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Block

1
INTRODUCTION TO PSYCHODIAGNOSTICS
UNIT 1
Introduction to Psychodiagnostics, Definition,
Concept and Description '5

UNIT 2
Methods of Behavioural Assessment 20

UNIT 3
Assessment in Clinical Psychology 36
UNIT 4
Ethical Issues in Assessment 54

••
 Expert Committee
Prof. A. V. S. Madnawat Dr. Madhu Jain Dr. Vijay Kumar Bharadwas
Professor & HOD Department Reader, Psychology Director
of Psychology, University of Department of Psychology Academie Psychologie, Jaipur
Rajasthan. Jaipur University of Rajasthan, Jaipur
Prof. Dipesh ChandraNath
Dr. Usha Kulshreshtha 'Dr. Shailender Singh Bhati Head of Dept. of Applied
Associate Professor, Psychology Lecturer, a D. Government Psychology, Calcutta University
University 'of' Raj~than, Jaipur Girls College, Alwar, Rajasthan Kolkata
Dr. Swaha Bhattacharya Prof. Vandana Sharma Dr. Mamta Sharma
Associate Professor - Professor and Head of Assistant Professor
Department of Applied Psychology Department Department of Psychology
Calcutta University, Kolkata' of Psychology Punjabi University, Patiala
Prof. P; H. L&nu Punjabi University, Patiala Dr. Vivek Belhekar
Professor and Head of the Prof. Varsha Sane Godbole Senior Lecturer
Department of Psychology Professor and Head of Bombay University, Mumbai
University of Pune,' Pune Department of Psychology Dr. Arvind Mishra
Prof. Amulya Khurana Osmania Uni:ersity, Hyderabad Assistant Professor
Professor & Head Psychology Dr: S. P. K. Jena Zakir Hussain Center for
Humanities and Social Sciences Associate Professor and Incharge Educational Studies, Jawaharlal
Indian Institute of Technology Department -of Applied Nehru University, New Delhi
New Delhi Psychology University of Delhi. .
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of Psychology Prof. Manas K. Mandal Lady Sri Ram College,
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Professor, Tata Institute of Department of Psychology (Rtd.)
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Psychology, The Global Open
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BLOCK 1 INTRODUCTION
Over the last century the scope of activity of clinical psychologists has increased
exponentially. In earlier times psychologists had a much more restricted range of
responsibilities. Today psychologists not only provide assessments but treat wide
variety of disorders in an equally wide variety of settings, consult, teach, conduct
research, help to establish ethical policies, deal with human engineering factors,
have a strong media presence, work with law enforcement in profiling criminals,
and have had increasing influence in the business world and in the realm of
advertising, to identify just a few of the major activities in which they are engaged.
Nonetheless, the hallmark of psychologists has alw. ys been assessment and it
continues to be a mainstay of their practices in the twenty-first century, Indeed,
in each of the activities just described, psychologists and their assistants are
performing assessments of some sort.

Unit 1 deals with the definition and concept of psycho diagnostics. In this unit the
variable-domains, data 'sources and practical applications of psychological
assessment have been covered in depth.

Unit 2 covers methods of behavioural assessment. In this unit attempt has been
made to explain what behavioural assessment is, the various methods or techniques
of behavioural assessment have been discussed along with their advantages and
limitations. The last part of the unit deals with the future perspectives of behavioural
assessment.

In Unit 3, the first half deals with the definition and purpose of clinical assessment
and last half is concerned with the application of assessment in the field of clinical
psychology. Unit 4 covers the main ethical considerations involved in psychological
assessment. It covers the specific standards and principles that a psychologist
must adhere while testing and this unit also covers the important ethical issues
such as confidentiality, informed consent and privacy in assessment.
UNIT 1 INTRODUCTION TO
PSYCHODIAGNOSTICS,
DEFINITION, CONCEPT AND
DESCRIPTION
Structure
1.0 Introduction

1.1 Objectives

1.2 Psychodiagnostics

1.3 Testing, Assessment and Clinical Practice

1.4 Variables Domains of Psychological Assessment

1.4.1 Performance Variables
1.4.2 Personality Variables

1.5 Data Sources for Psychological Assessment

1.5.1 Actuarial and Biographical Data
1.5.2 Behavioural Trace
1.5.3 Behavioural Observation
1.5.4 Behaviour Ratings
1.5.5 Expressive Behaviour
1.5.6 Projective Technique
1.5.7 Questionnaires
1.5.8 Objective Test
1.5.9 Psycho Physiological Data

1.6 Practical Applications

1.6.1 Assessment of Intelligence and Other Aptitude Functions

1.6.2 Psychological Assessment in Clinical Context

1.6.3 Assessment in Vocational Guidance Testing and Job Selection / Placement

1.7 Let Us Sum Up

1.8 Unit End Questions

1.9 Suggested Readings

1.0 INTRODUCTION
Intelligence tests, personality tests, behavioural assessments, and clinical interviews
all yield potentially important information about the person being tested, but none
.of these techniques provides an overall assessment of the examinee's level of
functioning. In other words, no individual test provides a complete picture of the
individual; it provides only a specific piece of information about that person. One
major task of psychologists involved in assessment is to evaluate information
provided by many tests, interviews, and observations, and to combine this 5
Introduction to information to make complex and important judgments about individuals. For
Psycbo<Uagnostics example, when an individual shows evidence of difficultyin adjusting to the demands
of daily life, a clinician must decide whether therapy would be helpful and, if so,
what type of therapy would be most appropriate.

Psychologists also are called on to assess individuals in a variety of non clinical

settings. For example, school psychologists might consider information about a
child's intellectual performance, social, skills, and home environment in
recommending placement in special education program Industrial psychologists
might be asked to evaluate management trainees who participate in a series of
assessment exercises. In each case, it is assumed that the assessment is more than
a simple combination of test scores - it is a judgment on the part of a trained
professional.

Although expert judgment plays a part in each form of psychological measurement,

the practice of clinicaJ assessment and the implementation of structured assessment
programs both broadly defmed as the integration of multiple pieces of information
into an overall evaluation of the present state of the individual being assessed, is
somewhat unique in that human judgment is an integral component of the process.
In this unit we are studying all about assessment in psycho diagnostics. We start
with introducing what is psycho diagnostics and follow up by testing, assessment
and clinical practice. Then we deal with variable domains of psychological
assessment within which we discuss performance and personality variables. Then
we present the data sources for psychological assessment and then 'deal with
practical application of assessment.

1.1 OBJECTIVES
After completing this unit, you will be able to:

• Explain the definition and concept of Psychodiagnostics;

• Discuss the various domains of psychological assessment;

..• Explain the ten data sources for psychological assessment; and

• Describe the practical applications of psycho diagnostic assessment.

1.2 PSYCHODIAGNOSTICS
Korchin and Schuldberg (1981) define psychodiagnosis as a process that
:/1

a) uses a number of procedures,

b) intended to tap various areas of psychological functions,

c) both at a conscious and unconscious level,

d) using projective techniques as well as more objective and standardized tests,

e) in both cases, interpretation may rest on syinbolic signs as well as scoreable

responses,

f) with the goal of describing individuals in personological rather than normative

terms. (p. 1147)
6
The term psychodiagnosis might be applied more aptly to the neutral term clinical Introduction to
assessment. The central difference between clinical assessment and other testing Psychodiagnostics,
Deflnition, Concept
applications is that the clinician, rather than the test, is at the center of the
and Description
assessment process. The clinician has two distinct functions, both of which are
essential to the assessment process. First, the clinician must gather data. Although
standardized tests are used in clinical assessment, projective tests, interviews, and
behavioural observations represent the clinician's most important measurement
tools. Second, the clinician must integrate data from various tests, interviews, and
observations to form an overall assessment of the individual.

The data gathering function has clear implications for the quality of psychological
measurement. A clinician who makes inaccurate observations, conducts poorly
structured interviews, or misinterprets or misrecords responses to open ended
questions or ambiguous stimuli (e.g., responses to Rorschach cards) is not likely
to produce valid assessments. The clinician often functions as a measurement
instrument, and it is important to assess the reliability and validity of the clinical
data he or she gathers. Although it may not be immediately obvious, the clinician's
second function the integrationof clinical data-also affects the quality of psychological
measurement in clinical settings. Assessment represents an attempt to arrive at a
valid classification of each individual patient or client. In some cases, clinicians
may be called on to diagnose or assist in the diagnosis of mental or behavioural
disorders. In others, the clinician must make recommendations regarding the
placement of children or adults in remedial education or in therapeutic programs.
In anycase, the classification of individuals represents a fundamental type of
measurement, and the clinician's skill in integrating diverse sources of data may
be a critical factor in determining the validity of his or her classifications and
assessments of individuals.

1.3 TESTING, ASSESSMENT AND CLINICAL

PRACTICE
At one time, psychological testing represented one of the most important activities
of clinical psychologists (Korchin & Schuldberg, 1981; McReynolds, 1968; Rabin,
1981). Since the early 1980s, the practice of clinical psychologists has shifted
steadily from an emphasis on assessment and diagnosis to an emphasis on
psychotherapy and adjustment. Several reviews of research. and practice, however,
sug~est that testing will remain an important activity and that many of the tests
now widely used (e.g., standardized measures of intelligence, theMMPI-21 will
remain popular even if they are partially supplemented by new testing technologies.

Although clinicians do not appear to devote as much of their time to testing as

in the past, psychological testin~ still represents an important activity for practicing
clinicians. Wade and Baker's (1977) survey suggested that over 85% ofpracticing
clinical psychologists used tests and that over one third of their therapy time was
devoted to test administration and evaluation. Patterns of test use have been quite
stable since the1970s and probably will remain so for the foreseeable future.
Psychological testing appears to be a common activity, regardless of the
psychologist's therapeutic orientation (e.g., behavioural, cognitive).

The most widely used clinical tests can be divided into three types:

1) Individual tests of general mental ability,

,7
Introduction to 2) Personality tests, and
Psychodiagnostics
3) Neurological tests.

The Wechsler Intelligence Scales (WISC-I11 and WAIS-III) and the Stanford-
Binet represent the most popular tests of general mental ability. These tests serve
a dual function in forming assessments of individuals. First, an evaluation of general
mental ability often is crucial for understanding an individual's behaviour, since
many behavioural problems are linked to intellectual deficits. Second, individual
intelligence tests present an opportunity to observe the examinee's behaviour in
response to several intellectually demanding tasks, and thus they provide data
regarding the subject's persistence, maturity, problem-solving styles, and other
characteristics.

The Rorschach, the Thematic Apperception Test (TAT), and the Minnesota
Multiphasic Personality Inventory (MMPI) represent three of the most popular
personality tests. Of the three, the MMPI is most closely associated with the
diagnosis of psychopathology, whereas the TAT is most closely associated with
the assessment of motives and drives. The Rorschach may be used for a variety
of purposes, ranging from the assessment of specific personality traits to the
diagnosis of perceptual disorders, depending on the scoring system used.

The Bender-Gestalt and the Luria-Nebraska Neuropsychological Test Battery

are widely used in the diagnosis of neurological disorders. The Bender-Gestalt is
used in the assessment of perceptual disorders and organic dysfunctions, although
it may be used for a wide range of diagnostic purposes, whereas the Luria
Nebraska Battery provides a wide ranging assessment of perceptual, motor, and
intellectual functions that might be affected by damage to specific portions of the
brain.

1.4 VARIABLE DOMAINS OF

PSYCHOLOGICAL ASSESSMENT
Psycho diagnostic assessment methods have been developed for a wide spectrum
of trait and state variables affecting human behaviour. Following a proposal by
Cronbach (1949), one distinguishes between performance and personality measures,
the former referring to measures of maximum behaviour a person can maintain
the latter to measures of typical style of behaviour. Intelligence tests are examples
of performance measures, a test of extraversion introversion or of trait anxiety
examples of personality measures. While handy for descriptive purposes, this
distinction must not be mistaken for a theoretical one, as trait measures of
performance may in fact correlate with trait measures of personality (for example,
speed of learning with level of trait anxiety).

Within the limits of this distinction, the following summary list help to illustrate the
scope of behavioural variables for which assessment procedures have been
developed.

1.4.1 Performance Variables

These include measures of sensory processes (for example: tactile sensitivity,
visual acuity, color vision proficiency, auditory intensity threshold); perceptual
aptitudes (tactile texture differentiation, visual closure, visual or auditory pattern
recognition, memory for faces, visuo spatial tasks, etc.). Measures of attention
8
and concentration (tonic and phasic alertness; span of attention, distractibility, Introduction to
double performance tasks, vigilance performance over time), psychomotor Psychodiagnostics,
Definition, Concept
aptitudes (including a wide variety of speed of reaction task designs), measures
and Description
oflearning and memory (short term vs. long term memory, memory span, intentional
vs. incidental memory, visual/auditory / kinesthetic memory), assessment of
cognitive performance and intelligence (next to general intelligence a wide range
of primary mental abilities like verbal comprehension, word fluency, numerical
ability, reasoning abilities, measures of different aspects of creativity, of social or
emotional intelligence; assessment of language proficiency (developmental linguistic
performance, aphasia test systems, etc.); measures of social competence.

1.4.2 Personality Variables

These include the assessment of primary factors of personality (especially of the
so called Big Five and numerous more specific personality measurement scales);
special clinical schedules and symptom checklists (to assess anxiety, symptoms of
depression, schizotypic tendency, personality disorders, etc.); motivation structures
and interests; styles of daily living; pastime and life goals; assessment of incisive
life events; assessment of stress tolerance and stress coping (including coping with
serious illnesses and ailments); plus a wide range of still more specific assessment
variables, like measures for the assessment of specific motives or specific styles
of coping with illness or stressful life events.

By now even the number of Psycho diagnostic assessment methods meeting high
.psychometric standards must have already reached many tens of thousands,
rendering it totally impossible to give more than an informative overview within the
limitations of this unit. Rather than enumerating hundreds of assessment procedures
we shall here take a systematic look at major data sources for psychological
assessment and then briefly examine a few selected psycho diagnostic assessment
problems and how they would be typically approached.

Self Assessment Questions

1) Define psycho diagnostics and describe its features.

2) Elucidate testing, assessment and clinical practice.

3) What are the two variable domains of psychological assessment?

Introduction to
Psychodiagnostics 1.5 DATA SOURCES FOR PSYCHOLOGICAL
ASSESSMENT
By a rough estimte, more than 80% of all published assessment methods will be
questionnaires or objective tests. As we shall see in this section, the range of
possible assessment data sources extends considerably farther though. And in
practical assessment work too psychologists tend to complement (cross-check or
simply expand) their assessment by some or several non-questionnaire and non-
test methods. For example, in clinical assessments behaviour observation and
interview data, often also psycho physiological data are considered essential
additional information, as is interview and actuarial/biographical data in industrial/
organisational assessments. You can refer to Pawlik (1996, 1998) for details of
this classification of data sources.

1.5.1 Actuarial and Biographical Data

This category refers to descriptive data about a person's life history, educational,
professional and medical record, possibly also criminal record. Age, type and
years of schooling, nature of completed professional education/vocational training,
marital status, current employment and positions held in the past, leisure activities,
and past illnesses and hospitalisations are examples of actuarial and biographical
data. As a rule, such data is available with optimum reliability and often represents
indispensable information, for example,in clinical and industrial/organisational
assessments. Special biographical check list-item assessment instruments may be
available in a given language and culture for special applications.

1.5.2 Behaviour Trace

This refers to physical traces of human behaviour like handwriting specimen,
products of art and expression (drawings, compositions, poems or other kinds of
literary products), left-overs after play in a children's playground, style (tidy or
untidy, organised or 'chaotic') of self-devised living environment at home, but also
attributes of a person's appearance (e.g., bitten fmger nails!) and attire. While at
times perhaps intriguing, also within a wider humanistic perspective, the validity of
personality assessments based on behaviour traces can be rather limited. For
example, graphology (handwriting analysis) has been known for a long time to fall
short of acceptable validity criteria in carefully conducted validation studies (Guilford,
1959; Rohracher, 1969). On the other hand, behaviour trace variables may provide
valuable information in clinical contexts and at the process stage of developing
assessment hypotheses.

1.5.3 Behaviour Observation

In some sense, behaviour observation will form part of each and every assessment.
In the present context the word observation is used in a more restricted sense,
though, referring to direct recording! monitoring, describing, and operational
classification of human behaviour, over and above what may be already incorporated
in the scoring rationale of a questionnaire, an interview schedule, or an objective
test. Examples of behavior observation could be: studying the behaviour of an
autistic child in a playground setting; monitoring the behaviour of a catatonic
patient on a 24-hour basis; observing a trainee's performance in a newly designed
work place; or self monitoring of mood swings by a psychotherapy patient in
10 between therapy sessions. In a way, it is regrettable that the development of self
administering questionnaires and objective tests, starting in the 1920s and 1930s,has Introduction to
pushed careful, systematic behaviour observation to the side of the assessment Psychodiagnostics,
Definition, Concept
process. Only in recent years, especially within clinical assessment and treatment
and Description
contexts following behavior therapeutic approaches, is the potential value of
behaviour ratings for the assessment process being re discovered.

1.5.4 Behaviour Ratings

In behaviour rating assessments a person is asked to evaluate her / his own
behaviour or the behaviour of another person with respect to given characteristics,
judgmental scales, or checklist items. The method can be applied to concurrent
behaviour under direct observation (as in modem assessment center applications)
or, and more typically, to the rater's explicit or anecdotal memory of the ratee's
behaviour at previous occasions, in (pastor imagined) concrete situations, or in a
general sense. Behaviour rating methods may tell more about the meutal
representations that raters hold (developed, believe in) regarding the assessed
person's behaviour than about that behaviour itself.

Behaviour ratings constitute an essential methodology in clinical and industrial /

organisational psychology, in psychotherapy research and, last but not the least,
in basic personality research. Modem text books of personality research usually
give detailed accounts of how to devise behaviour rating scales and how to
compensate for common sources of error variance in ratings.

1.5.5 Expressive Behaviour

,
As a technical term, expressive behaviour refers to variations in the way in which
a person may look, move, talk, express her / his current state of emotion, feelings
or motives. Making a grim-looking face, trembling, getting a red face, sweating
on the forehead, walking in a hesitant way, speaking loudly or with an anxiously
soft voice, would be examples of variations in expression behaviour.

Thereby expression refers to stylistic attributes in a person's behaviour which will

induce an observer to draw explicitly or implicitly inferences about that person's
state of mind, emotional tension, feeling state, or the like. Assessing another
person from her / his expressive behaviour has a long tradition which goes back
to pre scientific days. More recently this approach has been extended to the study
of gross bodily movement expression (Feldman & Rime, 1991). This research
is relevant also for developing teaching aids in psychological assessment and
observer training.

1.5.6 Projective Technique

In the 1930s and 1940s many clinical psychologists, often influenced by
psychoanalysis and other forms of depth psychology, placed high expectations in
projective techniques, believing that they would induce a person to express her/
his perception of the ambiguous stimulus material, thus willingly or even unwillingly
'uncovering' her/his personal individuality, including motives and emotions that the
person may not even be aware of. Later, in thel950s and 1960s, research has
dearly shown ,that such assessment methods not only tend to lack in scoring
-.objectivity and psychometric reliability, but, and still more important, also turned
out to be of very limited validity, if any.

Nevertheless projective tests still keep some of their appeal today, and research
in the1960s and thereafter succeeded in improving techniques like the Rorschach 11
 Introduction to test at least as far as scoring objectivity and reliability are concerned. Further
Psychodiagnostics more thematic associationtechniques like the TATmaintain their status as assessment
methods potentially useful for deducing assessment hypotheses. In addition, special
TAT forms have been devised for assessing specific motivation variables such as
achievement motivation(McClelland, 1971). In the clinical context, once their
prime field of application, projective techniques are no longer considered a tenable
basis for hypothesis testing and theory development, let alone therapy planning
and evaluation.

Most psychodiagnostic assessments will include an interview at least as an ancillary

component and be it only for establishing personal contact and an atmosphere of
trust. Extensive research on interview structure, interviewer influences, and
interviewee response biases has given rise to a spectrum of interview techniques
for different purposes and assessment contexts. As a rule, clinical assessments will
start out with an exploratory interview in which the psychologist will seek to focus
.. .the problem at hand and collect information for deriving assessment hypotheses .
An interview is called unstructured if questions asked by the psychologist do not
follow a predetermined course and, largely if not exclusively, depends on the
person's responses and own interjections, Today most assessment interviews are
semi structured or fully structured. In the first case, the interviewer is guided by
a schedule of questions or topics, with varying degrees of freedom as to how the
psychologist may choose to follow up on the person's responses. Fully structured
interviews follow an interview schedule containing all questions to be asked, often
with detailed rules about which question(s)to ask next depending on a person's
response to previous questions. An example of such a structured clinical interview
schedule is the Structured Clinical Interview (SCID; Spitzer, Williams, & Gibbon,
1987) for clinical assessments according to the Diagnostic and Statistical Manual
(DSM). .

1.5.7 Questionnaires

Originally,personality inventories, interest surveys, and attitude or opinion schedules

were devised as structured interviews in written, following a multiple choice
response format (rather than presenting questions open ended as in an interview
proper). In a typical questionnaire each item (question or statement) will be
followed by two or three response alternatives such as 'Yes, do not know, No'
or 'True, Cannot Say: Untrue'.

Early clinical personality questionnaires like the Minnesota Multiphasic Personality

Inventory (MMPI) drew much of their item content from confirmed clinical
symptoms and syndromes. By contrast, personality questionnaires designed to
measure extraversion, introversion, neuroticism, and other personality factors in
healthy normal persons rely on item contents from empirical (mostly factor analytic)
studies of these primary factors of personality. As in behaviour ratings, research
identified a number of typical response sets also in questionnaire data, including
acquiescence (readiness to choose the affirmative response alternative, regardless
of content) and social desirability (preference for the socially more acceptable
response alternative). One way to cope with these sources of deficient response
objectivity was to introduce special validity scales (as early as the MMPI) to
control for response sets in a person's protocol. Yet individual differences in
response sets may and in fact do relate also to valid personality variance
themselves.
12
There is common agreement today that a person's responses to a questionnaire Introduction to
must not be interpreted as behaviourally veridical, but only within empirically Psychodiagnostics,
Definition, Concept
established scale validities. For example, a person's response to the questionnaire
and Description
item 'I frequently feel fatigued without being able to give a reason' must not be
interpreted, for example, as being behaviourally indicative of the so called fatigue
syndrome. Rather subjects may differ in what they mean by 'frequently'; by
'fatigued', by 'without reason' and on how broad a time and situation sample they
base their response. After all, questionnaire data is assessment data about mental
representations (perception, memory, evaluation) of behaviour variations in a
person's self perception and self cognition. They tell us a lot about the awareness
persons develop of their own behaviorwhich may, but need not, turn out veridical
in objective behavioural terms. So the aforementioned item will carry its diagnostic
value only as contributing to the.validity of a psychometrically reliable questionnaire
scale, in this case the scale 'neuroticism', with proven high clinical validity.

1.5.8 Objective Test

Tests constitute the core of psychological assessment instruments; it is through
them that psychological assessment has reached its level of scientific credibility
and wide range of applications. A test is a sample of items, questions, problems
etc. chosen so as to sample, in a representative manner, the universe of items,
questions or problems indicative of the trait or state to be assessed, for example,
an aptitude or personality trait or a mood state like alertness. The adjective
'objective' refers to administration, scoring, and response objectivity in test
development. Objective tests have been developed for the full spectrum of behaviour
variables mentioned above. Their number goes into tens of thousands.

A test is called an individual test, if it needs an examiner to administer it individually

to the person assessed. Psychomotor and other performance tests are typical
examples of tests still given individually. Still the most widely used intelligence test
system, the Wechsler Adult Intelligent Scale (WAIS; Wechsler, 1958; and later
editions) and its derivatives are administered individually throughout. The other
test design, group tests, are devised so that one examiner can administer them
to a number of persons (typically 20 to 30) at the same time in the same setting.
Traditionally group tests were developed in so-called paper-and-pencil form, with
the test items printed in a booklet and the person answering on a special answer
sheet.

While the development of objective behaviour tests of performance has been

brought to a high level of proficiency and psychometric quality, objective behaviour
tests of personality still linger in a far from final phase of development that is
despite massive, continuing efforts by Eysenck, Cattell and many others (Cattell
& Warburton, 1965; Hundleby, Pawlik, & Cattell, 1963). There is confirmed
empirical evidence to the fact that personality variables, i.e., measures of mode
and style of typical behaviour (rather than of optimum performance), are more
difficult to assess through objective tests than through conventional questionnaire
scales, behaviour observations, or behaviour ratings.

1.5.9 Psycho Physiological Data

All variations in behaviour and conscious experience are nervous system based,
with ancillary input from the honnone and the immune system, respectively, and
from peripheral organic processes. This should lead us to expect that individual
differences as revealed in psychological assessment should be accessible also, 13
Introduction to and perhaps even more directly so, through monitoring psycho physiological system
Psycho<tiagnostics parameters that relate to the kind of behaviour variations that an assessment is
targeted at. These psycho physiological variables include measures of brain activity
and brain function plasticity (electroencephalogram, EEG; functional magnetic
resonance imaging, fMRI; magnetoencephalogram, MEG), of hormone and immune
system parameters and response pattern, and of peripheral psycho physiological
responses mediated through the autonomic nervous system (cardiovascular system
response patterns: electrocardiogram, ECG; breathing parameters: pneumogram;
variations in sweat gland activity: electro dermal activity, EDA; in muscle tonus:
electro myogram, EMG; or in eye movements and in pupil diameter: pupillometry).
Standard psychophysiology textbooks (Caccioppo & Tassinary, 1990) introduce
basic concepts and measurement operations. Modem computer assisted recording
and analysis of psycho physiological data facilitate on line monitoring, often
concurrent with presentation of objective tests, in an interview situation or even,
by means of portable recording equipment, in a person's habitual daily life course
(ambulatory psychophysiology).

Self Assessment Questions

1) In the data sources of psychological assessment, describe actuarial and
.biographical data.

2) Explain behavioural trace and behavioural observation.

3) Describe behaviour ratings.

4) What is expressive behaviour?

5) Describe projective techniques.

14.
 Introduction to
6) Elucidate objective tests and questionnaires. Psychodiagnostics,
Defmition, Concept
and Description

7) What is involved in psycho physiological data?

1.6 PRACTICAL APPLICATIONS

In this section, you will be introduced to some frequently used methods of
psychological assessment for three frequently encountered assessment problems:
testing of intellective and other aptitude functions; psychological assessment in
clinical contexts; and vocational guidance testing.

1.6.1 Assessment of Intelligence and Other Aptitude

Functions
Clearly this is the primary domain of objective behaviour tests. The tests of
cognitive and other aptitudes were among the first methods of assessment ever
to be developed. Following up on the scaling proposal of mental age (age
equivalence, in months, of the number of test items solved correctly) as suggested
by Binet and Henri (1896) in their prototype scale of intellectual development in
early childhood, the German psychologist William Stem suggested an intelligence
quotient (IQ), defined as the ratio of mental age over biological age, as a
measurement concept for assessing a gross function like intelligence in a score that
would be independent of the age of the person tested. When subsequent research
revealed psychometric inadequacies with this formula, the US psychologist David
Wechsler proposed in his test (Wechsler, 1958) an IQ computed as age
standardized normalized standard score (with mean of 100 and standard deviation
of 15). Now available in re designed and re standardized form as Wechsler Adult
Intelligence Scale (WAIS), Wechsler Intelligence Scale for Children (WISC) and
Wechsler Pre-School Test of Intelligence, this test package has become the trend
setting intelligence test system of widest application, also internationally through
numerous foreign language adaptations. So a closer look at its assessment structure
seems in order.

The WAIS, for example, contains ten individually administered tests of two kinds:

i) verbaltests (general information, general comprehension, digit memory span,

arithmetic reasoning, fmding similarities of concepts) and

ii) five performance tests (digit symbol substitution, arranging pictures according
to the sequence of a story, completing pictures, mosaic test block design,
object assembly of two dimensional puzzle pictures). A person's test
performance is assessed in three IQ scores, viz.,

a) Verbal IQ, 15
Introduction to b) Performance IQ, and
Psychodiagnostics
c) TotalIQ.

Surprisingly enough, this kind of over all test of cognitive functioning is still
maintained in practical assessment work, despite undisputable and overwhelming
empirical evidence that general intelligence as a trait will only account for part, at
most perhaps about 30% of individual difference variation in cognitive tests
(Carroll, 1993). More recent examples of general intelligence type tests are the
Kaufman Assessment Battery (Kaufman & Kaufman,1983, 1993) .

.An alternative, theoretically more developed approach is called differential aptitude

assessment. Tests in this tradition are usually based on the results of factor analytic
multi trait studies of intelligence, originating in the work of Thurstone, Guilford and
their students. Thurstone's Primary Mental Abilities Test (PMA, Thurstone &
Thurstone, 1943), the Differential Aptitude Tests Battery (DAT;Bennett et al.,1981),
the Kit of Reference Tests for Cognitive Factors (French, Ekstrom, & Price,
1963) are typical examples of this assessment approach that provides separate
standardized scales for each selected primary intelligence factor.

In addition to these tests of intellective functions, numerous more specialised

aptitude tests have been developed such as the Wechsler Memory Scale (Wechsler
& Stone, 1974), special performance tests for neuropsychological assessment,
e.g., of brain damaged patients (Lezak,1995), for assessing mentally handicapped
persons and the diagnosis of dementia, as well as for special sensory and
psychomotor functions.

1.6.2 Psychological Assessment in Clinical Context

In addition to some assessment questions mentioned in the preceding paragraph,
in clinical psycho diagnostics one faces questions of testing for personality variables,
for behaviour disorders and / or specific symptomatologies (as in the hyperactivity
attention deficit disorder or posttraumatic stress disorder syndrome, for example).
The MMPI was a classical prototype clinical personality test, which like the
Wechsler tests of intelligence, has frequently been adapted and translated into
other languages. In addition, the large item stock of the MMPI (more than 550
items) has been utilised as a base from which a great number of special questionnaire
scales were developed, perhaps best known among them the Taylor Manifest
Anxiety Scale (MAS by Taylor, 1953). More recent personality questionnaires
used in clinical psycho diagnostics would include, for example, the 16 Personality
Factors Questionnaire (16 PF; Cattell, Cattell, & Cattell, 1994; also adapted and
translated into many other languages).

Besides these broad-band multi-scale questionnaires numerous assessment

instruments of narrower focus have been developed. Examples are the Beck
Depression Inventory, assessment instruments for studying phobic or obsessive
symptoms or, more recently, interview and diagnostic inference schedules
implementing the DSM and ICD approaches of descriptive disease classification.
Often introduced as the master methodology of clinical psycho diagnostics, DSM
IV- and ICD lO-based assessment strategies, have recently received increasing
criticism because of their purely descriptive, at theoretical nature, without recourse
to etiology of behaviour disorders and their development. It yet remains to be
seen if this criticism will give rise to novel, more etiologically oriented clinical
assessment philosophies.
16
1.6.3 Assessment in Vocational Guidance Testing and Job Introduction to
Psychodiagnostics,
SelectionIPlacement Definition, Concept
and Description
Ever since the 1920s a multitude of tests of varying conceptual band width have
been developed to assess specific aptitudes and interest variables related to
different vocational training curricula and on the job work demands. In vocational
guidance testing, integrated multi dimensional systems like one inaugurated by
Paul Host in the 1950s for the US State of Washington have since become a
model of approach in many countries. For example, the German Bundesanstalt
fursrbeit (Federal Office of Labor) developed its own multi dimensional testing
and prognosis system for vocational guidance counseling at senior high school
level. A similar, CAT formatted multi dimensional test system has been developed
by the German Armed Forces Psychological Service Unit. Comparable assessment
systems for guidance and placement have been devised, for example, in the UK
and the US. Compared to these broad band assessment systems, job selection
/ placement testing in industrial and organizational psychology typically is narrower
in scope, though more demanding in specific functions and job related qualifications.

Before implementing such an assessment system, a careful analysis of the job

structure, the nature of professional demands and of contextual situational factors
is absolutely compulsory. The literature offers a developed instrumentalism for
carrying out such analyses (Kleinbeck & Rutenfranz, 1987). Since the1970s /
1980s a new methodology called 'assessment center' has been introduced to
provide for behaviour observation, behaviour rating, and interview assessment
data in selected social situations devised to mirror salient demand situations in
l

future on the job performance (Lattmann,1989). In continental Europe the

assessment center approach has even become something like the method of
choice, in selecting, for example, persons for higher level managerial positions.
Moreover, single stage assessment and testing is now being replaced by on the .
job personnel development programs and special trainings offered to devise a
more intervention oriented, multi stage approach to assessment in organisational
development. In·CAT formatted assessment programs for industrial / organisational
selection and placement applications, also special simulation techniques (for
example, in testing for interpersonal cooperation under stress conditions) are
currently under development.

Self Assessment Questions

1) Discuss practical application of psychological assessment.

2) Describe assessment of intelligence and other aptitude functions.

17
Introduction to
Psychodiagnostics 3) Elucidate psychological assessment in clinical context.

4) Discuss assessment in vocational guidance testing and job selection and

placement.

1.7 LET US SUM UP

As a technical term, 'psycho diagnosis' refers to methods developed to describe,
record, and interpret a person's behaviour, be it with respect to underlying basic
dispositions (traits),to characteristics of state or change, or to such external criteria
as expected success in a given training curriculum or in psychotherapeutic treatment.
Methods of psychological assessment and testing constitute a major technology
that grew out of psychological research, with widespread impact in educational,
clinical, and industrial/organisational psychology, in counseling and, last but not
least, in research itself.

In the most general sense, all assessment methods share one common feature:
they are designed so as to capture the enormous variability (between persons, or
within a single person) in kind and properties of behaviour and to relate these
observed variations to explanatory dimensions or to external criteria of psychological
intervention and prediction. As a distinct field of psychology, psychological
assessment comprises (1) a wide range of instruments for observing, recording,
and analysing behavioural variations; (2) formalised theories of psychological
measurement underlying the design of these methods; and, fmally, (3) systematic
methods of psycho diagnostic inference in interpreting assessment results. In this
unit all three branches of psychological assessment have been covered and major
methods of assessment have been reviewed.

Assessment methods differ in the approach taken to study behavioral variations:

through direct observation, by employing self ratings or ratings supplied from
contact persons, by applying systematic behaviour sampling techniques (so called
'tests') or through studying psycho physiological correlates of behaviour. In this
unit these alternative approaches are dealt with as different data sources for
assessment.

1.8 UNIT END QUESTIONS

1) Discuss the concept and definition of psychodiagnostics?

2) Mention some of the most widely used tests in clinical practice?

3) Describe the variable-domains of psychological assessment?

18
 Introduction to
4) Discuss in depth the ten data sources for psychological assessment?
Psychodiagnostics,
5) Write about the practical applications of psychological assessment? Definition, Concept
and Description

1.9 SUGGESTED READINGS

Plante, T. G. (2005). Contemporary Clinical Psychology (2nd Ed.).New Jersey:
John Wiley & Sons, Inc.
Troll, T.1. (2005). Clinical Psychology (7th Ed.). USA: Thomson Learning, Inc.

;-.,
...
•
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2:
19
 UNIT 2 METHODS OF BEHAVIOURAL
ASSESSMENT
Structure
2.0 Introduction

2.1 Objectives

2.2 Behavioural Assessment

2.2.1 Goals of Assessment
2.2.2 Behavioural Assessment and Traditional Assessment
2.2.3 Focus of Behavioural Assessment
2.2.4 Assumptions and Perspectives of Behavioural Assessment

2.3 Assessing Target Behaviours

2.3.1 Selection of Target Behaviour

2.4 Self-Report Methods

2.4.1 Examples of Self-Report Inventories
2.4.2 Strengths and Weaknesses of Self-Report Inventories
2.4.3 Formats of Self-Report Inventories

2.5 Direct Observation and Self-Monitoring

2.5.1 Disadvantages of Direct Observation
2.5.2 Types of Direct Observation
2.5.3 Unobtrusive Observation
2.5.4 Analogue Observation
2.5.5 Self-Monitoring

2.6 Psychophysiological Assessment

2.7 Future Perspectives

2.8 Let Us Sum Up

2.9 Unit End Questions

2.10 Suggested Readings

2.0 INTRODUCTION
In this unit we will be dealing with behavioural assessment. We start with
introduction to behavioural assessment within which we also discuss goals of
assessment, work out the differences between traditional and behavioural
assessments, indicate the typical focus of behavioural assessment and state the
various assumptions underlying behavioural assessment.

Then we point out the importance of target behaviours andhow the target
behaviours should be selected. This is followed by Methods of assessment
which includes self report methods including self report inventories. We point out
the strengths and weaknesses of these self report inventories and present the
format of self report inventories such as the interview, questionnaires etc. This is
followed by direct observation as a method of assessment, within which we
20
discuss the disadvantages of direct observations and present the types of Methods of Behavioural
observations which includes unobtrusive observation, analogue observation etc. Assessment

Then we take up the psychophysiolofical assessemtn and discuss the future

perspectives of behavioural assessment.

2.1 OBJECTIVES
After completing this unit you will be able to:

• Explain what behavioural assessment means;

• Describe the various methods of behavioural assessment;

• Discuss the advantages and limitations of the methods of behavioural

assessment; and

• Discuss the' future perspectives of behavioural assessment.

2.2 BEHAVIOURAL ASSESSMENT

A major impetus for behaviour therapy was disenchantment with the medical
model of psychopathology that views problem behaviours as the result Qf an
underlying illness or pathology. Behaviourists assert that both 'disordered' and
'non-disordered'behaviour can be explained using a common set of principles
describing classical and operant conditioning.

Behaviourists believe that behaviours are best understood in terms of their function.
Two 'symptoms'may differ in form, while being similar in function. For example,
Jacobson (1992) describes topographically diverse behaviours such as walking
away or keeping busy that all function to create distance between a client and his
partner.Conversely, topographically similar behaviours may serve different functions.
For example, tantrums may serve to elicit attention from adults or may be an
indication that the present task is too demanding. Behaviour therapists try to
understand not only the form but also the function of problem behaviours within
the client's environment.

2.2.1 Goals of Assessment

The initial goals of assessment are to identify and construct a case formulation of
the client's difficulties that will guide the clinician and patient towards potentially
effective interventions. For the behaviour therapist, this involves identifying problem
behaviours, stimuli that are present when the target behaviours occur, along with
associated consequences, and organism variables including learning history and
physiological variables. The results of this functional analysis are used to design
a behavioural intervention that is tailored to the individual client and conceptually
linked to basic learning principles.

2.2.2 Behavioural Assessment and Traditional Assessment

Behavioural assessment is one of a variety of assessment traditions such as
projective testing, neuropsychological assessment, and objective testing. Behavioural
assessment distinguishes itself by being a set of specific techniques as well as a
way of thinking about behaviour disorders and how these disorders can be changed.
One of its core assumptions is that behaviour can be most effectively understood
by focusing on preceding events and resulting consequences. Out of this core 21
Introduction to assumption has come a surprisingly diverse number of assessment methods;
Psychodiagnostics including behavioural interviewing, several strategies of behavioural observation,'
measurement of relevant cognitions, psycho physiological assessment, and a variety
of selfreport inventories.

Behavioural assessment can be most clearly defmed by contrasting it with traditional

assessment. One of the most important comparisons is the emphasis that
behavioural assessment places on situational determinants of behaviour. This
emphasis means that behavioural assessment is concerned with a full understanding
of the relevant antecedents and consequences of behaviour. In contrast, traditional
assessment is often perceived as more likely to view behaviour as the result of'
enduring, underlying traits. It is this underlying difference in conceptions of causation
that explains most of the other contrasts between the two traditions. An extension
of this conceptual difference is that behavioural assessment goes beyond the
attempt to understand the contextual or situational features of behaviour and,
more importantly, concerns itself with ways to change these behaviours. There is
-a close connection between assessment itself and its implications for treatment.
Thus, behavioural assessment is more direct, utilitarian, and functional.

The perceived limitations of traditional assessment were a major factor in stimulating

the development of behavioural assessment. Specifically, traditional assessment
was'considered to focus too extensively on abstract, unobservable phenomena
that were distant from the actual world of the client. In addition, behaviourists felt
that traditional clinical psychology had stagnated because its interventions were
not sufficiently powerful and too much emphasis was placed on verbal therapy.

A further contrast between behavioural and traditional assessment is that behavioural

assessment is concerned with clearly observable aspects in the way a person
interacts with his or her environment. A typical behavioural assessment might
include specific measures of behaviour (overt and covert), antecedents (internal
and external), conditions surrounding behaviours, and consequences. This
knowledge can then be used to specify methods for changing relevant behaviours.
Although some behavioural assessors might take selected personality traits into
account, these traits would be'considered relevant only if they had direct implications
for therapy. For example, certain personality styles interact with the extent and
type of depressive cognitions, and the existence of a personality disorder typically
predicts therapeutic outcome. This focus on the person and his or her unique
situation is quite different from psychodynamic, biochemical, genetic or normative
trait models.

2.2.3 Focus of Behavioural Assessment

The behavioural approach stresses that different behaviour disorders are typically
expressed in a variety of modes. These might include overt behaviours, cognitions,
changes in physiological states, and patterns of verbal expressions. This implies
that different assessment strategies should be used for each of these modes.

An inference based on one mode does not necessarily generalise to another. For
example, anxiety for one person may be caused and maintained primarily by the
person's cognitions and only minimally by poor social skills. Another person might
have few cognitions relating to anxiety but be anxious largely because of inadequate "
social skills. The person with inadequate social skills might be most effectively
treated through social skills training and only minimally helped through approaches
that alter irrational thoughts.
22
It should also be noted that altering a person's behaviour in one mode-is likely Methods of Behavioural
to affect other modes, and these effects might have to be considered. Whereas Assessment
the preceding information presents a relatively rigid and stereotyped distinction
between traditional and behavioural assessment, most practicing clinicians, including
those who identify themselves as behaviour therapists, typically combine and
adopt techniques from both traditions.

2.2.4 Assumptions and Perspectives of Behavioural

Assessment
The assumptions and perspectives of behavioural assessment have resulted in an
extremely diverse number of approaches and an even wider variety of specific
techniques. These approaches and their corresponding techniques can be organised
into the areas of behavioural interviewing, behavioural observation, cognitive
behavioural assessment, psychophysiological assessment, and self report inventories.

Self Assessment Questions

1) Define and .describe behavioural assessment.

2) What
, are the goals of behavioural assessment?

3) Differentiate between behavioural assessment and traditional assessment.

4) Describe the assumptions underlying behavioural assessment.

2.3 ASSESSING TARGET BEHAVIOURS

The process of defining and measuring target behaviours is essential to behavioural
assessment. Vague complaints must be expressed as specific quantifiable behaviours.
For instance, anger might include responses such as hitting walls, refusing to talk
or other specific behaviours. The client's goals must be defined in terms of those·
specific behavioural changes that would occur if treatment were effective. 23
Introduction to 2.3.1 Selection of Target Behaviour
Psychodiagnostics

Target behaviour selection can be complicated by the complexity with which

many responses are expressed. Behaviourists have long recognised that many
clinical problems involve responses that cannot be readily observed. Some responses
such as intrusive thoughts or aversive mood states are private by nature. Others,
such as sexual responses, may be private and unobservable due to social
convention. Many clinical complaints may include both observable and private
responses. For example, depressed mood and suicidal ideation might be
accompanied by crying, or other overt behaviours. Public and private responses
may not always appear consistent. For example, an agoraphobic client may enter
a shopping mall during an assessment but may do so only with extreme subjective
distress.

Cone (1978) suggested that the bio informational theory of emotion developed by
Lang(1971) is useful for conceptualising clinical problems. Lang (1971) asserted
that emotional responses occur in three separate but loosely coupled response
systems. These are the cognitive/linguistic, overt behavioural, and psycho
physiological systems. A given response such as a panic attack may be divided
into physiological responses such as increased heart rate and respiration, cognitive
responses such as thoughts about dying or passing out, and overt behavioural
responses such as escape from the situation, sitting down, or leaning against a wall
for support. Ideally, each response mode should be assessed, there being no a
priori reason to value one modality over another. Discrepancies arebest considered
with regard to the particular client, the goals of therapy, and ethical considerations.
For example, it may be wise to take verbal reports of pain seriously even if they
do not match evidence of tissue damage or physiological arousal.

The triple response conceptualisation of clinical problems has encouraged the

development and utilisation of methods that more or less directly assess each
response mode. Overt behaviours have been assessed by direct observation, with
psycho .physiological assessment used to assess bodily responses, and self-report
measures developed to quantify subjective experiences. The apparent link between
assessment methods and particular response modes is not absolute. For example,
a client might verbally report sensations such as heart pounding, muscle tension,
or other noticeable physical changes. However, in some cases, the method of
assessment is more closely bound to a particular response mode. This is true of
physiological processes such as blood pressure that are outside of the client's
awareness and in the case of thoughts or subjective states that can only be
assessed by verbal report. In the following sections self-report measures, direct
observation, and psycho physiological measurements are described in more detail.

2.4 SELF REPORT METHODS

A self report inventory is a personality inventory in which a person is asked which
of a list of traits and characteristics describe her or him or to indicate which
behaviours and hypothetical choices he or she would make. This type of test is
often presented in a paper-and-pencil format or may even be administered on a
computer. A typical self report inventory presents a number of questions or
statements that mayor may not describe certain qualities or characteristics of the
test subject.
24
Self-report measures have been used by many researchers to assess the behavioural, Methods of Behavioural
cognitive, and affective aspects of task engagement. Items relating to the cognitive Assessment

aspects of engagement often ask the subjects to report on factors such as their
attention versus distraction during a task, the mental effort they expend on these
tasks (e.g., to integrate new concepts with previous knowledge), and task
persistence (e.g., reactions to perceived failures to comprehend the concerned
material). Subjects can also be asked to report on their response levels during
class time (e.g., making verbal responses within group discussions, looking for
distractions and engaging in non-academic social interaction) as an index of
behavioural task engagement. Affective .engagement questions typically ask the
subjects to rate their interest in and emotional reactions to learning tasks on
indices such as choice of activities (e.g., selection of more versus less challenging
tasks), the desire to know more about particular topics, and feelings of stimulation
or excitement in beginning new projects.

A variety of self-report questionnaires have been used in research on subjects'

engagement, reflecting the multi faceted nature of the construct. Wigfield (1997)
suggested that high levels of task engagement were often reflected in factors such
as the subjects' learning beliefs and expectations (e.g., Miller, et al, 1996), self-
efficacy (Pintrich & Schrauben, 1992), task interest levels (Schiefele, 1995),and
use of effective and/or deep, rather than "shallow" or "surface" learning strategies.
Researchers have used different combinations of these indicators in empirical
evaluations. Thus, typical assessment protocols comprise a number of separate
indices for assessing the cognitive, affective or behavioural manifestations of task
related erlgagement. This reflects the fact that no one instrument is likely to be
able to comprehensively assess the subject's engagement on all of the construct
dimensions listed. Using separate indices also allows educators to adapt the focus
of their protocols more towards their own instructional goals.

Attitudes towards, and interests in, learning tasks are highly interrelated constructs
and thus often assessed within the same scale

2.4.1 Examples of Self-Report Inventories

The MMPI-2

Perhaps the most famous self-report inventory is the Minnesota Multiphasic

Personality Inventory (MMPI). This personality test was first published in the
1940s, later revised in the 1980s and is today known as the MMPI-2. The test
contains more than 500 statements that assess a wide variety of topics including
interpersonal relationships, abnormal behaviours and psychological health as well
as political, social, religious and sexual attitudes.

The 16 Personality Factor Questionnaire

Another well known example of a self-report inventory is the questionnaire

developed by Raymond Cattell to assess individuals based on his trait theory of
personality. This test is used to generate personality profile of the individual and
is often used to evaluate employees and to help people select a career.

California Personality Inventory

California personality inventory is based on the MMPI, from which nearly half
questions are drawn. The test is designed to measure such characteristic as self
control, empathy and independence. 25
Introduction to 2.4.2 Strengths and Weaknesses of Self-Report Inventories
Psychodiagnostics
Self-report inventories are often a good solution when researchers need to
administer a large number of tests in relatively short space of time. Many self
report inventories can be completed very quickly, often in as little as 15 minutes.
This type of questionnaire is an affordable option for researchers faced with tight
budgets.

Another strength is that the results of self report inventories are generally much
more reliable and valid than projective tests. Scoring of the tests a standardized
and based on norms that have been previously established.

However, self report inventories do have their weaknesses. For example, while
many tests implement strategies to prevent ''faking good" or "faking bad," research
has shown that people are able to exercise deception while taking self report tests
(Anastasi & Urbina, 1997) .

. Another weakness is that some tests are very long and tedious. For example, the
MMPI takes approximately 3 hours to complete. In some cases, test respondents
may simply lose interest and not answer questions accurately. Additionally, people
are sometimes not the best judges of their own behaviour. Some individuals may
try to hide their own feelings, thoughts and attitudes.

There are several formats for collecting self report data. These include interviews,
questionnaires and inventories, rating scales, think aloud, and thought sampling
procedures. It is most often the case that an assessment would include several of
these methods.

2.4.3 Formats of Self-Report Inventories

Interviews
The clinical interview is the most widely used method of clinical assessment, and
is particularly advantageous in the early stages of assessment. The most salient of
its advantages is flexibility. The typical interview begins with broad-based inquiry
regarding the client's functioning. As the interview progresses, it becomes more
focused on specific problems and potential controlling variables. Interviewing also
provides an opportunity to directly observe the client's behaviour, and to begin
developing a therapeutic relationship.

The clinical interview also has important disadvantages. Interviews elicit information
from memory that can be subject to errors, omissions, or distortions. Additionally,
the interview often relies heavily on the clinician to make subjective judgements
in selecting those issues that warrant further assessment or inquiry. One could
reasonably expect that different clinicians could emerge from a clinical interview
with very different conceptualisations of the client.

Structured and semi structured interviews were developed in order to facilitate

consistency across interviewers. Structured interviews are designed for
administration by non clinicians such as research assistants' in large scale studies.
A structured interview follows a strict format that specifies the order and exact
wording of questions. Semi-structured interviews are more frequently used by
trained clinicians. They J?rovide a more flexible framework for the course of the
interview while pro~iding enough structure to -promote consistency across
administrations. While specific questions may beprovide~he interviewer is free
26 to pursue additional information when this seems appropriate,. In general, the goal
of enhanced reliability has been attained with the use of structured and semi Methods of Behavioural
structured interviews. However, the majority of these interviews are designed for Assessment

purposes of diagnosis rather than more particular target behaviours or functional

assessment.

