the specific kind of behavior in which clinicians are
interested does not happen very often
 Environmental interference
 Observer effects
 Patient cannot be observed without their knowledge or
consent
  Controlled Observation: the environment is designed so that the assessor
can observe the targeted behavior or interactions
o Ex: asking couples to discuss relationship problems in the lab to
observe couple interactions
o Basically situational tests that put people in situations similar to real
life
o Advantages
 Able to manipulate situation to see how client reacts
o Disadvantages
 May not be comparable to real life
 Clients may not react the way they normally do (reactivity)
 Self-Monitoring: individuals observe and record their own behaviors,
thoughts, and emotions
o Keep record of frequency, intensity, and duration of target behaviors
o Antecedents and consequences
o Advantages
 Provides more info than observation
 Focus the client’s attention on undesirable behavior
 Connections between antecedents and consequences
o Disadvantages
 Some clients may be inaccurate or may purposefully distort
their recordings
 Others may have low motivation to self-monitor or avoid it
completely
3. How can the reliability and validity of behavioral observations be increased?
 Must specifically and accurately define the behaviors
o Increase complexity of definition
 Employ trained observers whose reliability has been established
 Make sure observational format is strictly specified and followed
o Observer drift: shifting of definition away from the agreed upon
coding system
 Be aware of potential sources of error and bias
 Consider the possibility of reactivity
4. What is reactivity?
 Reactivity: the phenomenon in which individuals respond to the fact that
they are being observed by changing their behavior
o Client may act unnatural
o Talkative person becomes quiet
o Can severely affect the validity of observations because it makes the
observed behavior unrepresentative of what normally occurs
o Also, the observer may not recognize that they are causing reactivity
 5. What is functional analysis? What is the ABC model? How is the SORC model
different from the ABC model?
 Functional Analysis: (B.F. Skinner, 1953) method used to understand the
function of behavior and direct intervention
o Assess problem behaviors (intensity, frequency, duration)
o Assess relevant antecedents (triggers)
o Assess consequences (including reinforcement and punishment)
o Determine where to intervene to change behavior
 ABC model
o Antecedent 
o Behavior 
o Consequence
 SORC model (Kanfer & Phillips, 1970)
o S = stimulus
o O = organismic variables related to the problematic behavior
(thoughts, emotions, attitudes, beliefs, motivations)
o R = response
o C = consequences
6. Traditional vs. Behavioral view of personality examples
 Traditional view of personality: personality is a set of stable traits that
influence behavior
o A school-aged boy often blurts out answers during class and talks
over other people while they are talking.
o What might the problem be here, according to the Traditional View of
Personality?
 The boy has a permanent personality that causes him to act
this way in every situation
o What would the problem be according to the Behavioral View of
Personality?
 The boy blurts out answers and talks over people only when
the teacher is paying attention to others in the classroom. Boy
behaves this way only when he wants attention from the
teacher.

Chapter 10: Clinical Judgment

1. What is the quantitative (statistical) approach to clinical judgment? What are
the advantages and disadvantages of this approach?
 Quantitative (statistical) Approach
o Rely on data
o Uses scientific literature
o Data driven, statistical predictions
 Objectively derived formulas
 Explicit norms
  Weighted predictors
 Advantages
o Particularly effective when the outcome or event to be predicted is
known and specific
o Best used when dealing with large numbers of people
 Disadvantages
o General relationships do not always apply to individuals
o Do not have formulas to predict everything
o Do not have tests to assess everything
2. What is the subjective (clinical) approach to clinical judgment? What are the
advantages and disadvantages of this approach?
 Subjective (clinical) Approach
o Rely on experience and intuition
 Clinical intuition: a private process in which clinicians are
sometimes unable to identify the cues that led to a conclusion
o A complex process involving:
 Stimuli
 Characteristics of the clinician
 Situation
 Clinician’s response
 Advantages
o Can predict therapy outcomes
o Make interpretations during therapy
o Make specific recommendations for the patient
 Disadvantages
o Tendency to depend on vague criteria
o Barnum effect
o Unreliability of judgements
3. What is the Barnum Effect?
 Barnum effect: interpretations that appear to be valid self-descriptions, but
actually characterize everybody
o Examples
 I am not always as confident as most people think I am
 Often, I keep my real feelings to myself unless I am around
people I like
4. Are clinical or statistical predictions superior? What evidence supports this
conclusion? What are the objections to this conclusion?
 Comparison Studies (Goldberg, 1965)
o 29 Clinicians vs. statistical predictions
 Asked to make judgements regarding the diagnosis of 800
patients based on their MMPI scores
  Judgements made without any contact with the patient or any
additional info
 Asked to determine if patient was “Psychotic” or “Neurotic”
 Had an average accuracy of 62%
o Statistical predictions involved the application of complex algorithms
combined with the MMPI scores
 Conclusions:
o Statistical prediction is equal to or superior to clinical prediction
5. What is bias in clinical judgment? How can bias be overcome?
 Bias:
o Accuracy of clinical judgment varies as a function of some client
characteristic
o Example:
 Same number of men and women show symptoms of
depression
 But a higher percentage of women are given the diagnosis of
depression
 How to overcome bias
o Be aware of documented biases
o Attend to diagnostic criteria
o Use statistical rules instead of clinical judgment whenever possible
6. Does clinical experience improve clinical prediction? What evidence supports
this conclusion?
 Almost all major studies examining this issue do not support the position
that increased clinical experience results in increased accuracy in prediction
o “Myth of experience”
o Spengler et al. (2009)
 Experienced clinicians acquire ~13% increase in decision-
making accuracy
 Experience may only slightly improve clinical judgment
7. When is the statistical approach best? When should the clinical approach be
used?
 Statistical approach is valuable when:
o The outcome to be predicted is objective and specifically defined
o The outcomes for large, heterogeneous samples are involved
o There is reason to be concerned about human judgmental error or
bias
 Clinical approach is valuable when:
o No adequate tests or statistical equations are available
o Predicting rare, unusual events
o Unforeseen circumstances could negate the efficiency of a formula
8. What are the 5 fallacies presented by Meehl? How can they affect clinical
judgment?
 Sick-sick fallacy: the tendency to perceive people very unlike ourselves as
being sick
o Causes clinicians to interpret such behavior as maladjusted
o We are likely to see pathology where it does not exist
 Me-too fallacy: denying the diagnostic significance of an event in a patient’s
life because it has also happened to us
o The more our patients are like us, the less likely we are to detect
problems
 Uncle George’s pancakes fallacy: “There is nothing wrong with that; my
Uncle George did not like to throw away leftover pancakes either”
o Things that close to use could not be maladjusted
 Multiple Napoleons fallacy: “well, it may not be real to us, but its real to
him”
o There was only one Napoleon, despite how strongly a psychotic
patient may feel that he or she is also Napoleon
o “Everything is real to the person doing the perceiving”
 If this argument were used consistently, nothing could be seen
as pathological
 Understanding it makes it normal fallacy: deviant behavior can begin to
seem acceptable once we convince ourselves that we know the reasons for
its occurrence
o Causes clinicians to see illegal or unethical issues as “excusable”