Just as the clinical interview proceeds from a general inquiry to more focused
assessment of behavioural targets, other self-report measures vary in the degree
to which they assess general areas of functioning versus particular problem
behaviours. In general, those measures that assess general constructs such as
depression or general domains of functioning are developed using group data
and are meant to be applicable to a wide range of clients. Examples of these
nomothetic measures include personality inventories and standardized
questionnaires. Other self report methods can be tailored more toward individual
clients and particular problem responses. These include rating scales and think
aloud procedure,s.

Table 1: Steps in Behavioural Interviewing

• Identify the problem and specify target behaviours.

• Identify and analyse relevant environmental factors.

• Develop 'a plan for intervention.

• Implement this plan.

• Evaluate the outcomes of treatment.

• Modify treatment as needed and re evaluate outcomes.

Questionnaires
Questionnaires are probably the next most common assessment tool after interviews.
Questionnaires can be easily and economically administered. They are easily
quantified and the scores can be compared across time to evaluate treatment
effects. Finally, normative data is available for many questionnaires so that a given
client's score can be referenced to a general population.

There has been a rapid proliferation of questionnaires over the last few decades.
Some questionnaires focus on stimulus situations provoking the problem behaviour,
such as anxiety provoking situations. Other questionnaires focus on particular
responses or on positive or negative consequences. The process of choosing
questionnaires from those that are available can be daunting. Fischer and Corcoran
(1994) have compiled a collection of published questionnaires accompanied by
summaries of their psychometric properties.

Many behaviourists have expressed concern with the apparent reliance on

questionnaires both in clinical and in research settings. These criticisms stem in
part from repeated observations that individuals evidence very limited ability to
identify those variables that influence their behaviour. Additionally, behaviourists
point out that we tend to reify the constructs that we measure. This may lead to
a focus on underlying dispositions or traits in explaining behaviour rather than a
thorough investigation of environmental factors and the individual's learning history.
Behaviourists do make use of questionnaires but tend to regard them as measures
of behavioural responses that tend to correlate rather than as underlying traits or
dispositions. 27
Introduction to . Rating Scales and Self-Ratings
Psychodiagnostics
Rating scales can be constructed to measure a wide range of responses. They are
often incorporated into questionnaires or interviews. For example, a client may be
asked to rate feelings of hopelessness over the past week on a scale of 0-8.
Clinicians might also make ratings of the client's noticeable behaviour during the
interview or the client's apparent level of functioning.

The main advantage of rating scales is their flexibility. They can be used to assess
problem behaviours for which questionnaires are not available. Additionally, rating
.scales can be administered repeatedly with greater ease than questionnaires. For
example, rather than pausing to complete an anxiety questionnaire, a client might
provide periodic self-ratings of discomfort during an anxiety provoking situation.
The main disadvantage of rating scales is the lack of normative data.

Thought Listing and Think A loud Procedures

Clinicians are sometimes interested in the particular thoughts that are experienced
by a client in a situation such as a phobic exposure or role play. The use of
questionnaires may interfere with the situation and may not capture the more
idiosyncratic thoughts of a particular client. Think aloud and thought sampling
procedures may be used under these circumstances. .

These procedures require the client to verbalize thoughts as they occur in the
assessment situation. Thoughts can be reported continually in a think-aloud format
or the client may periodically be prompted to report the most recently occurring
thoughts in a thought sampling procedure. When the requirements of think aloud
procedures may interfere with the client's ability to remain engaged in the assessment
situation, the client may be asked to list those thoughts that are recalled at the end
of the task. These procedures carry the advantage of being highly flexible. Like
other highly individualised methods, they also carry the disadvantage of lacking
norms.

Self Assessment Questions

1) What are self report methods?

2) State examples of a few major self report inventories.

3) Discuss the strengths and weaknesses of self report inventories.

28
 Methods of Behavioural
4) Discuss the different formats of self report inventories as for example Assessment
interviews etc.

2.5 DIRECT OBSERVATION AND SELF

MONITORING
One of the most direct forms of assessment is observation by trained observers.
Direct observation can be conducted by clinicians, professional staff, or by
participant observers who already have contact with the client. Rather than reporting
in retrospect, observers can record all instances of the target behaviour that they
witness, thereby.producing a frequency count. Depending on the type of target
response, this task could be arduous. Recording all instances of highly frequent
and repetitive behaviours can place undue demands on observers. There are
several ways to decrease the demands on the observer and thereby facilitate
more faithful data collection. One option is the use of brief observation periods.
For example, a. parent might be asked to record the frequency of the target
.behaviour at intervals during those specific situations when the behaviour is
probable: When the target behaviour is an ongoing response, the observer might
employ momentary sampling procedures and periodically check to see if the
behaviour is occurring. The features of direct observation are listed in the box
given below.

Key Characteristics of Direct Observation and Recording of Behaviour

• Behaviour is observed in a natural setting.

• Behaviour is recorded or coded as it occurs.

• Impartial, objective observers record behaviour.

• Behaviour is described in clear, crisp terms, requiring little or no inference

by the observer.

2.5.1 Disadvantages of Direct Observation

Direct observation carries some disadvantages. It can be costly and time-consuming.
In the strictest sense it would be favourable to utilise multiple observers so that
the concordance of their recording could be checked. It has been shown that the
reliability of observations is enhanced when observers know that the data will be
checked. However, this may not be practical, particularly in clinical settings. The
I use of participant observers may be a less costly alternative in many cases. Direct
observation can also result in reactive effects. Reactivity refers to changes in
behaviour that result from the assessment procedure. Making clients aware that
they are being observed can alter the frequency or form of the target response.
This can occur even with the use of participant observers. The variables that
influence observee reactivity are not well understood. For ethical reasons, it may
be unwise to conduct observations without the client's awareness. 29
Introduction to Also in direct observations, people know that you are watching them. The only
Psychodiagnostics danger is that they are reacting to you. As stated earlier, there is a concern that
individuals will change their actions rather than showing you what they're REALLY
like. This is not necessarily bad, however. For example, the contrived behaviour
may reveal aspects of social desirability, how they feel about sharing their feelings
in front of others, or privacy in a relationship. Even the most contrived behaviour
is difficult to maintain over time. A long term observational study will often catch
a glimpse of the natural behaviour. Other problems concern the generalisability of
findings. The sample of individuals may not be representative of the population or
the behaviours. observed are not representative of the individual (you caught the
person on a bad day). Again, long-term observational studies will often overcome
the problem of external validity. What about ethical problems you say? Ethically,
people see you, they know you are watching them (sounds spooky, I know) and
they can ask you to stop.

2.5.2 Types of Direct Observation

There are two commonly used types of direct observations:

Continuous Monitoring: This involves observing a subject or subjects and

recording (either manually, electronically, or both) as much of their behaviour as
possible. Continuos Monitoring is often used in organisational settings, such as
evaluating performance. Yet this may be problematic due to the Hawthorne Effect.
The Hawthorne Effect states that workers react.to the attention they are getting
from the researchers and in turn, productivity increases. Observers should be
aware of this reaction. Other CM research is used in education, such as watching
teacher-student interactions. Also in nutrition where researchers record how much
an individual eats. CM is relatively easy but a time consuming endeavor. You will
be sure to acquire a lot of data.

Time Allocation: This involves a researcher randomly selecting a place and time
and then recording what people are doing when they are first seen and before
they see you. This may sound rather bizarre but it is a useful tool when you want
to find out the percent of time people are doing things (i.e. playing with their kids,
'working, eating, etc.), Thereare several sampling problems with this approach.
First, in order to make generalisations about how people are spending their time
the researcher needs a large representative sample. Sneaking up on people all
over town is tough way to spend your days. In addition, questions such as when,
how often, and where should you observe are often a concern. Many researchers
have overcome these problems by using nonrandom locations but randomly visiting
them at different times.

2.5.3 Unobtrusive Observation

Unobtrusive measures involves any method for studying behaviour where individuals
do not know they are being observed (don't you hate to think that this could have
happened to youl). Here, there is not the concern that the observer may change
the subject's behaviour. When conducting unobtrusive observations, issues of
validity need to be considered. Numerous observations of a representative sample
need to take place in order to generalise the findings. This is especially difficult
when looking at a particular group. Many groups posses unique characteristics
which make them interesting studies. Hence, often such findings are not strong in
external validity.Also, replication is difficult when using non-conventional measures
30 (non-conventional meaning unobtrusive observation). Observations of a very
 specific behaviours are difficult to replicate in studies especially if the researcher Methods of Behavioural
is a group participant (we'll talk more about this later). The main problem with Assessment

unobtrusive measures, however, is ethical. Issues involving informed consent and

invasion of privacy are paramount here. An institutional review board may frown
upon your study if it is not really necessary for you not to inform your subjects. -

There are two types of unobtrusive research measures you may decide to undertake
in the field and these are given below. (i) behaviour trace studies (ii) disguidsed
field observation. Let us deal with these in some detail.

Behaviour Trace Studies: Behaviour trace studies involve findings things people
leave behind and interpreting what they mean. This can be anything to vandalism
to garbage. The University of Arizona Garbage Project one of the most well
known trace studies. Anthropologists and students dug through household garbage
to find out about such things as food preferences, waste behaviour, and alcohol
consumption. Again, remember, that in unobtrusive research individuals do not
know they are being studied. How would you feel about someone going through
your garbage? Surprisingly Tucson residents supported the research as long as
their identities were kept confidential. As you might imagine, trace studies may
yield enormous data.

Disguised Field Observations: In Disguised field analysis the researcher pretends

to join or actually is a member of a group and records data about that group. The
group does not know they are being observed for research purposes. Here, the
observer may take on a number of roles. First, the observer may decide to
become a complete participant in which they are studying something they are
already a member of. For instance, if you are a member of a sorority and study
female conflict within sororities you would be considered a complete participant
observer.

On the other hand you may decide to only participate casually in the group while
collecting observations. In this case, any contact with group members is by
acquaintance only. Here you would be considered an observer participant.

Finally, if you develop an identity with the group members but do not engage in
important group activities consider yourself a participant observer. An example
would be joining a-cult but not participating in any of their important rituals (such
as sacrificing animals). You are however, considered a member of the cult and
trusted by all of the members. Ethically, participant observers have the most
. problems. Certainly there are degrees of deception at work. The sensitivity of the
topic and the degree of confidentiality are important issues to consider.

2.5.4 Analogue Observation

Analogue observation is a method of direct observation, but it occurs in a contrived,
carefully structured setting, designed specifically for the assessment. By contrast,
direct observation occurs in a naturalistic setting. In analogue assessment or
observation, after the setting has been structured, direct observation of behaviour
follows, using many of the principles of observation previously described, .

2.5.5 Self-Monitoring
In self-monitoring procedures, the client is asked to act as his or her own observer
and to record information regarding target behaviours as they occur. Self monitoring
can be regarded as a self report procedure with sorv= benefits similar to direct 31
Introduction to observation. Because target behaviours are recorded as they occur, self-monitored
Psychodiagnostics data maybe less susceptible to memory related errors. Like other self report
methods, self monitoring can be used to assess private responses that are not
amenable to observation. Self-monitored data also have the potential to be more
complete than that obtained from observers, because the self monitor can potentially
observe all occurrences of target behaviours.

There are several formats for self monitoring. Early in assessment, a diary format
is common. This allows the client to record any potentially important behaviours
and their environmental context in the form of a narrative. As particular target
behaviours are identified, the client may utilise data collection sheets for recording
more specific behavioural targets and situational variables. When behaviours are .
highly frequent or occur with prolonged duration, the client may be asked to
estimate the number of occurrences at particular intervals or the amount of time
engaged in the target response.

It is often desirable to check the integrity of self monitored data. Making the client
aware that their self-monitored data will be checked is known to enhance the
accuracy of data collection. Self-monitored data can be checked against data
obtained from external observers or can be compared to measured byproducts
of the target response. For example, self monitored alcohol consumption can be
compared to randomly tested blood a1cohollevels.

Among the disadvantages of self monitoring are its demands on the client for data
collection and the lack of available norms. Like direct observation, self monitoring
also produces reactive effects. However, this disadvantage in terms of measurement
can be advantageous in terms of treatment. This is because reactive effects tend
to occur in the therapeutic direction, with desirable behaviours becoming more
frequent and undesired behaviours tending to decrease.

This temporary effect of the procedure can produce some relief for the client and
help to maintain an investment in treatment.

Self Assessment Questions

1) Define and describe direct observation.

2) Describe self monitoring.

3) What are the disadvantages of direct observation?

32
 Methods of Behavioural
4) Delineate the different types of direct observation. Assessment

5) What is meant by unobtrusive observation?

6) Describe analogue observation.

···············f······································ .

7) Elucidate self monitoring. r

.................................................................................................................

2.6 PSYCHOPHYSIOLOGICAL ASSESSMENT

Psychophysiological assessment is a highly direct form of measurement that involves
assessing the byproducts of physiological processes that are associated with
behavioural responses. For instance, a cardio tacho meter can be used to measure
electrical changes associated with activity of the heart. While clients can verbally
report many physiological changes, a direct measurement via instrumentation carries
several advantages. Physiological measures can be sensitive to subtle changes and
to physiological processes that occur without the client's awareness. They can
also provide both discrete and continuous data with regard to physiological
processes while requiring only passive participation from the client. Additionally,
most clients lack familiarity with psycho physiological measurement, making
deliberate distortion of responses improbable.
The main disadvantage of psychophysiologicalmeasurement is the cost of equipment
and training. This problem is compounded by the observation that it is often
desirable to include measures of multiple physiological channels. For example,
there can be substantial variance across individuals in the degree of response
exhibited on a given physiological index. Those measures that are most sensitive
for a given individual may not be included in a limited psycho physiological
assessment. With technological advances in this area, less costly instrumentation
I will likely become more available.
J
)

2.7 FUTURE PERSPECTIVES

Over the past two decades, research devoted to direct observation and self-
monitoring procedures has declined dramatically. This trend has been mirrored by 33

1
Introduction to a rapid proliferation of questionnaires and research examining their psychometric
Psychodiagnostics properties. One likely reason for this shift is the current climate of managed
healthcare. The goal of more efficient and less costly healthcare has created
pressure f?r more rapid and inexpensive forms of assessment and treatment.
Psycho physiologicalrecording equipment is simply too expensive for most clinicians
to afford and maintain. The task of training and paying trained observers can also
be costly.
Even when participant observers are used, the procedure can place inordinate
demands onthese individuals. While self-monitoring is less costly, it does place
more demands on the client and more time is required to obtain useful information
beyond an initial interview. In general, the more direct methods of behavioural
assessment have the disadvantage of also being more costly and time consuming.
The trend toward more rapid assessment seems to select for brief, easily
administered, and relatively inexpensive questionnaires and rating scales. There
have been calls for more research devoted to behavioural assessment methods.
This research might lead to more efficient methods for implementing' these
assessment procedures. There is also a need to determine if the data from these
assessments facilitates more efficient andloreffective treatment. If empirical support
for the utility of behavioural assessment techniques is generated, this may help to
increase the receptiveness of third party payers to the use of these procedures.

To conclude what wehave discussed so far, we could state that the goals and
conduct of behavioural assessment are directly linked to learning theory and to the
goal of altering behaviour through the use of behavioural principles. The hallmark
of behavioural assessment is an emphasis on the function rather than the form of
problem behaviours, and on the specification of problem behaviours, as well as
their environmental and organismic controlling variables in more detail than is
typical of diagnostic classification. While diagnostic assessment tools might be
included, behavioural assessment demands further molecular analysis of specific
target behaviours and controlling variables.

Behaviour therapists have long recognised that clinical problems are often part of
the client's private experience, and that many are a combination of verbal,
physiological, and overt behavioural responses. A comprehensive assessment
considers each of these modalities. While these ideas are still fundamental in
behavioural assessment, the more costly and time-demanding methods of
behavioural assessment are becoming more difficult to include in clinical assessment
and are less apt to be the focus of research.

2.8 LET US SUM UP

Behavioural assessment differs from traditional assessment in several fundamental
ways. Behavioural assessment emphasises direct assessments (naturalistic
observations) of problematic behaviour, antecedent (situational) conditions, and
consequences (reinforcement). By conducting such a functional analysis, clinicians
can obtain a more precise understanding of the context and causes of behaviour.
It is also important to note that behavioural assessment is an ongoing process,
occurring at all points throughout treatment.

We have surveyed some of the more common behavioural assessment methods.

Behavioural interviews are used to obtain a general picture of the presenting
problem and of the variables that seem to be maintaining the problematic behaviour.
34 Observation methods provide the clinician with an actual sample (rather than a
 self-report) of the problematic behaviour. Observations can be made in Methods of Behavioural
naturalistic conditions (as behaviour typically and spontaneously occurs) or under Assessment

more controlled conditions (in simulated or contrived situations or conditions).

Behavioural assessors may also have clients self-monitor ("self-observe") their
own behaviours, thoughts, and emotions.

Varietyof factors can affect both the reliability and validity of observations, including
the complexity of the behaviour to be observed, how observers are trained and
monitored, the unit of analysis chosen, the behavioural coding system that is used,
reactivity to being observed, and the representativeness of the observations.

2.9 UNIT END QUESTIONS

1) What is behavioural assessment?

2) Describe the various methods of behavioural assessment? Discuss their

advantages and limitations?

3) What are self report methods?

4) Discuss the observational methods and bring out the features of the same

5) What are psychophysiological assessments? Describe

6) What are the future perspectives of behavioural assessment?

2.10 SUGGESTED READINGS

Groth-Marnat, G (2003)' . Handbook of Psychological Assessment
(4 ed.). New Jersey: John Wiley & Sons, Inc.
th

Ramsay, M.C., Reynolds, c.R., Kamphaus, R.W (2002). Essentials of

Behavioural Assessment. New York:John Wiley & Sons, Inc.

,
u
)
l..
~

35
 UNIT 3 ASSESSMENT IN CLINICAL
PSYCHOLOGY
Structure
3.0 Introduction

3.1 Objectives

3.2 Definition and Purpose of Clinical Assessment

3.2.1 Definition of Psychological Assessment
3.2.2 Psychological Assessments
3.2.3 Psychologists as Detectives
3.2.4 Comprehensive Assessments
3.2.5 Psychological Assessment as Important Tools
3.2.6 Reliability and Validity

3.3 Types of Psychological Assessment

3.3.1 Addiction Assessments
3.3.2 Description of FAMHA
3.3.3 MISU Characteristics
3.3.4 SUMI Characteristics
3.3.5 MCSU Characteristics
3.3.6 Development of the Scale
3.3.7 Validity and Reliability

3.4 The Referral

3.4.1 Factors that Influence Clinicians Response to Referral Questions
\

3.5 Assessment in Clinical Psychology

3.5.1 Deciding on Therapy
3.5.2 Planning Therapy
3.5.3 Conducting Therapy
3.5.4 Evaluating Therapy

3.6 Instruments

3.7 Let Us Sum Up

3.8 Unit End Questions

3.9 Suggested Readings

3.0 INTRODUCTION
In this unit we will be discussing about assessment in clinical psychology. We start
with definition and purpose of clinical assessment followed by psychological
assessment as done by clinical psychologists. Then we take up the detection of
certain disorders by clinical psychologists almost like that of degtectives. Then
36 we deal with the comprehensive psychological assessments that clinical
psychologists make. Then we deal with types of psychological assessment which Assessment in Clinical
includes under it addiction assessments, description of the addiction and mental Psychology

illness test called FAMHA (Functional Assessment of Mental Health and Addiction
Scale). Then we deal with typical characteristics ofMISU (Mentally n substance
users), SUM! (Substance Using Mentally ill) and ~1:CSU(Medically compromised
substance using patents) characteristics. Then we present how then scale FAMHA
was developed and its reliability and validity. The next section deals with the
referral and how clinical psychologists deal with the same in terms of assessment.
This is followed by assessment in clinical psychology within which we dea1m with
how assessment helps in deciding on therapy, planning therapy, conducting therapy
and evaluating therapy.

3.1 OBJECTIVES
After completing this unit, you will be able to:

• Defme and describe the psychological assessment in clinical setting;

• Explain the different types of psychological assessment;

• Explain the purpose of clinical assessment;

• Explain the referral and assessment;

• Describe assessment in clinical psychology; and

• Describe the applications of psychological assessment in the field of clinical

psychology.

3.2 DEFINITION AND PURPOSE OF CLINICAL

ASSESSMENT
Psychological assessment as an area of emphasis has seen its ups and downs.
Abeles (1990) commented on the recent "rediscovery" of assessment. He observed
that during the 1960s and 1970s, there seemed to be a decline in interest in
psychological assessment. Therapy was the more glamorous enterprise, and
assessment almost seemed somehow "unfair" to clients. It appeared that clinical
psychology's historical commitment to assessment was waning. The prevailing
attitude about assessment was "Let the technicians do it!" But in the 1980s,
something else began to happen. Students began to show an interest in
specialisation. They discovered forensic psychology (the application of psychology
to legal issues), or they became intrigued by pediatric psychology, geriatrics, or
even neuropsychology.

But to become a specialist in such areas, one needs to know a great deal about
assessment. You cannot answer a lawyer's questions about the competence of a
defendant unless you have thoroughly assessed that individual through tests,
interviews, or observations. You cannot decide on issues of neurological insult
versus mental disorder until you have assessed that client. As Abeles (1990)
stated:

"It is my contention that one of the unique contributions of the clinical psychologist
is the ability to provide assessment data. Providing assessments is again becoming
a highly valued and respected part of clinical psychology and in my opinion is 37
Introduction to coequal with intervention and psychotherapy as a vital activity of clinicalpsychology.
Psychodiagnostics Let us continue to rediscover assessment! (p. 4).

3.2.1 Definition of Psychological Assessment

Psychological assessment can be formally defined in many ways. Clinical assessment
involves an evaluation of an individual's strengths and weaknesses, a
conceptualisation of the problem at hand (as well as possible etiological factors),
and some prescription for alleviating the problem; all of these lead us to a better
understanding of the client. Assessment is not something that is done once and'
then is forever finished. In many cases, it is an ongoing process--even an everyday
process, as in psychotherapy. Whether the clinician is making decisions or solving
problems, clinical assessment is the means to the end.

Intuitively, we all understand the purpose of diagnosis or assessment. Before

physicians can prescribe a treatment, they must first understand the nature of the
illness. Before plumbers can begin soldering pipes, they must first determine the
character and location of the difficulty. What is true in medicine and plumbing is
equally true in clinical psychology. Aside from a few cases involving pure luck, our
capacity to solve clinical problems is directly related to our skill in defining them.
Most of us can remember our parents' stem admonition: "Think before you act!"
In a sense, this is the essence of the assessment or diagnostic process.

3.2.2 Psychological Assessments

Physicians run "tests" to identify illnesses of diseases. Sometimes one test identifies
the source of problems such as an x-ray revealing a tumor, or a blood test
showing low iron levels or anemia. However, some illnesses aren't so clear-cut,
requiring a battery of tests and medical procedures to accurately diagnose complex
conditions.

Clinical psychologist's tools also are used to diagnose learning disabilities,determine

competency to stand trial for a crime, and guide individuals into a deeper
understanding of their vocational and avocationallikes and dislikes.

Clinical psychologists similarly use various tools, called psychological tests to help
diagnose mental illness and disease. But like complex medical conditions, tests
often don't provide all the answers, so psychologists rely on a broader educational
tool called an "assessment" to more accurately diagnose psychological conditions.
Based on assessments, psychologists develop and apply effective therapeutic
treatment plans and interventions

3.2.3 Psychologists as Detectives

Psychologists conducting assessments are likes detectives trying to solve a case.
The assessment requires a gathering of information from multiple sources, from
written tests, personal interviews, job history records, and reports and records
from other physicians, therapists, and counselors. The clinical psychologist
compiles an entire "case history" or in-depth story of a person's inner and outer
life, a sort of journey into the intricacies of psyche and behaviours. Past and
present life situations are also considered.

According to Wikipedia, 91 % of clinical psychologists perform some type of

assessment. But the complexity of the assessment depends on several factors,
such as the clinical setting, the severity of the condition, and the age and ability
38
of the particular client. For example, an assessment done on a child struggling Assessment in Clinical
in school will be quite different from an assessment conducted with a suspected Psychology

criminal.And an assessment given to a soldier in Afghanistan experiencing symptoms

of trauma will differ dramatically from an individual seeking treatment for depression
from a psychotherapist who uses a form of "talk therapy" to diagnose and treat
clients.

A "full" assessment of the soldier probably isn't likely given the conditions of war
and fighting, yet military psychologists are trained to assess soldiers using other
methods, such as observational or interview-type approaches, to determine an
effective immediate intervention, or to determine if the soldier needs to be removed
from the situation and admitted to a military facility for a more thorough assessment,
and longer term therapy. Likewise, psychotherapists in private settings have more
flexibility in the type of assessment given to clients than psychotherapists working
in a mental health facility or hospital, which often recommends standard, commonly
used tools for tests and assessments.

3.2.4 Comprehensive Assessments

The strength of the psychological assessment process stems from its comprehensive,
scientific methodology. Testing implies something like a blood test, where you just
give a test and get a number," explained Smith, also in private practice and a
faculty member at the University of California, Berkeley. "Assessment is a much
more complex enterprise where you integrate data points from various places to
get a more comprehensive understanding. Psychologists must be able to select the
best assessment tools available for certain client populations, and to become, in
a sense, wise consumers of psychological research. Also, a post-assessment must
occur after a psychological intervention has been applied, assessing the impact on
the client's behaviour and progress toward healing.

3.2.5 Psychological Assessment as Important Tools

Scientific research in clinical psychotherapy has evolved since its beginnings after
World War II, as psychologists attempted to understand and treat soldiers with
shell shock - what today is called post traumatic stress disorder. Over the years,
many in the scientific community have questioned the reliability and validity of
psychological testing as compared to medical testing. studies conducted over the
past few decades have proven the efficacy of psychological tests, according to
professionals working in the field. In the American Psychological Association's
journal "Monitor," an article by Jennifer Draw explored the results from a study
conducted by the American Psychological Association's Psychological Assessment
Work Group. The PAWG researchers found that many psychological tests produce
results of comparable validity to medical tests such as Pap smears, mammography,
magnetic resonance imaging (MRI) and electrocardiograms. As an example, the
researchers cited test scores from the Minnesota Multiphasic Personality Inventory
(MMPI) that had an average ability to detect depressive or psychotic disorders
with the same reliability that Pap tests detect cervical abnormalities.

The researchers also went a step further to conclude that some psychological
tests work as well as medical tests in detecting the same illnesses. They point to
neuropsychological testing for dementia producing results with the same level of
effectiveness as an MR!.
39
Introduction to 3.2.6 Reliability and Validity
Psychodiagnostics
Reliability means that an experiment or test reports the same results after a
repeated number of trials. Independent researchers must be able to replicate
experiments using the same controls as the original researchers, making the research
generalisable. Validity determines if the experiment measures exactly what the
researchers attempted to measure - or the specific concept under study. External
validity means that the study results are generalisable; internal validity concerns the
rigor of the study's design and procedures.

Self Assessment Questions

1) Define clinical assessment.

2) Describe the purpose of assessment.

3) What are psychological assessments?

4) Describe psychologists as detectives.

5) Discuss psychological instruments as important tools.

3.3 TYPES OF PSYCHOLOGICAL ASSESSMENT

Thousands of psychological tests exist all falling in one of the following categories:

i) intelligence or IQ tests, such as WAIS IV , WICS IV, Stanford Binet,

ii) Cattell Culture Fair ITI,

40 iii) Woodcock Johnson Tests of Cognitive Abilities Ill.

 iv) Attitude scales such as Thurstone scale or Liket scale and Assessment in Clinical
Psychology
v) Personality tests such as the MMPI, MCMI Ill,

vi) Beck Depression Inventory and

vii) Child Behaviour Check List.

viii) The Rorschach Test used less frequently is also a personality test.

ix) Direct Observation tests, such as the Parent-Child Interaction Assessment-

IT,the MacArthur Story Stem Battery and the Dyadic Parent-child Interaction
Coding System.
-
3.3.1 Addiction Assessments
The assessment of client functioning is a critical component of both treatment
outcome evaluation and assessment of individual level of need for individual
treatment planning and service delivery selection. This is especially true for the
dually diagnosed client with multiple concomitant needs, on a variety of levels ..
The Functional Assessment of Mental Health and Addiction scale (FAMHA) was
specifically designed to meet both criteria.

While it is beneficial to note the positive client changes that occur due to the
effects of treatment, it is perhaps more important to have a functional baseline or
clinical yardstick with which to plan an effective strategies of biopsychosocial
interventions. This is of utmost importance for dually diagnosed clients, with
multiple service needs in mental health, addiction treatment, and medical
interventions.

A basic, core goal of all treatment is to produce substantial and enduring changes
in client behaviours, cognitions and moods and more useful strategies for managing
their day-to-day lives. The only other goal of treatment is then to reduce a client's
distress to the greatest degree possible. By determining a client's specific level
of functioning across all major biopsychosocial domains and an overall level of
functioning, specific symptom and functional deficit profiles emerge that can then
> be used for more effective treatment planning. Such assessments are client centered
by their very nature and specifically relate to the distress and difficulties that each
patient must endure in their daily lives. Thus, functional assessments like the
FAMHA are the key to not only measuring the outcomes of treatments on a
broad scale, but crucial to the clinician's full understanding of patient's individual
needs.

3.3.2 Description of the FAMHA

The Functional Assessment of Mental Health and Addiction (FAMHA; Anderson
& Bellfield, 1999) is a clinician rating scale, specifically designed to accurately
assess dually diagnosed, across a broad range of symptom and functiorial domains.
It was developed in response to clinical and outcome research goals identified by
the Department of Health (1996) which emphasised the need for extending research
on the outcome of treatment for substance misuse problems. It is meant for three
different types of addicts.
i) mentally ill substance users (MISU),
ii) substance using mentally ili (SUMI), and
iii) medically compromised substance using patients (MCSU) 41
Introduction to The assessment scale is specifically tailored to assess the multifaceted needs of
Psychodiagnostics severely distressed patients and to identify specific areas for effective therapeutic
interventions. The 46 items of the scale document functional deficits across all
biopsychosocial functional domains in such a way as to capture the current state
of overall functioning, whilst demonstrating specific areas of need.

Thus, it can be used as both an indicator of current functioning for diagnostic

assessment and as a repeated measure to demonstrate the changes that occur to
patients throughout the clinical cycle.

, Sciacca (1991) noted significant differences between various subpopulations of

dually diagnosed patients (in both mental health and addiction treatment settings)
that have an impact on treatment planning and service delivery for each patient
population. The term dual diagnosis is somewhat broad and misleading (for example;
mental illness and learning disabilities are dual diagnoses).

The distinction between MISU, SUMI, and MCMU patients has a significant
impact on the selection and use of a variety of intervention techniques and strategies.

MISU patients generally present with symptoms of severe and enduring mental
illness that has been complicated by the use of psychotopic substances.

SUMI patients are characterised by their excessive use of psychotropic agents

with the subsequent development of a concomitant severe and persistent mental
illness.

MCSU patients characteristically use large amounts of psychotropic agents in the

presence of a long term or severe physical injury, illiness or ongoing medical
condition.

Traditionally,MISU patients have gravitated toward mental health treatment systems,

SUMI patients have generally sought treatment in addiction treatment settings;
while MCSU patients have relied on medical treatment facilities to seek therapeutic
relief.

Mental illness, substance use/misuse and medical conditions must be approached

differently for each group to achieve effective therapeutic outcomes (Sciacca,
1991). The severe and persistent mental illness ofMISU patients make it difficult
for them to engage in the motivational interviewing or more restrictive treatments
often used in addiction treatment settings (Bachrach, 1984).

On the other hand, SUMI and MCSU patients often require relief from the effects
of addiction and withdrawal before they can fully focus on their treatment for the
medical, psychological and social issues that have emerged or intensified as a
result of their substance use.

For this reason, the FAMHA was designed to assess individual differences in
symptomatology, whilst differentiating these two populations on a functional level.

Effective treatment of MISU, SUMI and MCSU patients requires diagnostic

clarification as the initial step in successful care planning. To address the problem
of m)iltiple diagnoses of mental illness, medical conditions and substance abuse,
clinicians from addiction, medical, and psychiatric backgrounds must learn to
make the clinical formulations for each of the concomitant disorders, using clear
diagnostic standards and evidence based assessments.

42
One of the principal goals of the FAMHA is to quantitatively measure the degree Assessment in Clinical
and intensity of mental illness and substance misuse. It also profiles the interactive Psychology

effects of multiple disorders that must be explored on an individual basis.

The consideration of which disorder came first, while perhaps etiologicallyimportant,
should not interfere with the diagnosis and treatment of persistent conditions that
exist and simultaneously interact on a functional level (Breakey, 1987; Miller,
1994).
A major advantage of using the FAMHA is that it can be quickly and effectively
administered to provide diagnostic indicators and monitor the effects of treatment
over time.

The following list identifies many of the characteristics that distinguish MISU,
SUM! and MCSU patients which can be quantitatively assessed on the FAMHA:

3.3.3 MISU Characteristics

1) Severe mental illness exists independently of substance abuse; persons would
meet the diagnostic criteria of a major mental illness even if there were not
a substance abuse problem present.

2) MISU persons have a DSM-IV-R, Axis I (American Psychiatric Association,

1987) diagnosis of a major psychiatric disorder, such as schizophrenia or
major affective disorder.

3) MISU persons usually require medication to control their psychiatric illness;

if medication is stopped, specific symptoms are likely to emerge or worsen.
4) Substance abuse may exacerbate acute psychiatric symptoms, but these
symptoms generally persist beyond the withdrawal of the precipitating
substance.

5) MISU persons, even when in remission, frequently display the residual effects
of major psychiatric disorders (for example, schizophrenia), such as marked
social isolation or withdrawal, blunted or inappropriate affect, and marked
lack of initiative, interest, or energy.

Evidence of these residual effects often differentiates MISU from populations of

substance abusers who are not severely mentally ill.

3.3.4 SUMI Characteristics

1) SUMI patients have severe substance dependence (alcoholism; heroin,
cocaine,amphetamine, or other addictions), and frequently have multiple
substance abuse and/or polysubstance abuse or addiction.
2) SUM! persons usually require treatment in alcohol or drug treatment programs.
SUMI persons often have coexistent personality or character disorders.

3) SUMI patients may appear in the mental health system due to "toxic" or
"substance-induced" acute psychotic symptoms that resemble the acute
symptoms of a major psychiatric disorder. In this-instance,the acute symptoms
are always precipitated by substance abuse, and the patient does not have
a primary Axis I major psychiatric disorder.

4) SUM! patients' acute symptoms remit completely after a period of abstinence

or detoxification. This period is usually a few days or weeks, but occasionally
, may require months. 43
 Introduction to 5) SUMI patients do not exhibit the residual effects of a major mental illness
Psychodiagnostics when acute symptoms are in remission.

3.3.5 MCSU Characteristics

1) MCSU patients continued to use large amounts of substances even after
their medical conditions have gone into remission or have been successfully
treated.

2) These patients begin using psychotropic agents in an effort to seek relief from
physical pain due a medical condition.

3) MCSU patients often have long term medical conditions (i.e. HIV, Heart
Conditions, Autoimmune deficiencies, etc.) that reduces their level of physical
functioning and makes them vulnerable to substance use disorder.

4) The hopeless and helpless feelings associated with long term or severe medical
'. conditions produce depressive states that are reduced by the use of intoxicating
or pain relieving substances.

5) The loss of physical function and range of motion often produces a reduction
in psychological functioning and increases the reliance on pharmacological
agents.

3.3.6 Development of the Scale

The FAMHA was developed with a variety of criteria in mind.' To adequately
assess MISU, SUMI, and MCSU patients in naturalistic settings, specific criteria
developed by Green and Greely (1987) were applied to the scale as it was
modified in development phases and pilot trials. It was felt that the FAMHA
should not only assess the obvious symptom categories of major mental illness
and addiction, but should also:

• include functional domains that are deemed important for community based
treatment clinics;

• demonstrate reliability and validity;

• possess sensitivity-to treatment-related change;

• be appropriate and relevant to the dually diagnosed population that it

functionally assesses;

• be a useful tool for treatment planning and clinical governance;

• have low administration costs;

• be relatively easy to use by all levels of clinical staff.

The current version of the FAMHA meets all of these criteria and can be
administered in as little as 8 minutes by a trained, experienced rater,

The FAMHA builds on the strengths of the Specific Level of Functioning scale
(SLOF) (Schnieder & Struening - 1983), Symptom Checklist 90 (SCL-
9OR)(Derogatis, 1975), the BelIevue Psychiatric Audit (BPA)(Hardesty & Burdock,
1962) and the Addiction Severity Index, 5th Edition (ASI)(McLellan et al, 1997).
It combines a variety of clinical and functional dimensions into a 46 item clinician
rating scale that is subdivided into 6 biopsychosocial dimensions:
44
1) Socio-legal Assessment in Clinical
Psychology
2) Social- Community Living
3) Social- Interpersonal Skills

4) Mood

5) Psychological Functioning

6) Physical Functioning.

In addition to the dimensional scales, data as to the patient's primary and secondary
drug of choice, alcohol consumption, prior mental health and addiction treatment
episodes, demographics, and current medical, mental health and addiction diagnoses
are also collected to add to the clarity of the diagnostic profile. It is expected that
continued statistical analysis, including factor analyses of further trials, will yield
more refined, discrete scale dimensions and add to the overall utility of the
instrument.

Similar to the SLOF in appearance, the FAMHA uses a seven point, three way
anchored Likert like scale, ranging from extremely dysfunctional symptoms or
behaviours (Score 1) to normative levels of these behaviours and symptoms
(Score 7).

The low end, mid-point and high points of functioning are anchored by descriptors
for each item, This allows for enhanced inter rater reliability and validity of patient!
clinic-wide functional assessments.

Like the SLOF and SCL-90R, each of the 46 items of the FAMHA is evaluated
on the Likert -like scale. Due to the specific nature of each of these 46 functional
items, the FAMHA assumes a high degree of assessor familiarity with the patient.

The scale was designed to quantify patient functional levels more systematically
than the Global Assessment of Functioning (GAF)(APA, 1994) and provides for
the systematic rating of functional deficits in critical areas of that could not otherwise
be assessed in this population. In addition, FAMHA overall scores are designed
with a coefficient that readily converts the total score to overall GAF scores.
Thus, it refines the diagnostic profile for individual patients that is necessary for
appropriate diagnosis within both ICD-lO (WHO-1996) and DSM-IV (APA
1994) diagnostic systems.

3.3.7 Validity and Reliability

The concordance rates between the FAMHA total scores, sub-scores and GAF
scores are currently in clinical trials and cannot yet be reported on. However, due
to the high degree of similarity between the SLOF and the FAMHA, it is assumed
that patient scores on each FAMHA dimension will significantly correlate with
overall GAF scores and subscores.

The SLOF concordance rates for the various components were reported to be
r =.67 for the social component, .60 for the psychological, and .50 for the
physical component. Moderate associations were found between the SLOF
substance abuse scale and the Drake et al. (1990) substance abuse scale (r =.73)
(Uehara et al. 1994). 45
, :
Introduction to This concordance rate should be mirrored in the FAMHA, since most of these
Psychodiagnostics specific SLOF items are embedded in the FAMHA as well.

Further clinical trials should conclusively demonstrate the usefulness of combining

level of functioning information across mental health and addiction dimensions and
ultimately,validate the FAMHA as an ideal instrument forassessing dually diagnosed
patients in mental health and addiction treatment settings.

To sum up this section, the FAMHA documents the outcomes of treatment by

quantifying the substantial and enduring changes in client behaviours, cognitions,
moods and day-to-day client functioning It also notes reductions in distress due
to the effects of treatment. By determining a client's specific level of functioning
across a number of domains and an overall level of functioning. specific profile
emerge that can then be used for more effective treatment planning.

FAMHA assessments are client centered by their very nature and specifically
relate to the distress and difficulties that each patient must endure in their daily
lives. Thus, such assessments are crucial to a clients mental health, substance use,
and medical recovery.

The FAMHA was designed to meet the specific clinical and research needs of
practitioners/researchers in a wide variety of treatment settings. From the data
currently available, it is clear that the FAMHA is a sensitive diagnostic tool for use
with MISU, SUM! and MCSU patients. It's ability to document functional changes
that occur throughout the treatment cycle and utility as a basic research tool to
obtain specificepidemiologicaland diagnosticinformationmake it an ideal instrument
for use with on this severely dysfunctional and distressed population.

Self Assessment Questions

1) What are the various types of psychological assessments?

2) Describe FAMHA.

3) Describe the characteristics of MISU, SUMI and MCSU.

46
 Assessment in Clinical
4) How was the FAMHA scale developed? Psychology

5) Discuss the reliability and validity of the scale.

3.4 THE REFERRAL

The assessment process begins with a referral. Someone-a parent, a teacher, a
psychiatrist, .a judge, or perhaps a psychologist-poses a question about the
patient. "Why is John disobedient?"

"Why can't Anita learn to read like the other children?" "Is the patient's
Impoverished behavioural repertoire a function of poor learning opportunities, or
does this constriction represent an effort to avoid close relationships with other
people who might be threatening?"

Clinicians thus begin with the referral question. It is important that they take pains
to understand precisely what the question is or what the referral source is seeking.
In some instances, the question may be impossible to answer; in others, the
clinician may decide that a direct answer is inappropriate or that the question
needs rephrasing. For example, the clinician may decide that the question "Is this
patient capable of murder?" is unanswerable unless there is more information
about the situation. Thus, the question might be rephrased to include probabilities
with respect to certain kinds of situations. If parents want their child tested for the
sole, often narcissistic, purpose of determining the child's IQ, the clinician might
decide that providing such information would eventually do the child more harm
than good. Most parents do not have the psychometric background to understand
what an IQ estimate means and are quite likely to misinterpret it. Thus, before
accepting the referral in an instance of this kind, the clinical psychologist would
be well advised to discuss matters with the parents.

3.4.1 Factors that Influence Clinician Response to Referral

Question
The kinds of information sought are often heavily influenced by the clinician's
theoretical commitments. For example, a psychodynamic clinician may be more
likely to ask about early childhood experiences than a behavioural clinician. In
other cases, the information obtained may be similar, but clinicians will make
different inferences from it. For example, frequent headaches may suggest the
presence of underlying hostility to a psychodynamic clinician but merely evidence
of job stress to a behavioural clinician. For some clinicians, case-history data are
important because they aid in helping the client develop an anxiety hierarchy; for 47
Introduction to others, they are a way of confirming hypotheses about the client's needs and
Psychodiagnostics expectations.

Assessment, then, is not a completely standardised set of procedures. All clients

are not given the same tests or asked the same questions. The purpose of
assessment is not to discover the "true psychic essence" of the client but to
describe that client in a way that is useful to the referral source-a way that will
lead to the solution of a problem. Of course, this does not mean that one description
is as good as another for a particular case. One clinician's cognitive-behavioural
formulation of a case may involve a poor understanding of cognitive-behavioural
.theory. There are even instances in which certain cases seem to lend themselves
more to a psychodynamic description than to a behavioural description. Because
of the complexity of our subject matter and incomplete state of our knowledge,
there is sometimes more than one good road to Rome. '

.3.5 ASSESSMENT IN CLINICAL PSYCHOLOGY

Psychological assessment is utilised in clinical psychology primarily for purposes
of differential diagnosis, treatment planning, and outcome evaluation.

Differential diagnosis involves drawing on assessment information to describe an

individual's psychological characteristics and adaptive strengths and weaknesses.
These descriptions provide a basis for determining

What type of disorder an individual may have,

The severity and chronicity of this disorder and the circumstances in which it is
likely to be manifest, and

The kinds of treatment that are likely to provide the individual relief from this
disorder.

With respect to further treatment planning, adequate assessment information helps

to guide treatment strategies and anticipate possible obstacles to progress in
therapy.As for outcome evaluation, pre-treatment assessments establish an objective
baseline against which treatment progress can be monitored in subsequent
evaluations, and by which the eventual benefits of the treatment can be judged at
, its conclusion. These clinical contributions of psychological assessment can be
implemented during each of four sequential phases in delivering psychological
treatment: deciding on therapy, planning therapy, conducting therapy, and evaluating
therapy.

3.5.1 Deciding On Therapy

The first step in the clinical utilisation of assessment information consists of deciding
whether a patient needs treatment and is likely to benefit from it.Accurate differential
diagnosis identifies pathological conditions (e.g. depression, paranoia) and
maladaptive characteristics (e.g. passivity, low self-esteem) for which treatment is
usually indicated, and adequate psychological evaluation helps to distinguish such
conditions and characteristics from normal range functioning that does not call for
professional mental health intervention. Assessment methods also provide valuable
information concerning two factors known to predict whether people are likely to
become involved in and profit from psychotherapy: their motivation for treatment
and their accessibility to being treated.
48
 Assessment in Clinical
Motivation for treatment usually corresponds to the amount of subjectively felt
Psychology
distress that people are experiencing. Accessibility to psychological treatment
typically depends on how willing people are to examine themselves, to express
their thoughts and feelings openly, and to make changes in their customary beliefs
and prefer fC~ v, ,t):. of conducting their lives. Information derived from appropriate
ass ,C"l, •..m procedures can provide clinicians with objective indices of each of
the se . ., nle and these assessment data can in turn be used as a basis for
determining . .hether to recommend and proceed with some form of treatment.

3.5.2 Planning Therapy

• Planning therapy for patients who need and want to receive psychological
treatment involves.

• Deciding on the appropriate setting in which to deliver the treatment,

• Estimating the duration of the treatment, and

• Selecting the particular type of treatment to be given.

With respect to deciding on the treatment setting, assessment data 'provide reliable
information concerning the severity of a patient's disturbance, the patient's ability
to distinguish reality from fantasy, and his or her likelihood of becoming suicidal
or dangerous to others, all of which bear on whether the person requires residential
care or can be treated safely and adequately as an outpatient. The more severely
disturbed people are, the farther out of touch with reality they are, and the greater
their risk potential for violence, the more advisable it becomes to care for them
in a protected environment.

Regarding treatment duration, clinical experience and research findings consistently

indicate that mild and acute problems of recent onset can usually be treated
successfully in a shorter period of time than severe and chronic problems of long-
standing duration. A variety of psychodiagnostic measures provide clues to the
chronicity as well as the severity of symptomatic and characterological mental
and emotional problems, and pretreatment data obtained with these measures can
accordingly help clinicians formulate some expectation of how long a treatment is
likely to last. Having available such'assessrnent-based information on expected
duration in turn assistsclinicians in presenting treatment recommendations to
prospective patients (Hurt, Reznikoff & Clarkin, 1991).

As for treatment selection, people who are relatively psychologically minded. self-
aware, andinterested in gaining fuller self-understanding arc relatively likely to
respond positively to an uncovering, insight-oriented, and conflict focused treatment
approach. Patients whose preference is to feel better without having to examine
themselves closely, on the other hand, are more likely to become actively engaged
in supportive and symptom-focused approaches to treatment than in exploratory
psychotherapy.

Psychologically minded people are inclined to feel dissatisfied with supportive

" treatment, because it does not get at the root of their problems, whereas relief-
,..b minded people tend to feel uncomfortable in uncovering treatment, because it
') makes unwelcome demands on them.

Additionally, there is reason to believe that some kinds of conditions and difficulties,
especially in people who are problem-oriented, respond relatively well to cognitive-
49
behavioural forms of treatment, whereas other kinds of di« -rders ana maladaptive
Introduction to tendencies, especially in people who are interpersonally oriented, respond better
Psychodiagnostics to psychodynamic-interpersonal than cognitive behavioural therapy (Beutler&
Harwood, 1995; Hayes, Nelson & Jarrett, 1987).

Psychological mindedness and preferences for problem-oriented or interpersonally

oriented approaches to life situations are among a vast array of personality
characteristics that can be measured with assessment methods. Accordingly,
adequately conceived pre-therapy psychological assessment can facilitate treatment
planning by differentiating among psychological states and orientations of the
individual that have known implications for successful response to particular
treatment approaches.

3.5.3 Conducting Therapy

Psychological assessment can play a key role in conducting therapy by helping to
identify in advance:

• Treatment targets on which the therapy should be focused and

• Possible obstacles to progress towards these treatment goals.

Appropriately collected assessment data, and particularly the results of a

niultimethod test battery, typically contain many normal range fmdings and often
some indications as well of notably good personality strengths and especially
admirable personal qualities. At the same time, especially in people who are being
evaluated for symptoms or difficulties that have led them to seek professional
help, test data are likely to reveal specific adaptive shortcomings and coping
limitations. One person may show a penchant for circumstantial reasoning and
poor judgement; another person may give evidence of poor social skills and
interpersonal withdrawal; a third may exhibit considerable emotional inhibition
with restricted capacity to express feelings and feel comfortable in emotionally
charged situations.

In short, any assessment findings that fall outside of an established normal range
and are known to indicate specific types of cognitive dysfunction, affective distress,
coping deficit, personal dissatisfaction, or interpersonal inadequacy in turn assist
therapists and their patients in deciding 011 the objectives of their work together
and directing their efforts accordingly.

Some psychological characteristics of patients that constitute targets in their

treatment may also pose obstacles to their becoming effectively engaged in therapy
and making progress toward their goals. For example, people who are set in their
ways and characteristically rigid and inflexible in their views often have difficulty
reframing their perspectives or modifying their behaviour in response even to well-
conceived and appropriately implemented treatment interventions. People who
are interpersonally aversive or withdrawr: may be slow or reluctant to form the
kind of working alliance with their therapist that facilitates progress in most forms
of therapy.

People who are relatively satisfied with themselves and not experiencing much
subjectively felt distress may have little tolerance for the demands of becoming
seriously engaged in a course of psychological treatment. Characteristics of these
kinds do not preclude effective psychotherapy, but they can result in slow progress,
and they may cause patients and therapists to become discouraged and terminate
prematurely a treatment that does not appear to be going well.
50
Pretreatment assessment data serve to alert therapists in advance to possible Assessment in Clinical
treatment obstacles, which can help them understand and be patient with initially Psychology

slow progress and also guide them in dealing directly with these obstacles, as by
concentrating in the early phases of therapy on encouraging flexibility and open-
mindedness. building a comfortable and trusting treatment relationship, or generating
some motivation for the patient's involvement in the therapy.

3.5... Evaluating Therapy

"-
Psychological assessment provides valuable data for monitoring the progress of
therapy and measuring its eventual benefit. For this potential benefit of assessment
to be realised, it is vital for assessment data to be collected from patients prior
to their beginning treatment. In addition to helping to identify treatment targets and
the long term objectives of therapy, pre-treatment data provide an objective
baseline for comparison with the results of subsequent assessments.

Periodic reevaluations can then shed light on whether the treatment is making a
difference, how close it has come to meeting its aims, in what way the focus of
continued treatment should be adjusted, and whether a termination point has been
reached. For example, if a reliable test index shows abnormally high anxiety, low
self-esteem, poor self-control, or excessive anger, and a retest during treatment
shows the same or a worse result for any of these treatment targets, there is
objective evidence that no progress has been made on this front. Such results can
then lead to an informed decision to alter the type or focus of the treatment,
change the therapist, or await the next re-assessment before making any change.
j

On the other hand, should retesting show an index closer to an adaptive range
than initially, there is reason to conclude that progress is being made on the
treatment target related to that index but that further improvement remains to be
made in that area. When an initially abnormal test result is found on retesting to
be in an adaptive range, then therapists and their patients can conclude with
confidence that they have achieved the objective to which this result relates and
do not need to address it further. At the point when rete sting indicates that most
or all of the treatment targets have reached or are approaching as much resolution
as could realistically be expected, then the assessment process helps to indicate
that an appropriate termination point has been reached.

Assessments conducted at the conclusion of psychotherapy, when compared with

initial baseline evaluations, provide an objective basis for evaluating the overall
benefit of the treatment that has been provided. Evaluations of treatment benefit
made possible by pre-therapy and post-therapy assessments serve important
research and practical purposes in clinical psychology. With respect to research
issues, assessment data bearing on treatment benefit facilitates comparison studies
of the relative effectiveness of different types and modalities of therapy. For
practical purposes, retest findings demonstrating treatment benefit bear witness to
the value of psychological interventions, particularly as weighed against the financial
cost of these services (Kubiszyn et aI., 2000).

3.6 INSTRUMENTS
Surveys of clinical psychologists and the contents of standard handbooks concerning
psychological assessment identify several instruments as being among those most
widely used by clinicians in the United States for purposes of differential diagnosis, 51
Introduction to treatment planning, and outcome evaluation. Four of these measures are relatively
Psychodiagnostics structured self-report inventories on which conclusions ate derived from what
respondents are able and willing to say 'about themselves: the Minnesota Multiphasic
PersonalityInventory,the Millon ClinicalMultiaxialInventory,the Sixteen Personality
Factors Questionnaire, and the Personality Assessment Inventory.

Four of them are relatively unstructured perfonnancebased measures in which the

key data consist not of what respondents say about themselves but how they deal
with various kinds of somewhat ambiguous tasks that are assigned to them: the
Rorschach Inkblot Method. the Thematic Apperception Test, several types of
figure drawing tasks, and some alternative sentence completion methods.

Self Assessment Ques inns

1) What is Referral and what does it involve?

...............................................................................................................

...............................................................................................................

................................................................................................................

2) Discuss the assessment in clinical psychology .

...............................................................................................................

...............................................................................................................

...............................................................................................................

3) How is psychological assessment used in deciding therapy?

...............................................................................................................

...............................................................................................................

...............................................................................................................

4) How is psychological assessment used in planning therapy?

...............................................................................................................

.
...............................................................................................................

...............................................................................................................

5) Discuss psychological assessment for conducting and evaluating therapy.

...............................................................................................................

...............................................................................................................

.............................................
=J
52
 Assessment in Clinical
6) State some of the instruments of clinical psychology. Psychology

3.7 LET US SUM· UP

Psychological assessment has been an integral part of clinical psychology since its
inception and continues to the present day to provide practitioners with valuable
information to guide their evaluation and treatment of persons who seek their help.
At times, failure ,to appreciate the benefits of preceding treatment with thorough
assessment has led to insufficient teaching and learning of psychodiagnostic methods
by clinical psychologists, as has the regrettable and shortsighted devaluing of
diagnostic procedures by health insurance providers. However, the future
application of psychodiagnostic methods in clinical psychology appears to rest
safely in the hands of practitioners and researchers who know from their experience
and data how useful assessment can be in facilitating good clinical decisions.

3.8 UNIT END QUESTIONS

1) What is the definition and purpose of clinical assessment?

2) Discuss in detail the application of psychological assessment in clinical

psychology?

3) Write about some of the most widely used instruments in clinical assessment?

4) Describe the FAMHA, its devising, its use, and reliability and validity.

5) How is psychological assessment used in clinical settings?

3.9 SUGGESTED READINGS

Plante, T. G (2005). Contemporary Clinical Psychology (2nd Ed.).New Jersey:
John Wiley & Sons, Inc.

Trull, T.J. (2005).Clinical Psychology (71it Ed.).USA: Thomson Learning, Inc.

53
 UNIT 4 ETHICAL ISSUES IN ASSESSMENT

Structure
4.0 Introduction

4.1 Objectives

4.2 Ethics in Assessment

4.2.1 Mismatched Validity
4.2.2 Confirmation Bias
4.2.3 Confusing Retrospective and Predictive Accuracy
4.2.4 Unstandardising Standardised Tests .
4.2.5 Ignoring the Effects of Low Base Rates
.. 4.2.6 Misinterpreting Dual High Base Rates
4.2.7 Perfect Conditions Fallacy
4.2.8 Financial Bias
4.2.9 Ignoring Effects of Audio Recording Video Recording or the Presence of
Third Party Observers

4.2.10 Uncertain Gate Keeping

4.3 APA Ethics Code

4.3.1 Ethical Principles

4.3.2 Ethical Standards

4.3.3 Standards for Educational and Psychological Tests

4.4 Ethical Issues in Assessment

4.4.1 Informed Consent
4.4.2 Confidentiality

4.4.3 Invasion of Privacy

4.5 Let Us Sum Up

4.6 Unit End Questions

4.7 Suggested Readings

4.0 INTRODUCTION
Wherever people live and work together, they evaluate their own actions and
those of others as good or bad, justified or unjustified, fair or unfair, and they
ascribe to others and to themselves in particular situations the responsibility for
doing what should be done and not doing what should not be done. The entirety
of the rules that these evaluations follow in everyday life is characterised as
morality. Anyone publicly violating them incurs the disdain of the others. Insofar
as people acknowledge the existence of moral rules, they also judge themselves
before their own conscience. Moral rules therefore have a high status in subjective
experiencing, thinking, and acting. Morality, however, can also be misused in
order to give others a bad conscience. It can likewise be employed as a weapon
54
to question the privileges of others or to defend one's own privileges. Finally, it Ethical Issues in Assessment
can be used to create solidarity with others.

Moral rules can also find their way into national laws. But not all national laws
have amoral basis. Whoever can be shown to have violated national laws must
usually reckon with sanctions of the state, such as fines or prison terms. Finally,
in addition to the rules of morality and the laws of the state, there are standards
or norms, such as those of associations or professional organisations (American
Educational Research Association, American Psychological Association). These
prescribe how the members of these organisations are to conduct themselves
during the performance of their professional activities. Anyone who can be
demonstrated to have violated these rules is threatened in the worst instance with
expulsion from the professional organisation, which in some countries can have
legal consequences, namely, one can be prohibited from carrying out one's
professional activities.

Assessment may be defined as "a conceptual, problem solving process of gathering

dependable, relevant information about an individual, group, or institution to make
informed decisions" (Turner, DeMers, Fox, &Reed, 2001, p. 11(0). The importance
of assessment to psychology cannot be overstated, as psychological testing may
be considered "a defining practice of professional psychology since the field's
inception" (Camera, Nathan, & Puente, 2000, p. l41). The outcomes of
psychological assessment may be life altering, such as placing a child in special
education classes, 'denying an applicant a job, or altering treatment of a patient.

Given the importance of assessment, it is not surprising that there are numerous
ethical pitfalls for the assessor. This unit reviews the main ethical issues inherent
in assessment, including competence, informed consent, and confidentiality.

4.1 OBJECTIVES
After completing this unit, you will be able to:

• Describe ethics in assessment;

• Elucidate the common fallacies in psychological assessment;
• Explain the main ethical considerations involved in psychological testing;

• Discuss the specific norms and principles that a tester is expected to adhere
while testing;

• Explain confidentiality issues;

• Elucidate the APA Ethics code; and

• Describe the ethical issues in assessment.

4.2 ETmCS IN ASSESSMENT

Tests are tools used by professionals to 'make what may possibly be some serious
decisions about a client; thus both tests and the decision process involve a variety
of ethical considerations to make sure that the decisions made are in the best
interest of all concerned and that the process is carried out in a professional
manner. There are serious concerns, on the part of both psychologists and lay
people, about the nature of psychological testing and its potential misuse, as well
as demands for increased use of tests. 55
Introduction to It must be remembered that there are certain important fallacies in psychological
Psychodiagnostics assessment. These have to be kept in mind while doing assessment. In addition
we have many ethical considerations that have to be considered which are given
in the sections below.
There are 10 common fallacies and pitfalls that plague psychological testing and
assessment.

They are:

1) mismatched validity;

2) confrrmation bias;

3) confusing retrospective and prospective accuracy (switching conditional

probabilities)

4) unstandardising standardised tests;

5) ignoring the effects of low base rates;

6) misinterpreting dual high base rates;

7) perfect conditions fallacy;

8) fmancial bias;
9) ignoring the effects of audio-recording, video-recording, or the presence of
third-party observers; and

10) uncertain gate keeping.

These assessment fallacies and pitfalls are discussed in more detail below.

4.2.1 Mismatched Validity

Some tests are useful in diverse situations, but no test works well for all tasks with
all people in all situations.Hence selecting assessment instruments involves complex
questions, such as for instance, "Has research established sufficient reliability and
validity (as well as sensitivity, specificity, and other relevant features) for this test,
with an individual from this population, for this task (i.e., the purpose of the
assessment), in this set of circumstances?" It is important to note that as the
population, task, or circumstances change, the measures of validity, reliability,
sensitivity, etc., will also tend to change.

To determine whether tests are well-matched to the task, individual, and situation
at hand, it is crucial that the psychologist ask a basic question at the outset: Why
exactly am I conducting this assessment?

4.2.2 Confirmation Bias

Often we tend to seek, recognise, and value information that is consistent with our
attitudes, beliefs. and expectations. If we form an initial impression, we may
favour findings that support that impression, and discount, ignore, or misconstrue
data that do not fit.

This premature cognitive commitment to an initial impression which can form a

strong cognitive set through which we sift all subsequent findings is similar to the
logical fallacy of hasty generalisation.
56
To help protect ourselves against confirmation bias (in which we give preference Ethical Issues in Assessment
to information that confirms our expectations), it is useful to search actively for
data that disconfirm our expectations, and to try out alternate interpretations of
the available data.

4.2.3 Confusing Retrospective and Predictive Accuracy

Predictive accuracy begins with the individua1's test results and asks: What is the
likelihood, expressed as a conditional probability, that a person with these results
has condition (or ability, aptitude, quality, etc.) X?

Retrospective accuracy begins with the condition (or ability, aptitude, quality) X
and asks: What is the likelihood, expressed as a conditional probability, that a
person who has X will show these test results?

Confusing the "directionality" of the inference (e.g., the likelihood that those who
score positive on a hypothetical predictor variable will fall into a specific group
versus the likelihood that those in a specific group will score positive on the
predictor variable) causes many errors.

This mistake of confusing retrospective with predictive accuracy often resembles

the affmning the consequent logical fallacy:

4.2.4 Unstandardising Standardised Tests

Standardised tests gain their power from their standardisation. Norms, validity,
reliability, specificity, sensitivity, and similar measures emerge from an actuarial
base, that is a well selected sample of people providing data (through answering
questions, performing tasks, etc.) in response to a uniform procedure in (reasonably)
uniform conditions. When we change the instructions, or the test items themselves,
or the way items are administered or scored, we depart from that standardisation
and our attempts to draw on the actuarial base become questionable.

There are other ways in which standardisation can be defeated. People may show
up for an assessment session without adequate reading glasses, or having taken
cold medication that affects their alertness,or having experienced a family emergency
or loss that leaves them unable to concentrate, or having stayed up all night with
a loved one and now can barely keep their eyes open. The professional conducting
the assessment must be alert to these situational factors, how they can threaten
the assessment's validity, and how to address them effectively.

It is our responsibility to recognise the limits of competence and to make sure that
any assessment is based on adequate competence in the relevant areas of practice,
the relevant issues, and the relevant instruments.

4.2.5 Ignoring the Effects of Low Base Rates

Ignoring base rates can play a role in many testing problems but very low base
rates seem particuiarly troublesome. Imagine a psychologist has been coimnissioned
to develop an assessment procedure that will identify crooked judges so that
candidates for judicial appointment can be screened. It's a difficult challenge, in
part because only lout of 500 judges is (hypothetically speaking) dishonest.

Let us say that the psychologist pulls together all the actuarial data that he can
locate and finds that he is able to develop a screening test for crookedness based
on a variety of characteristics, personal history, and test results. Let us say that
his method is 90% accurate. 57
 Introduction to When this method is used to screen the next 5,000 judicial candidates, there
Psychodiagnostics might be 10 candidates who are crooked (because about 1 out of 500 is crooked).
A 90% accurate screening method will identify 9 of these 10 crooked candidates.
as crooked and one as honest.

The problem is the 4,990 honest candidates. Because the screening is wrong
10% of the time, and the only way for the screening to be wrong about honest
candidates is to identify them as crooked, it will falsely classify 10% of the honest
candidates as crooked. Therefore, this screening method will incorrectly classify
499 of these 4,990 honest candidates as crooked.

So out of the 5,000 candidates who were screened, the 90% accurate test has
classified 508 of them as crooked (i.e., 9 who actually were crooked and 499
who were honest). Every 508 times the screening method indicates crookedness,
it tends to be right only 9 times. And it has falsely branded 499 honest people
as crooked.
'.
4.2.6 Misinterpreting Dual High Base Rates
As part of a disaster response team, let us say a psychologist is flown in to work
at a community mental health' center in a city devastated by a severe earthquake.
Taking a quick look at the records the center has compiled, he notes that of the
200 people who have come for services since the earthquake, there are 162 who
are of a particular religious faith and are diagnosed with PTSD related to the
earthquake, and 18 of that faith who came for services unrelated to the eannquake,
Of those who are not of that faith, 18 have been diagnosed with PTSD related
to the earthquake, and 2 have come for services unrelated to the earthquake.

It seems almost self-evident that there is a strong association between that particular
religious faith and developing PTSD related to the earthquake. That is, 81 % of
the people who came for services were of that religious faith and had developed
PTSD. Perhaps this faith makes people vulnerable to PTSD. Or perhaps it is a
more subtle association, in that this faith might make it easier for people with
PTSD to seek mental health services.

But the inference of an association is a fallacy, because ninety percent of all

at
people who seek services this center happen to be of that specific religious faith
(i.e., 90% of those who had developed PTSD and 90% who had come for other
reasons) and 90% of all people who seek services after the earthquake (i.e., 90%
of those with that particular religious faith and 90% of those who are not of that
faith) have developed PTSD. The 2 factors appear to be associated because both
have high base rates, but they are statistically unrelated.

4.2.7 Perfect Conditions Fallacy

When we are in haste, we like to assume that "all is well," that in fact "conditions
are perfect." If we do not check, we may not discover that the person we are
assessing for a job, a custody hearing, a disability claim, a criminal case, asylum
status, or a competency hearing took standardised psychological tests and
completed other phases of formal assessment under conditions that significantly
distorted the results. For example, the person may have forgotten the glasses they
need for reading, be suffering from a severe headache or illness, be using a
hearing aid that is not functioning well, be taking medication that impairs cognition
or perception, have forgotten to take needed psychotropic medication, have
58
experienced a crisis that makes it difficult to concentrate, be in physical pain, or Ethical Issues in Assessment
have trouble understanding the language in which the assessment is conducted.

4.2.8 Financial Bias

It is a very human error to assume that we are immune to the effects of financial
bias. But a financial conflict of interest can subtly affect the ways in which we
gather, interpret, and present even the most routine data. This principle is reflected
in well established forensic texts and formal guidelines prohibiting liens and any
other form of fee that is contingent on the outcome of a case. The Specialty
Guidelines for Forensic Psychologists, for example, state: "Forensic psychologists
do not provide professional services to parties to a legal proceeding on the basis
of 'contingent fees,' when those services involve the offering of expert testimony
to a court or administrative body, or when they call upon the psychologist to
make affirmations or representations intended to be relied upon by third parties."

4.2.9 Ignoring Effects of Audio Recording, Video Recording

or the Presence of Third Party Observers
Empirical research has identified ways in which audio recording, video recording,
or the presence of third parties can affect the responses (e.g., various aspects of
cognitive performance) of people during psychological and neuropsychological
assessment. Ignoring these potential effects can create an extremely misleading
assessment. Part of adequate preparation for an assessment that will involve
recording or the presence of third parties is reviewing the relevant research and
professional guidelines.

4.2.10 Uncertain Gate Keeping

Psychologists who conduct assessments are gatekeepers of sensitive information
that may have profound and lasting effects on the life of the person who was
assessed. The gatekeeping responsibilities exist within a complex framework of
federal (e.g., HIPAA) and state legislation and case law as well as other relevant
regulations, codes, and cont~xts.

The following scenario illustrates some gate keeping decisions psychologists may
be called upon to make.

Clarifying issues to the client regarding to whom the information will be conveyed
when asked for, while planning an assessment is important because if the
psychologist does not clearly understand them, it is impossible to communicate
the information effectively as part of the process of informed consent and informed
refusal. Information about who will or will not have access to an assessment
report may be the key to an individual's decision to give or withhold informed
consent for an assessment. It is the psychologist's responsibility to remain aware
of the evolving legal, ethical, and practical frameworks that inform gatekeeping
decisions.

Self Assessment Questions

1) Define and describe ethics in assessment.

.59
Introduction to
Psychodiagnostics 2) What are the 10 fallacies in psychological assessment?

3) Describe what is mismatched validity and confirmation bias?

4) Describe unstandardising standardised tests.

5) What is ignoring effects of audio and video recording?

6) Describe uncertain gate keeping.

4.3 APA ETHICS CODE

.
The American Psychological Association has since 1953 published and revised
ethical standards, with the most recent publication of Ethical Principles of
Psychologists and Code of Conduct in 2002. This code of ethics also governs,
both implicitly and explicitly, a psychologist's use of psychological tests.

4.3.1 Ethical Principles

The Ethics Code contains six general principles:

i) Competence: Psychologists maintain high standards of competence, including

knowing their own limits of expertise. Applied to testing, this might suggest
that it is unethical for the psychologist to use a test with which he or she is
not familiar to make decisions about clients.

ii) Integrity: Psychologists seek to act with integrity in all aspects of their
professional roles. As a test author for example, a psychologist should not
make unwarranted claims about a particular test.

iii) Professional and scientific responsibility: Psychologists uphold professional

60 standards of conduct. In psychological testing this might require knowing
 Ethical Issues in Assessment
when test data can be useful and when it cannot. This means, in effect, that
a practitioner using a test needs to be familiar with the research literature on
that test.
iv) Respect for people's rights and dignity: Psychologists respect the privacy
and confidentiality of clients and have an awareness of cultural, religious, and
other sources of individual differences. In psychological testing, this might
include an awareness of when a test is appropriate for use with individuals
who are from different cultures.

v) Concern for others' welfare: Psychologists are aware of situations where

specific tests (for example, ordered by the courts) may be detrimental to a
particular client. How can these situations be resolved so that both the needs
of society and the welfare of the individual are protected?

vi) Social responsibility: Psychologists have professional and scientific

responsibilities to community and society.With regard to psychological testing,
this might cover counseling against the misuse of tests by the local school.

4.3.2 Ethical Standards

In addition to these six principles, there are specific ethical standards that cover
eight categories, ranging from "General standards" to "Resolving ethical issues."
The second category is titled, "Evaluation, assessment, or intervention" and is thus
the area most explicitly related to testing; this category covers 10 specific standards:

1) Psychological procedures such as testing, evaluation, diagnosis, etc., should

occur only within the context of a defined professional relationship.

2) Psychologists only use tests in appropriate ways.

3) Tests are to be developed using acceptable scientific procedures.

4) When tests are used, there should be familiarity with and awareness of the
limitations imposed by psychometric issues, such as those discussed in this
course.
5) Assessment results are to be interpreted in light of the limitations inherent in
such procedures.
6) Unqualified persons should not use psychological assessment techniques.

7) Tests that are obsolete and outdated should not be used.

8) The purpose, norms, and other aspects of a test should be described

accurately.

9) Appropriate explanations of test results should be given.

10) The integrity and security of tests should be maintained.

4.3.3 Standards for Educational and Psychological Tests

In addition to the more general ethical standards discussed above, there are also
specific standards for educational and psychological tests (American Educational
Research Association, 1999), first published in 1954, and sub cquently revised a
61
number oftimes.

I
 Introduction to These standards are quite comprehensive and cover
Psychodiagnostics
• Technical issues of validity, reliability, norms, etc.

• Professional standards for test use, such as in clinical and educational settings;

• Standards for particular applications such as testing linguistic minorities; and

• Standards that cover aspects of test administration, the rights of the test
taker and so on.

Self Assessment Questions

1) Describe the importance of APA ethics code .

..
2) What are ethical principles?

3) What do you understand by ethical standards?

4) Describe standards for educational and psychological tests.

4.4 ETHICAL ISSUES IN ASSESSMENT

In considering the ethical issues involved in psychological testing, three areas seem
to be of paramount importance: informed consent, confidentiality, and privacy.

4.4.1 Informed Consent

The term informed consent is commonly used throughout the field of psychology;
for example, consent to treatment, consent to participate in research, and consent
to release information are but a few of the .contexts in which consent is given and
sought. Consent, however, is a legal term, and care should be given to its application
within the realm of psychological assessment. While the intent here is to provide
a general understanding of informed consent, the information presented should not
62 be used in substitution for state law or ethical guidelines.
 Informed consent in assessment implies that the test taker (or his or her legal Ethical Issues in Assessment
guardian) has agreed to be evaluated prior to testing and after being informed of
reasons for testing, intended uses of data, possible consequences (including risks
and benefits), what information will be released (if any), and to whom the information
will be released (APA, 1996). The APA Committee on Psychological Tests and
Assessment (1996) indicated that informed consent may be desirable to obtain
even when not required (e.g., court-ordered assessment). Further, even when
informed consent is not required, it is advisable to inform test takers of the testing
process, including who may have access to the report, unless such information will
threaten the psychometric properties of the instrument or test (APA, 1996).

Typically, consent consists of three separate aspects: voluntariness, competence,

and information. First, voluntariness implies that the examiner must obtain the test
taker's consent "without exercising coercion or causing duress, pressure, or undue
excitement or influence" (Koocher & Keith-Spiegel, 1998, p. 417).

Second, the test taker must be considered legally competent to grant consent.
Unless legally deemed incompetent, all adults are assumed competent to give
consent. Children, however, generally are not presumed to be competent, although
the legal age to give consent varies by state. In assessing children or adults
deemed legally incompetent, substitute consent should be obtained from parents,
legal guardians, or from the court as applicable. Everstine and colleagues (1980)
recommendedobtaining consent from both the required substitute and from the
incompetent person whenever possible. At the very least, information about testing
- in developmentally-appropriate language should be given to the legally incompetent
person, and assent, or agreement, should be obtained.

Finally, the test taker must have the requisite information to consent. Sufficient
information must be provided to the test taker to allow the individual the opportunity
to make an informed decision regarding his or her participation in assessmer..t.
While it is unnecessary (and perhaps impossible) to review all possible outcome
scenarios with the client, it is necessary to provide facts a reasonable person
would need in arriving at an informed decision. Whether test results will be used
in decision making, if copies of test reports will be kept in the client's file and the
right to refuse testing or to withdraw at any time are examples of information that
should be given to each potential test taker.

Information on feedback policies is particularly important, as it appears that

psychologists do not routinely provide feedback to test takers. As recently as
1983, Bemdt's survey of psychologists found that a majority favored only limited
feedback to test takers, suggesting that most examiners viewed full disclosure on
a regular basis as an unrealistic goal. However, APA (1996) clearly has stated that
test takers have the right to feedback about testing results, unless this right is
waived by the test taker prior to testing or prevented by law (e.g., when courts
mandate testing for competency to stand trial). A feedback session is recommended
to serve two main purposes (Welfel, 1998). First, a feedback session allows the
test taker an opportunity to respond to incorrect or misleading conclusions. Second,
feedback may be therapeutic for the client, promoting symptom reduction and
improved client-therapist rapport.

However, special care should be given in how information is presented to the

indi vidual client. Many psychological assessment instruments are complex, even
for the professional trained in its usage, psychometric properties, and interpretation.
Therefore, summary reports may be more beneficial to clients than raw test data. 63
Introduction to Reports should be written in a manner that is clear and simple and free from
Psychodiagnostics technical language in order to avoid misinterpretation and misunderstanding.
Examiners should be available to answer specific questions about assessment
results and to clarify questions raised by the client.

In summary, a good rule of thumb is "to provide as full a description as time,

interest, and test security allow, [only] omitting or postponing review of results
that the counselor judges would be harmful to the client's current wellbeing"
(Welfel, 1998, p. 230). Regardless of the method of feedback utilised, a description
of the examiner's feedback policy should be reviewed during informed consent
, procedures.

Information on obsolete data policies should also be reviewed with each test
taker. APA (2002) requires that examiners refrain from basing recommendations
or decisions on obsolete or outdated testing data. How long a psychologist may
rely on certain test results depends primarily on the construct being measured
(Welfel, 1998). Tests that measure rapidly changing constructs, such as depressed
or anxious moods (e.g., Beck Depression Inventory, Beck Anxiety Inventory)
may be valid only for several days or weeks. Other tests that measure more
stable personality constructs (e.g., Minnesota Multi phasic Personality Inventory)
may be valid for several months. Regardless of the tests employed, examiners
should inform potential test takers of their policies on removal of such data.

Clearly, much information should be provided to test takers prior to examination.

Following the presentation of this information, common practice entails asking the
client to state the concept in his own words. This practice gives the examiner
some degree of certainty regarding the client's understanding of consent.

U se of written documents to record the terms of consent is standard. Both client

and clinician can benefit from a written contract specifying client rights and
responsibilities, limitations of confidentiality, and fees for services. Documentation
of informed consent should be reviewed verbally with the client in language
appropriate to the client's level of understanding and free from technical jargon
or colloquial terminology. As a rule of thumb, consent forms should be written at
no higher than a 7th grade reading level. Additionally, the client should be given
an opportunity to look over such documentation and ask questions before signing, .
in order to ensure understanding. Research conducted on the effects of written
informed consent forms generally has found positive effects. For example,
Handelsman (1990) found that the use of written consent forms increased clients'
positive judgments of therapists' experience, likeability, and trustworthiness.

4.4.2 Confidentiality
There are many issues of concern when it comes to ethics, one such issue being
the right to privacy. The concepts of individual rights and privacy are an essential
part of our society and must be taken seriously when students are involved. The
Ethical Principles assert individual rights to privacy and confidentiality as wen as
self ..determination. The term confidentiality indicates that individuals are guaranteed
privacy in terms of all personal information that is disclosed and that no information
will then be disclosed without the individual's direct permission. There are times
however, that confidentiality is breached because managers, for example, will
seek out psychological information about their employees. Another example is
that teachers may seek test scores for students, however, with the good intention
of understanding issues ut performance (McIntire & Miller, 2007).
64
/
 Another ethical concern is the right to informed consent. Self-determination is a Ethical Issues in Assessment
right to every individual which means that individuals are entitled to receive complete
explanations in regards to why exactly they are being tested as well as how the
results of the test will be used and what their results mean. These complete
explanations are commonly known as informed consent and should be conveyed
in such a way that is straight-forward and easy for students to understand. In
situationsinvolving minors or those with limited cognitive abilities,informed consent
needs to come from both the student themselves as well as their parent or
guardian. However, parental permission should not be confused with informed
consent. Educators have a responsibility to ensure that the student as well as their
parent or guardian understand all implications and requirements that will be involved
in any test before it is even administered (McIntire & Miller, 2007).

Koocher and Keith-Spiegel defined confidentiality as "a general standard of

professional conduct that obliges a professional not to discuss information about
a client with anyone" (1998, p. 116). Confidentiality between clinician and client
cannot be overstated as a critical ingredient for candid and cooperative participation.
It can be argued that confidentiality is what allows psychological services to be
effective, since without candid client participation assessment results can be invalid,
diagnoses inaccurate, and therapy ineffective. The basis for most clients agreeing
to receive psychological services is an understood agreement of confidentiality,
and is among the primary reasons why informed consent is requested and
documented.

It is important to ensure that clients have an understanding of the limits of

confidentiality. For example, in USA, all 50 states have legal statutes which
mandate disclosure of various information, including child abuse, elder abuse,
suicide, and/or imminent harm to others. In addition, assessment and testing are
frequently conducted for third parties that have a vested interest in the outcome
of test data. For example, insurance companies and health maintenance
organisations (HMOs) can and do request assessment information in order to
determine eligibility for coverage or reimbursement for services rendered.
Furthermore, employers, legal representatives, and schools often request testing
results to aid in decision-making. The amount of information requested can vary
widely from complete and full disclosure of all test data in legal proceedings to
summary reports prepared for prospective employers.

Releasing information to individuals or entities other than the client presents a

myriad of ethical and legal obstacles. Psychologists should refer to the APA Ethics
Code (2002) for guidance. To comply with the Ethics Code, psychologists should
inform test takers, prior to assessment, of any mandatory, as well as any likely,
releases of information. In addition, when requests from third parties are received,
psychologists should have test takers sign their consent to release specific testing
information. Finally, psychologists, once granted consent, should exercise extreme
caution in releasing only the necessary information to satisfy the inquiry of the third
party rather than releasing the entire contents of the client's chart. As stated
previously, examiners should not release secure test materials (e.g., protocols, test
:'I
P"" items) unless permission is granted from the testing publisher.
.Lt•
i

:.> Child test takers pose special dilemmas for examiners. As previously discussed,
1.
E unless granted by law, children are not considered capable of consenting to
assessment. Therefore, testing results may be shared with the legal guardian who
consented to the child's participation in assessment. However, a good rule of
65
Introduction to thumb is to follow the same procedures utilised for release of information to third
Psycho<tiagnostics parties. In other words, examiners must clarify limits of confidentiality with the
child and legal guardian at the outset of testing and should only release relevant
information to the legal guardian.

4.4.3 Invasion of Privacy

One of the main difficulties examinees can encounter in relation to psychological
tests is that the examiner might discover aspects of the client that he or she would
rather keep secret. Also of concern is that this information may be used in ways
that are not in the best interest of the client. The Office of Science and Technology
(1967), in a report entitled Privacy and Behavioral Research, has defined
privacy as " the right of the individual to decide for him/herself how much he will
share with others his thoughts, feelings, and facts of his personal life" (p. 2). This
right is considered to be "essential to insure dignity and freedom of self-
determination" (p. 2). The invasion of privacy issue usually becomes most
controversial with personality tests because items relating to motivational, emotional,
and attitudinal traits are sometimes disguised. Thus, persons may unknowingly
reveal characteristics about themselves that they would rather keep private.
Similarly, many persons consider their IQ scores to be highly personal.

The ethical code of the American Psychological Association (1992) specifically

states that information derived by a psychologist from any source can be
released only with the permission of the client. Although there may be exceptions
regarding the rights of minors, or when clients are a danger to themselves or
others, the ability to control the information is usually clearly defined as being
held by the client. Thus, the public is often uneducated regarding its rights
and typically underestimates the power it has in determining how the test data will
be used.

Despite ethical guidelines relating to invasion of privacy, dilemmas sometimes

arise. For example, during personnel selection, applicants may feel pressured into
revealing personal information on tests because they aspire to a certain position.
Also, applicants may unknowingly reveal information because of subtle, non
obvious test questions, and, perhaps more important, they have no control ov.er
the inferences that examiners make about the test data. However, if a position
requires careful screening and if serious negative consequences may result from
poor selection, it is necessary to evaluate an individual as closely as possible.
• Thus, the use of testing for personnel in the police, delicate military positions, or
important public duty overseas may warrant careful testing. In a clinical setting,
obtaining personal information regarding clients usually does not present problems.
The agreement that the information be used to help clients develop new insights
and change their behaviour is generally clear and straightforward. However, should
legal difficulties arise relating to areas such as child abuse, involuntary confinement,
or situations in which clients may be a danger to themselves or others, ethical
questions often arise. Usually, there are general guidelines regarding the manner
and extent to which information should be disclosed. These are included in the
American Psychological Association's Ethical Principles of Psychologists and
Code of Conduct (1992), and test users are encouraged to familiarise themselves
with these guidelines. Adequate handling of the issue of an individual's right to
privacy involves both a clear explanation of the relevance of the testing and
obtaining informed consent. Examiners should always have a clear conception of
the specific reasons for giving a test.
66
 Thus, if personnel are being selected based on their mechanical abilities, tests Ethical Issues in Assessment
measuring areas such as general maladjustment should not ordinarily be
administered. Examiners must continually evaluate whether a test, or series of
tests,. is valid for a particular purpose, and whether each set of scores has been
properly interpreted in relation to a particular context. Furthermore, the general
rationale for test selection should be provided in clear, straightforward language
that can be understood by the client. Informed consent involves communicating
not only the rationale for testing, but also the kinds of data obtained and the
possible uses of the data. This does not mean the client should be shown the
specific test subscales beforehand, but rather that the nature and intent of the test
should be described in a general way. For example, if a client is told that a scale
measures "sociability," this foreknowledge might alter the test's validity in that the
client may answer questions based on popular, but quite possibly erroneous,
stereotypes. Introducing the test format and intent in a simple, respectful, and
forthright manner significantly reduces the chance that the client will perceive the
testing situation as an invasion of privacy.

Self Assessment Questions

1) What is meant by informed consent?

................................................................................................................
I

2) Describe the various issues involved in confidentiality.

3) What is meant by invasion of privacy?

4.5 LET US SUM UP

For psychologists conducting assessments, both ethical and legal issues must be
considered. Psychologists should be familiar with the main ethical issues of
competence, informed consent, and confidentiality as they relate to assessment.
Remaining competent as an assessor implies psychologists should regularly seek
consultation and education opportunities, as the field of assessment continues to
I

U expand and develop. Those conducting psychological assessments are encouraged

)
l. to vigilantly revisit the components of informed consent and continue exploring
~
techniques to effectively communicate the aspects of consent to their clients.
Psychologists should also be aware of state and federal laws that pertain to
assessment and seek clarification and consultation for legal questions as needed. 67
 Introduction to
Psychodiagnostics 4.6 UNIT END QUESTIONS
1) Describe the various common fallacies involved in psychological assessment.

2) Describe in detail the principles and standards for assessment in APA code
of ethics?

3) Elucidate the ethical issues in assessment.

4.7 SUGGESTED READINGS

Groth-Marnat, G (2003). Handbook of Psychological Assessment (4thed.).
New Jersey: John Wiley & Sons, Inc.

Trull, T.J. (2005). Clinical Psychology (7th Ed.).USA: Thomson Learning, Inc .

68
REFERENCES
Abeles, N. (1990). Rediscovering psychological assessment. Clinical Psychologist,
10, 3-4.

American Educational Research Association. (1999). Standards for Educational

and Psychological Testing. Washington, DC: Author.

American Psychological Association Committee on Psychological Tests and

Assessment. (1996). Statement on the disclosure of test data. American
Psychologist, 51(6), 644-648.

American Psychological Association. (1992). Ethical principles of psychologists

and code of conduct. American Psychologist, 47, 1597-1611.

American Psychological Association. (2002). Ethical principles of psychologists

and code of conduct. American Psychologist, 57(12), 1060-1073.

Bennett, G K, Seashore, H. G, &Wesman, A G (1981). Differential Aptitude

Tests (DAT) (5th ed.). New York: Psychological Corporation

Beutler, L.E. & Harwood, T.M. (1995). How to assess clients in pre-treatment
planning. In Butcher, J.N. (Ed.), Clinical Personality Assessment (pp. 59-77).
New York: Oxford.

Binet, A, & Henri, V. (1896). Psychologieindividuelle. Ann 'eet'sychologique, 2,

411-465. '

Caccioppo, J. T., &Tassinary, L. G. (Eds.). (1990). Principles of

Psychophysiology - Physical Social and Interventiai Elements. New York:
Cambridge University Press.

Camera, W. J., Nathan, J. S., & Puente, A E. (2000). Psychological test usage:
Implications in professional psychology. Professional Psychology: Research and
Practice, 31(2) 141-154.

Cattell, R. B., & Warburton, F. W. (1965). Principles of Personality

Measurement and A Compendium of Objective Tests. Champaign, IL: University
of Illinois Press.

Cattell, R. B., Cattell, A. K, & Cattell, H. E. P. (1994). 16 PF-Test (5th ed.).

Champaign, IL:

Cone, ID. (1978). The behavioural assessment grid (BAG): a conceptual

framework and a taxonomy. Behaviour Therapy, 9,882-888.

Cronbach, L. J. (1949). Essential of Psychological Testing (3rd ed.). New

York: Harper & Row.

Everstine, L., Everstine, D. S., Heymann, G M., True, R. H., Frey, D. H.,
Johnson, H. G, et al. (1980). Privacy and confidentiality in psychotherapy.
American Psychologist, 35, 828-840.

Feldman, R. S., &Rim'e, B. (Eds.). (1991). Fundamentals of Nonverbal

Behavior. Cambridge: Cambridge University Press.

Fischer, J. & Corcoran, K (1994). Measuresfor Clinical Practice: A Sourcebook

(2 vols., 2nd ed.). New York: Macmillan. 69
Introduction to French, J. W., Ekstrom, R. B. & Price, L. A. (1963). Manual and Kit of
Psychodiagnostics Reference Tests for Cognitive Factors. Princeton, NJ: Educational Testing
Service.

Guilford, J. P. (1959). Personality. New York: McGraw-Hill.

Handelsman, M. M. (1990). Do written consent forms influence clients' first

impressions of therapists? Professional Psychology: Research and Practice,
21(6), 451-454.

Hayes, S.c., Nelson, R.O. & Jarrett, R.B. (1987). The treatment utility of
assessment. American Psychologist, 42, 963-974.

Hundleby, J. D., Pawlik, K., &Cattell, R. B. (1963). Personality Factors in

Objective Test Derives. San Diego, CA: Knapp.

Hurt, S.W., Reznikoff, M. &Clarkin, J.F. (1991). Psychological Assessment,

Psychiatric Diagnosis, & Treatment Planning. New York: Brunnerl Mazel.

Institute for Personality and Ability Testing Inc. (IPAT).

Jacobson, N.S. (1992). Behavioural couple therapy: a new beginning. Behaviour

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71
NOTES
 ·Ignou GROUP A
~
. I
Indira Gandhi
THE PEOPLE'S
UNIVERSITY MPCE·012
Psychodiagnostics
National Open University
School of Social Sciences

Block

'. 2
PSYCHODIAGNOSTICS IN PSYCHOLOGY
UNIT 1
Objectives of Psychodiagnostics 5

UNIT 2
Different Stages in Psychodiagnostics 23
UNIT 3
Batteries of Test and Assessment Interview 39
UNIT 4
Report Writing and Recipient of Report 54

••
 Expert Committee
Prof. A. V. S. Madnawat Dr. Madhu Jain Dr. Vijay Kumar Bharadwas
Professor & HOD Department Reader, Psychology Director
of Psychology, University of Department of Psychology Acadernie Psychologie, Jaipur
Rajasthan. Jaipur University of Rajasthan, Jaipur
Prof. Dipesh Chandra Nath
Dr. Usha Kulshreshtha Dr. Shai1ender Singh Bhati Head of Dept. of Applied
Associate Professor, Psychology Lecturer, G. D. Government Psychology, Calcutta University
University of Rajasthan, Jaipur Girls College, Alwar, Rajasthan Kolkata
Dr. Swaha Bhattacharya Prof. Vandana Sharrna Dr. Mamta Sharrna
Associate Professor Professor and Head of Assistant Professor
Department of Applied Psychology Department Department of Psychology
Calcutta University, Kolkata of Psychology Punjabi University, Patiala
Punjabi University, Patiala r
Prof. P. H. Lodhi Dr. Vivek Belhekar
Professor and Head of the Prof. Varsha Sane Godbole Senior Lecturer
Department of Psychology Professor and Head of Bombay University, Mumbai
University of Pune, Pune Department of Psychology
Osmania University, HyderabadDr. Arvind Mishra
Prof. Amulya Khurana Assistant Professor
Professor & Head Psychology Dr. S. P. K. Jena Zakir Hussain Center for
Humanities and Social Sciences Associate Professor and Incharge Educational Studies. Jawaharlal
Indian Institute of Technology Department of Applied Nehru University, New Delhi
New Delhi Psychology University of Delhi. .
South Campus Benito Juarez Dr. Karuka Khandelwal Associate
Prof. Waheeda Khan .Road. New Delhi Professor and Head of
Professor and Head Department. Department of Psychology
of Psychology Prof. Manas K. Mandal Lady Sri Ram College,
Jarnia Millia University Director Kailash Colony, New Delhi
Jarnia Nagar, New Delhi Defense Institute of Prof. G. P. Thakur
Psychological Research
Prof. Usha Nayar DRDO, Tirnarpur, Delhi Professor and Head of
Professor, Tata Institute of Department of Psychology (Rtd.)
Social Sciences, Deonar, Mumbai Ms. Rosley Jacob M.G. Kashi Vidhyapeeth
Lecturer, Department of Varanasi
Prof. A.K. Mohanty Psychology, The Global Open
Professor, Psychology University Nagaland, Paryavaran
Zakir Hussain Center for Complex, New Delhi
Education Studies, Jawaharlal
Nehru University, New Delhi

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Emeritus Professor, Psychology
Department of Psychology
SOSS, IGNOU, New Delhi

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Units 1-4 Ms. Kiran Rathore
Assistant Professor
Department of Psychology
Osmania University, Hvderabad

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 BLOCK 2 INTRODUCTION
Unit 1 begins the focus on assessment in all aspects of clinical psychology.
Different types of assessment have different goals, and these purposes are
articulated. Consideration is given to differences when assessments are geared
toward direct service to patients, in consultation to other professionals, and to
answer specific clinical questions or monitor clinical progress. This unit starts with
the objectives of assessment, followed by presenting distinction between psycho
diagnostic assessment and psychiatric consultation. Then we deal in detail the
DSM IV TR diagniostic criteria. This is followed by the specific types of
assessments such as the cognitive assessment, behavioural and personality
assessment.

Unit 2 presents the different stages in psycho diagnostics. 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 psycho diagnostic 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.

. Procedures used in the assessment of a particular patient should, ideally, be those

best suited to answer specifically the referral questions, as these emerge from
earlier assessment and are clarified by the referring and testing clinicians. For
such questions may be answered either through a single standardized test or a
group of tests. The first half of this unit covers the definition and uses of test
batteries.

Probably the single most important means of data collection during psychological
evaluation is the assessment interview. Unit 3 deals with this aspect in detail.
Without interview data, most psychological tests are meaningless. The interview
also provides potentially valuable information that may be otherwise unobtainable,
such as behavioural observations, idiosyncratic features of the client, and the
person's reaction to his or her current life situation. In addition, interviews are the
primary means for developing rapport and can serve as a check against the
meaning and validity of test results. The second half of this unit is concerned with
the assessment interview. The skills and techniques, formats and types of interviews
are discussed in detail. We start the unit with defining and describing test batteries,
followed by the use of test batteries. Then we take up Assessment interview
followed by skills and techniques of interview. Under this we discuss rapport,
listening skills, communication, observation of behaviour etc. This is followed by
presenting the various formats of interviews which includes structured, semi
structured and unstructured formats of interview. Then we take up types of
interviews under which we discuss the intake interviews, mental status assessment
interview, crisis interviews, diagnostic interview and computer assisted interviews.

Unit 4 deals with the psychological report which is the end product of assessment.
It represents the clinician's efforts to integrate the assessment data into a functional
whole so that 'the information can help the client solve problems and make decisions.
Even the best tests are useless unless the data from them is explained in a manner
that is relevant and clear, and meets the needs of the client and referral source.
This requires clinicians to give not merely test results, but also interact with their
data in a way that makes their conclusions useful in answering the referral question,
making decisions, and helping to solve problems.

An evaluation can be written in several possible ways. The manner of presentation

used depends on the purpose for which the report is intended as well as on the
individual style and orientation of the practitioner. The format provided in this unit
is merely a suggested outline that follows common and traditional guidelines. It
includes methods for elaborating on essential areas such as the referral question,
behavioural observations, relevant history, impressions (interpretations), and
recommendations. In this unit we start with a definition and description of what
a psychological report is and how to communicate assessment results etc. Then
we present the general guidelines of writing a psychological report which includes
the length of the report, degree of emphasis, domains etc. Then we discuss the
models of psychological report and the levels of report which includes three
levels. This is followed by a section on format of psychological report.
UNIT 1 OBJECTIVES OF
PSYCHODIAGNOSTICS
Structure
1.0 Introduction

1.1 Objectives

1.2 Objectives of Psychodiagnostics

1.2.1 Differences between Psychodiagnostic Assessment and Psychiatric
Consultation
1.2.2 Referral for Psychodiagnostic Testing
1.2.3 The Psychodiagnostic Report
1.2.4 Application of Psychodiagnostic Testing
1.2.5 Reasons for Psychodiagnostic Testing
1.2.6 The PUrpose of Diagnostic Assessment
1.2.7 Areas to Be Covered in Diagnostic Interview

1.3 DSM IV (TR) Diagnosis

1.3.1 Classification Systems
1.3.2 Logistics and Details of Diagnostic Assessments
1.3.3 ,Clinical Examples
1.3.4 Descriptive Assessments
1.3.5 Prediction Assessments

1.4 Specific Types of Assessment

1.4.1 Cognitive Assessment
1.4.2 Personality Assessment
1.4.3 Behavioural Assessment

1.5 Let Us Sum Up

1.6 Unit End Questions

1.7 Suggested Readings

1.0 INTRODUCTION
This unit begins the focus on assessment in all aspects of clinical psychology.
Different types of assessment have different goals, and these purposes are
articulated. Consideration is given to differences when assessments are geared
toward direct service to patients, in consultation to other professionals, and to
answer specific clinical questions or monitor clinical progress. This unit starts with
the objectives of assessment, followed by presenting distinction between psycho
diagnostic assessment and psychiatric consultation. Then we deal in detail the
DSM IV TR diagniostic criteria. This is followed by the specific types of
assessments such as the cognitive assessment, behavioural and personality
assessment.
5
Psychodiagnostics in
Psychology 1.1 OBJECTIVES
After completing this unit, you will be able to:

• Elucidate the objectives for clinical assessment;

• Describe the purpose for conducting at least three types of assessment

(cognitive assessment, personality assessment, and behavioural assessment);

• Explain the purpose of psycho diagnostic assessment;

• Differentiate between psychiatric interview and psycho diagnostic testing;

• Elucidate the various types of testing;

• Analyse the logistics and details; and

.• Delineate the specific types of assessment.

1.2 OBJECTIVES OF PSYCHODIAGNOSTICS

Before taking up the objectives of psycho diagnostics, let us see how
psychodiagnostic testing differs from psychiatric consultation

1.2.1 Differences between Psychodiagnostic Assessment and

Psychiatric Consultation
A psychiatric consultation consists of a thorough clinical interview, review of
records, and observation of the patient's behaviour by a psychiatrist or psychologist.
For many psychiatric concerns, this is the most appropriate referral and connects
the patient with a mental health provider.

Psychodiagnostic testing is a specialised diagnostic procedure that identifies and

quantifies degrees of psychopathology. In contrast to a psychiatric consultation,
it uses written, oral and projective instruments to evaluate a patient's mental
processes and to assess how their thinking and emotions are likely to impact their
behaviour. Therefore, psycho diagnostic testing provides objective data on a
patient's psychological functioning and is a useful tool for clarifying confusing
clinical presentations.

Psychodiagnostic testing enhances diagnostic accuracy by controlling for

subjective opinion because it uses highly reliable, standardized tests that have
been validated in clinical trials. Because it is able to provide both accurate
diagnostics and grade the severity of impairment, psycho diagnostic testing
helps the physician or psychiatrist to make pharmacological or psychotherapeutic
treatment recommendations that have the highest likelihood of success.

Psychodiagnostic testing, because of its standardized and objective qualities, aids

the practitioner in developing differential treatment recommendations.

1.2.2 Referral for Psychodiagnostic Testing

Patients sometimes present confusing clinical pictures. They require sophisticated
and extensive work ups to distinguish the psychological contributions that confound
accurate diagnoses. Referral for psycho diagnostic testing is a valuable tool in
arriving at a diagnostic decision.
6
Examples of appropriate referrals for psychological testing include the following: Obiectives of
Psychodiagnostics
• Patients having 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.

1.2.3 The Psychodiagnostic Report

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 ITdisorders), intellectual functioning, 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 examination, patient's personal, family
and cultural history, and findings from the standardized tests. Clinicians can use
these objective reco~endations to develop interventions with the highest likelihood
of success.

1.2.4 Application of Psychodiagnostic Testing

Psycho diagnostic testing is a widely recognised diagnostic procedure that is used
.in a variety of non-medical settings. Examples include:

I) Forensics: In this context, 80% of psychological testing is ordered when the

defendant's psychiatric condition is seen important in a criminal case. Other
legal uses of psycho diagnostic testing include child custody evaluations,
contested estates, wrongful termination and harassment cases, etc.

2) Insurance Settlements: Insurance companies rely on psycho diagnostic

testing for a variety of disability and Workman's Compensation cases. Similarly,
the Department of Social Services routinely uses psycho diagnostic tests to
make Social Security determinations. Psycho diagnostic testing is particularly
useful in ruling out malingering.

3) Employment Environments: Psychodiagnostic testing was originally

developed during World War 11a screening device to increase the efficacy
in deploying military personnel in stressful situations. It is still used extensively
. by police departments, the military, and other employers to ensure that recruits
are psychologically suited to the required tasks.

4) School Settings: Psychodiagnostic testing is used by counselors in schools

and universities to help students make career choices basedon their aptitudes
and abilities. It is also the mainstay of assessments for special education
placement, admission to gifted programs, and learning disability assessment.
7
Psychodiagnostics in The function of assessment in clinical practice varies greatly and can include any
Psychology and all of the following objectives:

• Diagnosis and/or evaluation of clients' reason for seeking treatment

• Case conceptualisation

• Treatment planning

• Monitoring of client response to treatment

.• Change clients' behaviour or cognitions through increased self-awareness

(e.g., self-monitoring, behavioural experiments)

• Program evaluation or individual clinician evaluation of effectiveness.

1.2.5 Reasons for Psychodiagnostic Testing

. There are many reasons for conducting a psychological assessment, and each
reason requires the assessor to initiate different tasks. Likewise, selecting methods
and techniques for acquiring clinical information depends on the nature and ~ction
of the assessment. Therefore, before learning how to conduct an assessment,
practitioners of clinical psychology must understand why or for what purpose
assessments are conducted.

In general, the major aims of assessments are to gather information about persons,
systems, environments, or phenomenon (or some combination of these), and to
enable classification, description, and comprehension or evaluation of current
circumstances. Assessments also may be directed to predict future behaviours
(dangerousness, suicide) or circumstances (maintaining employment). Commonly,
assessments seek to respond to more than one of these goals at a time and can
be tailored to address several clinical or research questions. Therefore, there will
be overlap among the strategies and techniques used for collecting information for
each purpose.

1.2.6 The Purpose of Diagnostic Assessment

The purpose of diagnostic assessment is to differentiate between "normal" and
"abnormal" behaviour, to differentiate among various "abnormal" constellations of
symptoms, and to classify individuals based on identified abnormalities or
"presentation of disease" (Chaplin, 1985).

The purpose of the diagnostic interview is to arrive at an understanding of a .

client's presenting problem through an assessment of current life situations,
developmental processes, family and developmental background, enduring
personality trends, assets, and vulnerabilities, as well as manifest behaviour and
responsiveness in the interview situation.

In order to conduct such psycho diagnostics, the clinician must have the following
steps:

1) Signed consent form(s).

2) Audio/Video tape of interview session.

;

3) Verbatim transcript of audio/video tape.

4) Case report.
8
Conducting the Interview: The clinical psychologist is expected to explore the Objectives of
Psychodiagnostics
presenting problem and its precipitating factors in some depth. How he chooses
to do so should be based on his clinical judgment, and procedures used.

1.2.7 Areas to be Covered in Diagnostic Interview

1) . Identifying Information: Description of interview setting and role of
interviewer in establishing an intake process.

Include client's sex, age, social class, race, religion, marital status, occupation,
education, and current living situation of client (with a description of the
family constellation at time of interview). Also include a current level and
effectiveness of functioning when you describe current living situation.

2) Presenting Complaints: Current symptoms, anxieties, moods, difficulties

in personal arid I or occupational relationships and activities. Overt reason(s)
for seeking help and referral route to interviewer.

3) Presenting Appearance: Description of salient aspects of physical

appearance and mannerisms, as well as observations of significant interactions
with interviewer. Specify significant behavioural, affective, interactional
observations that helped in assessing the client's problems and strengths.

4) Precipitating Factors and History of the Problem: Events and I or life

changes that accompanied appearance of psychological distress, or appear
associated with such distress. Development and course of problems since
client [list noticed their appearance. Previous efforts at resolution and apparent
consequences.

5) History of the Person/Social Context: Areas of information developed

will depend on the type of problem and interviewer's orientation and rationale
. for the interview.

Integrate, as applicable, issues of diversity, including, but not limited to gender,

sexual orientation, race, age, cultural background, socio economic status,
religious or spiritual identifications, and ability or disability when addressing
the following sub sections.

6) Developmental History: Developmental milestones and attendant stresses

(e.g. early separations from family, adolescent stresses, young adult crises,
etc.). The "Developmental History" and "Family History" sections can be
integrated.

7) Family History: Family of origin, constellation, ages, ethnic racial and

religious backgrounds, description of parents, siblings, and quality of
relationships with such figures at critical times in childhood and adolescence,
major losses, changes, and traumas within family history as evidence. Whether
there ha')been any severe or mild psychological disturbance in family members.
Such problems should be mentioned here if not included fully in earlier
sections. Include the inter factional consequences of behaviour within family.

8) School History: Achievements, problems, aspirations significant relationship

with authority figures.

9) Peer Relations: Significant relationships, difficulties, conflicts through life.

9
Psychodiagnostics in 10) Sexual History: Early childhood memories, traumas / abuse, parental
Psychology attitudes, reactions to physical changes at puberty, dating, sexual intercourse,
masturbation, sexual orientation and/or conflicts in that area. Current attitudes
toward sexuality, current sexual activity.

11) Work History: Relations to work roles, work, mates, authorities, job
changes, central work assets and liabilities.

12) Medical History: Past history of significant illness, injuries, disabilities,

reactions to such physical problems, family reactions to' illness. Include the
presence of substance abuse, use of prescription medications, cigarettes,
alcohol, etc.

13) Analysis / Formulations: The clinical psychologist integrates material

presented in the report to develop an understanding of client's major manifest
and latent presenting complaints. He then uses those concepts most consistent
with his orientation and most relevant to his treatment recommendation.

Regardless of theoretical orientation, appropriate integration of issues of diversity

is a requirement of the professional and competent psychologist.

Self Assessment Questions

1) State the objectives of psychodiagnostic testing.

2) Differentiate between psychodiagnostic assessment and psychiatric

consultation.

3) What should be the format and contents in psycho diagnostic report?

4) Discuss the applications of psychodiagnotic testing.

5) What are the purposes of diagnostic assessment?

10
 Objectives of
6) What areas should be covered in diagnostic interview? Psychodiagnostics

1.3 DSM IV (TR) DIAGNOSIS

The report must include a DSM diagnosis that addresses all five Axes with
diagnostic modifiers, if or when applicable.
Recommendations
The nature of recommendations should flow from the needs of the client and the
orientation of the interviewer. If interviewer's orientation emphasises treatment
goals and specific modalities of therapy, recommendations along these lines should
be included. If the orientation of interviewer is along a more expressive / exploratory
modality, recommendations will be far less structured or definite. Rather, the
interviewer might note possible areas deserving some focus in the therapy.
The interview is to last no more than 50 minutes, and no less then 45 minutes.
A 60 minute interview will be allowed.

Questions that diagnostic assessments can answer include the following examples.

• A 6-year-old child is having trouble in school, and not staying in his seat
during lessons: Does the child have an attention deficit disorder, an anxiety
disorder, or conduct disorder?

• A 68-year-old female has been increasingly forgetful, less energetic, and

confused: Is she depressed or suffering from the onset of dementia?
• Why is the 35-year-old male having chest pains and rapid heart rates without
any biological explanation for these symptoms?
Answering such questions through diagnostic assessments may lead to
recommendationsfor treatment,establishmentof the clients' eligibility(or ineligibility)
for disability services (e.g., disability accommodations, reimbursement from
insurance companies), or simply increased understanding of patients' symptoms,
which will enable other health care practitioners to work more effectively with
them.

Diagnostic assessments in a psychological setting are similar in concept to

physicians' medical examinations. Medical patients arrive in physicians' offices for
many reasons. Depending on the motivation for the visit, physicians either focus
on a specific complaint presented by the patient, or may evaluate the entire
person in the search for "what's wrong?"
There is a clear mission to search for abnormality or pathology, identify the
malady, and report the findings. Typically, such an examination would lead to
treatment if a disease or abnormality were found. Seldom does a physician examine
a patient only to identify optimal functioning; information is typically a by product
of the diagnostic or physical examination. Similarly, diagnostic psychological
assessments tend to be "disease" focused and are criticized for following a deficit
11
model, rather than a balanced model of strengths and deficits.
Psychodiagnostics in Furthermore, behavioural and cognitive behavioural psychologists criticizediagnostic
Psychology assessments for excluding contextual information about antecedents, consequences,
and social, physical, and cultural environmental factors from the evaluation of
persons' reported problems and symptoms. Partially, this phenomenon is a function
of the classification systems that guide diagnostic evaluations.

1.3.1 Classification Systems

The Diagnostic and Statistical Manual of Mental Disorders (4th Edition; DSM-
IV- TR; American Psychiatric Association, 2000) is the guide most commonly
. used by mental health professionals in the United States for diagnosing
psychological, psychosocial, interpersonal and environmental problems in children,
adolescents, and adults. The International Classification of Disorders-I 0 (ICD-
10; WHO, 1992) is also used worldwide, and is the preferred classification
system by physicians.

Classification systems, as the basis for diagnostic assessments, are derived from
enormous amounts of research on very large samples of the population. Their
purpose is to provide nomothetic information.Nomothetic information is information
that establishes general principles, norms, or laws.

With regard to the DSM-IV-TR (American Psychiatric Association, 2000) or

lCD-IO (WHO, 1992), nomothetic information.informs us how many people with
certain characteristics, features, or symptoms may behave, interact with others, or
reportedly feel about themselves, others, and the world around them. The
information differentiates persons with such characteristics, features, or symptoms
from data collected on large volumes of."normal" people, or individuals who db
not have difficulty in personal, social, occupational, or academic functioning.

For example, we know that many adults with major depressive disorders often
have persistent feelings of extreme hopelessness about their future, and they have
felt this way for an extended period (2 weeks or more; American Psychiatric
Association, 2000). Non depressed, normal persons, while in a temporary negative
mood state, may endorse intermittent feelings of hopelessness about specific
situations or momentary feelings of hopelessness about their futures, but they do
not typically report enduring feelings of hopelessness under ordinary circumstances.
It is important to remember, however, that information in the DSM-JV-TR and
ICD-lO is based on average scores and commonalities in self reports or evaluations,
and that there are variations within the group and exceptions to the rules and
criteria established. Therefore, not all persons who meet criteria for a Major
Depressive Disorder will endorse having persistent feelings of hopelessness, but
they will likely overlap with the majority group in other symptomatology.

The classification"systems continue to evolve in accordance with the development

in the fields of clinical and social psychology, anthropology, and epidemiology.
The DSM-JV-TR is revised periodically to include information about populations
and variables that had been under represented in the past. In the most recent
revision, the task forces in charge of improving on the DSM-JV-TR have increased
attention to diversity and cultural factors and strive to increase understanding and
classification of patterns of symptoms that may warrant a diagnosis or specific
nomenclature in future additions.

Diagnostic manuals have significant merits and have allowed for a certain degree
of standardization in the field of clinical psychology. They provide a means for
12
 professionals to communicate about clients or patients, and disseminate synthesized Objectives of
Psychodiagnostics
conclusions from volumes of research. Psychologists gear diagnostic assessments,
in part, to seek confirmation or disconfirmation of persons' fit with nomothetic
information.

The DSM-IV-TR provides a starting pointfor understanding clients' clinical

presentations and for determining general directions for treatment planning.
However, to solely rely on nomothetic information would be equivalent to taking
a cookbook approach to identifying persons' problems and solutions to their
problems. As you know from your own experience with others, people are much
more complex. Relying on group norms and typical or common presentations
. would be misleading in diagnosis and treatment. Psychologists also have an ethical
obligation to consider personal characteristics of individuals assessed to ensure
tests are valid for the person tested, interpretation of data is appropriate, and
recommendations based on test data are culturally and individually relevant (APA,
2003, 9.0). As such, nomothetic information is balanced and integrated with
ideographic (individual) information. Ideographic assessments are characteristic
of behavioural assessments, and are defined and discussed in more detail in
blockl.

1.3.2 Logistics and Details of Diagnostic Assessments

Mental health professionals who have training and experience using the DSMlV-
TR or leD-IO, and specialised measures, inventories, or structured interviews use
.these tools,to conduct diagnostic assessments for a variety of purposes. The APA
Ethical Principles and Code of Conduct (APA, 2003) specifies that only trained
qualified individuals should use psychological tests, and outlines the cautions to be
taken. Clients or family members of clients might request a diagnostic assessment.
Clinicians routinely incorporate diagnostic assessments into their standard practices
for evaluating new clients for treatment planning.

Non mental health professional colleagues (medical professionals, school

administrators, teachers), or mental health professionals who desire more precise
understanding of their patients' presentations of symptoms may request consultation
with professionals trained to conduct diagnostic assessments. Diagnostic
assessments may also be conducted to screen, classify, or assign individuals for
clinical research studies according to the information obtained. Likewise, forensic
psychologists may conduct diagnostic assessments to determine clients' mental
competencies to stand trial or mental states related to committed crimes.

Depending on the complexity of the client's presentation of symptoms, a diagnostic

assessment may be accomplished through interviewing alone, or may require
interviewing in combination with other tests and measurements. A diagnostic
assessment may be one component of a comprehensive evaluation of an,individual,
or it may be the sole purpose of an assessment. Although diagnostic assessments
may be repeated over time to determine whether temporal symptoms have been
alleviated,certain diagnoses are considered unremitting, lifelong conditions (antisocial
personality disorder, borderline personality disorder, narcissistic personality
disorders; A. T; Beck, Freeman, Davis, & Associates,2004), and therefore,
reevaluation may not occur. Unlike some forms of behavioural assessment,
practitioners may conduct diagnostic assessments in almost any setting in which
they work. These evaluations are not dependent on viewing clients in their naturalistic
environments.
13
Psychodiagnostics in 1.3.3 Clinical Examples
Psychology
Example 1: For a client who is self referred to a psychologist specialising in
sleep disorders, a diagnostic assessment is necessary to determine if the client
indeed has a sleep disorder, and if so, what kind; or to determine if the sleep
difficulties are secondary to other medical or psychological problems. Once the
psychologist determines the nature of the client's difficulty, treatment interventions
may be offered, or an appropriate referral made if the sleep difficulties are
determined to be secondary to another psychological or medical problem .

.Example 2: In psychiatric emergency rooms, psychologists may conduct diagnostic

assessments to determine patients' needed level of care, and to communicate this
information to triage facilities (inpatient unit, partial program, or out patient clinic)
before discharging or admitting patients to other units for follow up care.

Example 3: If someone you know told you that her child has a reading disability,
would you know how to help your friend assess the services that her child needs?
Most professionals would need more specific information to develop
recommendations or a treatment plan. For starters, what are the child's current
learning strengths and difficulties, environmental supports, learning strategies used
individual and family expectations, and self efficacy beliefs? Note that you can
ethically help a friend consider services that might be appropriate for a particular
disorder, but you cannot ethically give recommendations or treatment plans on a
casual basis to personal friends and acquaintances. Assessments, just like therapy,
must always be conducted within the boundaries of aformal professional relationship
(APA, 2002).

1.3.4 Descriptive Assessments

Descriptive assessments, broadly described, are conducted to learn more about
clients' cognitive functioning, psychosocial functioning, academic achievement,
personality, behaviour, or specific needs within an identified area of interest (e.g.,
caregivers' needs). Assessment questions may focus on individuals, families, groups
of people (e.g., group home setting; hospital unit), or person environment
interactions (e.g., goodness of fit between a developmentally disabled adult and
her social rehabilitation program setting).

Mental health professionals conduct these assessments to obtain background and

general information necessary for better understanding of clients' problems and
factors contributing to those problems. Such assessments aid professionals in
/ planning treatment, providing academic or occupational counseling, and designing
group or individual behaviour modification interventions. Researchers or program
evaluators may use descriptive assessments to provide end users of their work
with inforrnation about populations or programs .under study.

Descriptive assessments are often combined with diagnostic assessments, and

some methods of evaluation will accomplish data collection for both purposes.
Data collection techniques for descriptive assessments include a combination of
interviews, observation, self report inventories and questionnaires, reports by
others, computerized assessment, and physiological assessment. Clinical
psychologists with proper training can conduct most types of descriptive
assessments. Psychologists also commonly specialise in assessments for specific
aged populations (e.g., children/adolescents, adults, senior adults), disorders (e.g.,
14
 learning disabilities, traumatic brain injury, Huntington's chorea)or psychosocial Objectives of
Psychodiagnostics
problems (e.g., court adjudicated offenders).

1.3.5 Prediction Assessments

While evaluation of current functioning is critical to most types of assessment,
under certain circumstances, psychologists are also asked or required to predict
clients' future behaviours or the effect or impact that situations or life events will
have on individuals' thoughts, feelings, behaviours, or overall functioning.

Predictive assessments are often necessary in or for medical, forensic, and

occupational settings, and traditional mental health in and outpatient settings. Given
the uniqueness of individuals, and the inconsistency of behaviours characteristic of
persons with certain personality disorders or other problems, most predictive
assessments remain tentative and qualified as "best estimations.

The accuracy of.any assessment, but especially of predictive assessments, relies

on the availability, accuracy, and reliability of data about the predictor and predicted
variables. Predictor variables are those factors that are presumed to proceed or
eo occurs with the behaviour to be predicted, and to be causally related in some
way.

Some behaviours are more easily predictable than others. Assuming we have
comprehensive information leading to the diagnosis, it is likely that a young adult
with social anxiety, without treatment, will have difficulty delivering his 30-minute
presentation to the 75 students in his college course; an older adult who had little
social support other than her recently deceased spouse, who also has a history
of poor coping skills, may be likely to have difficulty adjusting to widowhood, and
may suffer from complicated bereavement. Such predictions are fairly easy to
make, given a thorough assessment of past behaviour, current functioning, and
other psychosocial variables, and the predictable nature of the behaviours in
question.

When more difficult predictions of future behaviour are requested or necessary,

significant consequences may be associated with the outcome of the evaluation.
For example, predictions of suicide risk, dangerousness, psychological suitability
for specific medical treatments, or prediction of psychological preparedness for
parenthood (adoption) require psychologists to gain as much certainty as possible,
since the consequences related to poor or inadequate assessment can obviously
be grave.

The APA Code of Ethics cautions that predictions or recommendations made

based on assessments should specify the sources of data collected and that for
mandated individuals specifically (and all others, generally), appropriate informed
consent must be obtained. Some examples of prediction assessments will illustrate
the complexities of this work.

'<
Psychologists working in almost any clinical setting will be faced with the need to
conduct suicide and dangerousness risk assessments. Current suicide symptoms
and homicidal ideation are standard components of most psychologists' intake
assessment and mental status examination. When clients endorse suicidal or
homicidal ideation (thoughts), further evaluation is necessary to determine ~e
severity of these thoughts, the clients' likelihood of acting on these thoughts and
plans to do so, and their ability or access to the means by which they could
execute their plans. 15
Psychodiagnostics in Based on thorough assessments, clinical psychologists are expected to make
Psychology predictions about a client's safety and the safety of others, before they can release
the client from their presence. However, Rudd and Joiner (1998) emphasise that
although the court system seems to imply that clinicians should be able to predict
suicide, empirical data show that "prediction" models of suicide consistently fail;
therefore, the complexity of this task cannot be overstated.

Based on research reviewed by Rudd and Joiner, clinicians' "risk" assessments

(focusing on patients' current state) are more accurate and reliable than actual
predictions (implying future behaviour) of suicide attempts or completion. Risk
.assessment for suicide consists of evaluation of predisposing factors (e.g., age,
sex, previous psychiatric diagnosis, history of suicidality), acute and chronic risk
factors and precipitating factors (current stressors or losses, such as job, loved
ones, physical or cognitive ability, chronic pain, affective disorders, poor problem
solving skills, social isolation, poor impulse control), and protective factors (active
involvement in treatment, good physical health, good problem solving ability, social
.support, hopefulness).

In medical settings, physicians constantly make decisions and predictions about

patients' likely physical response to medications, medical interventions (e.g., surgery,
radiation, organ transplantation), and treatments (e.g., light therapy). However,
many physicians recognise that biological responses are not the only concern.
Patients' compliance with medical regimens and ability to cope with necessary
lifestyle and behavioural changes can be equally important. Clinical (or clinical
health) psychologists aid physicians' decision making and treatment planning for
patients by conducting predictive assessments relating to these issues.

For example, organ transplant recipients must comply with medication and
behavioural (bone marrow transplant recipients must stay away from crowds for
6 months to 1 year, due to low immune functioning) regimens following transplants.
Many recipients take as many as 5 to 10 medications following the transplant,
including anti rejection medications to prevent their bodies from rejecting the new
organ. If patients do not comply with this requirement, fatal consequences could
result.

Physicians, therefore, want to be as certain as possible that treatment is truly in

an individual's best interest. Likewise, individuals with histories of drug or alcohol
abuse may be questionable candidates for some medical treatments because of
the potential for them to cope poorly with the short or long term effects of
treatment, and the lethality of mixing alcohol or drugs with the prescribed regimen
they may be given. Psychologists must assess patients' past behaviours, current
functioning (emotional state, desire or motivation for treatment, coping skills),
psycho social resources (strength in faith or spirituality, social support), and other
factors, to evaluate the strengths and potential threats or weaknesses that can
impact future behaviour.

Psychologists working in forensic settings are likely to conduct predictive

assessments for various reasons. For offender populations, prediction of recidivism
is likely required as part of court system procedures relating to sentencing and
parole, and defendant and plaintiff initiated evaluations. Family/maritallawyers
also frequently hire clinical and forensic psychologists to evaluate clients' current
functioning (descriptive assessment or diagnostic assessment), and predict future
behaviours. Behaviours of interest in family/maritallaw might include clients'
16 likelihood of future abusive behaviours; clients' future abilities to manage anger
and aggression if rehabilitation is sought; clients' likelihood of complying with child Objectives of
Psychodiagnostics
custody mandates and abilities to maintain effective parenting skills, and children's
predicted responses to custody arrangements. Numerous other examples exist.
Occupational settings provide rich opportunities for psychological assessment.
Questions to be answered in occupational settings may relate to the workforce
in a company as a whole, or individuals within a work force. Prediction assessments
might be sought to answer questions such as the following ones:
1) What is the likelihood of this employee's occupational success, given the
specific accommodations and training available?
2) What variables are predictive of burnout in persons with a particular job or
position?
3). What is the likely psychological impact of a specified corporate change on
upper level,management?
Psychologists working in employee assistance programs may conduct more
traditional clinical prediction assessments.
Thus far, descriptions and,examples of the goals and types of assessments clinical
psychologists conduct have remained general. The following section describes
several specific types of assessment that are conducted to answer specific questions.
Self Assessment Questions
1) What are the criteria given in DSM IV TR diagnosis?

2) Discuss in detail the classification system of DSM IV TR.

3) What are the logistics and details of diagnostic assessments?

4) What is a descriptive assessment?

17
 Psychodiagnostics in
5) Discuss in detail the predictive assessments.
Psychology

1~4 SPECIFIC TYPES OF ASSESSMENT

To differentiate among the different types of assessment, several key questions are
answered within each of the following subsections to address the elements of
what, when, who, where, why, and how.

1) What are the goals of assessment?

2) When, relative to other life events, will the assessment take place?

3) Who requests the evaluation or who refers clients for specific assessments?

4) Who is (are) the person(s) to be evaluated?

5) Where will the assessment be conducted?

6) Why is the assessment necessary?

7) How will the information be used?

The answers to these questions vary depending on the assessment prescribed.

Some overlap can also be noted as the different applications of assessment are
illustrated. .

Although classifying an individual as mentally retarded may be useful for

communicating a person's general functioning level among professionals, describing
the person's strengths, weaknesses, likes and dislikes, will be equally or more
important in the development of a behaviour modification plan.

1.4.1 Cognitive Assessment.

Cognitive assessment focuses on understanding brain behaviour relationships,
informationprocessing, and thinking skills.The following critical aspects of cognition
may be targeted for assessment: attention, perception, memory, schemas, learning
(intelligence; achievement; aptitude), cognitive/development, creativity, language,
problem solving, decision making, and judgment. Neuropsychological tests,
intelligence tests, achievement and aptitude tests, and development tests are specific
types of cognitive assessments for evaluating these areas.

Clinicians who conduct or request cognitive assessments are interested in

understanding individuals' skills (strengths and deficits), abilities, and limits, and
comparing these skills and abilities with clients' own displayed affect and behaviours.
Individuals' functioning is usually compared with their own previous or prospective
functioning, to normative standards predetermined by research, or both. Some
high schools require youth football players (and other sports participants) to have
cognitive assessments prior to beginning the football season. These baseline
/ assessments provide individual norms that are later used for comparison with post
injury (concussions) cognitive assessments if football players are hurt during the
18 season. Cognitive assessments may be conducted periodically to evaluate positive
or negative change overtime, such as yearly achievement testing in language Objectives of
Psychodiagnostics
development or mathematics skills.

Intelligence testing exemplifies an assessment done to evaluate individuals'

functioning compared with normative standards: parents may request IQ (intelligence
quotient) testing to determine children's scholastic needs and readiness to begin
elementary school, or later in life for psycho educational planning.

Other reasons cognitive assessments may be indicated are numerous. Cognitive

assessments may be required when persons are not reaching expected
developmental milestones, such as language skills. Self recognition or by others
of non normative (non average) behaviour, either positive (superior intellectual
abilities, creativity), or negative (attention problems, extreme emotionallability),
often generates referrals for cognitive assessment. Significant changes in cognitive
functioning are usually noticed by individuals, family, and friends, and often lead
to visits to primary care physicians or emergency rooms; these health professionals
may require psychologists' assistance in diagnosing or understanding the cause for
the behaviour change (Rozensky, Sweet, & Tovian, 1997).

Such sudden or gradual behaviour changes may have resulted from a known
external event (accident), or a known or initially unknown biological change (tumor,
medication side effects, aging process). Thus, cognitive assessments are useful for
individuals across the life span, for purposes of diagnosis, understanding, and
treatment or future planning.

1.4.2 Personality Assessment

Definition of Personality
Various theorists have defined personality in many ways, over the many years
that the discipline of psychology has evolved. Most definitions and theorists have
agreed that personality refers to stable, enduring characteristics that uniquely
define individuals' ways of being or of viewing life situations, theworld, and others
in it (see Chaplin, 1985, for various definitions). Furthermore, personality may be
defined using the terminology of individuals' temperament and traits.

Temperament
This refers to a person's disposition and is often assumed to be largely biologically
predetermined. Much research on temperament has been conducted on infants
and children. Equating temperament with personality may be appropriate according .
to some psychological theories, especially those rooted in the psychodynamic
traditions or medical models; other theories might suggest that persons are born
with a particular temperament, and stable characteristics develop in addition to
this biologically predetermined disposition to result in personality.

Traits
/ /
These refer to individuals' relatively stable ways of thinking or behaving, or their
disposition that ma); develop/over time. The term trait implies that the environment
and one's interaction with it or others may formatively develop one's personality.
Traits differ from persons' behaviours, that is, traits zefer to how people are;
behaviours describe-what people do. If you had to describe your best friend in
three sentences, w}lat would you say? Perhaps, you might say thatyour friend is
"fun or funny," '71oyal," "kind and compassionate," "trustworthy,""sociable,"
"outgoing," or other similar descriptors. 19
Psychodiagnostics in Most people define others in global terms, describing the most characteristic style
Psychology of the individuals. They attach these global terms based on behaviours they have
observed. Your friend may be described as "funny" because she tells jokes and
elicits laughter. Some people are described as having "different personalities"
depending on the social context (e.g., social versus business). Descriptors, such
asthose of your friend, are typically representative of the combination of
temperament and traits, or his or her "personality."

How did you arrive at the description of your friend? If you are like most people,
you have observed your friend in various situations or in interactions with you.
You observed her behaviour and the emotions she expressed. You also noticed
her consistent ways of viewing herself and relating to others and her environment,
and made inferences based on these observations. In essence, you have conducted
a personality assessment, because formal assessment relies on similar processes!

Possible goals and objectives of formal personality assessment are diagnosis and
understanding of persons' ways of relating to others and the environment for the
purpose of description, prediction, and treatment in clinical or counseling (career
vocational) settings, employment settings, or forensic settings, among others. In
your assessment of your friend, you have diagnosed (classified your friend) and
attempted to understand him or her. (Don't worry; if you have chosen to pursue
a career in clinical psychology, you will often be accused of or asked if you are
analyzing your friends anyway!)

Substantialtraining in psychometrics, test theory,test development, diversity variables

(ethnicity, race, culture, gender, age, language, disabilities), and supervised
experience are required for use of most psychological tests, including personality
tests (S. M. Turner, DeMers, Fox, & Reed, 2001).

1.4.3 Behavioural Assessment

Behavioural assessment aims to identify the frequency, context, and most
importantly, the function of a person's behaviour. The focus of behavioural
assessment is on individual, specific behaviours and comparison of the person's
behaviour across situations and in different environments (home, school, work,
social situations).

Behavioural assessment developed from the principles of behavioural therapy, and

therefore, emphasises the importance of behavioural chains, or the relationships
between stimuli and responses, and behaviours and consequences. In the truest
sense, behavioural assessments focus only on operationally defined, overt,
observable behaviour that can be objectively measured.

Behaviour has been more broadly defined over time with the merging of the
cognitive and behavioural theoretical orientations and principles. Behaviours
sometimes may refer to cognitive processes such as coping, which has overt and
covert components. Behaviourists may accept this leniency in the definition with
the caveat that covert processes may be considered internal behaviours. For the
purpose of this discussion, however, behavioural assessment will be reviewed in
its truest form.

In general, psychologists might adopt a behavioural assessment paradigm as a

means for evaluating clients and conceptualising their problems (Haynes & O'Brien,
2000; A. M. Nezu et al., 1997). As a paradigm, clinicians who base all assessments
20 on this model do so because it is usually largely consistent with their theoretical
orientation to understanding human behaviour, and their approach to assessment Objectives of
Psychodiagnostics
and treatment of patients.

Self Assessment Questions

1) Discuss in detail the cognitive assessment.

2) Describe how personality is assessed?

. ...........
,
' ~. .

3)
..
What is involved in behavioural assessment?

1.5 LET US SUl\1 UP

Psychological assessments generally seek to classify, describe, or predict clients'
psychological functioning and behaviours. Many referral or assessment questions
require evaluations structured to accomplish more than one of these goals. Clinical
psychologists conduct assessments in various settings, assuming various roles
(e.g., consultant, health care team, independent practitioner).

1.6 UNIT END QUESTIONS

1) A psychologist who claims that Test X can predict a behaviour with 100%
accuracy, most likely is breaking the ethical principle of integrity. True or
False?

2) The purpose of diagnostic assessment is to classify individuals based on

identified abnormalities or "presentation of disease" True or False?

3) Mental health professionals conduct diagnostic assessments to obtain

background and general information necessary for better understanding of
clients' problems and factors contributing to those problems. True or False?

4) Predictor variables are those factors that are presumed to precede or eo-
occur with the behaviour to be predicted, and to be causally related in some
way. True or False?

5) Clinicians who conduct or request cognitive assessments are interested in

understanding individuals'· skills (strengths and deficits), abilities, and limits.
True or False?
21
Psychodiagnostics in 6) Trait refers to stable, enduring characteristics that uniquely define individuals'
Psychology
ways of being or of viewing life situations, the world, and others in it. True
or False?

7) Temperament refers to a person's disposition and is often assumed to be

largely biologically predetermined. True or False?

8) The term trait implies that the environment and one's interaction with it or
others may fonnatively develop one's personality. True or False?

9) Behavioural assessment developed from the principles of psychoanalytic

therapy. True or False?

10) Data collection techniques for descriptive assessments include a combination

of interviews, observation, self-report inventories and questionnaires, reports
by others, computerized assessment, and physiological assessment. True or
False?

11) Discuss in depth the objectives of psychodiagnostics with relevant examples?

12) Describe the several specific types of assessment that are conducted to
answer specific questions in psychological assessment with examples?

1.7 SUGGESTED READINGS

Groth-Mamat, G (2003). Handbook of Psychological Assessment (4thed.).
New Jersey: John Wiley & Sons, Inc.

Trull, T.J. (2005). Clinical Psychology (Z'" Ed.).USA: Thomson Learning, Inc.

22
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.

38
 UNIT 3 BATTERIES OF TEST AND
ASSESSMENT INTERVIEW
Structure
3.0 Introduction
3.1 Objectives
3.2 Test Batteries
32.1 The Use of Test Batteries

3.3 Assessment Interview

3.4 Skills and Techniques
3.4.1 Rapport

3.4.2 Effective Listening Skills

3.4.3 Effective Communication
-: 3.4.4 Observation of Behaviour

3.45 Asking the Right Questions

3.5 Formats of.Interviews

35.1 Structured Interviews

35.2 Semi Structured Interviews

35.3 Unstructured Interviews

3.6 Types of Interviews

3.6.1 Initial Intake Assessment

3.6.2 Mental Status Assessment

3.6.3 Crisis Interviews

3.6.4 Diagnostic Interview

3.65 Computer Assisted Interviews

3.6.6 Exit Interviews

3.7 Let Us Sum Up

3.8 Unit End Questions
3.9 Suggested Readings

3.0 INTRODUCTION
Procedures used in the assessment of a particular patient should, ideally, be those
best suited to answer specifically the referral questions, as these emerge from
earlier assessment and are clarified by the referring and testing "l'"'''1<Ins For such
questions may be answered either through a single standardized test or a group
of tests. The first half of this unit covers the definition and uses of test batteries.
Probably the single most important means of data collection during psychological
evaluation is the assessment interview. Without interview data, most psychological
tests are meaningless. The interview also provides potentially valuable information 39
Psychodiagnostics in that may be otherwise unobtainable, such as behavioural observations, idiosyncratic
Psychology features of the client, and the person's reaction to his or her current life situation.
In addition, interviews are the primary means for developing rapport and can
serve as a check against the meaning and validity of test results. The second half
of this unit is concerned with the assessment interview. The skills and techniques,
formats and types of interviews are discussed in detail. We start the unit with
defining and describing test batteries, followed by the use of test batteries. Then
we take up Assessment interview followed by skills and techniques of interview.
Under this we discuss rapport, listening skills, communication, observation of
behaviour etc. This is followed by presenting the various formats of interviews
which includes structured, semi structured and unstructured formats of interview.
Then we take up types of interviews under which we discuss the intake interviews,
mental status assessment interview, crisis interviews, diagnostic interview and
computer assisted interviews.

3.1 OBJECTIVES
After completing this unit, you will be able to:
• Define test batteries and describe their use;
• Define assessment interview;
• Describe the skills and techniques needed for assessment interview;
• Explain the formats of interviews; and
• Describe the different types of interviews.

3.2 TEST BATTERIES

Battery is a term often used in test titles. A battery is a group of several tests,
or subtests, that are administered at one time to one person. When several tests
are packaged together by a publisher to be used for a specific purpose, the word
battery usually appears in the title and the entire group of tests is viewed as a
single, whole instnnnent. Several examples of this usage occur in neuropsychological
instmments (such as the Halstead-Reitan Neuropsychological Battery) where many
cognitive functions need to be evaluated, by means of separate tests, in order to
detect possible brain impairment. The term battery is also used to designate any
group of individual tests specifically selected by a psychologist for use with a
given client in an effort to answer a specific referral question, usually of a diagnostic
nature.

3.2.1 The Use of Test Batteries

Although tests are used for a variety of purposes in the area of psychopathology,
their use often falls into one of two categories as given below:
I) a need to answer a very specific and focused diagnostic question (e.g., does
this patient represent a suicide risk");
2) a need to portray in a very broad way the client's psychodynamics,
psychological functioning, and personality structure.
The answer to the first category can sometimes be given by using a very specific,
40 focused test. In the example given above, The typical scale of suicidal ideation
 ,
is the answer to the diagnostic question. For the second category" the answer is Batteries of Test and
provided either by a multivariate instrument like the MMPI, or a test battery, Assessment Interview
a group of tests chosen by the clinician to provide potential answers.

A test battery gives a broader and firmer base for assessment than is possible with
individual tests. The battery should be chosen to be as representative as possible
to the particular needs of the individual patient. In the psychodynamic tradition,
a common battery for testing adults for therapy planning includes, as a rule, the
Wechsler Adult Intelligence scale, Rorschach, and TAT.Although the same basic
battery may be used, such procedures are interpretable toward different ends.
Thus, the individualisation of a psychological examination involves varying one's
orientation toward the analysis and interpretation of data yielded by the same
battery of broad gauged tests as well as putting together a unique package of
different procedures for each patient. .

In practice, the two alternatives are often combined and a common nucleus is
used with procedures added to answer specific questions.

Sometimes test batteries are routinely administered to new clients in a setting for
research purposes, for evaluation of the effectiveness of specific therapeutic
programs, or to have a uniform set of data on all clients so that base rates,
diagnostic questions, and other aspects can be determined. The use of a test
battery has a number of advantages other than simply an increased number of
tests. For one, differences in performance on different tests may have diagnostic
significance, If we consider test results as indicators of potential hypotheses (e.g.,
this client seems to have difficulties solving problems that require spatial reasoning),
then the clinician can look for supporting evidence among the variety of test
results obtained.

3.3 ASSESSMENT INTERVIEW

Some assessments are more systematic (scanning the refrigerator and pantry
before going to the supermarket; evaluating budgets in consideration of purchasing
expensive items), and others are less so (comparison of lines to stand in at the
grocery store). Similarly, assessment techniques in clinical psychology vary greatly
in their purposes and goals, and the methods by which data collection is
. accomplished.

Most helping professionals use interviewing as a standard approach to assessing

problems and formulating hypotheses and conclusions. Talking with appropriate,
interested, and knowledgeable parties (the patient, family members, school teachers,
physicians ) is usually an important early step in conducting an assessment.
Interviewing in clinical psychology entails much more than posing a series of
questions to collect data about a case. Asking critical questions, carefully listening
to answers, attending to missing or inconsistent information, observing nonverbal
behaviour, developing hypotheses, and ruling out alternative hypotheses are all
part of the interviewing process.
~
,...
I
The interview is a thoughtful, well planned, and deliberate conversation designed
u to acquire important information (facts, attitudes, beliefs) that enables the
.J
1-
psychologist to develop a working hypothesis of the problem(s) and its best
E
solution. Although a great deal of research has been conducted on interviewing
skills, the psychologist does not read a manual on how to conduct an interview
and then become an expert. Effective interviewing is developed over time with 41
Psychodiagnostics in "
practice, supervision, experience, and natural skill. While the actual information
Psychology obtained might vary greatly depending on the specific purpose of the interview,
generally a list of standard data is collected and discussed (Table below).

This includes demographic information such as name, address, telephone number,

age, gender, or grade in school, occupation, ethnicity, marital status, and living
arrangements. Information about current and past medical and psychiatric problems
and treatments are also usually obtained. The chief complaint or a list of symptoms
experienced by the patient is discussed as well as the patient's hypotheses regarding
the contributing factors associated with the development and maintenance of the
problem(s).The interviewer often wants to know how the person has tried to
cope with the problem(s) and why he or she wishes to obtain professional services
now.

Table 3.1: Typical Information Requested during a Standard

Clinical Interview

Identifying information (e.g., name, age, gender, address, date, marital status,
education level)

Referral Source (who referred the person and why)

Chief Complaint or presenting problems (list of symptoms)

Family background

Health background

Educational background

Employment background

Developmental history (birth and early child development history)

Sexual history (sexual experiences, orientation, concerns)

Previous medical treatment

Previous psychiatric treatment

History of Traumas (e.g., physical or sexual abuse, major losses, major

accidents)

Current treatment goals

Self Assessment Questions

1) Defme test batteries.

42
 Batteries of Test and
2) Describe test batteries and bring out its features. Assessment Interview

3) State the use of test batteries.

4) What is assessment interview?

5) What does an assessment interview contain?

3.4 SKILLS AND TECHNIQUES

An interview is generally conducted as part of any psychological evaluation.
Although numerous different interviewing situations exist, certain techniques and
skills are necessary for nearly all types of interviews. These include developing
rapport, effective listening skills, effective communication, observation of behaviour,
and asking the right questions.

3.4.1 Rapport
When patients talk with a psychologist about problems they are experiencing,
they are often uncomfortable sharing their intimate concerns with a complete
stranger. They may have never discussed these concerns with anyone before,
including their best friends, parents, or spouse. They may worry that the psychologist
might make negative judgments about their problems. They may feel embarrassed,
silly, worried, angry, or uncomfortable in a variety of ways. An individual from an
ethnic, racial, or sexual minority may fear being misunderstood or maltreated. To
develop a helpful, productive, and effective interview, the psychologist must develop
rapport with the person he or she is interviewing. Rapport is a term used to
N
T'"
I. describe the comfortable working relationship that develops between the
W
o professional and the interviewee. The psychologist seeks to develop an atmosphere
Q.

:E and relationship that is positive, trusting, accepting, respectful, and helpfuL

Although there is no specific formula for developing rapport, several principles are
generally followed. These are given below: 43
Psychodiagnostics in .1) Principle of Attention
Psychology
First, the professional must be attentive. He or she must focus complete
attention on the patient without interruption from distractions such as telephone
calls or personal concerns.

2) Principle of friendly posture

Second, the professional must maintain a rapport building posture, as for
example, by maintaining eye contact and facing the patient with an open
posture without a physical barrier such as a large desk impeding
communication.

3) Principle of Listening
Third, the psychologist actively and carefully listens to the patient, allowing
him or her to answer questions without constant interruption.

4) Principle of being non judgemental

Fourth, the psychologist is nonjudgmental and non critical when interacting
with the patient, especially in regard to personal disclosures.

5) Principle of empathy and respect for the patient

Fifth, the professional also strives toward genuine respect, empathy, sincerity,
and acceptance, without acting as a friend or a know it all type of person.

6) Principle of creating a supportive professional atmosphere

Sixth, the professional tries to create a supportive, professional, and respectful
environment that will help the patient feel as comfortable and as well understood
as possible during the interview.

3.4.2 Effective Listening Skills

In addition to the development of rapport, an effective interviewer must be a good
listener.

. While this may appear obvious, good listening skills are important to develop and
generally do not come naturally for most people. People often find it challenging
to fully listen to another without being distracted by their thoughts and concerns.
Many are too focused on what they are thinking or want to say rather than on
listening to someone else. Furthermore, careful listening must occur at many different
levels. This includes the content of what is being said as well as the feelings
behind what is being said.

Listening also involves paying attention to not only what is being said but how it
is presented. For example, some one may deny that he or she is angry yet have
their arms crossed and teeth clenched, thus suggesting otherwise. Listening also
includes paying attention to what is not being said. Thus, listening involves a great
deal of attention and skill including the ability to read between the lines.

Effective interviewers must learn to use and develop active listening skills, which
include paraphrasing,reflection, summarization,and clarificationtechniques (Cormier
& Cormier,1991). Paraphrasing involves rephrasing the content of what is being
said. It means careful listening to another's story and then attempting to put the
content of the story into a brief summary. The purpose of paraphrasing is to help
44
the person focus arid attend to the content of his or her message. In contrast, Batteries of Test and
reflection involves rephrasing the feelings of what is being said in order to encourage Assessment Interview
the person to express and understand his or her feelings better.

Summarization involves both paraphrasing and reflection in attempting to pull

together several points into a coherent brief review of the message. Summarization
is used to highlight a common overall theme of the message.

Finally, clarification includes asking questions to ensure that the message is being
fully understood. Clarification is needed to ensure that the interviewer understands
the message as well as helping the person elaborate on his or her message.

Examples of these techniques are provided in the following example of a couple

trying to decide if they should get married. (See box below)

Edward is a 32-year-old man who has been dating Jenny, a 29-year-old

woman, for several years. He feels that he cannot commit to marriage
because he feels unsure if Jenny is the "right one" for him. Jenny wants to
marry Edward and reports feeling frustrated that he has so many doubts.
Edward further reports that he is unsure if he could stay faithful to one
person for the rest of his life.

EDWARD: "I'm not much of a believer in the institution of marriage. It

seems to me that it made sense when the average life span was only 30 years
or so. How can some one make a decision like this during their 20s or 30s
and have it be a good decision for 50 years or more? My parents are still
married after 50 years but they hate each other. I don't know why they stay
together. Jenny is really nice and I like being with her but who knows what
the future will hold for us. She has a lot of great qualities but some
characteristics drive me nuts. For example, I really don't like some of her
friends. They are boring. She is really a practical person, which I like, but
sometimes there is not a lot of excitement in our relationship."

Examples of active listening techniques offered by the therapist follow:

PARAPHRASE: "So you seem to be unsure if marriage to Jenny or anyone

for that matter is right for you."

REFLECTION: "To some degree you feel bored in your relationship."

SUMMARIZATION: "You are unsure if marriage is right for you and you
are concerned that Jenny may not be the right person for you regardless of
your views on marriage."

CLARIFICATION: "When you say that your relationship lacks excitement

are you also referring to your sexual relationship?"

3.4.3 Effective Communication

To conduct a successful interview, effective communication is a requirement. The
professional must use language appropriate to the patient, whether a young child,
an adolescent, or a highly educated adult. The interviewer generally avoids the use
of professional jargon, or psycho babble, and speaks in terms that are easily
understood. The interviewer tries to fully understand what the patient is trying to
communicate and asks for clarification when he or she is unsure. 45
Psychodiagnostics in 3.4.4 Observation of Behaviour
Psychology
The interviewer pays attention not only to what is being said during a clinical
interview, but also to how it is being said. Observation of nonverbal communication
• J'

(e.g., body posture or body language, eye contact, voice tone; attire) provides
potentially useful information. For example, a patient may describe severe depressive
symptoms and suicidal thoughts, yet smile a great deal and appear energized and
in good spirits during the interview.

Another patient might state that he or she feels completely comfortable, yet sits
with arms and legs tightly crossed while avoiding eye contact. Inappropriate dress
(e.g., T-shirt and shorts on a very cold winter day or for ajob interview) or a
disheveled appearance may provide further insight into the nature of the patient's
difficulties.

3.4.5 Asking the Right Questions

A good interviewer must ask the right questions. All too often, inexperienced
interviewers forget to ask a critical question only to remember it after the patient
. has left. Experience with interviewing and a solid understanding of psychopathology
and human behaviour are needed in order to ask the right questions. Typical
questions deal with issues such as the frequency, duration, severity, and patient's
perception of the etiology of the presenting problem. A careful understanding of
the symptoms as well as the patient's efforts to cope with the problem is usually
important.

Self Assessment Questions

1) What are the various kills and techniques of interview? Explain

2) How does one establish rapport?

3) Elucidate the effective listening skills.

4) State what effective communication is.

46
 Batteries of Test and
5) What are the features of observation of behaviour? Assessment Interview

6) Explain the technique of asking the right questions.

3.5 FORMATS OF INTERVIEWS

The most common types of interviews include initial intake interviews (first meeting
overview), exit interviews (closure to a clinical relationship),mental status interviews,
crisis interviews, and diagnostic interviews. The goals and purposes of these
interviews are the same as the overall goals of assessment. Among these types of
interview, there' are three major formats: structured, semi structured, and
unstructured.

3.5.1 Structured Interviews

Structured interviews are usually published or pre established and standardized
lists of questions with specific directions or flowcharts of questions to ask following
certain responses. These interview outlines (similar to scripts or questionnaires)
are used for predetermined purposes (diagnosis, symptom, or behaviour
description) and allow for comparison of responses across individuals or therapists.
Since the interviews require little clinical judgment or inference, persons without
graduate training in psychology can be trained to use structured interviews under
supervision.

The Diagnostic Interview for Children and Adolescents (DICA-R; Reich, Jesph,
&Shayk, 1991) and the Structured Clinical Interview for DSM-JV (SCID-I; First,
Gibbon, Spitzer, Williams& Benjamin 1997) are two examples of such interviews.

3.5.2 Semi Structured Interviews

Semi structured interviews require more clinical skill and judgment. These interviews,
such as the Hamilton Rating Scale for Depression (Hamilton, 1960), provide a list
of questions or content areas that need to be covered. The exact wordings of the
questions or order in which they are asked are determined by the clinicians.
- Often, the flow of a semi structured interview seems like a more natural dialogue
between the clinician and client compared with a structured interview, which
provides little opportunity for tangential patient self disclosure or input into the
direction of the interview. Much like structured interviews, many semi structured
interviews are published in manuals and provide scoring instructions and normative
or comparison scores.Semi structured interviews are commonly used in qualitative
research and in clinical assessments. 47
Psychodiagnostics in 3.5.3 Unstructured Interviews
Psychology
Unstructured interviews are clinician driven, and are usually individualized to the
purpose of the assessment. Since they are not manualized and are not accompanied
by administration or scoring instructions, unstructured interviews are rarely, if ever,
used in research settings.The quality of data gathered by cliniciansusing unstructured
interviews is entirely dependent on the clinicians' interviewing skills, clinical
judgment, and insight. This type of interview structure is most susceptible to
individual biases and requires the greatest amount of training and skill for maximum
results.

Self Assessment Questions

1) Discuss format of interviews.

2) Describe structured interviews and give example.

3) Elucidate semi structured interview and indicate how these differ from
structured interview.

4) What are unstructured interviews?

3.6 TYPES OF INTERVIEWS

There are many different types of interviews conducted by psychologists. Some
interviews are conducted prior to admission to a clinic or hospital, some are
conducted to determine if a patient is in danger of injuring herself or someone
else, some are conducted to determine a diagnosis. Whereas some interviews are
highly structured with specific questions asked of all patients, others are unstructured
and spontaneous.

While not an exhaustive list, this section briefly reviews examples of the major
types of interviews conducted by clinical psychologists.
48
3.6.1 Initial Intake Assessment Batteries of Test and
Assessment Interview
Initial intake interviews are designed to gain an overview of a patient's problems,
strengths, and resources, and reasons for seeking assessment, treatment, or hospital
admission. In some ways, it can be viewed as a needs assessment of the patient,
and an opportunity for the clinician's observation, diagnosis, and short term and/
or long term clinical pathway goal planning. Intake interviews often include a
combination of mental status interviews and diagnostic interviews.

3.6.2 Mental Status Assessment

Mental status interviews focus on a client's current psychological functioning. The
goal of a mental status interview is to gain an overview of client mental health, and
identify normal versus abnormal or unusual thinking, thought processing, behaviours,
or other characteristics. This type of interview has specific components and is
mostly factual and data based.

Clinicians make little to no interpretations of data collected in this type of interview,

with the exception of some estimation of judgment, insight, and intellectual
functioning, which maybe largely based on clinical impression.

The mental status interview goes beyond the exchange of questions and answers,
and incorporates many behavioural observations. Behavioural observations include
evaluation of the client's hygiene based on presentation, gait, speech (normal,
pressured, slowed, slurred), eye contact, posture, behavioural manifestations cif
mood disprder (e.g., anxiety as represented by excessive fidgetiness or
handwringing), and other observations.

Traditional questioning is used to inquire about a client's orientation to Persons

(Who are you? Who brought you here? Who am I? Who is the President of
India?) Places (Where are you now? What city and state do you live in? Where
were you born?), and Time (What time of day is it? What day of the week is it?
What year are we in? What holiday is coming up next?), thoughts, mood, affect,
behaviours, short-term memory (e.g., remember this list of three objects, and I
will ask you about them again later) and cognitive functioning (attention,
concentration), medical status (e.g., use of medications), illicit and legal substance
use, estimate of intellectual functioning, suicidal and homicidal history or current
thoughts or plans, insight, and judgment. Assessment of delusions and hallucinations
is typically included in this evaluation.

As mentioned, most mental status interviews are conducted as part of an intake

or subsequent evaluation. Because this interview is a standard clinical method of
assessment and not typically used for comparative purposes, formalised rating
scales are rarely if ever used.

3.6.3 Crisis Interviews

Psychologists who work in acute psychiatric services, emergency rooms, or out
patient mental health clinics are most likely to conduct crisis interviews. However,
most clinical psychologists need to conduct crisis interviews periodically, regardless
of their setting of employment. Crisis interviews are directed toward clients who
are in acute distress due to an exacerbation or increase in psychological disturbance,
or who have suffered a traumatic or life threatening incident.

Because these situations can arise in any setting (psychiatric, medical, school,
research, etc.), all therapists must be prepared for the responsibility of determining 49
Psychodiagnostics in clients' imminent risk for harming themselves or someone else, or inability to care
Psychology for themselves, given a heightened state of psychological arousal or psychotic
episode.

Crisis interviews are more focused than intake interviews, and diagnostic interviews.
Often, portions of a mental status exam, if not an entire exam, will be incorporated
into this type of interview. Crisis interviews have the specific purpose of informing
therapists' decisions about patients' safety, placement (psychiatric or medical
hospital admission), or immediate intervention (crisis hotline leading to police
outreach). Questions are typically focused on gaining information about crisis
situations, chief symptom complaints, symptom duration and severity,clients' safety,
resources and supports, risks, and overall client functioning. Rational and systematic
clinical decision making, and knowledge and facility with procedures for individual
settings (e.g., emergency help contacts, involuntary commitment procedures, steps
for assisting women to leave homes of domestic violence) are two of the most
important therapist attributes necessary for management of crisis situations and
crisis interviews.

3.6.4 Diagnostic Interview

The purpose of a diagnostic interview is to obtain a clear understanding of the
patient's particular diagnosis. Thus patient reported symptoms and problems are
examined in order to classify the concems into a diagnosis. Typically,the Diagnostic
and Statistical Manual-IV (DSM IV; American Psychiatric Association, 2000)
is used to develop a diagnosis based on five categories, or axes.

The DSM IV is used by hospitals, clinics, insurance companies, and the vast
majority of mental health professionals to classify and diagnose psychiatric problems.
While this is the most widely used diagnostic classification of psychiatric disorders
in the United States, other classification systems exist and have. both advantages
and disadvantages.

The five axes for each diagnosis provide information concerning the clinical
syndromes, influence of potential personality disorders, medical problems,
psychosocial stressors, and level of functioning. Specifically,

Axis I includes the presence of clinical syndromes (e.g., depression, panic disorder,
schizophrenia).

Axis II includes potential personality disorders (e.g., paranoid, antisocial,

borderline).

, Axis III includes physical and medical problems (e.g., heart disease, diabetes,
cancer).

Axis IV includes psychosocial stressors currently experienced by the patient (e.g.,

fired from job, marital discord, financial hardship).

Axis V (Global Assessment of Functioning or GAF) includes a clinician rating of

how well the patient is coping with his or her problems (1 = poor coping, 100
= excellent coping). The interview is conducted to rule out inapplicable diagnoses
and rule in applicable ones. Thus, the goal of the interview is to determine whether
the patient meets the diagnostic criteria of a particular disorder.
50

I
Diagnostic interviewing can be challenging. It is frequently difficult to ascertain Batteries of Test and
the precise diagnosis through interview alone. Also, comorbidity may complicate Assessment Interview
the clinical picture. For instance, a patient who has been losing a lot of weight
might be interviewed to determine whether he or she has anorexia nervosa, a
disorder that results in self starvation. Anorexia nervosa is especially prevalent in
adolescent girls. Significant weight loss may also be associated with a number of
medical problems (e.g., brain tumor) or other psychiatric problems (e.g.,
depression).

To determine whether the weight loss symptoms might be associated with anorexia
nervosa, the clinician may wish to conduct a diagnostic interview to see if the
patient meets the DSM-/V diagnostic criteria for anorexia nervosa. Furthermore,
additional possible diagnoses may need to be considered as well (e.g., depression,
phobia, borderline personality). While some clinicians might choose to use a
structured clinical interview, most would conduct their own clinical interview.

3.6.5 Computer Assisted Interviews

A next step in the evolution of structured interviews involves computer interviewing.
As computers become more sophisticated and less expensive, programs can be
developed to administer highly complex, efficient, and effective interviews.
Computers can be used to ask patients questions and record their responses in
a very objective manner. Numerous decision trees can be employed for appropriate
follow up questions to patient's answers.

Furthermore, some patients feel more comfortable answering sensitive and

potentially embarrassing questions via computer rather than talking face to face
with a human interviewer. However, some people are uncomfortable with using
computers in this way and prefer to talk with a professional person about problems.
Computer assisted interviews have been used in clinic settings where patients can
answer a variety of questions about their concerns while in a waiting area prior
to their face to face meeting with a counselor. Results from the computer interview
can be provided to the counsel or to help in the treatment process.

Confidentiality concerns must be addressed when sensitive material is being

requested in a public area (e.g., waiting room) and when access to computer files
is not closely controlled.

3.6.6 Exit Interviews

Exit interviews are conducted at the end of an inpatient or outpatient treatment,
medical inpatient visit, or occupational tenure. These interviews provide therapists
or another designated professional or paraprofessional with an opportunity to
review assessment or therapy content with clients; provide feedback on progress;
help clients engage in future thinking about maintenance of treatment gains or
managing future problems; create plans for future crises, relapses, or booster
sessions; and gain clients' feedback on the usefulness of various aspects of the
treatment. When exit interviews are conducted by the therapist at the end of
treatment, these interviews are often called "termination sessions," although one
could argue that ending treatment marks a new beginning for clients, rather than
an ending. A termination interview provides a forum for clients to appropriately
express their feelings and emotions about ending therapy. 51
Psychodiagnostics in
Psychology Self Assessment Questions

1) Discuss the various types of interviews.

2) Describe the interview in initial intake.

3) Delineate the characteristic features of mental status assessment interview.

4) What are crisis interviews?

5) Discuss the diagnostic interview.

6) How do we use the computer for interviews?

i ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

7) Elucidate the exit interviews.

3.7 LET US SUM UP

A battery is a group of several tests, or subtests, that are administered at one time
to one person. The clinical interview is a thoughtful and deliberate conversation
52 designed to acquire important information (facts, attitudes, beliefs) that allows the
psychologist to develop a working hypothesis of what the problem( s) is/are about. Batteries of Test and
Although there are numerous examples of interviewing situations (initial intake or Assessment Interview
admissions interview, mental status interview, crisis interview, structured interview,
computer-assisted interview, exit, or termination interview), several techniques
and skills are necessary for all types of interviews. These include developing
rapport, active listening, effective communication, observation of behaviour, and
asking the right questions.

3.8 UNIT END QUESTIONS

1) A battery consists of tests used only for clinical assessment. True or False?

2) A test battery gives a broader and firmer base for assessment than is possible
with individual tests. True or False?

3) An interview is generally not conducted as part of any psychological

evaluation. True or False?

4) is a term used to describe the comfortable working

relationship that develops between the professional and the interviewee.

5) Effective listening includes the of what is being said as well

as the behind what is being said.

6) .involves rephrasing the feelings of what is being said in order

to encourage the person to express and understand his or her feelings better.

7) Interviews are usually published or pre-established and

standardized lists of questions with specific directions or flowcharts of questions
to ask following certain responses.

8) interviews focus on a client's current psychological functioning.

9) The purpose of a crisis interview is to obtain a clear understanding of the

patient's particular diagnosis. True or False?

10) When exit interviews are conducted by the therapist at the end of treatment,
these interviews are often called -----------

11) What is a test battery and explain its uses?

12) What are the factors that contribute to effective interviewing?

13) What are the different formats of assessment interviews?

14). What are the different types of clinical interviews?

15) How do you keep yourself calm and levelheaded during a crisis interview?

16) What do you do if the patient refuses to participate in the interview or is

uncooperative in other ways?

3.9 SUGGESTED READINGS

Plante, T. G. (2005). Contemporary Clinical Psychology (2nd Ed.).New Jersey:
John Wiley & Sons, Inc.

Trull, TJ. (2005). Clinical Psychology (?" Ed.).USA: Thomson Learning, Inc. 53
 UNIT 4 REPORT WRITING AND
RECIPIENT OF REPORT
Structure
4.0 Introduction

4.1 Objectives

4.2 The Psychological Report

4.3 Communicating Assessment Results

4.4 General Guidelines
4.4.1 Length of the Report
4.4.2 Degree of Emphasis
4.4.3 Domains
4.4.4 Deciding What to Include

4.4.5 Raw Data and Quantitative Scores

4.4.6 Client Feedback

4.5 Models of Psychological Reports

4.5.1 Level of Reports

4.6 Format for Psychological Reports

4.6.1 Referral Question

4.6.2 Evaluation Procedures

4.6.3 Behavioural Observations

4.6.4 Background Information
4.6.5 Test Results

4.6.6 Impressions and Interpretations

4.6.7 Summary and Recommendations

4.7 Future Perspectives and Conclusions

4.8 Let Us Sum Up

4.9 Unit End Questions

4.10 Suggested Readings

4.0 INTRODUCTION
The psychological report is the end product of assessment. It represents the
clinician's efforts to integrate the assessment data into a functional whole so that
the information can help the client solve problems and make decisions. Even the
best tests are useless unless the data from them is explained in a manner that is
relevant and clear, and meets the needs of the client and referral source. This
requires clinicians to give not merely test results, but also interact with their data
in a way that makes their conclusions useful in answering the referral question,
making decisions, and helping to solve problems.
54
An evaluation can be written in several possible ways. The manner of presentation Report Writing and
Recipient of Report
used depends on the purpose for which the report is intended as well as on the
individual style and orientation of the practitioner. The format provided in this unit
is merely a suggested outline that follows common and traditional guidelines. It
includes methods for elaborating on essential areas such as the referral question,
behavioural observations, relevant history, impressions (interpretations), and
recommendations. In this unit we start with a definition and description of what
a psychological report is and how to communicate assessment results etc. Then
we present the general guidelines of writing a psychological report which includes
the lenth of the report, degree of emphasis, domains etc. Then we discuss the
models of psychological report and the levels of report which includes three
levels. This is followed by a section on format of psychological report.

4.1 OBJECTIVES
After completing this unit, you will be able to:

• Explain what psychological report is;

• Provide the general guidelines for psychological report;

• Describe how to communicate assessment results;

• Explain the general guidelines for writing the report;

• Elucidate the models of psychological report and the levels of report;

• Analyse the format of psychological report; and

• Discuss the future prospects of psychological report.

4.2 THE PSYCHOLOGICAL REPORT

The psychological report presents an opportunity for the professional psychologist
to present the results of assessment in a case focused, problem solving manner.
Its major purpose is to help the referral source make decisions related to the
client. It thus represents the end product of assessment. An ideal report will be
written according to general guidelines and in a flexible but predictable format.

The most frequent categories of reports are centered around questions related to
intelligence / achievement, personality / psychopathology, and neuropsychology
areas. Additional, less frequent categories include adaptive / functional,
developmental, neuro behavioural, aphasia, and behavioural medicine / rehabilitation.
The most frequent general issues relate to diagnosis and answering which type of
treatment would be most effective for a given client. Each of the various categories
of assessment require different types of assessment instruments, knowledge related
to the type of difficulty, awareness of the context( educational, legal, medical,
rehabilitation, forensic ),and knowledge of the various resources available in the
community. This knowledge will then be integrated into the report in order to
make it more problem focused and relevant to the referral source.

4.3 COMMUNICATING ASSESSMENT RESULTS

After testing is completed, analysed, and interpreted, the results are usually first
communicated orally to patients and other interested parties. Results are 55
Psychodiagnostics in communicated to others only with the explicit permission of the person unless
Psychology extraordinary conditions are involved (e.g., the patient is gravely disabled).After
a psychological evaluation, the psychologist will often schedule a feedback session
to show the patient the results, explain the findings in understandable language,
and answer all questions. Often psychologists must also explain their assessment
results to other interested parties such as parents, teachers, attorneys, and
physicians.

In addition to oral feedback, the psychologist typically prepares a written report

to communicate test findings. Most testing reports include the reason for the
referral and the identification of the referring party, the list of assessment instruments
used, actual test scores (such as percentile ranks), the psychologist's interpretation
of the scores and findings, a diagnostic impression, and recommendations. It is
important to ascertain the audience for whom the report is being written.

A report directed to another mental health professional may be very different from
one to a school teacher or a parent. Most psychologists avoid professional jargon
so that their reports will be understandable to non psychologists. Psychologists
also must handle reports confidentially and send them only to appropriate persons.

4.4 GENERAL GUIDELINES

4.4.1 Length of the Report
The length of the report varies considerably across various referral settings.
Traditionally, psychological reports have been between four and seven single
spaced pages. In medical contexts where time efficiency is crucial, psychological
reports rarely exceed two pages. However, psychological reports in a wider
number of contexts also appear to be getting shorter due to the cost containment
and time efficiency demands of managed healthcare. In contrast, legal contexts
demand far more detail, require greater accountability, typically have more complex
referral questions, and involve more flexible, ample methods of reimbursement. As
a result, reports tend to be 7-10 pages and sometimes even longer.

Reports are therefore influenced by and formatted according to the conventions

of other health professionals working within the contexts psychologists write for.

4.4.2 Degree of Emphasis

A well written report also pays particular attention to the degree of emphasis
given to various points. Sometimes, the evidence for a conclusion will be consistent,
strong, and clear and this can then be stated accordingly in the report. Other
information might be more speculative and should be written with an appropriate
degree of tentativeness.

4.4.3 Domains
Test interpretations are ideally presented and organised around specific domains.
The selection of which domains to include should be driven by the types of
questions the referral source is requesting. These questions largely determine the
types of assessment tools used and types of questions asked of the resulting data.
Since each client is different and lives within a different context, the number of
domains will vary considerably. Within a psycho educational context, relevant
domains might revolve around cognitive ability, level of achievement, presence of
56
 a learning disability, or learning style. In contrast, a report written to assess Report Writing and
personality / psychopathology might focus more on such areas as coping style, Recipient of Report
level of emotional functioning, suicide potential, characteristics relevant to
psychotherapeutic intervention, or diagnosis.

Sometimes test results are presented in a test by test fashion. This has the advantage
of m.king it clear where the data came from. However, it runs the risk of being
overly data / test oriented rather than person oriented. Research has consistently
indicated that readers of reports do not feel this style is 'user friendly' . In addition,
it indicates a failure to integrate data from a wide number of sources and suggests
that the practitioner has not adequately conceptualised the case. It also encourages
a technician oriented role rather than one in which a knowledgeable clinician
integrates a wide array of information to help solve a client's problem.

4.4.4 Deciding What to Include

Consistent with the above themes, deciding what include is largely determined
by the referral source. One general principle is that material should only be
included if it helps to further understand the client. In this respect, what is unique
rather than what.is average is usually more important. For example, describing a
client's appearance is typically not useful if they made modal responses to the test
material and were dressed in average appropriate clothes. In contrast, a client
who was obsessively concerned with accuracy (ignoring time concerns) and dressed
in an unusually formal fashion does provide useful behavioural observations. These
. observations also help to place test scores in a wider context, give information
related to.coping style, and an indication of their personality type.

4.4.5 Raw Data and Quantitative Scores

Generally raw data and quantitative scores should be avoided in the impressions
/ interpretations section of the report. They can potentially make the report seem
overly technical and cluttered. Sometimes, however, providing concrete behavioural
observations or actual responses to selected items (i.e. MMPI-2 critical items)
can make abstract points seem more immediate and insightful into the content of
the person's thought processes. This can serve to balance out more high level
abstractions. In addition, providing a clear statistic such as a percentile can
sometimes make a description seem more clear and accessible. For example, a
report might describe how a client with an average IQ had a quite low auditory
memory. Stating they only scored in the '5th percentile' (or 'only five people out
of a hundred scored in this range') call provide some precision into the magnitude
of their difficulties.

4.4.6 Client Feedback

One of the crucial roles of a psychological report is to assist in providing client
feedback. This is in accordance with client advocacy legislation and the American
Psychological Association's ethical guidelines in that clients should know the types
"'~-
of information and recommendations being made about and for them. Such
N
"t-
feedback is expected to be clear, accurate, direct, and understandable. This
, I
W means the results need to be phrased in everyday language rather than formal
o
Q. psychological terminology. There has also been increasing evidence that well
:e integrated client feedback has clear therapeutic benefits. Thus the report (and
related feedback) can potentially become an integral part of therapy itself. While
feedback is typically verbal, an important option is to design the written report, 57
Psychodiagnostics in or at least an edited version of the report, in such a way as to be of optimal
Psychology
benefit to the client.

Self Assessment Questions

1) Define and describe psychological report.

2) What features are included in the psychological report?

3) Delineate the general guidelines for psychological report writing.

4.5 MODELS OF PSYCHOLOGICAL REPORTS

There are many models / approaches to psychological reports. Some of the
models of reports are discussed below.

The three models for psychological reports to be discussed are the

• The Test Oriented Model,

• The DomainOriented Model, and

• The Hypothesis Oriented Model.

In the Test Oriented Model, results are discussed on a test-by-test basis. Each
test is listed by name and significant results for that test are presented. Each test
is generally discussed in a separate paragraph. Little or no effort is made to
compare and contrast data between the various tests (at least not in the "Results
of Assessment" section). The strength of this approach is that it makes clear the
source of each piece of data. This could be important in certain settings, such as
forensic reports. The weakness of this model is that the reader's attention becomes
focus sed on the tests, rather than on the client's adaptive functioning.

It also communicates to the reader that psychological assessment is a low-level,

technical skill which involves little more than giving the test and copying some
interpretive statements out of a manual. It ignores the role of the psychologist as .
the integrator of the test data; a professional who brings to bear his knowledge
of how the test was constructed, how it Wasnormed, limits to generalis ability of
test data, and how to use the data in a theoretical/conceptual manner to better
understand the client. The Test Oriented Model was used extensively in past, but
58 has become increasingly unpopular in recent years.
 In the Domain Oriented Model, results are grouped according to abilities or Report Writing and
"functional domains". Separate paragraphs are usually devoted to such topics as Recipient of Report
intellectual ability, interpersonal skills, psychosocial stressors, coping techniques,
intrapersonal needs, motivational factors, depression, psychotic features, etc. This
model is useful when there is no specific referral question and you're not certain
what use will be made of your data. For example, little background information
may beavailable on a newly admitted patient. You're not sure why he was
admitted or what factors precipitated the admission. Therefore, it is hard to know
which portions of your data will be useful to the treatment team. The Domain
Oriented Model is also co~on in neuropsychological reports, where a variety
of providers may eventually become involved in the case. Each provider will focus
on separate parts of the report to assist in a specific aspect of intervention. This
approach is also helpful when assessment is being used to monitor treatment
progress. It allows you to monitor changes in the client's functioning across a wide
variety of areas'; The weakness of the Domain Oriented approach is that the
reader may be presented with a lot of information that has little relevance to his
intended intervention. He may become so distracted by parts of the report he
doesn't understand, that he fails to focus on information which could be helpful
to him. This model is sometimes pejoratively referred to as a "shotgun" approach,
referring to its apparent effort to hit all the possible target issues.

In the Hypothesis Testing Model, results are focussed on possible answers to the
referral question(s). The idea is to present a hypothesis in the "Purpose for
Evaluation" section, then present data systematically to support or refute the
hypothesis. Separate paragraphs in the "Results of Evaluation" section address
theoretical/conceptual issues by integrating data from the history, mental status
exam and behavioural observations with data from all the tests. Tests are rarely
mentioned by name. For example, information from scale 2 on the MMPI-2 may
be combined with interpretive data from the MCMI dysthymia scale. If the
integration of this information is consistent with the history and the mental status
exam, it is included in a paragraph dealing with depression. The strength of this
model lies in its efficiency and concise focus on the referral problem. The reader
isn't distracted by unrelated details. The primary weakness of the model is that
you don't report some of the information which is unrelated to the "purpose of
the evaluation" but which could potentially be useful to other disciplines.

4.5.1 Levels of Reports

Having covered the issue of report Models, this discussion will now turn to
"levels" of reports. Three levels of reports, viz., level I, level 2and level 3 will
be covered.

A "Level One" report is the copied out of the manual level. The interpretive data
come directly from the manual (or computer print out) and usually follow the
format. This makes for a conceptually weak report and may actually do more
harm than good for the client. Keep in mind that many of the referral agents will
have little understanding of the limits to generalis ability and external validity of

, "raw" test data. This level of report is only appropriate when there are extenuating
circumstances which make it impossible to interview the patient or to obtain .
background information. In those cases the report should be clearly qualified with
a statement to the effect that.. .."These results represent a blind interpretation of
test data and should be considered tentative until confirmed by subsequent clinical
data or background information". 59
Psychodiagnostics in A "Level Two" report represents the minimum level of conceptual input which
Psychology should be used for most purposes. Of all the possible interpretive' hypotheses
generated by the test, the only ones included in the "Results of Evaluation" are
those that have been confirmed (either by the history or in the clinical interview). ,

A "Level Three" report represents the highest level of conceptualization. Its format
is similar to a Level Two report. However, it also presents a theoretical
conceptualisation of the problem. Ideally, this report will integrate all available
information to:

• describe the nature of the problem and how it developed over time

• describe factors which influence and reinforce the problem

• describe any recent exacerbating factors which led to the referral

• provide suggestions for intervention based on the client's strengths,

. weaknesses, and coping skills.

Self Assessment Questions

1) What are the various models of psychological report?

............. ..............................................................................................•....
'

.................................................................................................................
2) Discuss the domain oriented model.

3) Elucidate the hypothesis testing model.

4) Discuss the three levels of report writing.

4.6 FORMAT FOR PSYCHOLOGICAL REPORTS

There are various ways of organising a psychological report. Some practitioners
prefer to use an informal, relatively unstructured letter format. This is especially
appropriate when the report will be seen by a single referral source and the
referring person is known to the practitioner. Other reports might be more
appropriately organised around quite structured headings (i.e. 'Referral question',
60
 Report Writing and
'Test results', 'Summary and recommendations'). Some reports might demand
Recipient of Report
(and practitioners prefer to include) an extensive history whereas others might
minimize the history in favour of spending relatively greater time elaborating on
impressions and interpretations. Given the recent trends towards treatment planning
and demonstrating the practical, every day relevance of assessment, some reports
might place relatively greater emphasis and length into providing concrete, specific
recommendations for psychotherapy planning, vocational training, educational
intervention, or neuropsychological rehabilitation.

Even if reports do not formally designate specific headings and subheadings, they
still typically include a predictable series of content areas. The following listing
provides an outline of typical areas (from Groth Mamat, 1999;Williams & Boll,
2(00):

Name:

Age (date of birth):

Sex:

Ethnicity:

Date of report:

Name of examiner:

Referred by:

i) Referral question

ii) Evaluation procedures

iii) Behavioural observations

iv) Background information

v) Test results

vi) Impressions and interpretations

vii) Summary and recommendations

An additional feature is an indication at the top of the report that the report is
'Confidential'. The report should conclude with the signature, name, and title of
the author. This is crucial since it indicates that responsibility for the contents of
the report is being formally acceptedby the author. Identifying information is fairly
straight forward (name, age, sex, etc\) but the additional features (I-VII) require
elaboration. \

4.6.1 Referral Question

The referral question sets the stage for the rest of the report. It is therefore
especially important to make sure it is as clear and specific as possible (i.e. 'My
understanding is that you would like me to evaluate Mr. X with particular reference
to the nature and severity of his deficits, the extent of care he would require,
ability to work, personality functioning, and the likelihood of any further
improvement'). Often clarifying the referral question will require discussions with
the referral source since it is not unusual to have an initially poorly articulated (or
at least partially developed) referral question. One means of assisting with this is - 61
Psychodiagnostics in to ask the referral source what decisions they need to make related to the client.
Psychology Sometimes discussions with the referral source will mean indicating the sorts of
questions that can and cannot realistically be answered through formal assessment.
Such discussions may even result in a mutual decision that formal assessment is
not appropriate for the case. A clearly articulated referral question will carry
through to the rest of the report in that it provides a frame of reference for this
material as well as a rationale for what is relevant to include in the sections on
background information (history), impressions / interpretation, and especially the
summary / recommendations section.

One effective technique is to create bulleted points in the summary, each of which
provide a clear answer to each of the referral questions. However, the points
need to be consistent with material presented previously in the impressions /
interpretation section. A nice beginning to the referral question section (and the
report in general) is to make a brief, succinct, orienting, statement related to the
client (i.e. 'Mr. X is a 36year old, white, right handed, married male with a high
school education who sustained a severe, diffuse closed head injury on April 12,
1998').

4.6.2 Evaluation Procedures

The evaluation procedures section is simply a listing of the various instruments
used. Sometimes, particularly in legal settings, this includes the date when
administered and the length of time they took to complete the test. It is sometimes
useful to include the total time involved in the entire evaluation. If the report relied
on previous records (academic, vocational, legal, medical), then the dates and, if
relevant, the authors of the reports should be given (i.e. 'In addition, I reviewed
the following reports by .. .').

4.6.3 Behavioural Observations

Often behavioural observations can provide a useful context for understanding
test data. For example, low scores on cognitive tests may be the result of low
motivation or perhaps a problem solving style that sacrifices speed for accuracy.
These and related behavioural observations can be noted in the behavioural
observations section. Behavioural observations should generally be kept concise
and relevant. They should also refer to concrete, obsyrvable behaviours rather
than either high level abstractions or conclusions about the client. Thus, it would
be preferable to state that the client moved slowly and they were self critical (i.e.
'the client continually commented that they weren't able to do very well') rather
than to make inferences (i.e. 'the client appeared depressed'). Inconsistencies in
the client's behaviour might also be useful to note. These might include a young
person who acts older than their stated age or a person who says they feel fine
butappear anxious and defensive. Additional domains of behavioural observations
include attitude toward the examiner and test situation, attitudes toward self,
reaction to praise, reaction to failure, motor coordination, reaction time, and
behaviours related to speech and language.

4.6.4 Background Information

One of the potentially most useful functions of the professional psychologist is to
provide descriptions of relevant background information. This might be
particularly important in a medical context where physicians neither have the time
nor the appropriate training to access important client information. At the same
62
time, the background information section should avoid being overly inclusive. For Report Writing and
example, it is unlikely to be useful to provide a detailed developmental history for Recipient of Report
an adult who is seeking vocational assessment. On the other hand, a detailed
developmental history would be essential for an adolescent referred to assess
possible learning disabilities. It is usually important to clarify where the information
came from (i.e. 'The client reported that ... ' or 'The report of 3/6/98 by Dr.
Y indicated that ... '). Possible domains for history taking and inclusion in the
background information section include the following: history of the problem,
medical history, vocational / employment background, family background, personal
history (infancy, early/middle childhood, adolescence, early/middle adulthood, late
adulthood), and miscellaneous areas such as fears, self concept, recurring dreams,
or specific memories.

4.6.5 Test, Results

Some reports include a test results section which lists the actual scores on the
tests. If this is done, it is often useful to translate the scores into percentiles to
enable readers to more easily understand the meanings of the test scores. A
further related strategy is to develop a profile sheet depicting relative high and low
performances. Some times these might nave cutoffs for such categories as 'impaired',
'superior', or 'dysfunctional'. In some cases the test results / scores are placed
in a section within the body of the report itself. In reports, the 'test results' section
is included as an' appendix. It is also not unusual for reports to exclude the actual
.test data. This is especially the case in medical settings where concise reports are
greatly valued. Actual test scores might also be excluded if it is known that the
referral source is neither trained in, nor interested in, seeing the actual scores.

4.6.6 Impressions and Interpretations

The main body of the report is contained in the impressions and interpretation
section. It represents an integration of fmdings based not only on test scores, but.
also behavioural observations, relevant history, relevant records, and additional
available data. The importance of presenting the information according to domains
rather than test by test has already been discussed. The selection of domains is
based on answering the referral question. If ability / IQ measures have been
measured, it is traditional to place these first since they usually provide an important
context for understanding most other types of information. Most of the time actual
IQ scores are given along with percentiles and intelligence classification (Low
Average, Superior, etc.). Some authors might prefer to provide an estimate of the
range of possible error of IQ scores by including the Standard error of Measure.
In contrast, other authors might consider this to be too technical and test oriented
and decide to omit this information. If there is a chance the IQ scores might be
misunderstood, then they are sometimes excluded and only the percentiles and
intelligence classifications are given.

Different types of referral categories, along with the specific referral questions, will
determine the additional domains to include. For example, when assessing
intellectual/achievement types of referrals; important domains might include general
cognitive ability, specific strengths and weaknesses, level of achievement, aptitudes,
learning style, interests, and possibly vocational interests. A neuropsychological
report might not only focus on cognitive abilities and achievement but also learning!
memory, language functions, attention,visuo constructive abilities,executive function,
emotional functioning, and potential and strategies for cognitive rehabilitation.
63
Psychodiagnostics in 4.6.7 Summary and Recommendations'
Psychology
The most valuable section is usually the summary and recommendations. The
importance of this section is that sometimes it is the only section read by allied
health professionals concerned with time efficiency. The summary provides an
opportunity for the practitioner to succinctly state the main conclusions of the
report. As indicated previously, the summary section also provides an opportunity
to make sure each one of the referral questions have been addressed. The
recommendations are an opportunity to provide person focused suggestions on
solving specific problems. A clear research finding is that reports are typically
rated as most useful if the recommendations are highly specific rather than general.
Thus a statement such as the 'client should begin individual psychotherapy' is not
as useful as one that states the 'client is likely to benefit most from weekly
sessions of individual psychotherapy using strategies to decrease their level of
subjective distress, enhance social supports, and increase their level of awareness
related to self defeating patterns in interpersonal relationships' . Once a report has
been submitted, follow up contact with the referral source is advisable in order
to provide ongoing feedback related to the accuracy and usefulness of the report
as well as help facilitate the actual implementation of the recommendations.

A sample of a format

PSYCHOLOGICAL EVALUATION

(Facility Name Here)

RupaKumar Dates of Evaluation: 3.6.2011
Case No.: Building No.: 11
Admission Date: 4.6.11 Date of Report: 3.6.11.

Purpose for Evaluation: Rather than "Reason for Referral" the first section for
the report is better called "PURPOSE FOR EVALUATION." This gives the
clinical psychologist a lot more flexibility. If you us "Reason for Referral" is used
the psychologist has to copy whatever the consult says. Unfortunately, many
consults ask questions which tests can not answer (or else they do not ask any
question at all).

This section should be used to briefly introduce the patient and the problem.
Begin with a concise "demographic picture" of the patient. (e.g., This is the third
inpatient admission for this 32 year old, single, white female who has 13 years of
formal education and is employed as a beautician. She was admitted due to
symptoms of major depression with possible psychotic features.)

Use this section to tell your reader what issues you will address in the body of
the report. The reader will then know on what issues to focus, and he can be
forming his own impressions while he is reading the report .. (e.g., The purpose
for the current evaluation was to screen for evidence of psychosis and clarify the
nature of the underlying depressive disorder.) In sum, use this section to "pose
a question," which you will ~nswer in the "SUMMARY" section.

Finally, if the evaluation takes more than 5 days to complete, you should put
a progress note in the patient's chart giving preliminary test results. For
example, you might conclude the "PURPOSE FOR EVALUATION' section of
64 your report with, "Preliminary results were reported in the patient's progress
notes on 3.6.11. The current report will supplement and elaborate upon those Report Writing and
preliminary findings." Recipient of Report

Assessment Procedures: Refer to this section as "ASSESSMENT

PROCEDURES" rather than "TESTS ADMINISTERED." This allows the
psychologist to include the Mental Status Exam and the Clinical Interview as two
procedures. This also helps communicate to referral sources that the psychologist
do more than give some tests and copy interpretive statements out of a manual.
It lets them know that the psychologist's evaluation is a professional integration
of information from a variety of sources. Be sure to also note who gave the tests
and how long it took. These issues are important if a case ever goes to court.

e.g.: Millon Clinical Multiaxial Inventory-Ill (MCMI-Ill)

Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
Mental Status Examination
Review of Prior Psychological Assessment
Review of Prior Medical Records
Clinical Interview

This patient participated in 3 hours of testing and a 1 hour diagnostic interview.

Tests were administered by Jim Smith, M.S. and interpreted by Dr. Ram Kishore
and interpreted by Dr. Lavanya Seth.

Background Infonnation: In this section present paragraphs dealing with family,

social, legal, medical, family mental health, etc. issues, if needed. Only include
those issues; that are relevant to the "questions" posed under "PURPOSE FOR
EVALUATION." Excessive, unnecessary details will distract the reader from the
case that is being built in support of the psychologist's conclusions. Whenever
possible, maintain chronological order when presenting background information.

Next describe the patient's history of substance abuse / mental problems, and
mental health care in CHRONOLOGICAL order. Where possible, provide enough
details of prior intervention efforts to clarify what was attempted and whether it
was successful.

The psychologist's goal is to encourage replication of prior successes and / or

avoid duplication of prior treatment failures. Also, be sure to describe the patient's
behaviour and level of adaptive functioning BETWEEN prior interventions. These
details will help give the treatment team an idea of what "target level" of adaptive
functioning to look for in the current intervention.

Follow with a paragraph describing the onset and development of the present
illness / exacerbation. Let the reader get an idea of how the current admission
compares to prior admissions and what specific events precipitated the current
admission. End this section with a brief paragraph summarizing staff observations,
patient behaviour, level of motivation, etc. during the current admission. Keep in
mind that objective observations by professional staff are one of the best sources
of data. Conclude with a sentence indicating medications being taken at the time
of testing.

Mental Status Examination: Focus on one's own observations and impressions.

This section of the report should focus on the psychologist's objective evaluation.
Avoid quoting the patient's opinion of his own mood, affect, etc. It is also best
to avoid mixing in background information or test information with this section.
A typical MSE for a 'normal' patient might read: 65
Psychodiagnostics in Results of mental status examination revealed an alert, attentive individual
Psychology who showed no evidence of excessive distractibility and tracked
conversation well. The patient was casually dressed and groomed.
Orientation was intact for person, time and place. Eye contact was
appropriate. There was no abnormality of gait, posture or deportment.
Speech functions were appropriate for rate, volume, prosody, and fluency,
with no evidence of paraphasic errors. Vocabulary and grammar skills
were suggestive of intellectual functioning within the average range.

The patient's attitude was open and cooperative. His mood was euthymic.
Affect was appropriate to verbal content and showed broad range.
Memory functions were grossly intact with respect to immediate and
remote recall of events and factual information. His thought process was
intact, goal oriented, and well organised. Thought content revealed no
evidence of delusions, paranoia, or suicidal or homicidal ideation. There
was no evidence of perceptual disorder. His level of personal insight
appeared to be good, as evidenced by ability to state his current diagnosis
and by ability to identify specific stressors which precipitated the current
exacerbation. Social judgment appeared good, as evidenced by appropriate
interactions with staff and other patients on the ward and by cooperative
efforts to achieve treatment goals required for discharge.

Resuls of Evalution: The idea is to present a hypothesis in the "PURPOSE

FOR EVALUATION" section, then present data systematically to support or
refute the hypothesis. Separate paragraphs in the "RESULTS OF EVALUATI0N"
section address theoretical / conceptual issues by integrating data from the history,
mental status exam and behavioural observations with data from all the tests.

Specific tests are rarely mentioned by name. For example, information from
scale 2 on the MMPI-2 may be combined with interpretive data from the MCMI-
ill dysthymia scale. If the integration of this information is.consistent with the
history and the mental status exam, it is included in a paragraph dealing with
depression.
SummarylRecommendations: Begin by specifically answering the questions you
posed under "PURPOSE FOR EVALUATION." Then elaborate as much as
needed to present your conceptualisation of the case. It's fine to include DSM.
diagnostic impressions, but your summary of the patient's psychological makeup
is far more important. If you do include DSM labels, be sure to provide enough
detail in the body of the report to support the diagnostic criteria as described in
DSM. Any recommendations for treatment can also go here. For example:

Results of psychological evaluation reveal an extended history of alcohol

abuse and a psychotic disorder characterised primarily by disturbance of
thought content, with relative integrity of thought process and no clear
indication of perceptual disturbance. The current clinical presentation
appears to represent an acute exacerbation of a chronic psychotic
disturbance which had its onset approximately 8 years ago. Currently, the
patient appears to remain extremely distressed, anxious, paranoid, and
delusional, despite self reports to the contrary. He lacks sufficient capacity/
motivation to rely on external supports and lacks sufficient personal insight
to cope independently at present. The patient appears to be attempting
to cope with his illness using extreme guardedness and withdrawal. During
recent months he has shown no signs of aggressive ideation and is not
66 believed to be a physical risk to himself or others at present.
 It is recommended that efforts to establish a trusting relationship with this Report Writing and
patient be continued, in order to help him cultivate a more adaptive Recipient of Report

coping/defensive patte~. Individual therapy will be more productive than

group interventions. Once his guardedness has been relaxed, it will likely
be beneficial to explore psychosocial issues present at the time The patient
lost his job, as these appear to have partially precipitated the current
psychotic exacerbation. Additionally, the patient will benefit from
encouragement to explore the social and adaptive significance of his
substance abuse history.

Self Assessment Questions

1) What is meant by referral questions?

2) Elucidate how to write evaluation procedures.

3) Describe behavioural observation in a psychological report.

4) What type of background information is included in psychological report?

5) What ways the test results are presented in a psychological report?

6) Why is impressions and interpretations are important in a report?

67
Psychodiagnostics in
Psychology 7) What would contain in the summary and recommendations?

4.7 FUTURE PERSPECTIVES AND

CONCLUSIONS
The above guidelines and outline for a psychological report may, in some ways,
appear as a mechanical process. It should also be stressed that the most successful
reports are likely to emerge from clinician and client interactions that are
characterised by a high level of involvement and understanding. This is then likely
to be reflected in a report that is more full, in depth, and captures the complexity
and 'humanness' of the client. Technical skills and mechanical interpretation are
-c •

no substitute for this process. An additional essential quality is that clinicians are
well informed related to the type of problem and overall context the client is
functioning in. Given that there is surprisingly little research on psychological
reports, it would be crucial to expand this research base. The most likely avenue
would be to investigate the interface between research on clinical judgement,
psychometrics, and the ability of clinicians to interface with computer assisted
interpretations in such a way as to increase the accuracy of clinician based
judgements. This would need to be continually evaluated against the relative
usefulness of reports with various referral sources.

4.8 LET US SUM UP

Assessment results are often communicated verbally to interested parties. After a
psychological evaluation a psychologist will often schedule a feedback session to
show the person who was tested the results and explain the findings in language
that is understandable to a non psychologist. In addition to oral feedback, the
psychologist typically prepares a written report to communicate test findings.
Most psychologists avoid professional jargons so that their reports will be
understandable to non psychologists. This unit outlined the way in which the
referral for a psychodiagnostic test evaluation arises, the importance of its
communicative nature, its place in the referral and helping process, and the fact
that it can be focused in various ways. It was also pointed out that any pathology
uncovered by the test data needs to be related to the referral problem. The
particular importance of each section in the psychological report was defined, and
a rationale was presented to reveal the logical inter connections and sequence of
the various sections.

4.9 UNIT END QUESTIONS

I) The psychological report is the end product of -------

2) A report directed to another mental health professional is similartoone to a

68 school teacher or a parent. True or False?
3) The length of the report varies considerably across various referral settings. Report Writing and
Recipient of Report
True or False?

4) One of the crucial roles of a psychological report is to assist in providing -

5) The ~~------- sets the stage for the rest of the report.

6) The main body of the report is contained in the -------:and-

------ section.

7) The test results provide an opportunity for the practitioner to succinctly state
the main conclusions of the report. True or False?

8) Discuss the importance of psychological report?

9) Describe the general guidelines for a psychological report with examples?

10) Describe the format for psychological report by using suitable examples?

4.10 SUGGESTED READINGS

Groth-Marnat, Gary. (2003). Handbook of Psychological Assessment (4thed.).
New Jersey: John Wiley & Sons, Inc.

Murphy, K.R., Davidshofer, CO. (2005). Psychological Testing: Principles

and Applications (61hed.). New Jersey: Pears on Education International.

69
 References
REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of
mental disorders (4thed., text rev.). Washington, DC: Author.

American Psychological Association. (2002). Ethical principles of psychologists

and code of conduct. American Psychologist, 57(12), 1060-1073.

American Psychological Association. (2003). Guidelines on multicultural education,

training, research, practice, and organizational change for psychologists. American
Psychologist, 58, 377-402.

Beck, A T., Freeman, A, Davis, D., & Associates. (2004). Cognitive therapy
of personality disorders (2nd ed.). New York: Guilford Press.

Chaplin, J. P. (1985). Dictionary of psychology (2nded.). New York: Dell.

'. Connier, W. H., & Connier, L. S. (1991). Interviewing strategies for helpers.
Pacific Grove, CA: Brooks/ Cole.

First, M. B., Gibbon, M., Spitzer, R. L., WiIliams, J. B., & Benjamin, L. (1997).
Structured Clinical Interview for DSM-IV Axis I disorders (SCID-l), clinical
version. Washington, DC: American Psychiatric Press.

Groth-Marnat, G. (1999). Handbook of Psychological Assessment (3rd ed.).

New York: John Wiley & Sons.

Hamilton, M. (1960). Hamilton Rating Scale for depression. Journal of Neurology,

Neurosurgery" and Psychiatry, 23, 56-61.

Haynes, S. N., & O'Brien, W. H. (2000). Principles and practice of behavioral

assessment. New York: Kluwer.

,Kaplan, R. M., &Saccuzzo, D. (2001). Psychological testing: Principles,

applications, and issues (5th Ed.). Pacific Grove, CA: Wadsworth.

Korchin, SJ. (2004). Modem Clinical Psychology: Principles of Intervention

in the clinic and community. New Delhi: CBS Publishers & Distributers.

Maloney, M. P., & Ward, M. P. (1976). Psychological assessment: A conceptual

approach. New York: Oxford University Press.

Nezu, A M., Nezu, C. M., Friedman, S. H., & Haynes, S. N. (1997). Case
formulation in behavior therapy: Problem-solving and functional analytic strategies.
In T. D. Eels (Ed.), Handbook of psychotherapy case formulation (pp. 368-
401). New York: Guilford Press.

Plante, T. G. (2005). Contemporary Clinical Psychology (2nd Ed.). New Jersey:

John Wiley & Sons, Inc.

Reich, W., Jesph, J., &Shayk, M. A. (1991). Diagnostic instrument for children
and adolescents-revised: Child and Parent (Version 7.2). Seattle: University of
Washington.

Rozensky, R. H., Sweet, J. 1., &Tovian, S. M. (1997). Psychological assessment

r

in medical settings. New York: Plenum Press. ~

70
Rudd, M. D., & Joiner, T. (1998). The assessment, management, and treatment References
of suicidality: Toward clinically informed and balanced standards of care. Clinical
Psychology, 5, 135-150.

Sundberg, N.D., Tyler, L.E. (1962). Clinical Psychology. New York: Appleton-
Century-Crofts.

Trull, T.1. (2005). Clinical Psychology (71h Ed.). USA: Thomson Learning, Inc.

Turner, S. M., DeMers, S. T., Fox, H. R., & Reed, G. M. (2001). APA's
guidelines for test user qualifications: An executive summary. American
Psychologist, 56(12), 1099-1113.

Williarns, M.A. & Boll, T.1. (2000). Report writing in clinical neuropsychology.
In Groth-Marnat, G. (Ed.), Neuropsychological Assessment in Clinical Practice:
A Guide to Test Interpretation and Integration. New York: John Wiley &
Sons. '

World Health Organization. (1992). ICD-J o. Geneva, Switzerland: Author.

71
NOTES
 .
~
I
lndira Gandhi
Ignou
THE PEOPLE'S
UNIVERSITY
GROUP A
MPCE-012
Psychodiagnostics
National Open University
School of Social Sciences

10 Block

'.
3
TESTS OF COGNITIVE FUNCTIONS
UNIT 1
Measures of Intelligence and Conceptual Thinking 5

UNIT 2
The Measurement of Conceptual Thinking .I

(The Binet and Wechsler's Scales) 24

UNIT 3
Measurement of Memory and Creativity 37

UNIT 4
Utility of Data .from the Test of Cognitive Functions 55

N
.•...
I
W
o
a..
:E
Expert Committee
Prof. A. V. S. Madnawat Dr. Madhu Jain Dr. Vijay Kumar Bharadwas
Professor & HOD Department Reader, Psychology Director
of Psychology, University of Department of .Psychology Acadernie Psychologie, Jaipur
Rajasthan. Jaipur University of Rajasthan, Jaipur
Prof. Dipesh Chandra Nath
Dr. Usha Kulshreshtha Dr. Shailender Singh Bhati Head of Dept.' of. Applied
Associate Professor, Psychology Lecturer, 0. D. Government Psychology, Calcutta University
University of Rajasthan, Jaipur Girls College, Alwar, Rajasthan Kolkata
Dr. Swaha Bhattacharya Prof. Vandana Sharma Dr. Mamta Sharma
Associate Professor Professor and Head of Assistant Professor
Department of Applied Psychology Department Department of Psychology
Calcutta University, Kolkata of Psychology Punjabi University, Patiala
Punjabi University, Patiala
Prof. P. H. Lodhi Dr. Vivek Belhekar
Professor and Head of the Prof. Varsha Sane Godbole Senior Lecturer
Department of Psychology Professor and Head of Bombay University, Mumbai
University 'of Pune, Pune Department of Psychology
Osmania University, HyderabadDr. Arvind Mishra
Prof. Amulya Khurana Assistant Professor
Professor & Head Psychology Dr. S. P. K. Jena Zakir Hussain Center for
Humanities and Social Sciences Associate Professor and Incharge Educational Studies. Jawaharlal
Indian Institute of Technology Department of Applied Nehru University, New Delhi
New Delhi Psychology University of Delhi. .
South Campus Benito Juarez Dr. Kamka Khandelwal Associate
Prof. Waheeda .Khan Road. New Delhi Professor and Head of
Professor and Head Department - Department of Psychology
of Psychology Prof. Manas K. Mandal Lady Sri Ram College,
Jarnia Millia University Director Kailash Colony, New Delhi
Jarnia Nagar, New Delhi Defense Institute of
Psychological Research Prof. G. P. Thakur
Prof. Usha Nayar DRDO, Timarpur, Delhi Professor and Head of
Professor, Tata Institute of Department of Psychology (Rtd.)
Social Sciences, Deonar, Mumbai Ms. Rosley Jacob M.o. Kashi Vidhyapeeth
Lecturer, Department of Varanasi
Prof. A.K. Mohanty Psychology, The Global Open
Professor, Psychology University Nagaland, Paryavaran
Zakir Hussain Center for Complex, New Delhi
Education Studies, Jawaharlal
Nehru University, New Delhi

Content Editor
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Emeritus Professor, Psychology
Department of Psychology
SOSS, IGNOU, New Delhi

Format Editor: Prof. VimalaVeeraraghavan& Dr. Shobha Saxena (Academic Consultant), IGNOU, New Delhi
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Units 1-4 Ms. Kiran Rathore
Assistant Professor
Department of Psychology
Osmania University, Hyderabad

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 BLOCK 3 . INTRODUCTION
The assessment of intelligence was conceived in a theoretical void and born
into a theoretical vacuum. During the last half of the nineteenth century, first
Sir Francis Galton in England (1883) and then Alfred Binet in France (Binet
& Henri, 1895) took turns in developing the leading intelligence tests of the
day. Galton, who was interested in men of genius and in eugenics, developed
his test from a vague, simplistic theory that people take in information through
their senses, so the most intelligent people must have the best developed senses.
His test included a series of sensory, motor, and reaction time tasks, all of which
produced reliable, consistent results (Galton, the half cousin of Charles Darwin,
was strictly a scientist, and accuracy was essential), but none of which proved
to be valid as measures of the construct of intelligence.

The assessment, of intelligence has tremendous potential for great use and great
abuse. IQ tests can be used to categorize people into oblivion and misinterpreted
to support a wide variety of racist and sexist ideologies. But they can also
be used to examine and treat children once simply called 'stupid'. Unit 1, will
briefly touch on the history of intelligence assessment and then focus on the
Wechsler Scales, the most used tests of cognitive development, the Stanford-
Binet V, the descendant of the first major test of cognitive development, and
then describe more recent tests of cognitive development, such as the Kaufman
tests, the Woodcock-Johnson, the Differential Ability Scales, and the Cognitive
Assessment System.

Abstract reasoning or conceptual thinking is no doubt the most advanced of

the cognitive abilities. Whereas animals may be capable of problem solving, only
humans can abstract. Thus, abstraction and problem solving are not synonymous,
and problems can be solved without abstraction. However, formation of an
abstract concept is often the most elegant way of solving a problem. The word
abstraction connotes abstracting some unifying idea or principle on the basis
of observation of diverse material. It is therefore an activity that is removed
from direct sensory experience and constitutes a representation of such
experience. The term abstraction is often contrasted to concreteness, the latter
term indicating cognitive activity associated with direct experience, and without
such representation. Concreteness is direct interaction with the "real world"
without additional processing.

Conceptual thinking or abstract reasoning is a recognised form of thinking that

includes aspects of critical, creative, and meta cognitive thinking. Conceptual
thinking requires the ability to critically examine factual information; relate to
prior knowledge; see patterns and connections; draw out significant understand-
ings at the conceptual level; evaluate the truth of the understandings based on
the supporting evidence; transfer the understanding across time or situation; and,
often, use the conceptual understanding to creatively solve a problem or create
N a new product, process, or idea. In Unit 2, we will be dealing with conceptual
't""

W
I
thinking and its measurement. We will present the various tests that could be
o
a. used for the purpose and then discuss the applicabllity and limitations of these
:E tests.
Webster's dictionary (1966) defines memory as the 'conscious or unconscious
evocation of things past'. As such, the term 'memory' can refer to a variety
of learned behaviours, and it could be argued that many aspects of perception
and language involve the use of certain memory systems. A number of authors
have alluded to the range of possible human memory systems but in the present
context we will mainly be concerned with the more customary use of the term,
that is the retention of specific information which has been acquired in the
recent past. It is this aspect of memory which forms the basis of most of the
memory symptoms reported by brain damaged patients and which is the main
focus of this unit. The first half of this unit will cover in depth the various aspects
of memory assessment.

What does it mean to be creative? Some might say thinking outside the box;
others might argue it as having a good imagination, and still others might suggest
creativity is a synergy that can be tapped through brainstorming. We take an
empirical, psychological approach to this question. One of the first things we .
will cover in Unit 3 is to define what creativity is. Secondly this unit will cover
the different types of tests used in assessment of creativity.

Cognitive testing is a general term referring to the assessment of a wide range

of information processing or thinking skills and behaviours. These comprise
general neuro psychological functions involving brain-behavior relationships,
general intellectual functions (such as reasoning and problem solving) as well
as more specific cognitive skills (such as visual and auditory memory), language
skills, pattern recognition, finger dexterity, visual perceptual skills, academic skills,
and motor functions. Cognitive testing may include aptitude testing (which
assesses cognitive potential such as general intelligence) and achievement testing
(which assesses proficiency in specific skills such as reading or mathematics).
Cognitive testing uses well known tests such as the Scholastic Aptitude Test
(SAT) and intelligence quotient (IQ) tests of all kinds. Thus, cognitive testing
is an umbrella term that refers to many different types of tests measuring many
different types of thinking and learning skills.

The Unit 4 expands the discussion of assessment in clinical psychology. Cognitive

assessment measures a host of intellectual capacities and encompasses the
subspecialty of neuropsychological assessment that examines brain-behaviour
relationships. Once all the assessment data are collected and examined by the
psychologist, decisions can be made regarding diagnosis, treatment plans, and
predictions about future behaviour.
UNIT 1 MEASURES OF INTELLIGENCE
AND CONCEPTUAL THINKING
Structure
1.0 Introduction

1.1 Objectives

1.2 History of Intelligence Assessment

1.3 Measures of Intelligence

1.3.1 Wechsler Scales
1.3.2 We,chsler Scales for Adults
1.3.3 WAIS-III
1.3.4 WAIS-IV
1.3.5 The Wechsler Scale for Children
1.3.6· The Wechsler Preschool and Primary Scale of Int~lligence (WPPSI)

1.4 Stanford-Binet Scales

1.4.1 Characteristics of Stanford Binet Scale

1.5 Woodcock-Johnson Psycho Educational Battery-S'" Edition:

Tests of Cognitive Ability (WJ-III)

1.6 Raven's Progressive Matrices

1.7 Kaufman Assessment Battery for Children (K-ABCII)

1.7.1 Kaufman Adolescent and Adult Intelligence Test (KAIT)

1.8 Differential Abilities Scales (DAS)

1.9 Cognitive Assessment System (CAS)

1.10 Questions and Controversies Concerning IQ Testing

1.11 Future Perspectives and Conclusions

1.12 Let Us Sum Up

1.13 Unit End Questions

1.14 Suggested Readings

1.0 INTRODUCTION
The assessment of intelligence via the conventional IQ test has tremendous potential
for great use and great abuse. IQ tests can be used to categorize people into
oblivion and misinterpreted to support a wide variety of racist and sexist ideologies.
But they can also be used to examine and treat children once simply called
'stupid'. This unit will briefly touch on the history of intelligence assessment and
then focus on the Wechsler Scales, the most used tests of cognitive development,
the Stanford-Binet V,the descendant of the first major test of cognitive development,
and then describe more recent tests of cognitive development, such as the Kaufman
tests, the Woodcock-Johnson, the Differential Ability Scales, and the Cognitive
Assessment System. 5

I
Tests of Cognitive
Functions 1.1 OBJECTIVES
After completing this unit, you will be able to:

• describe the history of intelligence assessment;

• describe some of the important measures used for intellectual assessment;

• explain the Stanford Binet scales;

• elucidate the Woodcock Jhonson battery;

• describe Raven's Progressive Matrices;

• explain Kaufman assessment battery for children and for adolescents and
adults;

• elucidate the differential ability scales;

• explain the cognitive assessment system;

• analyse the controversies concerned with IQ testing; and

• discuss the future perspectives of intelligence testing.

1.2 HISTORY OF INTELLIGENCE ASSESSMENT

The assessment of intelligence was conceived in a theoretical void and born into
a theoretical vacuum. During the last half of the nineteenth century, first Sir Francis
Galton in England (1883) and then Alfred Binet in France (Binet & Henri, 1895)
took turns in developing the leading intelligence tests of the day. Galton, who was
interested in men of genius and in eugenics, developed his test from a vague,
simplistic theory that people take in information through their senses, so the most
intelligent people must have the best developed senses. His test included a series
of sensory, motor, and reaction time tasks, all of which produced reliable, consistent
results (Galton, the half cousin of Charles Darwin, was strictly a scientist, and
accuracy was essential), but none of which proved to be valid as measures of the
construct of intelligence.

Alfred Binet, with the assistance of the Minister of Public Instruction in Paris (who
was eager to separate mentally retarded from normal children in the classroom),
published the first 'real' intelligence test in 1905. Like Galton's test, Binet's
instrument had only a vague tie to theory (in this case, the notion that intelligence
was a single, global ability that people possessed in different amounts). In a stance
antithetical to Galton's, Binet declared that because intelligence is complex, so,
too, must be its measurement. He conceptualised intelligence as one's ability to
demonstrate memory, judgment, reasoning, and social comprehension, and he and
his colleagues developed tasks to measure these aspects of global intelligence.

Binet's contributions included his focus on language abilities (rather than the non-
verbal skills measured by Galton) and his introduction. of the mental age concept,
derived from his use of age levels, ranging from 3 to 13 years, in his revised 1908
scale (mental age was the highest age level at which the child had success; the
Intelligence Quotient, or IQ, became the ratio of the child's mental age to .
chronological age, multiplied by 100).In 1916,Lewis Terman of Stanford University
translated and adapted the Binet-Simon scales in the US to produce the Stanford
6
Binet (Terman, 1916).
Nearly coinciding with the Stanford Binet's birth was a second great influence on Measures of Intelligence and
Conceptual Thinking
the development of IQ tests in the US: America's entry into World War I in 1917.
Practical concerns superseded theoretical issues. Large numbers of recruits needed
to be tested quickly, leading to the development of a group IQ test, the Army
Alpha. Immigrants who spoke English poorly or not at all had to be evaluated
with nonverbal measures, spearheading the construction of the nonverbal group
test, the Army Beta.

The next great contributor to IQ test development was David Wechsler. While
awaiting induction into the US Army in 1917, Wechsler obtained ajob with E.G.
Boring that required him to score thousands of Army Alpha exams. After induction
he was trained to administer individual tests of intelligence such as the new Stanford
Binet. These clinical experiences paved the way for his Wechsler series of scales.
Wechsler borrowed liberally from the Stanford Binet and Army Alpha to develop
his Verbal Scale and from the Army Beta and Army Performance Scale Examination
to develop his non verbal Performance Scale. His creativity came not from ·his
choice of tasks, .all of which were already developed and validated, but from his
insistence that everyone should be evaluated on both verbal and non-verbal scales,
and that profiles of scores on a variety of mental tasks should be provided for
each individual to supplement the global or aggregate measure of intelligence.

1.3 MEASURES
, OF INTELLIGENCE
There are hundreds of tests that propose to measure intelligence or cognitive
ability. Different tests have been developed for use with various populations such
as children, adults, ethnic minority group members, the gifted, and the disabled
(e.g., visually, hearing, or motorically impaired individuals). Some tests are
administered individually, while others are administered in groups. Some tests
have used extensive research to examine reliability and validity, whereas others
have very little research support. Some are easy to administer and score, while
others are very difficult to use. Although there are many intelligence tests to
choose from, only a small handful of tests tend to be used consistently and widely
by most psychologists. Clearly, the most popular and frequently administered tests
include the Wechsler Scales (i.e., the Wechsler Adult Intelligence Scale-Third
Edition [WAIS-Ill], the WAIS-R as a Neuropsychological Instrument [WAIS-R
NI], the Wechsler Intelligence Scale of Children-Fourth Edition [WISC-IV], the
Wechsler Primary and Preschool Scale-Third Edition [WPPSI-III]). The second
most frequently used intelligence test is the Stanford-Binet (Fifth Edition). Other
popular choices include the Kaufman Assessment Battery for Children (K-ABC)
and the Woodcock-lohnson Psycho educational Battery etc.

1.3.1 Wechsler Scales

While Wechsler (1974) defined intelligence as being a person's capacity to
understand and cope with his or her environment, his tests were not predicated
on this definition. Tasks developed were not designed from well-researched
concepts exemplifying his definition. In fact virtually all of his tasks were adapted
7
Tests of Cognitive from other existing tests. Wechsler did not give credence to one task above
Functions
another, but believed that this global entity called intelligence could be ferreted out
by probing a person with as many different kinds of mental tasks as one can
conjure up. Wechsler did not believe in a cognitive hierarchy for his tasks, and
he did not believe that each task was equally effective. He felt that each task was
necessary for the fuller appraisal of intelligence. All of his scales yields IQs with
a mean of 100 and standard deviation (SD) of 15, as well as subtest scaled
scores with mean =10 and SD= 3.

1.3.2 Wechsler Scales for Adults

The Wechsler-Bellevue Intelligence Scale was developed and published by David
Wechsler (1896-1981) in1939. The test was revised in 1955 and renamed the
Wechsler Adult Intelligence Scale (WAIS) and revised again in 1981 as the
Wechsler Adult Intelligence Scale Revised (WAIS-R; Wechsler, 1981). The third
edition was published in 1997 (WAIS-III; Wechsler, 1997) and the most recent
edition is the scale of the fourth edition published in 2008 (WAIS-IV; Wechsler,
2008) thus the WAIS-IV is the current version of the test in use today.

1.3.3 WAIS-III
The WAIS-III consists of seven individual verbal subtests (Information, Similarities,
Arithmetic, Vocabulary, Comprehension, Digit Span, and Letter-Numbering
Sequencing) and seven Performance (or nonverbal) subtests (Picture Completion,
Picture Arrangement, Block Design, Object Assembly, Matrix Reasoning, Digit
Symbol, and Symbol Search) (see table 1). Each subtest includes a variety of
items that assess a particular intellectu~l skill of interest (e.g., the vocabulary
subtest includes a list of words that the respondent must defme). The WAIS-III
generally takes about one to one-and-a-half hours to individually administer to
someone between the ages of 16 and 74. Three IQ scores are determined using
the WAIS-III: a Verbal IQ, a Performance IQ, and a Full Scale (combining both
Verbal and Performance) IQ score. The mean IQ score for each of these three
categories is 100 with a standard deviation of 15. Scores between 90 and 110
are considered within the average range of intellectual functioning. Scores below
70 are considered to be in the mentally deficient range, while scores above 130
are considered to be in the very superior range. The individual subtests (e.g.,
Vocabulary, Block Design) have a mean of 10 and a standard deviation of 3.
These subtests form the basis for subtle observations about the relative strengths
and weaknesses possessed by each individual. The table below gives the details
of the subtests of WAIS Ill.

Table 1: Descriptions of the WAIS-III Subtests

Sub Tests Description

1) Picture completion A set of colour pictures of common objects

and settings, each of which is missing an
important part that the examinee must
identify.

2) Vocabulary A series of orally and visually presented

words that the examinee
orally defmes.

8
 Measures of Intelligence and
3) Digit Symbol Coding A series of numbers, each of which is paired Conceptual Thinking
with its own corresponding hieroglyphic-like
symbol. Using a key, the examinee writes
the symbol corresponding to its number.

4) Similarities A series of orally presented pairs of

words for which the examineeexplains
the similarity of the common objects or
concepts they represent

5) Block Design A set of modeled or printed two-

dimensional geometric patterns that the
examinee replicates using two-color cubes.

6) Arithmetic A series of arithmetic problems that the

examinee solves mentally and responds to
orally.

7) Matrix Reasoning A series of incomplete gridded patterns that

the examinee completes by pointing to or
saying the number of the correct response
from fivepossible choices.

8) Digit Span A series of orally presented number

sequences that the examinee repeat
sverbatim for Digits Forward and in reverse
for Digits Backward.

9) Information A series of orally presented questions

that tap the examinee's knowledgeof
common events, objects, places, and
people.
10) Picture Arrangement A set of pictures presented in a mixed-
up order that the examineerearranges into
a logical story sequence.

11) Comprehension A series of orally presented questions

that require the examinee to understand
and articulate social rule and concepts or
solutions toeveryday problems.

12) Symbol Search A series of paired groups, each pair

consisting of a target group and asearch
group. The examinees indicates, by marking
the appropriate box, whether either target
symbol appears in the search group.

13) Letter-Number Sequencing A series of orally presented sequences

of letters and numbers that the examinee
simultaneously tracks and orally repeats,
with the number in ascending order and the
letters in alphabetical order.

14) Object Assembly Set of puzzles of common objects, each

presented in a standardized configuration
that the examinee assembles to form a
meaningful whole.

Source: From Wechsler Adult Intelligence Scale, Third Edition, by D. Wechsler,

1997, San Antonio, TX: Psychological Corporation. 9
Tests of Cognitive Administration and Scoring of the WAIS-m
FW1CtiOns
WAIS-IIl must be administered on an individual basis by a specially trained
psychologist. Although the administration and scoring of some sub tests (e.g.,
arithmetic) is a relatively simple matter, many of the subtests, especially those
comprising open-ended questions, call for informed professionaljudgment in scoring
responses. A large part of the examiner's job is to establish and maintain rapport
with the person taking the test. The sub tests of the WAlS ill are given separately,
alternating the verbal and performance subtests. The examinee first completes the
picture completion subtest, which is simple and nonthreatening (this helps to
capture the examinee's interest), then the vocabulary subtest, then the digit-symbol
coding subtest, and so on. In each subtest, items are arranged in order of difficulty,
with the easier items at the beginning of each subtest and the more difficult items
given later. For most subtests, it is neither necessary nor useful to administer all
test items to every subject. Instead, a fairly easy item is given first, and a subject
who answers that item correctly receives credit for that item and for all the easier
items of the subtest. If the subject fails the first item, the examiner administers all
the easier items to determine what types of problems the subject can or cannot
solve. Similarly, if a subject consecutively fails a number of the moderately difficult
items, the examiner concludes the subtest, rather than administering the most
difficult items. The rationale for this procedure is that subjects tend to lose interest
in testing if they are forced to respond to a number of items that are either
insultingly easy or impossibly difficult for them.

The WAIS III manual includes tables that are used to transform raw scores on
each of the subtests to standard scores with a mean of 10 and a standard
deviation of 3 (the same scale as used by the Stanford-Binet Fifth Edition). These
standardized sub test scores provide a uniform frame of reference for comparing
scores on the different sections of the WAlS ill. For example, if a person receives
a score of 16 on the digit span test and 9 on the block design test, one might
reasonably infer that this person is relatively better at the functions measured by
the digit span test than at those measured by the block design test.

Traditionally, interpretation of the WAIS focused on Verbal, Performance, and

Full-Scale IQ. These scores are still reported in WAlS-IIl, but there is growing
consensus that the Verbal-Performance dichotomy is not sufficient for understanding
individuals' intelligence. The WAIS-III provides scores for four empirically
supported indices: Verbal Comprehension (Vocabulary, Similarities, Information),
Perceptual Organisation (Picture Completion, Block Design, Matrix Reasoning),
Working Memory (Arithmetic, Digit Span, Letter-Number Sequencing),and
Processing Speed (Digit-Symbol Coding, Symbol Search). The Picture
Arrangement, Comprehension, and Object Assembly subtests do not contribute
to these index scores. The WAlS-ill manual provides tables for converting verbal,
performance, and full-scale scores into deviation IQs based on a mean of 100
and a standard deviation of 15.

1.3.4 WAIS-IV
The current version of the test, the WAIS-IV, which was released in 2008, is
composed of 10 core subtests and five supplemental subtests, with the 10 core
subtests comprising the Full Scale IQ. With the new WAIS-IV, the verball
performance subscales from previous versions were removed and replaced by the
index scores. The General Ability Index (GAl) was included, which consists of
10
the Similarities, Vocabulary, Information, the Block Design, Matrix Reasoning and Measures of Intelligence 'and
Conceptual Thinking
Visual Puzzles subtests. The GAl is clinically useful because it can be used as a
measure of cognitive abilities that are less vulnerable to impairment.

There are four index scores representing major components of intelligence:

1) Verbal Comprehension Index (VCI)

2) Perceptual Reasoning Index (PR!)

3) Working Memory Index (WMI)

4) Processing Speed Index (PSI) .

The Verbal Comprehension Index includes four tests:

1) Similarities: Abstract verbal reasoning (e.g., "In what way are an apple and
a pear alike 7")

2) Vocabulary: The degree to which one has learned, been able to comprehend
and verbally express vocabulary (e.g., "What is a guitar?")

3) Information: Degree of general information acquired from culture (e.g., "Who

is the president of Russia?")

4) Comprehension (supplemental):Ability to deal with abstract social conventions,

rules and expressions (e.g., "What does Kill 2 birds with 1 stone
metaphorically mean?")

The Perceptual Reasoning Index comprises five tests

1) Bock Design: Spatial perception, visual abstract processing & problem solving

2) Matrix Reasoning: Nonverbal abstract problem solving, inductive reasoning,

spatial reasoning. '

3) Visual Puzzles: non-verbal reasoning

4) Picture Completion (supplemental): Ability to quickly perceive visual details

5) Figure Weights (supplemental): quantitative and analogical reasoning

The Working Memory Index is obtained from three tests:

1) Digit span: attention, concentration, mental control (e.g., Repeat the numbers
1-2-3 in reverse sequence)

2) Arithmetic: Concentration while manipulating mental mathematical problems

(e.g., "How many 45-cent stamps can you buy for a dollar?")

3) Letter-Number Sequencing (supplemental): attention and working memory

(e.g., Repeat the sequence Q-I-B-3-J-2, but place the numbers in numerical
order and then the letters in alphabetical order)

The Processing Speed Index includes three tests:

1) Symbol Search: Visual perception, speed

2) Coding: Visual-motor coordination, motor and mental speed

3) Cancellation (supplemental): visual-perceptual speed

11,
Tests of Cognitive Two broad scores are also generated, which can be used to summarize general
Functions intellectual abilities:

• Full Scale IQ (FSIQ), based on the total combined performance of the

VCI, PRI, WMI, and PSI

• General Ability Index (GAl), based only on the six subtests that comprise
the VCI and PR!

The WAIS-IV was standardized on a sample of 2,200 people in the United

States ranging in age from 16 to 90. An extension of the standardization has been
conducted with 688 Canadians in the same age range. The median Full Scale IQ
is centered at 100, with a standard deviation of 15. In a normal distribution, the
IQ range of one standard deviation above and below the mean (i.e., between 85
and 115) is where approximately 68% of all adults would fall.

1.3.5 The Wechsler Scales for Children

The Wechsler Intelligence Scale for Children(WISC) was first published in 1949
and was revised in 1974 (and renamed the Wechsler Intelligence Scale for Children-
Revised; WISC-R) and revised again in 1991(renamed the Wechsler Intelligence
Scale for Children-Third Edition; WISC-ill) and again in 2003 (now named the
Wechsler Intelligence Scale for Children-Fourth Edition).

The WISC-IV is the version currently used today. The WISC-IV has both verbal
and nonverbal subscales similar to those used in the WAIS-ill. However, WISC-
IV questions are generally simpler because they were developed for children aged
6 to 16 rather than for adults. Furthermore, they are clustered in four categories
that represent different areas of intellectual functioning. These include;

i) Verbal Comprehension, ii) Perceptual Reasoning, iii) Working Memory, and iv)
Processing Speed.

Each of these four areas of intellectual functioning include both "core" or mandatory
subtests that must be administered to derive an index or IQ score as well as at
least one "supplementary" or optional subtest that is not included in the index or
IQ score. The Verbal Comprehension category consists of three core subtests
including Similarities, Vocabulary, and Comprehension as well as two supplementary
sub tests that include Information and Word Reasoning. The Perceptual Reasoning
category also consists of three core subtests, including Block Design, Picture
Concepts, and Matrix Reasoning as well as one supplementary subtest called
Picture Completion. The working memory category consists of two core subtests
including Digit Span and Letter-Number Sequencing as well as one supplementary
subtest entitled Arithmetic. Finally, the Processing Speed category consists of two
core subtests including coding and Symbol Search as well as one supplementary
subtest entitled Cancellation.

The WISC-IV provides four index score IQs as well as an overall or full-scale
IQ based on the scores from all of the four index scores. These IQ scores all are
set with a mean of 100and a standard deviation of 15. The four factor scores.
(i.e., Verbal Comprehension, Perceptual Reasoning, Working Memory, and
Processing Speed) were developed using factor analytic techniques and numerous
research studies to reflect human intellectual functioning. Each of the subtests uses
a mean of 10 and standard deviation of 3. The WISC- IV has been shown to
have excellent reliability, validity, and stability (Wechsler, 2003).
12
1.3.6 The Wechsler Preschool and Primary Scale of Measures of Intelligence and
Conceptual Thinking
Intelligence (WPPSI) ,1;

WPPSI was developed and published in 1967 for use with children aged 4 to6.
The test was revised in 1989 and became known as the Wechsler Preschool and
Primary Scale of Intelligence-Revised (WPPSI-R) and revised again in 2002 as
the WPPSI-III. The WPPSI-III is the current version of the test being used
today. The WPPSI -III is used for children ranging in age from 2 to 7. Like the
other Wechsler scales (WAIS-ID, WAIS-ID NI, and WISC-IV), the WPPSI-III
has both Verbal and Performance scales resulting in four IQ scores: Verbal IQ,
Performance IQ, Processing Speed IQ, and Full Scale IQ. Similar to the other
Wechsler scales, IQ scores have a mean of 100 and a standard deviation of 15,
while the subtest scores have a mean of 10 and a standard deviation of 3. The
Verbal IQ score consists of the Information, Vocabulary, and Word Reasoning
subtest while theComprehension and Similarities subtests are not included in the
calculation of the Verbal IQ .score. The Performance IQ consists of the Block
Design, Matrix Reasoning, and Picture Concept subtests while the Picture
Completion and Object Assembly are not included in the calculation of the
Performance IQ score.

The Processing .Speed IQ score consists of the Symbol Search and Coding
.Subtest. The WPPSI-ID has been shown to have satisfaction, reliability, validity,
and stability (Wechsler, 2002) .

.Self Assessment Questions

1) Trac~ the history of intelligence assessment.

2) Describe Wechsler Scales.

3) Elucidate Wechsler scale for children.

4) What are the important features of Weehsier preschool and primary scale
of intelligence.

5) Describe WAIS III and WAIS IV.

13
Tests of Cognitive
Functions 1.4 STANFORD-BINET SCALES
The major impetus for the development of intelligence tests was the need to
classify (potentially) mentally retarded school children. The scales developed for
this purpose by Binet and Simon in the early 1900s was the forerunners of one
of the most successful and most widely researched measures of general intelligence,
the Stanford-Binet Intelligence Scale. The Stanford-Binet is used widely in assessing
the intelligence of children and young adults, and it is one of the outstanding
examples of the application of the principles of psychological testing to practical
. testing situations.

The scale developed by Binet and Simon in 1905 consisted of a set of 30

problems, varying from extremely simple sensory motor tasks to problems involving
judgment and reasoning. The basic strategy followed in this test and in its many
revisions was to observe the subject's reactions to a variety of somewhat familiar,
yet challenging tasks. Terman and Merrill (1937) neatly summarize Binet's
procedures, noting that this type of test is "not merely an intelligence test; it is a
method of standardized interview which is highly interesting to the subject and
calls forth his natural responses to an extraordinary variety of situations" (p. 4).

Binet's original scales have undergone several major revisions. The fifth edition of
the Stanford-Binet (Roid, 2003) represents the cumulative outcome of a continuing
process of refining and improving the' tests. Following a model adopted with the
release of the fourth edition of this test in 1986, the selection and design of the
tests included in the Stanford-Binet is based on an increasingly well-articulated
theory of intelligence. The fifth edition of the Stanford-Binet leans less heavily on
verbal tests than in the past; the current version of the test includes equal
representation of verbal and nonverbal sub tests. In this edition, both verbal and
nonverbal routing tests are used to quickly and accurately adapt test content and
testing procedures to the capabilities of the individual examinee.

Each subtest of the Stanford-Binet is made up of open-ended questions or tasks

that become progressively more difficult.

1.4.1 Characteristics of the Stanford Binet Scale

Like many other tests of general mental ability, the Stanford-Binet samples a wide
variety of taskstt that involve the processing of information and measures an
individual's intelligence by comparing his or hers performance on these tests; the
Stanford-Binet has employed a well-developed theory of intelligence to guide the
selection and development of subtests. Drawing on the work ofVernon (1965),
R. B. Cattell (1963), Sternberg (1977, 1981), and others, the authors of the
Stanford-Binet have formulated a hierarchical model of cognitive abilities and
have used this model in selecting subtests and in scoring the Stanford-Binet

The theoretical model used in developing and interpreting the Stanford-Binet is

shown table 2. The current version of the Stanford-Binet measures five general
factors (Fluid Reasoning, Knowledge, Quantitative Reasoning, Visual-Spatial
Processing and Working Memory), using both verbal and nonverbal tasks. In
table 2, the factors measured and the subtest names are shown in boldface,
whereas the specific tasks that are used to measure each of these factors are
shown in plain text. In several cases there are different sets of tasks that are
appropriate at varying developmental levels. So, for example, in evaluating the
14
 Verbal Fluid Reasoning of a young examinee (or an examinee who finds age- ' Measures of Intelligence and
Conceptual Thinking
appropriate questions too difficult), you might use simple reasoning tasks, whereas
verbal absurdities tasks might be used for more advanced examinees and verbal
analogies tasks might be appropriate for the oldest and most advanced examinees.

Examinees receive scores on each of the ten subscales (scales with a mean of 10
and standard deviation of 3), as well as composite scores for Full Scale, Verbal
and Nonverbal IQ, reported on a score scale with a mean of 100 and a standard
deviation of 15.Historically, the IQ scale based on a mean of 100 and a standard
deviation of 15 had been the norm for almost every other major test, but the
Stanford-Binet had used a score scale with a standard deviation of 16. This might
strike you as a small difference, but what it meant was that scores on the Stanford-
'Binet were hard to compare with scores on all other tests; ascore of 130 on
previous versions of the Stanford-Binet was not quite as high a score as a 130
on any other major test (if the standard deviation isl6, 130 is 1.87 standard'
deviations abovethe mean, whereas on tests with a standard deviation of 15, it
'. is 2 standard deviations above the mean). The current edition of the Stanford-
Binet yields IQ scores that are comparable to those on other major tests.

Table 2: Theoretical Model for the Stanford-Binet (Fifth Edition)

Verbal Non Verbal

Fluid Reasoning Verbal Fluid Reasoning' Nonverbal Fluid

Reasoning Object Series/
Early Reasoning (2-3) Matrices
" VerbalAbsurdities (4) Nonverbal
Verbal Analogies (5-6) Knowledge
Procedural Knowledge
(2-3)

Knowledge Verbal Knowledge Picture Absurdities

Vocabulary (4-6)

Quantitative Reasoning Verbal Nonverbal

Quantitative Reasoning Quantitative
Quantitative Reasoning Reasoning
(2-6) Quantitative
Reasoning (2-6)

Visual-Spatial Processing Verbal Nonverbal

Visual-Spatial Visual-Spatial
Processing Processing
Position and Direction Form Board (1-2)
(2-6) Form Patterns (3-6)

Working Memory Verbal Working Nonverbal

Memory Working Memory
Memory for Sentences Delayed Response (1)
(2-3) Last Word (4-6) Block Span (2-6)

Administration and Scoring of the Stanford-Binet

Throughout its history, the Stanford-Binet has been an adaptive test in which an
individual responds to only that part of thetest that is appropriate for his or her 15
 Tests of Cognitive developmental level. Thus, a young child is not given difficult problems that would
Functions lead only to frustration (e.g., asking a 5-year-oldwhy we have a Constitution).
Similarly, an older examinee is not bored with questions that are well beneath his
or her age level (e.g., asking a lO-year-old to add 4 + 5).Subtests in the Stanford-
Binet are made up of groups of items that are progressively more difficult. A child
taking the test may respond to only a few sets of items on each subtest.

One of the examiner's major tasks has been to estimate' each examinee's mental
age to determine the level at which he or she should be tested. The recent
revisions of the Stanford-Binet include objective methods of determining each
appropriate level for each examinee through the use of routing tests; the current
edition uses both verbal (Vocabulary) and nonverbal (Matrices) routing tests.

Historically, the Stanford-Binet has been regarded as one of the best individual
tests of a chilli's intelligence available. The recent revisions of the Stanford-Binet
may increase its relevance in adult testing. This test draws on a long history of
development and use, and it has successfully integrated theoretical work on the
'.
nature of intelligence. It is likely that the Stanford-Binet will remain a standard
against which many other tests of general mental ability are judged.

1.5 WOODCOCK-JOHNSON PSYCHO

EDUCATIONAL BATTERY (3rd EDITION):
TESTS OF COGNITIVE ABILITY (WJ Ill)
The original Woodcock Johnson Psycho-Educational Battery: Tests of Cognitive
Ability (WJ; Woodcock & Johnson, 1977) made a major contribution to test
development because of its inclusion of a diversity of novel tasks that represented
the first major departure from subtests originally developed by Binet or by World
War I psychologists. The WJ, however, was developed from an entirely practical
perspective, with no apparent emphasis on theory. All that changed with the
publication of the WJ-R (Woodcock & Johnson, 1989), an expanded and
reformulated test battery that is rooted firmly in Horn's modified gf-gc
psychometric theory of intelligence, as is its recent successor, the third edition of
the WJ (WJ I11;Woodcock, McGrew & Mather, 2000).

The WJ Ill, for ages 2 to 90+ years and composed of Cognitive and Achievement
sections, is undoubtedly the most comprehensive test battery available for clinical
assessment. The WJ III Cognitive battery (like the WJ-R) is based on Horn's
(1989) expansion of the fluid/crystallized model of intelligence and measures seven
separate abilities: Long-Term Retrieval, Short-Term Memory, Processing Speed,
Auditory Processing, Visual Processing, Comprehension-Knowledge and Fluid
Reasoning. An eighth ability, Quantitative Ability, is measured by several subtests
on the Achievement portion of the WJ Ill.

Self Assessment Questions

1) What is Stanford Binet scales and what are their characteristics?

16
 Measures of Intelligence and
2) Discuss the administration and scoring of Stanford Binet scale. Conceptual Thinking

3) Elucidate Woodcock Johnson Psycho educational battery.

1.6 RAVEN'S PROGRESSIVE MATRICES

Raven's Progressive Matrices, probably the most widely cited culture-reduced
tests, have had a long and distinguished history. Factor analyses carried out in
Spearman's laboratory in the 1930s suggested that tests made up of simple
pictorial analogies showed high correlations with a number of other intelligence
tests and, more important, showed high loadings on Spearman's g.
\

Raven's Progressive Matrices (available in both paper and computer-administered

forms) are made up of a series of multiple-choice items, all of which follow the
same basic principle. Each item represents a perceptual analogy in the form of a
matrix. S~me valid relationship connects items in each row in the matrix, and
some valid relationship connects items in each column of the matrix. Each matrix
is presented in such a way that a piece of the matrix, located in the lower-right
.corner, is missing. The subject must choose from among six or eight alternatives
the piece that best completes each matrix.

There are three forms of Raven's Progressive Matrices. The most widely used
form, the Standard Progressive Matrices, consists of 60 matrices grouped into 5
sets. Each of the 5 sets involves 12 matrices whose solutions involve similar
principles but vary in difficulty. The principles involved in solving the 5 sets of
matrices include perceptual discrimination, rotation, and permutations of patterns.
The first few items in each set are comparatively easy, but the latter matrices may
involve very subtle and complex relationships.

The Standard Progressive Matrices are appropriate both for children above 5
years of age and adults; because of the low floor and fairly high ceiling of this test,
the Standard Matrices are also appropriate for most ability levels. For younger
children (ages 4 to 10), and for somewhat older children and adults who show
signs of retardation, the Coloured Progressive Matrices seem to be more
appropriate. This test consists of three sets of 12 matrices that employ color and
are considerably less difficult than those that make up the Standard Progressive
Matrices.

Finally, the Advanced Progressive Matrices are appropriate for intellectually

advanced subjects who find the Standard Matrices too easy. The Advanced
Matrices are made up of 3 sets of 12 matrices, many of which involve extremely
subtle principles in their solutions. The test effectively discriminates among those
who receive extremely high scores on the Standard Progressive Matrices
17
Tests of Cognitive
Functions . 1.7 KAUFMAN ASSESSMENT BATTERY FOR
CHILDREN (K-ABC 11)
The K-ABC-II (Kaufrnan & Kaufman, 2004) is administered to children between
the ages of 3 and 13 and has five global scales including Sequential Processing,
Simultaneous Processing, Learning Ability, Planning Ability, and Crystallized
Ability. Scores are then combined to create a Mental Processing Index (MPI)
and a nonverbal index. The development of the K-ABC reflects a different
.theoretical approach to intellectual assessment relative to the Wechsler scales.
The K-ABC-II was developed from research and theory in neuropsychology
and, unlike both the Wechsler and Stanford-Binet scales, has achievement scores
to measure skills such as reading ability. Many clinicians feel that the K-ABC-II
is more enjoyable and engaging for children than the Wechsler scales and Stanford-
Binet, as well as a less verbally dependent test. Furthermore, the K-ABC-U
generally takes less time to administer than the Wechsler and Stanford-Binet.

The Sequential Processing/Short-Term Memory Scale is designed to measure the

ability to solve problems by remembering and using an ordered series of images
or ideas. The Simultaneous/Visual Processing Scale measures the ability to solve
spatial, analogical, or organisational problems that require the processing of many
stimuli at one time. The Learning Ability/Long- Term Storage and Retrieval Scale
measures the ability to successfully complete different types of learning tasks.
Immediate recall and delayed recall tasks are included in this scale. The Planning/
Fluid Reasoning Scale measures the ability to solve nonverbal problems that are
different from the kinds taught in school. Verbally mediated reasoning must be
used to solve the problems. The Knowledge/Crystallized Ability Scale measures
knowledge of words and facts using both verbal and pictorial stimuli and requiring
either a verbal or pointing response. Means are set at lOO with standard deviations
of 15.

1.7.1 Kaufman Adolescent and Adult Intelligence Test

(KAIT)
The Kaufman Adolescent and Adult Intelligence Test (KAIT) (Kaufman &
Kaufman, 1993) is an individually administered intelligence test for individuals
between the ages of 11 and more than 85 years. It provides Fluid, Crystallized,
and Composite IQs. It includes a Core Battery of six subtests (three Fluid and
three Crystallized) and an Expanded Battery that also includes alternate Fluid and
Crystallized subtests plus measures of delayed recall of information learned earlier
in the evaluation during two of the Core subtests.

1.8 DIFFERENTIAL ABILITIES SCALES (DAS)

The DAS was developed by Elliott (1990) and is an individually administered
battery of 17 cognitive and achievement tests for use with individuals aged 2
through to 17 years. The DAS Cognitive Battery has a preschool level and a
school-age level. The school-age level includes reading, mathematics, and spelling
achievement tests that are referred to as 'screeners'. The same sample of subjects
was used to develop the norms for the Cognitive and Achievement Batteries;
therefore, intra- and inter-comparisons of the two domains are possible. The
DAS is not based on a specific theory of intelligence. Instead, the test's structure
 is based on tradition and statistical analysis. Elliott (1990) described his approach Measures of Intelligence and
Conceptual Thinking
to the development of the DAS as 'eclectic' and credited the work of researchers
such as Cattell Horn, Das, Jensen, Thurstone, Vemon, and Spearman.

1.9 COGNITIVE ASSESSMENT SYSTEM (CAS)

The Das-Naglieri Cognitive Assessment System(CAS; Naglieri& Das, 1997), for
ages 5 to 17 years, is based on, and developed according to, the Planning,
Attention, Simultaneous, and Successive (PASS) theory of intelligence. The PASS
theory is a multidimensional view of ability that is the result of the merging of
contemporary theoretical and applied psychology (Das, Naglieri& Kirby, 1994).
According to this theory, human cognitive functioning includes four components:
planning processes that provide cognitive control, utilisation of processes and
knowledge, inten,tionality and self-regulation to achieve a desired goal; attentional
processes that provide focused, selective cognitive activity over time; and
simultaneous ana successive information processes that are the two forms of
operating on information.

Self Assessment Questions.

1) Describe Raven's Progressive Matrices.

2) How are Kaufman Assessment Battery for children different from Kaufrnan
adolescent and adult intelligence test?

3) Describe Differential Abilities Scales.

4) What is cognitive assessment system?

',j 1.10 QUESTIONS AND CONTROVERSIES

~ CONCERNING IQ TESTING
L.

Are We Born With A Certain IQ?

Often people assume that we are born with an innately determined level of
intellectual ability that is not influenced by social, emotional, and environmental 19
Tests of Cognitive factors. Some suggest that IQ differences found among different racial groups
Functions might be due to inborn differences in intelligence. A great deal of controversy has
raged in this debate for many years. The publication of the book The Bell Curve
(Hermstein & Murray, 1994) reignited this controversy by suggesting that African
Americans were innately less intelligent than Caucasians while Caucasians were
less intelligent than Asians. Research examining genetic influences on intelligence
generally studies the heritability (i.e., the estimate of genetic contribution to a given
trait) of IQ using twin studies. Identical (monozygotic) and fraternal (dizygotic)
twins reared together and reared apart present a unique research opportunity for
examining the influence of both genetic and environmental contributions to a wide
variety of traits. It has been estimated that the heritability of intelligence is
between.40 and .80. Thus between 16% and 64% of the variance in intellectual
ability is due to genetic influence. Research generally supports the notion of at
least some significant genetic influence in intellectual ability. However, biological
(e.g., prenatal care, genetics, nutrition), psychological (e.g., anxiety, motivation,
self-esteem), and social (e.g., culture, socioeconomic status) influences all appear
to be associated with intelligence or at least with IQ scores on standardized tests.

Is IQ Scores Stable Over Time?

Measures of attention, memory, and other cognitive abilities assessed during the
first year of life generally are moderately associated (i.e., r = .36) with intelligence
test scores assessed later in childhood. Often people assume that an IQ score
obtained in childhood is stable over time. Thus, many people erroneously believe
that someone who obtained an IQ of 120 in the first grade will also have an IQ
of 120 in adulthood. Intelligence tests, however, provide an index of current
functioning, and scores may change significantly over time. Many factors influence
the stability of IQ scores. First, scores obtained when a child is very young (e.g.,
age 3) are likely to be less stable than scores obtained when a child is older (e.g.,
age 16). This is partially because early childhood tests focus on perceptual and
motor skills, whereas tests for older children and adults focus more on verbal
skills. Second, the longer the time between testing administrations, the more
unstable the IQ score will appear. Thus, the difference between scores obtained
at ages 3 and 30 is likely to be greater than the difference between scores
obtained at ages 16 and 19. Furthermore, environmental factors such as stress,
nutrition, educational opportunities, exposure to toxins such as lead, and illness,
among other influences, all play a role in the determination of IQ scores.

Are IQ Scores Biased?

Many people are concerned about potential bias in intelligence testing. For example,
many feel that IQ testing may be biased in that children from high socioeconomic-
level homes tend to perform better on standardized tests than those from lower
socioeconomic-level homes. Furthermore, some argue that currently available
intelligence tests may not be appropriate for use with individuals from many ethnic
minority groups. In fact, California passed legislation that prohibited intelligence
testing from being used for school placement of African-American children (Larry
P vs Wilson Riles). The ruling suggested that intelligence testing was biased
against African Americans and that they were disproportionately represented in
educable mental retardation (EMR) classrooms. Bias is determined by examining
the test's validity across different groups. A test is biased if the validity of the test
varies from group to group. Research suggests that most standardized IQ tests
such as the Wechsler and Stanford-Binet scales are not biased. However, tests
20 can be misused by both unqualified and well meaning people.
Should The Terms Intelligence Quotient or IQ Continue To Be Used? Measures of Intelligence and
Conceptual Thinking
A number of misconceptions and myths about IQ exist. These include the notion
that the IQ measures an innate or genetically-determined intelligence level, that IQ
scores are fixed and never change, and that IQ scores generated from different
tests mean the same thing. These concerns have led some experts to suggest that
general IQ scores be eliminated in favour of standard scores that more accurately
describe specific skills. In fact, many recent tests of intellectual and cognitive
abilityhave not used the terms intelligence quotient or IQ at all. These include
the Woodcock-Johnson Psychoeducational Battery, the Kaufman Assessment
Battery for Children, and the newest version of the Stanford-Binet.

1.11 FUTURE PERSPECTIVES AND

CONCLUSIONS
.The unchanging nature of IQ tests has begun to thaw. For the first three-quarters
of a century, from Binet's 1905 scale until to about 1980, there was the Binet and
there was the Wechsler and that was about it. Then came a series of tests that
included novel tasks and an attempt to link theory to IQ assessment. Today,
clinicians have more choice than ever before and these choices include a pick of
theory - namely Horn-Cattell gf-gc, expanded Horn gf-gc, and Luria PASS.

The critics of IQ tests abound, especially among popular and influential theorists
such as Sternberg (e.g. Sternberg & Kaufman, 1998), and these critics must be
heard. It is partly because of the critics that the developers of IQ tests have
constantly striven to improve the existing measures and to attempt to bring more
theory and research into the development of new tests and the revision of old
ones. Tests that are powerful psychometric tools that have a solid research history,
and that are clinically and neuro psychologically relevant are valuable if used
intelligently by highly trained examiners.

Clinicians who employ the intelligent testing philosophy as outlined in Kaufman

(1994) can make a meaningful difference in a client's life when interpreting the
results of a test profile in the context of clinical observations during the test
session, background information about the client, research fmdings, and theoretical
models. The array of instruments described in this entry, as well as others not
included because of space constraints, can each serve quite well as the IQ test
of choice for clinical evaluation. Perhaps when some of the highly respected
theories of intelligence are translated into individual tests of intelligence it will be
time to abandon existing instruments. But the test developers who attempt to
translate the theories necessarily. must be well versed in the clinical,
neuropsychological, and psychometric aspects of assessment; otherwise, the perfect
theory-based test will prove to be an imperfect clinical tool.

And what of the future? There has been considerable progress during the past
two decades in providing options for clinicians apart from the Wechsler and Binet,
and several of these options have impressive theoretical foundations. Yet progress
has not been as rapid as most would wish. By their very nature, test publishers
are conservative, investing their money in proven ventures rather than speculating
on new ideas for measuring intelligence.Progress will likely continue to be controlled
as the twenty-first century unfolds.

Eventually, new and improved high-tech instruments will be available that meet the
21
rigours of psychometric quality and the demands of practical necessity. Hopefully
Tests of Cognitive those tests will not abandon theory but will embrace it, continuing the trend in the
Functions development of IQ tests that began in the early 1980s and has continued to the
present. But none of the excellent instruments that are now available for clinical
assessment of intelligence - Wechsler or otherwise - should be left for dead until
there is something of value to replace them.

1.12 LET US SUM UP

The assessment of intelligence has a long history in clinical psychology. Compulsory
education and psychologists' ability to measure mental abilities contributed to the
development and success of the field of intelligence testing. However, by the end
of the 1960s, the validity of these tests was being challenged. To this day, there.
are many controversies about how intelligence is defined and how it is measured.
Contemporary clinical psychologists appear to believe in both a general factor of
intelligence, g and specific abilities that underlie the general intelligence factor.
Intelligence scores are correlated with school success, occupational status, and
job performance. In addition, there are group differences in intelligence test scores
between males and females and among ethnic/racial groups. Although intelligence
test scores are influenced by genetic factors, environment does play some role in
the development of intelligence. IQ scores are more stable for adults than they are
for children.

We have discussed some major intelligence tests in use today. The Wechsler
Scales are the most commonly used tests of intelligence assessing preschool
children (WPPSI-III), elementary and secondary school children (WISC-IV),
and adults (WAIS-Ill and WAIS-IV). The Stanford-Binet, Kaufman Scales, and
other intelligence tests are also frequently used. In addition to overall intellectual
skills and cognitive strengths and weaknesses, these tests are frequently used to
assess the presence of learning disabilities, predict academic success in school,
examine brain dysfunction, and assess personality. Intelligence test results are
used to quantify overall levels of general intelligence as well as specific cognitive
abilities. This versatility allows clinical psychologists to use intelligence test scores
for a variety of prediction tasks (e.g., school achievement).

1.13 UNIT END QUESTIONS

Multiple Choice Questions
1) Which of the following is nearly always the best predictor of academic
achievement?
a) overall intelligence or g
b) nonverbal intelligence
c) verbal intelligence
d) mother's educational level
2) Reading skill of the examinee is often a confounding factor in the use of
a) group- administered intelligence tests.
b) comprehensive, individually administered intelligence tests.
c) brief, individually administered intelligence tests.
22 d) group- administered reading tests.
 Measures of Intelligence and
3) When screening for intellectual level Conceptual Thinking

a) G is the only important concern.

b) verbal and nonverbal intelligence should be considered.

c) memory assessments should nearly always be considered.

d) working memory and processing speed are the best estimators inmost
cases.
4) Test developers hoped to accomplish which of the following when revising
the original K-ABC?

a) update noDUS
b) develop alternative subtests to measure verbal ability

c) develop alternative subtests to measure nonverbal ability

d) both a and b

5) FODUulafor IQ is

a) MAlCA* 100

b) CA*MAlIOO

c) CAlMA*IOO

d) . None

Theoretical Questions
1) Describe the history of intellectual assessment?

2) What are some of the different tests used to measure IQ and how are they
similar and different?
3) Will an IQ score obtained at age 5 be the same as an IQ score obtained
at age 40 for the same person? Why or why not?

4) Discuss the controversies surrounding IQ testing

5) What are the future prospects of IQ testing?

1.14 SUGGESTED READINGS

th
Groth-Mamat, Gary. (2003). Handbook of Psychological Assessment (4 ed.).
New Jersey: John Wiley & Sons, Inc.
Murphy, K.R., Davidshofer, C.O. (2005). Psychological Testing: Principles
and Applications (6th ed.). New Jersey: Pearson Education International.

23
 UNIT 2 THE MEASUREMENT OF
CONCEPTUAL THINKING
(THE BINET AND WECHSLER'S
SCALES)
Structure
2.0 Introduction

2.1 Objectives

2.2 The "Abstract Attitude"

2.2.1 Characteristics of Abstract Attitude
2.2.2 Characteristics of Tests of Abstraction

2.3 Measurement of Conceptual Thinking

2.4 Overview of Tests

f
/2.4.1 Analogies and Proverb Tests
2.4.2· Performance Tests (Sorting Tests)
2.4.3 Colour Sorting Tests
2.4.4 Halstead Category Tests
2.4.5 Tha Haufmann Kasanin Concept Formation Test (1937)
2.4.6 The Twenty Questions Tasks

2.5 Range of Applicability and Limitations

2.6 Cross-Cultural Considerations and Accommodations for Persons with

Disabilities

2.7 Let Us Sum Up

2.8 Unit End Questions

2.9 Suggested Readings

2.0 INTRODUCTION
Abstract reasoning or conceptual thinking is no doubt the most advanced of
\

the cognitive abilities. Whereas animals may be capable of problem solving, only
humans can abstract. Thus, abstraction and problem solving are not synonymous,
and problems can be solved without abstraction. However, formation of an
abstract concept is often the most elegant way of solving a problem. The word
abstraction connotes abstracting some unifying idea or principle on the basis
of observation of diverse material. It is therefore an activity that is removed
from direct sensory experience and constitutes a representation of such
experience. The term abstraction is often contrasted to concreteness, the latter
term indicating cognitive activity associated with direct experience, and without
such representation. Concreteness is direct interaction with the "real world"
without additional processing.

Conceptual thinking or abstract reasoning is a recognised form of thinking that

includes aspects of critical, creative, and meta cognitive thinking. Conceptual
24
thinking requires the ability to critically examine factual information; relate to The Measurement of
Conceptual Thinking (The
prior knowledge; see patterns and connections; draw out significant understandings Binet and Wechsler's Scales)
at the conceptual level; evaluate the truth of the understandings based on the
supporting evidence; transfer the understanding across time or situation; and,
often, use the conceptual understanding to creatively solve a problem or create
a new product, process, or idea. In this unit we will be dealing with conceptual
thinking and its measurement. We will present the various tests that could be
used for the purpose and then discuss the applicability and limitations of these
tests.

2.1 OBJECTIVES
After completing this unit, you will be able to:

• discuss the concept of abstract reasoning or conceptual thinking;

• explain various tests of abstract reasoning;

• describe the applications and limitations of the tests of concept formation;

and

• discuss the cross-cultural considerations and accommodations for per

sons with disabilities in tests of concept formation.

2.2 THE "ABSTRACT ATTITUDE"

The relationship between brain function and abstract reasoning was probably
first discussed during the late nineteenth century by the neurologists Henry Head
and Hughlings Jackson. However, this relationship had its first full theoretical
development in the work of Kurt Goldstein and Martin Scheerer and is best
articulated in their 1941 monograph on abstract and concrete behavior (Goldstein
& Scheerer, 1941).They characterised the abstract attitude with eight points.

2.2.1 Characteristics of Abstract Attitude

1) To detach our ego from the outer world or from inner experiences.

2) To assume a mental set.

3) To account for acts to oneself; to verbalize the account.

4) To shift reflectively from one aspect of the situation to another.

5) To hold in mind simultaneously various aspects.

6) To grasp the essential of a given whole; to break up a given whole into

parts, to isolate and synthesize them.

7) To abstract common properties reflectively; to form hierarchic concepts.

8) To plan ahead ideationally; to assume an attitude towards the "mere

possible" and to think or perform symbolically.

Based on these points, tests of abstraction can be said to have the following
task characteristics.
25
Tests of Cognitive 2.2.2 Characteristics of Tests of Abstraction
Functions
1) Learning to identify a relevant attribute or multiple attributes to solve a
problem or make an accurate generalisation.

2) Learning a rule or set of rules that solve a problem.

3) Concept formation or spontaneous generation of hypotheses that relate

disparate material.

4) Inductive reasoning through spontaneous formation of hypotheses that rule

out alternative possibilities for a solution, and that finally lead to a correct
solution.

5) Having an "attitude toward the possible" or forming and manipulating a

mental representation of an object that is not physically present.

6) Spontaneous generation of plans that lead to ultimate solution of a problem.

7) The ability to shift, or change hypotheses or plans when the current one
or the pre potent response is not productive.

The large variety of cognitive and neuropsychological tests available makes it

possible to identify procedures that provide assessments of all of these tasks.
With respect to neuropsychology, patients with various forms of brain damage
or disease lose all or some of these characteristics, as do some patients with
psychiatric disorders, notably schizophrenia. Tests.of abstract reasoning require
to a greater or lesser degree the ability to maintain a mental set, to shift
reflectively, to hold in mind simultaneously various aspects of a task (now known
as dual processing), to abstract common properties, and to grasp essentials.
Most scholars in the field would agree that these tests may be treated
quantitatively, and would not agree with the relatively extreme view taken b)'
Goldstein and Scheerer regarding numerical scoring. However, contemporary
neuropsychology does not eschew the use of qualitative observation, and efforts
are being made to make such observations objective, reliable, and perhaps
quantifiable.

The distinction within abstract reasoning between those tasks in which the test-
taker has to generate concepts ana those in which an established concept has
to be identified through experiencing a series CIfpositive and negative instances
needs to be emphasised. Whereas self initiated concept formation, attribute
identification, and rule learning may all require the abstract attitude, they
nevertheless appear to be separable cognitive abilities that may have differing
clinical and adaptive implications. Absence of the abstract attitude, and
consequent concreteness, may prevent solution of even the simplest conceptual
tasks, but the capability of abstract reasoning can exist at numerous levels. Ability
to identify relevant and irrelevant perceptual attributes and the ability to learn
rules does not guarantee intact ability to generate conceptual strategies in "open-
field" novel problem-solving situations.

The importance of flexibility is also important, because attainment of a perfectly

correct concept may not be adaptive when environmental circumstances
necessitate a change, The Wisconsin Card Sorting Test stresses this latter
consideration. The symptom of fixed perseverative rigidity is perhaps the end
point of this failure to re conceptualise under changing circ].lmst~~es. '
26
 The Measurement of
Self Assessment Questions Conceptual Thinking (The
Binet and Wechsler's Scales)
1) Define abstract attitud.

2) What are the characteristics of abstract attitude?

3) What are the characteristics of tests of abstraction?

2.3 MEASUREMENT OF CONCEPTUAL

TlDNKING
The measurement of conceptual thinking is based upon the principle that
emotional disturbances and personality disorders.interfere with thinking processes,
particularly with the ability to form abstract concepts. The purpose of these
tests are, therefore, to help the psychologist observe the subject's thought
processes and to discover the extent to which maladjustment or mental illness
has impaired his conscious thinking, as revealed in efforts to solve problems
requiring the formation of concepts.
In particular, these tests are intended to evaluate the subject's ability to deal
with objects and situations on the abstract or conceptual level, as compared
with the concrete. Ability to form concepts implies conscious reasoning at the
abstract level; that is, transcending the immediate specific sensory situation,
abstracting the common property from particular instances, analysing and
synthesizing, shifting from one aspect to another, keeping in mind several aspects
simultaneously, planning ideationally, and self-criticism. An individual's behaviour
at the concrete level, on the other hand, lacks these characteristics. The individual
is then unreflective; he responds to the immediately given object or situation
as something unique; he does not perceive an object or situation as one instance
of a general class or category.
::>
/'

2.4 OVERVIEW OF TESTS

Within neuropsychological assessment, there are specialized tests of abstract
reasoning as well as tests generally classed as assessing other abilities that can
be interpreted from the standpoint of abstract and concrete behavior through
qualitative observation. Although abstract reasoning may be involved in all these
procedures, the specialised tests provide a direct assessment of the individual's
ability to learn or form an abstract concept. Some of these procedures are
paper and pencil tests that use language directly as the test medium. 27
Tests of Cognitive 2.4.1 Analogies and Proverb Tests
Functions
The most commonly used tests of this type are analogies and proverbs tests.
The Raven Progressive Matrices Test (1982) contains analogy items that use
pictorial material, but factor analytic studies have shown that the test has a strong
verbal component, apparently because many of the pictures of objects are
nameable (Lezak, 1995). Proverbs tests, such as the one developed by Gorham
(1956), test the ability to form verbal abstractions in either a free-response or
multiple choice form. Some items from the Comprehension subtest of the various
Wechsler intelligence scales are proverbs that require a free verbal response.
Interpretation of a proverb, such as "One swallow doesn't make a summer"
requires the forming of an abstract generalization from a metaphor.

2.4.2 Performance Tests (Sorting tests)

The tests used most commonly in neuropsychological assessment are performance
tests, which should not be characterised as nonverbal tests for various reasons,
but which use nonverbal media, such as colored blocks, or geometric forms.
The major reason for not characterising these tests as nonverbal is that although
the media used are generally not linguistic symbols, the test solution process
may place heavy reliance on language. We will refer to them as performance
tests, for want of a better term.
The most commonly used of these performance tests are sorting tasks. Many
years ago Egon Weigl (1927) invented the prototype of these tasks that are
still referred to as Weigl type sorting tests. The first tests developed were of
the free sorting type in which a variety of objects are placed on a table, and
the subject is asked to group the objects through such instructions as "Sort
those figures which you think belong together," or "Put those together which
you think can be grouped together." After the first sorting, the subject isasked
to put the objects together in another way.
The sorting tests first made generally available in a published form were those
described in a monograph on abstract and concrete behavior wrtlten by Kurt
Goldstein and Martin Scheerer (1941). This monograph contains what is
essentially a test manual for a series of procedures now known as The Goldstein-
Scheerer tests. In the Goldstein-Scheerer series, there is one relatively simple
sorting task: The Weigl-Goldstein-Scheerer Color Form Sorting Test, and two
more complex tasks: the Gelb-Goldstein Color Sorting Test and the Gelb,
Goldstein, Weigl and Scheerer Object Sorting Test. The test method, however,
is the same in all cases; the materials are set out, the subject is asked to sort
them and then to re sort them. These tests assess the general capacities to
form an abstraction or concept as the basis for the initial sorting and also evaluate
cognitive flexibility, or the capacity to shift concepts.
2.43 Colour Sorting Tests
The administration of the Colour Sorting Test is some what different from the
other sorting tests. The test material consists of many skeins of wool (Holmgren
Wools) that vary in hue and brightness. The subject is asked to select a skein
of her or his preference, and to pick out the other skeins that can be grouped
with it (e.g., different shades of green). When this procedure is completed, the
examiner picks out a skein of a different hue and asks the subject to pick
out the other skeins that go with it. This procedure is followed by triple matching:
Three skeins at a time are placed before the subject varying in hue and brightness.
28 The left and center skeins have the same hue but different brightness, and the
 right skein has the same brightness as the center skein, but differs in hue. The The Measurement of
Conceptual Thinking (The
examiner points to the left and right skein and asks about where the center Binet and Wechsler's Scales)
one belongs. The shift relates to whether the subject can sort according to hue
and brightness. Shifting from hue to brightness is difficult for some normal people,
and prompting about the idea of brightness is permissible, the point being whether
the subject accepts the shift, and the idea of common brightness.
These free categorization tests provide abundant opportunity for qualitative
assessment and variations of the procedure to elicit various features of
concreteness. However, they differ from the concept identification procedures
to be described later in this unit in the sense that they are true measures of
concept formation. That is, the subject is provided with an array of diverse
material out of which the abstraction has to be formed. The concept has to
be self-initiated, and the subject makes up the rule that provides the basis for
grouping. The. rule may be simple (e.g., colour or shape) or quite complex as
in the brightne~s or hue concept involved in the Color Sorting Test. Nevertheless,
the subject is required to initiate his or her own categorization, or fail to do
so.
2.4.4 Halstead Category Test
The Goldstein-Scheerer tests are no longer commonly used, but their theoretical
descendants are in common use. The most widely used ones are the Halstead
Category Test(Halstead, 1947) and the Wisconsin Card Sorting Test (Grant&
Berg, 1948; Heaton et aI., 1993) .
. Halstead (1947) was aware of Kurt Goldstein's theory of the abstract attitude,
and it is historically important to note that the Wisconsin Card Sorting Test
was first described as "a Weigl-type card sorting problem." In these tests that
followed the Weigl type sorting tests and the Goldstein Scheerer tests, there
was an important change. The concepts in these tests are not formed by the
subject, but are inherent in the test materials themselves. The subject's task
had changed from forming concepts to identifying concepts formed by the test
maker.
Investigators in this area have therefore made a distinction between concept
formation, which can be assessed with free sorting tests, and concept
identification, which is what is involved in the Category and Card Sorting
procedures.
In a series of experimental studies by Boume and collaborators, the process
of concept identification was intensively studied, mainly in normal individuals,
to provide a detailed understanding of its relevant parameters, such as complexity
and the role of informative feedback (Boume,1966). In a sense, the difference
between a concept formation and a concept identification procedure is analogous
to the difference between a projective and an objective test. In the former,
the subject can exercise free self expression; whereas the latter requires
adherence to a particular structure. Perrine (1993) has made the important
distinction in concept identification tests between attribute identification and rule
learning. The Wisconsin Card Sorting Test stresses attribute identification. The
correct answer is the stimulus attribute of form, colour, or number. In the case
of the Category Test, the correct principle is a rule, regardless of the attributes
of the stimuli. For example, the correct answer is the odd object in an array.
Interestingly, Perrine reported only 30%shared variance between the two
procedures. 29
Tests of Cognitive Brief descriptions of these two tests are as follows:
Functions
1) The Halstead Category Test is administered through the use of an
apparatus that displays the test stimuli and provides information to the subject
regarding whether a response is correct. The subject looks at a screen below
which are four numbered keys. The instructions are to look at the patterns on
the screen and press the key that represents the right answer. If the correct
key is pressed, the subject hears a pleasant chime. If the answer is incorrect,
a rasping buzzer follows the response. The subject is told that he or she will
be guessing at first, but when the concept or principle that unites the stimuli
is learned, he or she will always get the chime. The test consists of seven subtests.
The first of them is really a familiarisation trial, and the second is a simple counting
task. The remaining subtests require identification or learning of a concept, such
as oddity or spatial location. The most commonly used score for this test is
total errors, but error scores can be obtained for each subtest and are sometimes
useful clinically. For example, some of the concepts are spatial in nature and
some are numerical, each of which may have different implications for brain
ftmction.
2) The Wisconsin card sort test (WCST) was developed to examine
concept formation and the ability of participants to overcome the tendency to
perseverate. The Wisconsin Card Sorting Test (see figure 1) in its original version
consists of a deck of cards with colored geometric forms printed on them. The
cards vary with regard to forms, colors, and number of forms. Four of the
cards are laid out as models, and the subject is given the deck. The general
instruction is to place each card below the correct model card. After each
placement, the examiner tells the subject whether the correct response was made.
The task is to learn to sort the cards by form, colour, or number based on
the pattern of right and wrong answers. When ten consecutive correct responses
are made, the examiner, unbeknown to the subject, changes the concept. For
example, if colour was the correct response, the correct concept may be changed
to form. The test continues until the subject correctly solves the six categories
tested, or the supply of 128 cards is exhausted. Numerous scores are derived
from this test, the most commonly used ones being the number of the six
categories achieved, total errors, and preservative errors measuring persistence
in sorting by a particular attribute after the relevant concept has been changed.
W",,<:I
[::::J bluo
.9,e"
L..J yellow

~r: *
~461
r=.11**1
(bj

30 Fig. 1: Typical Responses in the WCST

In (a) the unstated rule was 'sort by colour'. The subject's response is incorrect The Measurement of
Conceptual Thinking (The
because they actually sort by shape. Binet and Wechsler's Scales)

In (b) the unstated rule is 'sort by colour', which the respondent does correctly
even though the card differs from the matching cards both in respect of shape
and number.

Some tests incorporate aspects of concept formation and concept identification.

2.4.5 The Haufmann Kasanin Concept Formation Test

(1937)
This is also known as the Vygotsky Test, and a recent modification called the
Modified Vygotsky Concept Formation Test (MVCFT; Wang, 1983) represent
tasks of that type. The Hanfman Kasanin is a challenging procedure in which
the subject is asked to perform a number of sorts, much like the Color Form
Sorting Test. However, there is a correct answer that the subject must learn
through making sorts and obtaining information from the examiner concerning
the correctness of the solution. The task is challenging because the concept
is not a directly" perceivable attribute, but is a second order principle that has
to be derived from the characteristics of multiple attributes. The MVCFT modifies
the original procedure. It consists of 22 different blocks varying in color, size,
shape, and height. In the first part (convergent thinking),the examiner selects
a target block and asks the participant to identify all other blocks that would
.belong with
, it, telling participants whether each response is right or wrong.
Participants are given correcting cues following each incorrect attempt. The
procedure is repeated for four sets of blocks. A successful solution requires
simultaneous consideration of the width and height of the blocks. Thus, the
participant must combine abstract principles to determine the rule. When each
complete set has been identified, the participant is then asked to state the sorting
rule and then move on to the next set. Scores are based on the number of
errors. After completion of this procedure, the examiner asks the participant
to reclassify the blocks according to as many rules or ways as he/she can think
of, one at a time (divergent thinking). After each classification, the examiner
randomly mixes the blocks and asks for a new way of grouping. When the
participant exhausts hislher means of classification, points are awarded for total
number of logical principles. This test contains concept formation and concept
identification elements.

2.4.6 The Twenty Questions Task (Minshew, Siegel,

Goldstein and Weldy, 1994)
This also has a correct answer, but the subject has to self initiate sorting strategies
to arrive at that answer. The procedure is much like the Twenty Questions parlor
game in which a target object must be named based on questions that can
be answered only yes or no. The strategy for narrowing the possibilities and
arriving at the right answer has to be formed by the player.

Another way of studying abstraction is through the examination of generalization.

When the same response is made to a continuum of stimuli, the phenomenon
is referred to as stimulus generalisation. At a conceptual level, stimulus
generalisation allows for classification, such that all objects w;t!l the same invariant
characteristics may be classed into specific categories. Thus, a table is still a
31

I
Tests of Cognitive table regardless of wide variations in size, colour, shape, and other characteristics.
Functions When tasks are of a conceptual nature, stimulus generalisation is referred to
as equivalence range (Gardner & Schoen, 1962).

Equivalence range problems assess an individual's tolerance for variability in

stimulus characteristics within some category. In the case of the Colour Sorting
Test, for example, the equivalence range is the amount of variation in brightness
accepted to categorize a skein as being of a common hue. Generalisation
procedures have been used mainly in research investigations .

. In a study by Olson, Goldstein, Neuringer, and Shelly (1969), the task involved
presenting geometric figures, half of which were permutations of a circle and
the other half of which were permutations of a diamond, The permutations
reduced the figures in width in the direction of a common shape. Subjects were
shown the figures one at a time and asked to indicate whether it was a circle,
a diamond, or neither. The measure of equivalence range was correctly classified
figures. A modified version of the Col or Sorting Test was also administered.
The literature suggested that brain damaged individuals have narrow equivalence
ranges, and that was what was found for both the color sorting and visual forms
tasks. Thus, it would appear that abstraction of common properties by brain
damaged individuals has a narrow focus, probably limited to specific, concrete,
stimulus properties.

Another aspect of abstract reasoning relates to what K. Goldstein and Scheerer

(1941) referred to as an "attitude toward the possible." It consists of the ability
to form a central representation of an object that is not perceptually present.
They used the Block Design Test (Kohs Blocks) for evaluating this aspect of
abstract and concrete behaviour, because it is necessary to form a changing
representation of the individual blocks in space to match the model. As the
model presented in their version of the test becomes more like the desired
production with the blocks, by making it larger or drawing in lines between
the blocks, the task becomes more concrete and simpler for patients.

Another form of abstract reasoning is challenged when a problem must be solved

through logical inference. Situations requiring such processes generally require
forming a plan or developing a strategy that ultimately leads to a solution. When
lost in a forest, what is the best way of finding the way out? When shopping,
what is the best way of completing errands in minimal time?

In trying to reach a solution to a problem, what inductive methods are best

for reaching the solution in the fewest steps? Psychological testing models for
these abilities include searching strategy tests, the recently developed multiple
errands tests (McCue et al., 1995), and game procedures in which a correct
identification must be made with the fewest possible number of steps. The twenty
questions game task, in which the test taker must identify an object contained
in a large array of objects by asking as few questions as possible would be
an example of a strategy task. (Minshew et al., 1994). The Tower of Hanoi
or London problem is another strategy formation task. It is a puzzle in which
rings are placed on pegs and the participant has to move the rings, one at
a time, from one peg to another and put them in the same arrangement using
the fewest possible moves (Shallice, 1982). The number of moves and time
to solution are typically used as scores.

Recently, we have seen the development of more practical strategy tasks in

32
 which the participant is given a task to perform and must form a strategy to The Measurement of
Conceptual Thinking (The
do it in an optimally effective and successful way. The Multiple Errands Test
Binet and Wechsler's Scales)
and the Modified Six Elements Test from the Behavioural Assessment of the
Dysexecutive Syndrome tests (Wilson, Alderman, Burgess, Emslie, & Evans,
1996) are examples of such procedures. In both of them, the participant is
assigned practical tasks and is scored for efficiency and success with which
these tasks are performed. For example, on the Modified Six Elements subtest,
the subject is rated for how he or she divides time among three assigned tasks.

Self Assessment Questions

1) How is conceptual thinking measured?

2) Describe analogies and proverb tests.

3) What are sorting tests how do these measure conceptual thinking?

4) What is colour sorting test?

5) Describe Halstead category test.

6) Elucidate the concept formation test of Haufmann asanin.

, 7) What is the role of the twenty questions task?

.u
J
l.
2:

33
Tests of Cognitive
Functions 2.5 RANGE OF APPLICABILITY AND
LIMITATIONS
Tests of abstraction and problem solving ability are commonly used in
neuropsychological assessment of children and adults. However, limits of
applicability exist at each end of the continuum of cognitive function. Severely
impaired or disorganised patients typically cannot cooperate for these procedures.
At the other extreme, because these tests were designed for assessment of brain-
damaged patients, they do not have the complexity or difficulty level of tests
developed for normal individuals. Therefore, unlike the intelligence tests that are
often used as part of a neuropsychological assessment, these tests are not really
useful for assessment of level of ability within the normal range. Furthermore,
they are particularly susceptible to practice effects. Therefore retesting is difficult
to interpret particularly among individuals who initially do reasonably well on
these tests. For example, once a near normal or normal performance on the
Wisconsin Card Sorting Test is obtained, retesting is compromised, because the
individual already knows the right answers and may remember that the examiner
changed the relevant concept after a series of correct responses.

2.6 CROSS CULTURAL CONSIDERATIONS AND

ACCOMMODATIONS FOR PERSONS WITH
DISABILITIES
These "tests would appear to be reasonably culture fair, because they do not
rely heavily on language or knowledge of some specific environment or culture.
The stimuli used, usually geometric forms, do not include artifacts associated
with some particular culture. Obviously, instructions written in English would have
to be interpreted for patients who do not speak English. The major socio cultural
limitation would therefore relate mainly to general considerations concerning the
meaning and acceptability of testing in different cultures.

These tests were designed for individuals with reasonably intact vision, hearing,
and motor abilities. Typically, ad hoc accommodations are made for various
disabilities where possible. There are two major issues with regard to
accommodation : testing of patients with severe sensory or motor handicaps
of the upper extremities and of patients who are not ambulatory. In general,
the former matter is dealt with on an adhoc basis. There are no formal versions
of the Category Test or the Wisconsin Card Sorting Test for the blind or the
deaf.

However, the Wisconsin Card Sorting Test can be administered at bedside, and
this can be accomplished for the Category Test as well if one wishes to use
the booklet version of this test, or a version that can be administered with a
lap top computer. In the case of individuals who are severely visually impaired,
the traditional methodology has been to substitute auditory modality tests. In
the case of abstract reasoning, proverbs or analogies tests may be used. Using
tests based upon tactile perception is another useful strategy. The Halstead
Tactual Performance Test may be administered to an individual who is blind
and provides a good assessment of problem solving ability. For patients with
profound hearing loss, spoken instructions may be presented visually or any
technology that provides sufficient amplification may be used. The absence of
standard neuropsychological tests for individuals with severe sensory deficits is
34 a limitation of the field that is in need of correction.
 For patients with impaired mobility, the use of laptop computers and related The Measurement of
Conceptual Thinking (The
software has greatly expanded the capability of bedside testing and testing of
Binet and Wechsler's Scales)
patients in their homes. Such technologies as head sticks, voice activation, and
application of robotics should become increasingly viable methods of
accommodating individuals with physical handicaps, or who are too ill to travel
to an assessment laboratory.

2.7 LET US SUM UP

Neuropsychological assessment of abstract reasoning may be accomplished with
specialised tests of conceptual ability, or with a variety of tasks that may be
accomplished abstractly or concretely. The former tasks are generally quantitative
procedures; whereas the latter method typically involves qualitative observation.
In assessment of abstraction ability, it is important to ascertain that the patient
passes or fails the task because of a deficit in abstract reasoning ability. Some
tasks appear to measure that ability, but may actually be accomplished through
a variety of other methods. Impairment of abstraction ability in brain damaged
patients may be ,a qualitative loss of the abstract attitude, or a quantitative
impairment of level of ability. Furthermore, there are varying levels of abstraction.
We have characterised two of these levels as concept formation and concept
identification. Concept formation refers to those tasks in which the subject must
self initiate concepts; concept identification describes the situation in which the
subject must learn an established concept. Within concept identification, learning
may involve identifying relevant attributes or learning rules that organise diverse
Stimuli.

2.8 UNIT END QUESTIONS

1) Tick the True/ False Statements

i) The majority of tests used by neuropsychologists were

not usually developed for the purpose of assessing
brain damage. (True / False)

ii) Translation of a test is sufficient to correct potential

inaccuracies that can occur in testing bilingual individuals. (True/ False)

ill) Wisconsin Card Sorting Test was first described as

"aWeigl-type card sorting problem". (True !False)

iv) The Goldstein-Scheerer tests are one of the most

commonly used tests today. (True/ False)

v) An important aspect of abstract reasoning relates to

what K. Goldstein and Scheerer referred to as an
"attitude toward the possible". (True / False)

2) Discuss the concept of abstract reasoning or concept formation?

N
.•....
, 3) Describe the characteristics of tests of abstract reasoning?
UJ
U
a. 4) Describe in detail the various measures of abstract reasoning?
~
5) Critically analyse the range of applicability and limitations of tests of concept
thinking
35
Tests of Cognitive
Functions 2.9 SUGGESTED READINGS
Lezak, M.D .. (1995). Neuropsychological Assessment (3rd ed.). New York:
Oxford University Press.

Sterling, J. (2002). Introducing Neuropsychology. New York: Taylor & Francis

Inc.

36
UNIT 3 MEASUREMENT OF MEMORY
AND CREATIVITY
Structure

3.0 Introduction

3.1 Objectives

3.2 Memory
3.2.1 Explicit and Implicit Memory
3.2.2 Memory Assessment
3.2.3 Tests of Explicit Memory
3.2.4 Tests of Implicit Memory
3.2.5 Assessment of Different Memory Systems

3.3 Future Perspectives and Conclusions

3.4 Creativity
3.4.1 Assessment of Creativity
3.4.2 Product Measures
3.4.3 Process Measures
3.4.4 person Measures
3.4.5 The SOl Assessments (Structure of Intellect Assesssments)
3.4.6, Torrance Test of Creative Thinking (TTCT)
3.4.7 Person Measures

3.5 Future Perspectives and Conclusions

3.6 'Let Us Sum Up

3.7 Unit End Questions

3.8 Suggested Readings

3.0 INTRODUCTION
Webster's dictionary (1966) defines memory as the 'conscious or unconscious
evocation of things' past'. As such, the term 'memory' can refer to a variety of
learned behaviours, and it could be argued that many aspects of perception and
language involve the use of certain memory systems. A number of authors have
alluded to the range of possible human memory systems but in the present
context we will mainly be concerned with the more customary use of the term,
that is the retention of specific information which has been acquired in the
recent past. It is this aspect of memory which forms the basis of most of the
memory symptoms reported by brain damaged patients and which is the main
focus of this unit. The first half of this unit will cover in depth the various
aspects of memory assessment.

What does it mean to be creative? Some might say thinking outside the box;
others might argue it as having a good imagination, and still others might suggest
creativity is a synergy that can be tapped through brainstorming. We take an
empirical, psychological approach to this question. One of the first things we
will cover in this unit is to define what creativity is. Secondly this unit will
cover the different types of tests used in assessment of creativity. 37
Tests of Cognitive
Functions 3.1 OBJECTIVES
After completing this unit, you will be able to:

• explain the concept of memory and creativity;

• describe explicit and implicit memory;

• delineate the tests of Explicit memory;

• delineate tests of implicit memory;

• explain assessment of different memory systems;

• define creativity;

• explain Assessment of creativity;

• discuss the product and process measures of creativity;

• describe Torrance test of creativity; and

• discuss the future perspectives in assessment of memory and creativity.

3.2 MEMORY
By a simple definition, memory is the capability to acquire, retain, and make use of
knowledge and skills. Since the early 1980s, the way that cognitive scientists think
about memory has dramatically changed. Today, memory is more often viewed not
as a unitary entity but as comprising different components or systems. Neuro cognitive
research has indicated that it is more appropriate to consider the human memory as
a collection of multiple but closely interacting systems than as a single and indivisible
complex entity (e.g. Tulving, 1985a; Squire, 1992; Schacter & Tulving, 1994a).
Different memory systems differ from one another in terms of the nature of
representations they handle, the rules of their operations, and their neural substrates
(e.g.Tulving, 1984;Weiskrantz, 1990;Tulving & Schacter, 1992;Schacter & Tulving,
1994b; Willingham, 1997).

Various classificatory schemes of human memory have been propose~ so far.

Undoubtedly, the two most influential and extended classifications are those
postulated by Squire (1992) and Schacter and Tulving (1994a). Squire
distinguishes two long term memory systems: declarative and non declarative
(or procedural) memory; whereas Schacter and Tulving identify five major
systems: procedural memory, perceptual representation system, semantic
memory, short term working memory and episodic memory. Related distinctions
include explicit versus implicit memory, direct versus indirect memory, and
memory with awareness versus memory without awareness. However, these
latter dichotomies may not be memory systems, but rather forms of expression
of memory. According to the Schacter and Tulving classification, retrieval
operations in the procedural, perceptual representation and semantic systems
are implicit, whereas in the working memory and episodic memory they are
explicit. On the other hand, Squire considers declarative memory as an explicit
system, whereas non declarative memory is viewed as a heterogeneous collection
of implicit abilities.

38
 Measurement of
Memory and
Creativity

Simple
.classical
oondiHoning

. Fig. 1: The Subdivisions of Long- Term Memory

3.2.1 Explicit and Implicit Memory

Compelling evidence for the existence of multiple memory systems is provided by
experimental findings of numerous convergent dissociations (functional,
developmental, pharmacological, neuro psychological, neuro anatomical)
between tasks of explicit and implicit memory (Schacter, 1987; Ruiz-Vargas,
1993; Nyberg &Tulving, 1996; Schacter, Wagner & Buckner,2000).

1) ExplicitMemory
This is revealed by intentional or conscious recollection of specific previous
information, as expressed on traditional tests of free recall, cued recall and
recognition. Although the relationships between cued recall, free recall, and
recognition are highly complex, these three memory tests share an essential
property: Success in them is predicated upon the subject's knowledge of events
that occurred when he/she was personally present in a particular spatio temporal
context. Because the task instructions make explicit reference to an episode in
the subject's personal history, such tasks have been referred to as
autobiographical, direct, episodic, explicit or intentional memory tests.

2) ImplicitMemory
This is revealed by a facilitation or change of performance on tests that do not
require intentional or conscious recollection, such as perceptual identification,
word stem completion, lexical decision, identification of fragmented pictures,
mirror drawing, and so on. These tasks, classified as implicit, indirect, or
incidental tests of memory, involve no reference to an event in the subject's
personal history but are none the less influenced by such events. For example,
prior experience with a particular word might later improve a subject's ability
to identify that item under conditions of perceptual difficulty, restore deleted
letters in order to complete that item, or make a decision concerning that item's
lexical status. In general, such tasks require the subject to demonstrate 39
Tests of Cognitive conceptual, factual, lexical, perceptual, or procedural know ledge, or to make some
Functions form of affective or cognitive judgment. The measures of interest reflect change in
performance (e.g. change in accuracy and/or speed) as a function of some form of
prior experience (e.g. experience with the task, with the test stimuli, or with related
stimuli). When the prior experience occurs within the experimental context, it is
possible to compare such measures of behavioural change with traditional measures
of memory for the events causing that change.
Consider these two experimental situations:
1) A list of 20 familiar words is presented to subjects who are instructed to pay
attention to each word because, after the presentation, they will be asked to
reproduce as many of the presented words as possible.
2) A list of 20 familiar words is also presented to subjects who are instructed to
perform an orienting task (e.g. pleasantness ratings).
3) After this study phase, the subjects will be asked to say the first word that
comes to mind in response to a series of three letter word stems. Obviously,
some word stems can be completed with presented words, and some cannot.
The first experimental situation reflects one of the ways in which psychologists
have traditionally measured human memory: by assessing deliberate or explicit
memory of subjects for items studied in a specific learning episode with a recall
test.
In the second situation, it is often observed that subjects show an enhanced
tendency to complete word stems corresponding to studied words in comparison
to 'new' word stems. This phenomenon is known as repetition priming of
perceptual priming.
Priming does not invol ve intentional or explicit recollection of the study episode,
and thus it is assumed to reflect implicit memory for previously acquired
information.
Distinction between explicit and implicit memory has had a profound impact
on contemporary research and theorizing of human memory. The finding that
some products of memory are expressed with conscious awareness of the
previous experience, and other ones without conscious awareness of the source
of the information, has constituted 'a revolution in the way that we measure
and interpret the influence of past events on current experience and behaviour'
(Richardson-Klavehn & Bjork,1988: 475-476). Therefore, both experimenters
and clinicians should take into account this distinction whenever they assess
human memory.

3.2.2 Memory Assessment

The German philosopher Hermann Ebbinghaus(1850-1909) was the first to
demonstrate that memory can be measured. His main contribution was
methodological in nature. Among his most important contributions were the
study/test paradigm for the study of memory, the basic foundation of any memory
experiment and test, and the savings method, currently considered as an implicit
memory test, which were a couple of inventions of very large influence. Since
then, memory assessment has undergone an extraordinary quantitative and
qualitative advance.
Both the evolution and the accumulation of new memory tasks have defined
the progress throughout the last century. The Ebbinghausian measure of serial
40
 recall led to new forms of testing recall (free recall, cued recall), and these measures Measurement of
Memory and
. fuelled new theoretical developments in the 1980s. Today, two major classes of Creativity
memory measures are distinguished: tests of explicit memory and tests of implicit
memory.
3.2.3 Tests of Explicit Memory
Explicit memory tests are those in which the instructions in the test phase make
explicit reference to an episode or experience in the subject's personal history. Thus,
they requireintentionalor consciousrecollectionof previous information.Traditionally,
these tests have been considered as the only memory tests. Table below rovides a
relatively extensive list of tests of explicit memory currently in use.
Table 1: Tests for Explicit Memory'
1. Adult Memory and Information Processing Battery (AMIPB)
2. The Benton Revised Visual Retention Test (BVRT)
3. The Buschke Selective Reminding (SR) Test
4. The California Verbal Learning Test (CVLT)

5. The Luria Nebraska Memory Scale (~NMS)

6. The Memory Assessment Clinic (MAC) Battery

7. The Misplaced Objects Test

8. fhe Rey Auditory Verbal Learning Test (AVLT)

9. The Rey-Osterreith Complex Figure Test (CFT)

10. The Rivermead Behavioural Memory Test (RBMT)

11. The Warrington Recognition Memory test
12. The Wechsler Memory Scale-Revised (WMS-R)

(Source: BaddeJey, Wilson and Watts (1995)

Table 2: Memory and Meta Memory Questionnaires

(Memory Questionnaires (MQs) ask people to recall or recognise
knowledge or events.
Meta Memory Questionnaires (MMQs) ask people to indicate how well
they recall or recognise knowledge or events.)
MQs
1. The Autobiographical Cueing Technique or TheCrovitz-Schiffman
Technique
2. The Autobiographical Memory Interview (AMI)
3. The Boston Remote Memory Battery (BRMB)
4. The 'Dead-or-Alive' test
5. The Famous Faces Test
6. The Famous Personalities Test
7. The Price Estimation Test 41
Tests of Cognitive MMQs
Functions
1. The Cognitive Failures Questionnaire (CFQ)

2. The Everyday Memory Questionnaire (EMQ)

3. The Inventory of Memory Experiences (1MB)

4. The Memory Assessment Clinic Self-Rating Scale(MAC-S)

5. The Self-Rating Scale of Memory Function (SRSMF)

'6. The Short Inventory of Memory Experiences (SIMB)

7. The Subjective Memory Questionnaire

The RBMT is one of the few memory tests to have aversion for children.
However, recently some memory tests for use with children have been presented
[e.g. The Children's test of Non word Repetition (CNRep) constructed by
Gathercole, Baddeley, Willis and Emslie; The Story Recall Test developed by
Beardsworth and Bishop].

The tests of explicit memory include free recall, cued recall and recognition memory
tasks. Prototypically, in tasks of free recall, subjects are shown a list of items (words,
pictures, sentences) and are later asked to recall the items in any order that they
choose. In cued recall, subjects are given explicit retrieval cues. The retrieval cues
are prompts, reminders or any additional information that guides the search processes
. , in memory (e.g. FRUITS for the to be recalled words 'apple', 'plum', 'grape',
'kiwi'). In free and cued recall, memory performance is assessed simply by counting
the number of to be remembered items recalled.

An exception to the prototypical tasks outlined above is serial recall, in which the
subject is asked to recall the items in the order of presentation, and performance is
assessed by the number of items recalled in the correct sequential order. This
procedure allows the assessment of memory for order or temporal memory, one
kind of memory especially relevant, for instance, in language perception and
comprehension. Serial recall is also used in the well-known short-term memory task
called digit span that has been traditionally included in tests of general intelligence
such as Wechsler-batteries .•

A typical recognition task involves presenting a list containing the to-be-remembered

or old items (e.g. words) just as in the presentation phase of recall tasks. However,
in the subsequent test phase, subjects are shown a series of words, that is, old items
mixed with new items or distractors and they are required to decide which the old
ones are.

In the last few years, much research has also been devoted to the study of the
subjective states of awareness associated with recognition memory. Tulving (1985b)
introduced a new methodology to distinguish 'remember' (R) and 'know' (K)
responses in recognition memory tests. An R response represents recognition with
conscious recollection of the item's prior occurrence; a K response represents
• recognition associated with feelings of familiarity in the absence 'of conscious
recollection. Tulving proposed that these two states of awareness reflect two kinds
of consciousness, autonoetic and noetic, which are respectively properties of episodic
and semantic memory. The rememberlknow paradigm merits its consideration
because a number of studies have demonstrated that the recollective experience of
42
remembering is affected in different ways by many independent variables. For our Measurement of
Memory and
purposes, its results are especially relevant to focus on different subject variables. Creativity
There is now considerable evidence that age, A1zheimer' s disease, amnesia, epilepsy,
schizophrenia and autistic disorders have dissociative effects on R and Kresponding.
The general finding has been that, in the conditions mentioned, 'remember'responses
are selectively impaired and 'know' responses are relatively spared (Gardiner & /'

Richardson- Kla vehn, 2000).

Finally, it cannot be ignored that an unlimited number of memory judgment tasks are
also explicit memory tasks. For example, judgments of presentation frequency,
judgements of temporal order or recency, judgements of input modality, judgements
of source/reality monitoring, feeling-of-knowingjudgements, and so on.

3.2.4 Tests of Implicit Memory

Implicit memory tests are those in which subjects are asked to respond to test
stimuli (e.g. generate a word, classify an object, perform a motor task) without
making reference to prior events. The impressive experimental evidence available
about dissociations between implicit and explicit memory tasks warrants the
assumption that there are fundamental differences between mnemonic information
assessed by implicit and explicit memory tests.

For example, numerous studies have documented across diverse tasks that amnesic
patients (and other special populations) exhibit preserved mnemonic functioning when
they are a~sessed with tests of implicit memory, and a memory severely impaired
when tests of explicit memory are given. Studies with normal subjects have also
shown that under some conditions (e.g. effects of alcohol, psychoactive drugs, general
anesthesia, or certain experimental manipulations) normal's exhibit implicit memory
for information that they cannot explicitly remember. The most important and
theoretically relevant conclusion from these findings is that implicit memories are
explicitly inaccessible and vice versa, because (a) different aspects of events are
encoded by distinct but interacting neuro cognitive systems, and (b) diverse tasks
tap different memory systems. Therefore, an adequate memory assessment requires
of experimenters and clinicians to make use of explicit memory tests as well as
implicit memory tests.

There are many implicit memory tests currently in use, and new tests are created
every year, A general classification scheme that includes most of them has been
recently proposed by Toth (2000). Implicit memory tests could be roughly organised
in two major categories: verbal and non verbal tests, and each one of them in its
turn into three subclasses:

1) Perceptual tests (e.g. perceptual identification, word stem completion, .

degraded word naming, object/non-object decision),

2) Conceptual tests (e.g. word association, category instance generation, object

categorization, person/trait attributions), and

3) Procedural tests (e.g. reading mirror inverted text, probability judgements,

mirror drawing, motor tracking). Generally speaking, the perceptual tests
challenge the perceptual representation system, the conceptual tests involve
the semantic memory s~stem, and the procedural tests tap the procedural
memory system. 43
Tests of Cognitive 3.2.5 Assessment of Different Memory Systems
Functions
From the multiple memory systems view, memory assessment must evolve to assess
every single memory system. According to the five-fold classification system
proposed by Schacter and Tulving, such systems are defmed and could be assessed
as follows:

1) The procedural memory system: This is a behavioural action system

concerned with the acquisition, retention and retrieval of motor, perceptual and
cognitive skills, simple conditioning, and non associative forms ofleaming. These
kinds of memory are measured by tests of implicit memory, such as the pursuit
rotor task, maze learning, mirror reading, artificial grammar learning, tower of
Hanoi, and so on.

2) The perceptual representation system (PRS): This encompasses various

domain-specific subsystems that process and represent information about the
form and structure of words and objects. The PRS is assessed with implicit
memory tests, such as perceptual identification, word stem completion,
homophone spelling, picture fragment completion, object / non object decision,
possible / impossible object decision, and many others.

3) The semantic memory system: This is the system involved in the acquisition,
retention and retrieval of general knowledge of the world. Therefore, the task
of assessing the status ofthis complex and multi-faceted system seems an
impressive one. This challenge could be overcome by using a multiplicity of
types of tests, such as word fluency, vocabulary, word association, naming
tasks (animals, objects, etc.), recognition offamous faces, category instance
generation, fact generation, category verification, semantic anomaly detection,
K responses in recognition tests, and so on.

4) The working memory system (WM): This is a short term system that makes
possible the temporary maintenance and processing of information, and to
manipulate that information. The WM is measured by explicit memory tests
such as the Brown-Peterson task, various memory span tests (e.g. forward
and backward digit span, word span, alpha span), the size of the recency
effect, the release from pro active inhibition task, the Dobbs and Rule task,
mental arithmetic, and others.

As Craik et al. (1995) emphasise, because WM tests do not all measure the
same component processes it is advisable to assess WM by using several tests
rather than one global test.

5) The episodic memory system: This is the system for personally experienced
episodes. Episodic memories are assessed with tests of explicit memory for
verbal and non-verbal materials, such as free recall (immediate and delayed),
cued recall, recognition, R responses in recognition tests, generation task, and
others. Different tasks may be used to assess autobiographical memory,
considered as a subtype of episodic memory, such as recall and recognition of
famous events, the Crovitz-Schiffman technique or the cueing method, etc. In
clinical contexts, the Auto biographical Memory Interview (AMI) provides
relevant information about the deterioration of this kind of memory in patients.

At this point, it should be noted that remembering and the different memory systems
summarized above all refer to the past. However, as everybody knows, people are
44
also capable of remembering what they must do in the future. The former is called Measurement of
Memory and
retrospective memory, and the latter, prospective memory. Creativity

Prospective memory is defined as the timely remembering of a planned action;

everyday tasks such as remembering to phone one's sister at eleven o'clock,
remembering to take medication after lunching, or remembering to reply to an e-
mail this evening are all significant memory acts common to everyday living. Because
both observations in the real world as well as laboratory studies show that prospective
memory declines with age, brain damages and progressive brain diseases, prospective
memory tasks should be given whenever memory is assessed.

Self Assessment Questions

I) Define Memory.

2) Differentiate between explicit and implicit memory .

........ ; .

3) How would you assess memory?

4) What are the various tests of explicit memory?

5) Elucidate the tests of implicit memory.

6) Describe the assessment of different memory systems.

45
Tests of Cognitive
Functions 3.3 FUTURE PERSPECTIVES AND
CONCLUSIONS
During the last decade, students of memory have witnessed a colossal progress in
scientific understanding of this capacity. However, scientists have also discovered
that 'the complexity of memory far exceeds anyone's imagination' (Tulving, 2000:
727). Thus, it is not unusual for the very term 'memory' to mean many things to
many people and, consequently, for the concept of 'memory impairment' to be
utilised in many different ways by researchers, clinicians and patients and their
families. This idea has been masterly captured by Tulving (2000: 728) when he said:
'Any claim about "memory" or "memory impairment" immediately requires
. clarification: About which kind of memory, memory task, memory process, or
memory system are we talking?'

. One fundamental reason for this lack of agreement is that memory is not a monolithic
entity but a collection of different systems with multiple processes which are expressed
in different ways. This idea should be assumed not only by researchers but also by
clinicians and neuropsychologists in order to reduce the undesirably great distance
existing between experimental research and clinical assessment.

Currently, most neuropsychological batteries are still focused on traditional memory

tests; that is, free recall, cued recall and recognition tasks. However, implicit memory
tests must be included without delay into explorations of special populations such as
brain-damaged individuals, patients with Alzheimer' s disease 'and other degenerative
brain diseases, the elderly, etc., who have already showed sharp dissociations between
explicit and implicit memory task performances.

Fortunately, the incipient convergence between psychologists and neuropsychologists

favoured by the new Cognitive Neuroscience framework (Kosslyn& Koenig, 1992;
Gazzaniga, 1995) undoubtedly will result in an impressive change in the ways human
memory will be assessed in the years to come.

3.4 CREATIVITY
Creativity is usually defmed as the capacity to generate ideas that are jointly original
and adaptive. Original ideas are those that have a low statistical likelihood of occurring
in the population, whereas adaptive ideas are those that satisfy certain scientific,
aesthetic, or practical criteria. An idea that is original but maladaptive is more likely
to be considered a sign of mental disturbance than creativity, while an idea that is
adaptive but unoriginal will be dismissed as mundane or perfunctory rather than
creative. Although almost universal consensus exists on this abstract definition of the
phenomenon, much less agreement is apparent regarding how best to translate this
definition into concrete instruments or tests.

3.4.1 Assessment of Creativity

Psychologists wishing to assess individual differences in creativity have a tremendous
range of instruments to choose from.

Therefore, before investigators can settle on any single test or battery of tests, it is
first necessary that they address four major questions:
46
 l
i) What is the age of the target population? Some measures are specifically Measurement of
Memory and
designed for school-age populations, whether children or adolescents, whereas Creativity
other measures are targeted at adult populations.

ii) Which domain of creativity is to be assessed? Not only may creativity in the
arts differ substantially from creativity in the sciences, but also there may appear
significant contrasts within specific arts (e.g. music vs. literature ) or sciences
(e.g. mathematics vs. invention).

iii) What is the magnitude of creativity to be evaluated? At one extreme is everyday

problem solving ability ('little c' creativity) where at the other extreme is eminent
creativity that earns awards and honours appropriate to the domain ('Big C'
Creativity, or genius).

iv) Which manifestation of creativity is to be targeted? That is, the investigator

must decide whether creativity manifests itself primarily as a product, a process,
or a person. Some instruments postulate that creativity takes the form of a
concrete product; others assume that creativity involves a particular type of
cognitive process, while still others posit that creativity entails a personal
disposition of some kind.

Of these four questions, it is the last that is perhaps the most crucial. Assessment
strategies differ dramatically depending on whether creativity is best manifested as a
product, process.or person. As a consequence, the description of creativity measures
. that follows willbe divided into three subsections.

3.4.2 Product Measures

Ultimately, a creative idea should take some concrete form, such as a poem, story,
painting, or design. Hence, one obvious approach to creativity assessment is to
measure the quantity or quality of productive output. A case in point is the Consensual
Assessment Technique devised by Amabile (1982). Here a research participant is
asked to make some product, such as a collage or a poem, which is then assessed
by an independent set of experts. This technique has proven especially useful in
laboratory experiments on the social circumstances that are most likely to favour
creative behaviour.

However, this approach has at least two disadvantages.

i) First, the creativity of an individual is decided according to performance on a

single task.

ii) Second, the assessment is based on a task that may not be representative of
the domain in which the individual is most creative. For instance, a creative
writer will not necessarily do well on a task in the visual arts, such as making
collages.

iii) An alternative is to assess individual differences in creativity according to

products that the person has spontaneously generated. For example, the Lifetime
Creativity Scales assess creative behaviour by asking participants to self identify
examples of their own creative achievements (Richards et al., 1988).
47
Tests of Cognitive According to this approach, creativity assessment is based on multiple products in
Functions the domain that the individual finds most germane to personal creative expression.
Although this instrument has proven validity and utility, it can be objected that a
product's creativity requires an external assessment, such as that provided in the
Consensual Assessment Technique. Further more, this instrument is clearly aimed at
everyday creativity rather than creative output that is highly valued professionally or
socially.

One way to assess such Big-C Creativity is to use some variety of productivity
measure. Thus, the creativity of scientists may be gauged by journal articles and that
of inventors by patents. Often such measures of pure quantity of output are
supplemented by evaluations of quality. For example, the quality of a scientist's
productivity may be assessed by the number of citations to his or her work. Another
approach is to assess creative impact in terms of awards and honours received or
the evaluations of experts in the field, which tactic dates back to Francis Galton
(1869). One especially innovative strategy is Ludwig's (1992) Creative Achievement
Scale, which provides an objective approach to evaluating a creator's life work.
This scale has proven useful in addressing the classic question of whether exceptional
creativity is associatedwith some degree of psychopathology (the 'mad-genius'
debate).

3.4.3 Process Measures

One major drawback of all product measures of creativity is that they appear barren
of truly psychological content. These measures stress outward behaviour and its
impact rather than internal mental states. Yet presumably there exists some special
thought processes that underly these creative products. Accordingly, psychologists
can instead devise instruments that tap into these crucial processes. For example,
Mednick (1962) theorized that creativity requires the capacity to generate remote
associations that can connect hitherto disparate ideas. He implemented this theory
by devising the Remote Association Test, or RAT, that has seen considerable use in
subsequent research. A person taking the RAT must identify a word that has an
associative linkage with three separate stimulus words (e.g. associating the word
'chair' with the given words 'wheel, electric, high').

An even more popular set of measures was devised by Guilford (1967) in the context.
of his multidimensional theory of intelligence. These measures assess various kinds
of divergent thinking, which is supposed to provide the basis for creativity. Divergent
thinking is the capacity to generate a great variety of responses to a given set of
stimuli. Unlike convergent thinking, which aims at the single most correct response,
ideational productivity is emphasized. A specific instance is the Unusual Uses test,
which asks research participants to come up with as many uses as possible for
ordinary objects, such as a toothpick or paperclip. The participants' responses can
then be scored for fluency (number of responses), flexibility (number of distinct
categories to which the responses belong), and originality (how rare the response is
relative to others taking the test).

Guilford's development of Divergent Thinking (DT) tests in the 1950s and 1960s is
usually considered to be the launching point for serious development efforts and
large- scale application. Among the first measures of divergent thinking were Guilford's
(1967) Structure of the Intellect (SOl) divergent production tests, Wallach and
Kogan's (1965) and Getzels and Jackson's (1962) divergent thinking tests, and
48 Torrance's (1962,1974) Tests of Creative Thinking (TTCT).
3.4.5 The SOl Assessments (Structure of Intellect Measurement of
Memory and
Assessments) Creativity

Guilford's (1967) Structure of the Intellect Model proposed 24 distinct types of

divergent thinking: One type for each combination of four types of content (Figural,
Symbolic, Semantic, Behavioural) and six types of product (Units, Classes, Relations,
Systems, Transformations, Implications).

For example, the SOl DT battery (Structure of Intellect and Divergent Thinking)
consists of several tests on which subjects are asked to exhibit evidence of divergent
production in several areas, including divergent production of semantic units (e.g.,
listing consequences of people no longer needing to sleep), of figural classes (finding
as many classifications of sets of figures as is possible), and of figural units (taking a
simple shape such as a circle and elaborating upon it as often as possible).

Another example is the Match Problem, which represented the divergent production
of figural transformations. The Match Problem has several variations, but they tend
to be variations on the basic theme of Match Problem I. In this test, 17 matches are
placed to create a grid of two rows and three columns (i.e., six squares). Participants
are asked to remove three matches so that the remaining matches form four complete
squares.

Guilford noted that such tasks are characterised by the need for trial and error
strategies and flexible thinking. Several other tests were also used to study figural
transformati,ons, all with the same basic requirements to come up with multiple ways
to transform visual spatial objects and relationships. Guilford believed that this
particular group of tests assesses flexibility. Guilford's entire SOl divergent production
battery consists of several dozen such tests corresponding to the various divergent \
~gcomponents.

3.4.6 Torrance Tests of Creative Thinking (TTCT)

The Torrance Tests of Creative Thinking which are also based upon many aspects
of the SOl battery are by far the most commonly used tests of divergent thinking
and continue to enjoy widespread international use.

Over several decades, Torrance refmed the administration and scoring of the TTCT,
which may account for its enduring popularity. The battery includes Verbal (Thinking
Creatively with Words) and Figural tests (Thinking Creatively with Pictures) that
each includes a Form A and Form B that can be used alternately.

The Figural forms have three subtests:

i) Picture Construction, in which a participant uses a basic shape and expands

on it to create a picture;

ii) Picture Completion, in which a participant is asked to finish and title incomplete
drawings; and

iii) Lines I Circles, in which a participant is asked to modify many different series
of lines (FormA) or circles (Form B).

The Verbal form has seven subtests. For the first three tasks, the examinee is asked
to refer to a picture at the beginning of the test booklet. For example, in Form A, the 49
Tests of Cognitive picture is of an elf staring at its reflection in a pool of water. These first three tasks
Functions are considered part of the Ask and Guess section:

Asking, in which a participant asks as many questions as possible about the picture;

Guessing Causes, in which a participant lists possible causes for the pictured action;

Guessing Consequences, in which a participant lists possible consequences for the

pictured action.

The [mal four verbal subtests are self- contained:

Product Improvement, in which a participant is asked to make changes to improve

a toy (e.g., a stuffed animal)

Unusual Uses, in which a participant is asked to think of many different possible

uses for an ordinary item (e.g., a card board box)

Unusual Questions, in which a participant asks as many questions as 'possible

about an ordinary item (this item does not appear in later editions); and

Just suppose, in which a participant is asked to 'just suppose" that an improbable

situation has happened then list possible ramifications.

Administration, scoring, and score reporting of the various tests and forms are
standardized, and detailed norms were created and revised accordingly. The original
test produced scores in the traditional four DT areas, but the streamlined scoring
system introduced in the 1984 revision made significant changes to the available
scores. Under the stream lined system, the Figural tests can be scored for resistance
to premature closure and abstractness of titles in addition to the familiar scores of
fluency, elaboration, and originality. Flexibility was removed because those scores
tended to be largely undifferentiated from fluency scores. Resistance to premature
closure is determined by an examinee's tendency to not immediately close the
incomplete figures on the Figural Picture Completion test. Torrance believed this
tendency reflected the examinee's ability "to keep open and delay closure long enough
to make the mental leap that makes possible original ideas. Less creative persons
tend to leap to conclusions prematurely without considering the available information"
(Torrance & Ball, 1984, p. 20).

3.4.7 Person Measures

Process measures of creativity operate under the assumption that creativity requires
the capacity to engage in somewhat distinctive cognitive processes. Not all
psychologists agree with this position. In the first place, often performance on process
instruments can be enhanced by relatively straightforward training procedures, and
sometimes performance enhancements can occur by changing the instructional set
when administering the test (i.e. the command to 'be creative! '). In addition, creative
individuals appear to have distinctive non cognitive characteristics that set them apart
from persons who fail to display creativity. This has led some psychologists to propose
that creativity be assessed by person based measures.

50
The most frequently used instruments assess creativity via the personality Measurement of
Memory and
characteristics that are strongly correlated with creative behaviour. These personality Creativity
assessments are of three kinds. First, the assessment may simply depend on already
established scales of standard tests, such as the Minnesota Multiphasic Personality
Inventory or Eysenck's Personality Questionnaire. These measures will tend to
yield the lowest validity coefficients.

Second, the assessment may be based on the construction of a specialised subscale

of an already established personality test. For instance, Gough (1979) devised a
Creative Personality Scale from his more general Adjective Check List. Third, the
assessment may rely on a measure that is specially constructed to gauge individual
differences in creative personality. An example is the How Do You Think: questionnaire
that gauges whether a person has the interests, values, energy, self confidence, humour,
flexibility, playfulness, unconven-tionality, and openness associated with creativity
(Davis, 1975).

An alternative person based approach is predicated on the assumption that creative

potential emerges by means of a particular set of developmental experiences. These
experiences may reflect either genetic predilections (nature )or acquired inclinations
(nurture). For example, Schaefer and Anastasi (1968) designed a biographical
inventory that identifies creativity in adolescent boys (see also Schaefer, 1970). The
items tap such factors as family background, school activities, and extracurricular
interests. Moreover; the inventory discriminates not only creative from non creative
adolescents but also between scientific and artistic creativity. Similar biographical
inventories have been devised for both children and adults. The box below presents
a summary of representative creativity measures.

Table 3: Summary Table of Representative Creativity Measures

Product Measures Consensual Assessment Technique (Amabile, 1982)

Lifetime Creativity Scales (Richards et aI., 1988)

Creative Achievement Scale (Ludwig, 1992)

Process Measures Remote Associates Test (Mednick, 1962)

Unusual Uses Test (Guilford, 1967)

Torrance Tests of Creative Thinking (Torrance, 1966; Crammond, 1994)

Person Measures Creative Personality Scale of the Adjective Check List (Gough,
1979)

How Do You Think Inventories (Davis, 1975)

Biographical Inventory - Creativity (Schaefer, 1970; Schaefer & Anastasi, 1968)

The above list by no means exhausts the inventory of tests that purport to measure
creativity. The instruments listed are merely chosen as representative ofthe
various types of tests that have been developed since the 1960s.

51
Tests of Cognitive
Functions Self Assessment Questions
1). What are the future perspectives and conclusions in regard to memory?

I
2) Defme creativity.

3) How would you assess creativity?

4) What are product measures of creativity?

5) What are process measures of creativity?

6) What are person measures of creativity?

7) Which of the three is more applicable to measuring creativity?

.................................................................................................................
!

8) ExpJ~rr~c~;est of creativity.
~/... \ : .

52
 Measurement of
3.5 FUTURE PERSPECTIVES AND Memory and
Creativity
CONCLUSIONS
Ideally, scores on the diverse creativity measures should inter correlate so highly
that all alternative instruments could be said to assess the same underlying latent
factor. The various measures can then be said to display convergent validity. Yet
many empirical studies have found that alternative instruments often fail to converge
on a single, psychometrically cohesive dimension. Even worse, many measures seem
to lack divergent validity as well. For instance, some of the process type instruments
exhibit unacceptably high correlations with scores on intelligence tests. These
correlations have driven some researchers to question whether creativity can be
reliably separated from the problem solving ability associated with general intelligence
(i.e. 'Spearrnan's G'). In contrast, other creativity researchers have advocated more
positive conclusions, believing that there indeed exists a sub set of instruments that
have the desired convergent and divergent validity as well as the requisite predictive
validity. Whether this optimistic position will receive empirical justification in future
research remains to be seen.

Clearly, psychologists who want to assess creativity must confront a tremendous

number of alternative creativity measures. Not only db the various instruments differ .
in their respective reliabilities and validities, but also the alternative measures are
often based on rather contrary conceptions about what has to be measured. Even
within a single approach there is available several rival measurement tools. Thus, the
'person type measures include both biographical inventories and personality
questionnaires, and the latter may be subdivided into more than one kind. Complicating
matters even more, the choice of instrument is contingent on such criteria as the age
of the target population, the domain of creativity involved, and the magnitude of
creativity to be assessed. Creativity assessment is no easy task, and may even require
some creativity.

3.6 LET US SUM UP

Memory tests need to be grounded in theory and research with the ability to assess
alicomponents of the memory process. It is only through a broad, comprehensive
approach to memory assessment that neuropsychologists can obtain valid, clinically
meaningful conclusions and recommendations for their patients.

Creativity is a key component ofhurnan cognition that is related yet distinct from the
construct of intelligence. One way of organising creativity assessment is in terms of
person, process, product, and press (i.e., environment).

3.7 UNITENDQUESTIONS
1) Which of the following is Not part of the "Four P" model?

1) Process

2) Product

3) Possibility

4) Person 53
Tests of Cognitive 2) Which of the following is most commonly associated with creativity?
Functions
1) Intrinsic motivation

2) Extrinsic motivation

3) Anticipation of rewards

4) Anticipation of evaluation

3) The Torrance Tests of Creative Thinking assess:

1) task motivation

2) domain- specific knowledge

3) artistic ability

4) divergent thinking

4) "Flow" refers to:

1) the speed at which one works

2) consistency among items in a divergent-thinking test

3) similarities between intelligence and creativity test scores

4) the experience of being intensely engaged in an activity

5) Tick the True or False statements.

i) The Structure of Intellect model looks at both the

. types of content and the types of product in
divergent thinking. (TruelFalse)

ii) Serial recall is also used in the well-known

short-term memory task called digit span. (True/False)

iii) Explicit memory is revealed by a facilitation or change

of performance on tests that do not require
intentional or conscious recollection. (TruelFalse)

iv) Prospective memory is defmed as the timely

remembering of a planned action. (True/False)

6) What is memory? Describe in detail the different tests for assessment

of memory?

7) Define creativity? Discuss the various ways of assessing creativity?

8) What are the future perspectives and conclusion in regard to creativity?

9) What are SOl assessments? Elucidate. , I

3.8 SUGGESTED READINGS

Kaufman, James c., Plucker,
Jonathan A.,Baer, John.(2008). Essentials of
Creativity Assessment. New Jersey: John Wiley & Sons, Inc.

Lezak, M.D. (1995). Neuropsychological Assessment (3rd ed.). New York: Oxford
54 University Press.
UNIT 4 UTILITY OF DATA FROM THE
TEST OF COGNITIVE
FUNCTIONS
Structure
4.0 Introduction

4.1 Objectives

4.2 Cognitive Testing

4.3 Utility of Data from Tests of Cognitive Functions

4.3.1 Clinical Use of Intelligence Tests
4.3.2 The Estimation of General Intellectual Level
4.3.3 The Case of Harold
4.3.4 Prediction of Academic Success
4.3.5 Occupational Performance
4.3.6 The Appraisal of Style

4.4 Uses of Neuropsychological Assessment

4.4.1 Determining the Biological (I.E., Neuroanatomical, Physiological) Correlates
of Test Results: Detection, Gradation, and Localisation of Brain Damage
4.4.2 Determining Whether Changes Are Associated With Neurological Disease,
Psychiatric Conditions, Developmental Disorders, or Non-Neurological
Conditions
4.4.3 Assessing Changes over Time and Developing a Prognosis
4.4.4 Offering Guidelines for Rehabilitation, Vocational/Educational Planning, or
A Combination of These
4.4.5 Providing Guidelines and Education for Family and Caregivers
4.4.6 Planning for Discharge and Treatment Implementation

4.5 Overview of Instruments

4.5.1 Behaviour Rating Inventory of Executive Function (BRIEF)
4.5.2 Behaviour Rating Inventory of Executive Function-Preschool Version
(BRIEF-P)
4.5.3 Comprehensive Test of Nonverbal Intelligence (CTONI)
4.5.4 Comprehensive Test of Phonological Processes (CTOPP)
4.5.5 Das Naglieri Cognitive Assessment System (CAS)
4.5.6 Detroit Tests of Learning Aptitude-Fourth Edition (DTLA-4)
4.5.7 Differential Ability Scales-Second Edition (DAS-II)
4.5.8 Kaufman Assessment Battery for Children-Second Edition (KABC-II)
4.5.9 Leiter International Performance Scale-Revised (Leiter-R)
4.5.10 NEPSY, Second Edition (NEPSY-II)
4.5.11 Stanford-Binet Intelligence Scales-Fifth Edition (SB5)
4.5.12 Universal Nonverbal Intelligence Test (UNIT)
4.5.13 Wechsler Abbreviated Scale of Intelligence (WASI)
4.5.14 Wechsler Adult Intelligence Scale-Third Edition (WAIS-III)
4.5.15 Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV)
4.5.16 Wechsler Intelligence Scale for Children-Fourth Edition Integrated
(WlSC-IV Integrated)
Wechsler Nonverbal Scale of Ability (WNV)
55
4.5.17
Tests of Cognitive 4.5.18 Wechsler Preschool and Primary Scale of Intelligence-
Functions Third Edition (WPPSI-III)
4.5.19 Wide Range Assessment of Memory and Learning-
Second Edition (WRAML-2)
4.5.20 Woodcock-lohnson Tests of Cognitive Abilities-Third Edition! Normative
update (WJ-III COG/NU)
4.6 Let Us Sum Up

4.7 Unit End Questions

4.8 Suggested Readings

4.0 INTRODUCTION
This unit expands the discussion of assessment in clinical psychology. Cognitive
assessment measures a host of intellectual capacities and encompasses the
subspecialty of neuropsychological assessment that examines brain-behaviour
relationships. Once all the assessment data are collected and examined by the
psychologist, decisions can be made regarding diagnosis, treatment plans,
and predictions about future behaviour.

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

• describe the uses of intelligence and neuropsychological tests in assessing

cognitive functions; and

• provide an overview of various instruments for assessing cognitive

functions.

4.2 COGNITIVE TESTING

Cognitive testing is a general term referring to the assessment of a wide
range of information processing or thinking skills and behaviours. These comprise
general neuro psychological functions involving brain-behavior relationships, general
intellectual functions (such as reasoning and problem solving) as well as more
specific cognitive skills (such as visual and auditory memory), language skills,
pattern recognition, finger dexterity, visual perceptual skills, academic skills, and
motor functions. Cognitive testing may include aptitude testing (which assesses
cognitive potential such as general intelligence) and achievement testing (which
assesses proficiency in specific skills such as reading or mathematics). Cognitive
testing uses well known tests such as the Scholastic Aptitude Test (SAT) and
intelligence quotient (IQ) tests of all kinds. Thus, cognitive testing is an umbrella
term that refers to many different types of tests measuring many different types
of thinking and learning skills.

4.3" UTILITY OF DATA FROM TESTS OF

COGNITIVE FUNCTIONS
In the preceding units, we have described several of the more commonly
used cognitive tests. It is time to take a closer look at how such tests are
used in the clinical setting.
56
4.3.1 Clinical Use of Intelligence Tests Utility of Data from the
Test of Cognitive
Functions
The intelligence test is a special measure that primarily helps to assess a wide
spectrum of cognitive features. The manner in which such .cognitive features
operate for the patient needs to be delineated. One of the main assets of
intelligence tests is their accuracy in predicting future behavior. Initially,
Binet was able to achieve a certain degree of predictive success with his
scales, and, since that time, test procedures have become progressively more
refined and accurate. More recent studies provide ample support that
intelligence tests can predict an extremely wide number of variables. In
particular, IQ tests are excellent predictors of academic achievement,
occupational performance and are sensitive to the presence of
neuropsychological deficit.

4.3.2 The Estimation of General Intellectual Level

The most obvious use of an intelligence test is as a means for arriving at an
estimate of the patient's general intellectual level. Frequently, the goal is the
determination of how much general intelligence (g) a given person possesses.
Often, the question is stated a bit differently-for example, what is the
patient's intellectual potential? Posing the question in this way suggests that
perhaps the person is not functioning as well as his or her potential would
indicate. The potential can form a baseline against which to measure current
achievements, thus providing information about the patient's current level of
-functioning. Many pitfalls and fallacies are associated with the pursuit of
these goals. The following is an example.

4.3.3 The Case of Harold

Harold was being routinely evaluated prior to transfer to a special class for
advanced junior high school students. Rather surprisingly, his Full Scale
WISC-IV IQ turned out to be 107. This score was in the average range but
below the cut off point for admission to the class. It was also considerably
below what his teachers had estimated based on his classroom performance.
A closer look at his subtest scores revealed that his performances on Block
Design and Coding were significantly below those on the other sub tests. A
follow-up interview with Harold was quite revealing. Since early childhood,
he had suffered from muscular weakness in both arms and hands. This
weakness prevented him from making fine, quick motor responses. However,
he had developed a number of clever compensations to prevent others from
guessing his limitation. For example, what had appeared to be slow, deliberate,
even confused responses on Block Design were really not that at all. He was
feigning confusion to mask his difficulty with fine motor functions. Clearly,
then, Harold's IQ score had been unduly affected by a motor weakness that
had nothing to do with his ability to perform intellectually.

This example is but the tip of the iceberg. It does suggest, however, that
obtaining an IQ is not the end of a clinician's task, but it is only the beginning.
The IQ score must be interpreted. Only through knowledge of the patient's
learning history and by observations made during the testing situation can
that score be placed in an appropriate interpretive context and adequately
evaluated.

57
Tests of Cognitive 4.3.4 Prediction of Academic Success
Functions
As mentioned previously, there are data that demonstrate a relationship between
intelligence test scores and school success (Neisser et al., 1996). To the extent
that intelligence should logically reflect the capacity to do well in school, we are
justified in expecting intelligence tests to predict school success. Not everyone
would equate intelligence with scholastic aptitude, but the fact remains that a
major function of intelligence tests is to predict school performance. One must
remember, however, that intelligence and academic success are not conceptually
identical.

4.3.5 Occupational Performance

In addition to predicting academic achievement, IQ scores have also been
correlated with occupation, ranging from highly trained professionals with
mean IQs of 125, to unskilled workers with mean IQs of 87 (Reynolds,
Chastain, Kaufman, & McLean, 1987). Correlations between job proficiency
and general intelligence have been highest in predicting relatively more complex
jobs rather than less demanding occupations. 1. Hunter (1986) reported
moderately high correlations between general intelligence and success for
managers (.53), salespersons (.61), and clerks (.54). For intellectually
demanding tasks, nearly half the variance related to performance criteria can
be accounted for by general intelligence (F. Schmidt, Ones, & Hunter, 1992).
The use of intelligence tests for personnel selection has demonstrated financial
efficacy for organisations (E Schmidt & Hunter, 1998). In addition, the accuracy
of using IQ tests can be incrementally increased by combining the results with
integrity tests, work samples, and structured interviews (F. Schmidt & Hunter,
1998).

4.3.6 The Appraisal of Style

As we have noted, what is important is not only whether the client succeeds or
fails on particular test items but also how that success or failure occurs. One of
the major values of individual intelligence tests is that they permit us to observe
the client or patient at work. Such observations can help us greatly in interpreting
an IQ. For example, did this child do as well as possible? Was there failure
avoidance? Did the child struggle with most items, or was there easy success?
Was the child unmotivated, and could this have detracted from the child's
performance? Such questions and the ensuing interpretations breathe life into an
otherwise inert IQ score.
The following simulated questions from the WAIS-III and a hypothetical patient's
responses to them are examples of the data that can be obtained beyond the
sheer correctness or incorrectness of a response.
Query: Who wrote Paradise Lost? (Information subtest)
Answer: Probably a Catholic. But since the Pope began changing things around,
they retitled it.
Query: What is the advantage of keeping money in a bank? (Comprehension
.subtest)
Answer: There isn't. There's so damn many crooks. But they'll get theirs
someday.
Query: In what ways are a lion and a tiger alike?(Similarities subtest)
58
Answer: Well, now, that's a long story. Do they look alike? They really can't Utility of Data from the
Test of Cognitive
breed together, you know. Functions

(These simulated items were provided courtesy of The Psychological Corporation.

The answers are based on responses to actual items.)

Some clinicianshave ventured considerably beyond making a few limited personality

inferences that would inject some added meaning into IQs and have based mental
disorder diagnoses on the Stanford Binet and Wechsler scales. They believed that
by examining patterns of scores (known as inter-test scatter); they could apply
diagnostic labels to patients (e.g., schizophrenia or depression). Over the years,
however, studies purporting to show the validity of these interpretations of inter
test scatter could rarely be replicated. Thus, diagnoses cannot be reliably inferred
from patterns of test performance.

Another import~nt asset of intelligence tests, particularly the WAIS-III and

WISCIII, is that they provide valuable information about a person's cognitive
strengths and weaknesses. They are standardized procedures whereby a person's
performance in various areas can be compared with that of age-related peers. In
addition, useful comparisons can be made regarding a person's pattern of strengths
and weaknesses. The WAIS-III, WISC-III, and other individually administered
tests provide the .examiner with a structured interview in which a variety of tasks
can be used to observe the unique and personal ways the examinee approaches
cognitive tasks. Through a client's interactions with both the examiner and the test
materials, .an .initial impression can be made of the individual's self-esteem,
behavioural idiosyncrasies, anxiety, social skills, and motivation, while also obtaining
a specific picture of intellectual functioning.

Intelligence tests often provide clinicians, educators, and researchers with baseline
measures for use in determining either the degree of change that has occurred in
an individual over time or how an individual compares with other persons in a
particular area or ability. This may have important implications for evaluating the
effectiveness of an educational program or for assessing the changing abilities of
a specific student. In cases involving recovery from a head injury or readjustment
following neurosurgery, it may be extremely helpful for clinicians to measure and
follow the cognitive changes that occur in a patient. Furthermore, IQ assessments
may be important in researching and understanding more adequately the effect on
cognitive functioning of environmental variables, such as educational programs,
family background, and nutrition. Thus, these assessments can provide useful
information about cultural, biological, maturational, or treatment-related differences
among individuals.

Self Assessment Questions

1) Define cognitive testing and describe the characteristics.

 Tests of Cognitive
Functions 2) What are the uses of tests of cognitive functions in clinical setting?

3) What are the uses of intelligence tests in clinical settings?

4) How do we estimate the general intellectual level?

..

5) Discuss the case of Harold.

~
...............................................................................................................

6) Can intelligence test scores be used for predicting academic success?

7) Can occupational performance be predicted through IQ scores?

8) What is appraisal style?

.......................... : \ .
\
................................................................... ~ .

4.4 USES OF NEUROPSYCHOLOGICAL

ASSESSMENT
One can identify at least seven different but related purposes or uses of
60 neuropsychological assessment. These categories are derived from what are
probably the most common clinical referral questions presented to Utility of Data from the
Test of Cognitive
neuropsychologists as well as from the information presented in many Functions
neuropsychological reports. These categories of use can.arise in a number of
different contexts, including medicine, law, education, and research. The8e;~,~egories
are presented here in the order reflecting the logic in which clinicalinferences are
typically made. ~

Describing and identifying changes in psychological functioning (cognition,

behaviour, emotion) in terms of presence/absence and severity. Although the
raison d' etre of clinical neuropsychology is to predict the presence of brain damage,
the ability to describe function precedes this seemingly core purpose of
neuropsychological tests. Neuropsychologists are usually expected to provide a
description of a patient or client by identifying cognitive strengths and weaknesses
and then by making the basic inference of whether the patient's current status
represents a change from some previous, usually not precisely defined, baseline
or pre morbid level of functioning. When children are evaluated and there is little
basis to estimate pre morbid abilities, clinicians may attempt to infer change from
expected developmental milestones. The issues of strengths and weaknesses and
rhe presence or absence of change are addressed before any other inferences
regarding brain function or recommendations for interventions may be considered.
The neuropsychologist must try to infer what part of the current observations
reflects the patient's "normal" allocation of intellectual functions versus what parts
of the current observations show changes attributable to brain dysfunction. Accurate
description and reference to correct normative standards for the individual are the
most basic and critical purposes of neuropsychologicalassessment.
"",-
4.4.1 Determining the Biological (I.E., Neuroanatomical,
Physiological) Correlates of Test Results:
Detection, Gradation and Localisation of Brain
Damage
After they have described the patient's behaviour, neuropsychologists typically try
to determine whether the pattern of test results, clinical behaviour, and particular
historical context of the observations can be attributed to abnormal brain function.
Such abnormalities may be the presence of a structural brain lesion, a developmental
disorder, or in some cases, neuro chemical lesion. Part of this determination is
trying to ascertain what region of the brain is involved.

4.4.2 Determining Whether Changes are Associated

with Neurological Disease, Psychiatric Conditions
Developmental Disorders, or Non-Neurological
Conditions
The next kind of inference that clinical neuropsychologists often try to make or
are asked to make concerns the likely etiology or etiologies that produced the
changes described. In the case of neurological disorder and known history, this
can sometimes be done accurately. This is particularly true in cases in which the
behavioural changes involve unusual and dramatic phenomena that have historically
been related to the presence of lesions, in specific parts of the brain and are
usually caused by a highly limited set of etiologies. For example, non-fluent aphasia
symptoms (e.g., hesitant, a grammatic speech) are most likely related to a limited
61
 Tests of Cognitive set of diseases that, if present by history, can be considered causative of the
Functions observed changes in language.

Many changes in neuropsychological functions, however, may be caused by

psychiatric, motivational, developmental, or cultural factors and may not be
attributable to a specific neurological etiology even when present by history.
Often, neuropsychological test findings are nonspecific to etiology and may
be related to a host 'of factors, such as depression, anxiety, sleep deprivation,
or even chronic pain. In these instances, the neuropsychologist must work as
an investigator to review the test findings thoroughly in the context of the
patient's history.

4.4.3 Assessing Changes over Time and Developing a

Prognosis

.. One of the most useful applications of neuropsychological assessment is to

track improvements and decrements in performance over time. This helps in
determining the etiology and progression of a disease, developing social or
financial plans for a patient, and tracking whether treatment or efforts toward
rehabilitation are effective.

4.4.4 Offering Guidelines for Rehabilitation, Vocational /

Educational Planning, or A Combination of These
The ability to provide inferences regarding etiology and descriptive power
has made neuropsychological assessment a popular tool in rehabilitation and
educational planning. Therapists and teachers can often use a patient's profile
of strengths and weaknesses to develop and optimize rehabilitation and
educational programs. Knowledge of which problems or weaknesses are
attributable to brain damage and which are likely the result of non neurological
sources can help a therapist allocate time and resources toward the treatment
priorities that are most likely to be effective.

4.4.5 Providing Guidelines and Education for Family and

Caregivers
In a similar vein, neuropsychological data can help families and caregivers to
understand the strengths and weaknesses of their loved ones and to cope
with patients who may suffer from challenging limitations on independent
functioning. Beleaguered family members are less likely to be angry with a
patient when they understand that symptoms that appear to be related to
motivation or personality are actually causally related to a disease state. An
understanding of the prognosis of the illness can also be invaluable to families
who must plan their use of finances and future care.

4.4.6 Planning for Discharge and Treatment Implementation

Neuropsychological deficits can sometimes be insidious and difficult to
describe, even for sophisticated clinicians, An understanding of a patient's
capabilities can help the clinician assess the degree to which a patient is
going to comply with treatment recommendations and medication use, as
well as the extent to which the patient or the patient's family may need
continued supervision after discharge.

62
 Utility of Data from the
Self Assessment Questions Test of Cognitive
Functions
1) Define and describe neuropsychological tests.

2) Can behaviour be related to abnormal functions through

neuropsychological tests?

...............................................................................................................
!I>

3) . Can neuropsychological test provide etiology for diagnosis and prognosis?

4) What are the various functions of neuropsychological tests?

4.5 OVERVIEW OF INSTRUMENTS

Assessing cognitive functioning in students or patients can yield valuable data that
inform instruction through identification of a pattern of strengths and weaknesses,
thus giving insight into learning styles and preferences. This, in turn, can help a
multidisciplinary team develop comprehensive instructional programs.

The following is a list of measures spanning all age ranges and levels of cognitive
functioning. Nonverbal measures are included as they may be appropriate for
students demonstrating limited language ability or limited English proficiency.
Measures used to assess various types of cognitive processing and executive
functions have also been included, as results of such assessment can facilitate a
cross-battery analysis of cognitive processes and positively impact instructional
decision-making.

4.5.1 Behaviour Rating Inventory of Executive Function

(BRIEF)
The Behaviour Rating Inventory of Executive Function (BRIEF; Gioia, Isquith,
Guy, & Ken-worthy, 2000) is an individualised, norm-referenced measure of
executive function behaviours designed for school-aged students from 5 to 18
years of age. The BRIEF is a questionnaire that is completed by parents or
teachers (two different forms), who rate behaviours related to executive functions 63
Tests of Cognitive in eight scales (Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan!
Functions Organise, Organisation of Materials, and Monitor).

Results of the scales are combined to generate two index scores, Behavioural
RegulationlBRI (based on three scales) and Meta cognitionIMI (based on five
scales), and an overall composite score, the Global Executive Composite/GEe.
Standardization of the BRIEF included individuals with a variety of developmental
or neurological conditions, allowing for use of the inventory with a broad range
of students. A Self-Report Form is also available for use with students 13 through
18 years of age, the Behavior Rating Inventory of Executive Function-Self-Report
Version (BRIEF-SR; Guy, Isquith, & Gioia, 2005).

4.5.2 Behaviour Rating Inventory of Executive Function-

Preschool Version (BRIEF-P)
The Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-
P; Gioia, Espy, & Isquith, 2003) is an individualised, norm-referenced measure
of executive function behaviours for preschool-aged children from 2 years to 5
years-ll months of age. The BRIEF-P, a questionnaire designed to be completed
by parents or teachers (single form), rates behaviors related to various executive
functions' observed in the home and in the preschool setting in five scales (Inhibit,
Shift, Emotional Control, Working Memory, and Plan!Organise). Items are rated
on a Likert scale (never, sometimes, often) comparing the significance of the
child's behaviours to those of other children of the same age over a specified
period of time.

Results of the scales are combined to generate three index scores, Inhibitory Self-
Control, Flexibility, and Emergent Meta cognition (each based on two scales),
and an overall composite score, the Global Executive Composite/GEe.
Standardization of the BRIEF-P included individuals with a variety of developmental
_or-neurological conditions and children considered at risk, allowing for use of the
----irhrentory with a broad range of students. Use of the BRIEF-P may facilitate early
identification of children with potential problems in areas of self-regulation.

4.5.3 Comprehensive Test of Nonverbal Intelligence (CTONI)

.>

, The Comprehensive Test of Nonverbal Intelligence (CTONI; Hammill, Pearson,

& Wiederholt, 1997) measures the nonverbal reasoning abilities of individuals
aged 6-0 to ~18-11. No oral responses, reading, writing, or manipulation of objects
.

are required. The crONI is useful for testing individuals with difficultiesin language
or fine-motor skills, including those who are bilingual, non-English-speaking, or
have motor or neurological disabilities. The test can be administered orally or
through pantomime.

The six subtests of the CTONI require subjects to view a group of pictures or
designs and to solve problems involving analogies, categorizations, and sequences.
The viewer simply indicates an answer by pointing to the answer. A computer-
administered version of the test is available, the CTONI-CA. This is an interactive
multimedia test that can be taken entirely on a computer. The program gives all
the instructions using a human voice; the examinee points the mouse and clicks
on the answer.

64
 4.5.4 Comprehensive Test of Phonological Processes Utility of Data from the
Test of Cognitive
(CTOPP) Functions

The Comprehensive Test of Phonological Processes (CTOPP; Wagner, Torgesen,

& Rashotte, 1999) is an individually administered, norm-referenced measure of
phonological awareness, phonological memory, and rapid naming, all foundational
skill areas that are critical in learning to read. One form of the CTOPP is
administered to children aged 5 and 6 years, focusing on the skills generally
needed in kindergarten and first grade. It consists of seven core subtests and one
supplemental subtest. A second form for individuals ranging from ages 7 through
24 years consists of six core subtests and eight supplemental subtests.
The purposes of the CTOPP include identifying students who are behind in
developing phonological skills and determining which skills have not been
acquired or adequately developed. The supplemental tests allow for assessing
specific strengths and weaknesses related to phonological processes. Subtests
include subtests to measure rapid naming, blending and segmenting words
and non-words, sound matching, and memory for digits. All subtests and
4
composites (Phonological Awareness, Phonological Memory, and Rapid
Naming) are reported in scaled scores, standard scores, and percentiles.

Self Assessment Questions

1) Describe Behaviour Rating Inventory of Executive Function (BRIEF).

2) How does Behaviour Rating Inventory of Executive Function-Preschool

Version (BRlEF-P) differ from BRIEF?

3) Describe the Comprehensive Test of Nonverbal Intelligence (CTONI).

4) Explain the Comprehensive Test of Phonological Processes (CTOPP).

4.5.5 Das Naglieri Cognitive Assessment System (CAS)

The Das Naglieri Cognitive Assessment System (CAS: Naglieri& Das, 1997) is
an individuallyadministered measure of cognitive ability designed to assess Planning, 65
Tests of Cognitive Attention, and Simultaneous and Successive (PASS) processes in individuals 5
Functions years to 24 years-ll months old. Planning tasks require the test taker to develop
an approach to solving a task in an efficient and effective manner. Attention tasks
require the individual to selectively attend to one and ignore the other aspect of
a two-dimensional stimulus. Simultaneous tasks require the individual to interrelate
the component parts of a particular item to arrive at the correct answer. Finally,
successi ve tasks require the individual to either reproduce a particular sequence
of events or answer questions that require correct interpretation of the linearity of
events.

There are 8 subtests in the Basic Battery and 12 subtests in the Standard Battery.
The CAS may be used for diagnosis, eligibility, determination of discrepancies,
reevaluation, and instructional planning.

4.5.6 Detroit Tests of Learning Aptitude-Fourth Edition

(DTLA-4)
The Detroit Tests of Learning Aptitude-Fourth Edition (DTLA-4; Harnmill, 1998)
is an individually administered measure of mental ability for individuals 6 to 17
years of age. It includes la subtests that may be combined to form 16 composites
measuring both general intelligence and discrete ability areas. This test not only
measures basic abilities but also shows the effects of language, attention, and
motor abilities on test performance.

The DTLA-4 yields an Overall Composite comprised of standard scores of all

10 subtests in the battery. This composite is probably the best estimate of general
intelligence. The Optimal Level Composite includes the four highest standard
scores on the subtests and is the best estimate of a person's overall "potential."
The Domain Composites are contrasting composites provided for three domains:
language, attention, and manual dexterity. DTLA 4 includes the following: Verbal
Composite, Nonverbal Composite, Attention-Enhanced Composite, Attention-
Reduced Composite, Motor-Enhanced Composite, and Motor-Reduced
Composite.

4.5.7 Differential Ability Scales-Second Edition (DAS-II)

The Differential Ability Scales-Second Edition (DAS-II; Elliott, 2007) is an
individually administered norm-referenced battery of cognitive subtests for children
and adolescents ages 2-6 through 17-11. Although most cognitive measures are
truly language-free, the DAS-II controls for language loading by providing a
special Nonverbal Index, and can be used easily with very young children and
English Language Learners. It consists of two overlapping batteries, the Early
Years Battery and the School-Age Battery. Several subtests within each battery
can be used out of level for individuals working above or below typical levels by
age.

The DAS-II yields (a) a composite score focused on reasoning and conceptual
abilities, the General Conceptual Ability (GCA) score; (b) lower-level composite
scores called cluster scores; and (c) diverse, specific-ability measures, including
the core subtests, which comprise the GCA and diagnostic subtests. Verbal Ability
measures the child's acquired verbal concepts and knowledge. Nonverbal Ability
represents complex, nonverbal, inductive reasoning requiring mental processing.
Spatial Ability measures complex visual processing. Diagnostic Clusters include
Working Memory, Processing Speed, and School Readiness. The DAS-H yields
t-scores for sub-tests and standard scores and percentiles for cluster and index
66 scores and the GCA.
 4.5.8 Kaufman Assessment Battery for Children-Second Utility of Data from the
Test of Cognitive
Edition (KABC- 11) Functions

The Kaufman Assessment Battery for Children-Second Edition (KABC-II;

Kaufman & Kaufman, 2004) is an individually administered measure of the
cognitive processing abilities of children and adolescents aged 3 through 18.
The KABC-II is a theory-based clinical instrument that contributes to culturally
fair assessment. The KABC-II offers two global summaries: the Fluid-
Crystallized Index (FCI), which includes all five scales, and the Mental
Processing Index (MPI) , which includes the first four scales but not the
Knowledge/Crystallized Ability Scale. The test manual states: "Measures of
Gc (general cognition) should be excluded from any score that purports to
measure a person's intelligence or overall cognitive ability whenever the
measure of Gc is not likely to reflect that person's level of ability."

The KABC-II offers a Nonverbal Scale (NVI) , which yields a nonverbal

index to assess the processing and cognitive abilities of children with whom
a nonverbal measure of cognitive ability is appropriate. The Sequential
Processing/Short -Term Memory Scale is designed to measure the ability to
solve problems by remembering and using an ordered series of images or
ideas. The SimultaneousNisual Processing Scale measures the ability to solve
spatial, analogical, or organisational problems that require the processing of many
stimuli at one time. The Learning AbilitylLong- Term Storage and Retrieval Scale
measures the ability to successfully complete different types of learning tasks.
Immediate. recall and delayed recall tasks are included in this scale. The Planning!
Fluid Reasoning Scale measures the ability to solve nonverbal problems that are
different from the kinds taught in school. Verbally mediated reasoning must be
used to solve the problems. The Knowledge/Crystallized Ability Scale measures
knowledge of words and facts using both verbal and pictorial stimuli and requiring
either a verbal or pointing response.

Self Assessment Questions

1) Give a description of Das Naglieri Cognitive Assessment System (CAS).

2) What is the role of Detroit Tests of Learning Aptitude-Fourth Edition

(DTLA-4).

3) What are the characteristic features of Differential Ability Scales-Second

Edition (DAS-II).
N
't""
I

W
U
e,
:E

67
Tests of Cognitive
4) Discuss Kaufman Assessment Battery for Children-Second Edition
Functions
(KABC-U)

4.5.9 Leiter International Performance Scale-Revised

(Leiter-R)
The Leiter International Performance Scale-Revised (Leiter-R; Roid& Miller, 1998)
is a standardized, individually administered, nonverbal test designed to assess
cognitive functions in children and adolescents ages 2-0 to 20-11 years. The
Leiter-R includes two groupings of subtests: the Visualization and Reasoning Battery
with 10 subtests of nonverbal intellectual ability related to visualization, reasoning,
and spatial ability; and the Attention and Memory Battery with 10 subtests of
nonverbal attention and memory function.

The Fluid Reasoning composite is comprised of subtests that show evidence of

providing a unique fluid measure of seriation, reasoning, and pattern generation.
The Full IQ score represents a measure of general nonverbal intelligence. The IQ
is the sum of the subtests that compose the IQ estimate, and the subtests represented
vary depending on the age of the student. The IQ score includes diverse aspects
of cognition and is comprised of highly correlated subtests to obtain a single
measure of intellectual ability.

4.5.10 NEPSY, Second Edition (NEPSY-II)

The NEPSY-U (Korkm.in, Kirk, & Kemp, 2007) is a comprehensive instrument
designed to assess neuropsychological development in preschool and school-age
children from 3 years to 16 years, 11 months. It has a strong theoretical foundation
that emphasises the interrelatedness of brain operations. The full assessment
evaluates six domains, including Executive Function and Attention, Language,
Memory and Learning, Sensorimotor, Visuospatial Processing, and Social
Perception. The Social Perception domain has been added to the original NEPSY.
It includes Affect Recognition and Theory of Mind, which would be beneficial
particularly for children with possible autism. Performance is reported in standard
(scaled) scores, process scores, and percentiles. Behavioural observations are
presented as cumulative percentages or base rates.

4.5.11 Stanford-Binet Intelligence Scales-Fifth Edition (SB5)

The Stanford-Binet-Fifth Edition (SB5; Roid, 2003) provides comprehensive
coverage of five factors of cognitive ability:Fluid Reasoning, QuantitativeReasoning,
Visual-Spatial Reasoning, Working Memory, and Knowledge. The SB5 scoring
provides a Full Scale IQ score, a Nonverbal IQ score, and a Verbal IQ score,
which are reported in standard scores and percentiles and can be used to assess
individuals from 2 years of age through 85 years. The SB5 Nonverbal IQ (NVIQ)
is based on the nonverbal subtests of the five-factor index scales. It measures
skills in solving abstract, picture-oriented problems; recalling facts and figures;
solving quantitative problems shown in picture form; assembling designs; and
68
recalling tapping sequences. The NVIQ measures the general ability to reason, Utility of Data from the
Test of Cognitive
solve problems, visualize, and recall information presented in pictorial, figural, and Functions
symbolic form, as opposed to information presented in the form of words and
sentences.

The SB5 Verbal IQ (VIQ) provides a composite of all the cognitive skills required
to solve the items in the five verbal subtests. The VIQ measures general ability
to reason, solve problems, visualize, and recall important information presented in
words and sentences (printed and spoken). In addition, it reflects the examinee's
ability to explain verbal response clearly, present rationale for response choices,
create stories, and explain spatial directions. General verbal ability, measured by
VIQ, is one of the most powerful predictors. of academic success in classrooms,
because of the heavy reliance on language, reading, and writing.

Fluid Reasoning is the ability to solve verbal and nonverbal problems using inductive
or deductive reasoning. Quantitative Reasoning is an individual's facility with
numbers and numerical problem solving, whether word problems or picture
relationships. Activities in the SB5 emphasise applied problem solving more than
specific mathematical knowledge acquired through school learning. Visual-Spatial
Processing measures an individual's ability to see patterns and relationships.Working
Memory is a class of memory processes in which diverse information stored in
short-term memory is inspected, sorted, or transformed. Knowledge is a person's
accumulated fund of general information acquired at home, school, or work. Also
called crystallized ability, it involves learned material such as vocabulary that has
been acquired and stored in long-term memory. Verbal knowledge subtests fall
under the narrow abilities of Lexical Knowledge and General Knowledge.

4.5.12 Universal Nonverbal Intelligence Test (UNIT)

The Universal Nonverbal Intelligence Test (UNIT; Bracken & McCallum, 1998)
is a set ofindividually administered tasks that measure the general intelligence and
cognitive abilities of children and adolescents from ages 5 through 17 years who
may be disadvantaged by traditional verbal and language-loaded measures. As
such, the UNIT provides a comprehensive assessment of general intelligence.

The UNIT offers three administration options: abbreviated battery (2 subtests),

standard battery (4 subtests), and extended battery (6 subtests). The Nonverbal
Intelligence Quotient (NIQ) is, in most instances, the best index for measuring the
ability to solve problems, or to reason, not requiring words. The Nonverbal
Quotient (NIQ) measures three cognitive abilities (analogical reasoning, categorical
classifying, and sequential reasoning), all assessed in two contexts (pictorial objects
and geometric designs). The Memory Quotient is an index of attending, organising,
encoding, storing, and recalling information and experiences. The Reasoning
Quotient provides a measurement of thinking skills, including the ability to use
information to solve problems. The Symbolic Quotient measures symbolic
processing or mediation. Symbolic mediation represents the verbal component of
a nonverbal task. The Nonsymbolic Quotient measures abilities of perception,
recognition, sequencing, organisation, and integration. These skills encompass all
aspects of cognition including reasoning and memory. Subtest scores are reported
in standard scores and percentiles.
69
Tests of Cognitive
Self Assessment Questions
Functions
1) Describe Leiter International Performance Scale-Revised (Leiter-R).

2) In what ways the NEPSY, Second Edition (NEPSY-II) cab used?

3) Describe states the functions of Stanford-Binet Intelligence Scales-Fifth

Edition (SB5).

4) What is Universal Nonverbal Intelligence Test (UNIT)? Describe the test.

4.5.13 Wechsler Abbreviated Scale of Intelligence (WASI)

The Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 1999) is an
individuallyadministered, brief intelligence scale consisting of either two or four
subtests designed to be used with individuals age 6 to 89. Subtests (from the
WISe-IV and WAIS-III) are Vocabulary, Block Design, Similarities, and Matrix
Reasoning. Subtest raw scores are converted to t-scores (mean of 50 and a
standard deviation of 10). If two subtests are given, a Full Scale IQ (reported as
a standard score) can be derived. If four subtests are given, a Verbal IQ,
Performance IQ, and Full Scale IQ can be derived. The manual states that, "The
WASI is appropriate for screening, estimating IQ when a full evaluation is not
possible, reevaluations when time is limited, research estimates of IQ, and other
situations when a more comprehensive evaluation is not needed or not possible."

70
4.5.14 Wechsler Adult Intelligence Scale-Third Edition Utility of Data from the
Test of Cognitive
(WAIS-III) Functions

The Wechsler Adult Intelligence Scale-Third Revision (WAIS-ill; Wechsler, 1997)

is an individually administered, standardized test designed to measure general
intelligence, or the overall ability of the individual "to act purposefully, to think
rationally and to deal effectively with his environment" (Wechsler, 1999, p. 3).
The WAIS-ill covers an age range from 16 to 89 years. It contains 14 subtests,
each yielding scaled scores with a mean of 10 and a standard deviation of 3.
From these subtest scores, the WAIS-III provides three separate intelligence
quotients (lQs): a Verbal Scale IQ, a Performance Scale IQ, and a Full Scale IQ.
Alternately, it may be scored using the Full Scale IQ and the four Index Scores
model used with the WISC- IV (Verbal Comprehension Index, Perceptual
Organisation Index, Working Memory Index, and Processing Speed Index).

4.5.15 Wechsler Intelligence Scale for Children-Fourth

Edition (WISC-IV)
The WechslerIntelligence Scale for Children-Fourth Edition (WISC-IV; Wechsler,
2(03) provides a measure of general intellectual functioning (Full Scale Intelligence
Quotient [FSIQ]) and four index scores. It can be used to assess individuals
between the ages of 6 and 16 years, 11 months. Its framework is based on theory
and supported by clinical research and factor-analytic results. The four index
scores are the Verbal Comprehension Index (VCI), the Perceptual Reasoning
Index (Piu), the Working Memory Index (WMI) , and the Processing Speed
Index (PSI). The WISC-IV consists of 10 core subtests and five supplemental
subtests. The VCI is composed of subtests measuring verbal abilities utilising
reasoning, comprehension, and conceptualisation. The PR! is composed of subtests
measuring perceptual reasoning and organisation. The WMI is composed of subtests
measuring attention, concentration, and working memory. The PSI is composed
of subtests measuring the speed of mental and grapho motor processing.

4.5.16 Wechsler Intelligence Scale for Children-Fourth

Edition Integrated (WISC-IV Integrated)
The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV Integrated;
Kaplan, Fein, Kramer, Delis, & Morris, 2004) enhances the WISC-IV by
adding 16 process sub-tests, as well as qualitative and quantitative observations
and error scores. The addition of more measures of cognitive processes allows
for a broader definition of intelligence for individuals aged 6 years through 16-11.
All or selected process subtests may be used when a low scaled score is obtained
on a corresponding subtest or when a child displays inconsistent or atypical
performance. Results may be used to investigate low scores and identify strengths
and weaknesses in the corresponding areas.

To supplement the Verbal domain (VCI on WISC-IV), subtests include

(a) Similarities Multiple Choice, (b) Vocabulary Multiple Choice, (c) Picture
Vocabulary Multiple Choice, (d) Comprehension Multiple Choice, and
(e) Information Multiple Choice. To supplement the Performance domain (PR!
on WISC IV), subtests include (a) Block Design Multiple Choice, (b) Block
Design Process Approach, and (c) Elithorn Mazes. The six process subtests that
71
Tests of Cognitive enhance the Working Memory domain (WMI on WISC IV) include (a) Visual
Functions Digit Span, (b) Spatial Span, (c) Letter Span, (d) Letter-Number Sequencing
Process Approach, and (e) Elithom Mazes. Finally, process subtests used to
enhance the Processing Speed (PSI on WISC-IV) include Coding Recall and
Coding Copy.

4.5.17 Wechsler Nonverbal Scale of Ability (WNV)

The Wechsler Nonverbal Scale of Ability (WNV; Wechsler &Naglieri, 2006) is
an individually administered test of nonverbal intelligence for individuals from ages
4 through 21 years. When language poses a barrier to typical administration, or
.if traditional intellectual assessment results are questionable due to language-related
difficulties, the WNV is appropriate.

The WNV uses subtests to determine a full-scale measure of cognitive ability. The
subtests yield a raw score that is converted to a t-score, allowing a student's
performance to be compared to that of his peers. T-scores have a mean of 50
and a standard deviation of 10. The t-scores of the subtests are totaled and
converted to a full-scale score that is a standard score, with a mean of 100 and
a standard deviation of 15. The subtests consist of (a) Matrices, (b) Coding, (c)
Spatial Span (a visual memory measure corresponding to the auditory task in
Digit Span), (d) Spatial Span Forward, (e) Spatial Span Backwards, (f) Picture
Arrangement, (g) Object Assembly, and (h) Recognition.

4.5.18 Wechsler Preschool and Primary Scale of

Intelligence-Third Edition (WPPSI-Ill)
The Wechsler Preschool and Primary Scale of Intelligence-Third Edition ewwpSI-
ill; Wechsler, 2002) is an individually administered, standardized instrument for
assessing the intelligence of children aged 2-6 through 7-3. It includes short,
game-like tasks that engage young children. The WPPSI-ill provides a Full Scale
IQ (FSIQ), Verbal IQ (VIQ), and Performance IQ (PIQ) for ages 2-6 through
3-11 using four subtests. For ages 4-0 through 7-3, seven subtests are used to
yield a FSIQ, VIQ, and PIQ. Optional subtests may be given to obtain a General
Language Composite for younger children or a Processing Speed Quotient for
older children.

Self Assessment Questions

1) Describe Wechsler Abbreviated Scale of Intelligence (WASI).

2) How does the Wechsler Adult Intelligence Scale-Third Edition (WAIS-ill)

differ from the abbreviated scale?

72
 Utility of Data from the
3) Explain the test items in the Wechsler Intelligence Scale for Children-
Test of Cognitive
Fourth Edition (WISC-IV). Functions

4) How is the Wechsler Intelligence Scale for Children-Fourth Edition

Integrated (WISC-IV Integrated) differing from the IV edition ofWISC?

5) Describe Wechsler Nonverbal Scale of Ability (WNV).

6) . Explain theWechsler Preschool and Primary Scale of Intelligence- Third

Edition (WPPSI-III).

4.5.19 Wide Range "Assessment of Memory and

Learning-Second Edition (WRAML-2)
The Wide Range Assessment of Memory and Learning-Second Edition (WRAML-
2; Sheslow& Adams, 2004) is an individually administered measure of memory
functions that may have a significantimpact on learning and school-relatedproblems.
The WRAML-2 may be used with individuals from age 5 through 90. It provides
a General Memory Index, three additional index scores (Verbal Memory, Visual
Memory, and Attention and Concentration), and three supplemental index scores
(Working Memory, Delayed Memory, and Recognition). Each index score is
derived from performance on from two to four subtests, and all are reported in
standard scores and percentile ranks. Standard scores have a mean of 100 and
a standard deviation of 15.

4.5.20 Woodcock-Johnson Tests of Cognitive Abilities-Third

Edition/Normative Update (WJ-III COGINU)
The Woodcock-Johnson III Tests of Cognitive Abilities (Wl-III COGINU;
Woodcock, McGrew, & Mather, 2005) is a comprehensive set of individually
administered co-normed tests for measuring cognitive ability. The tests may
be used from ages 2 through adult. The battery assesses general intellectual
ability as well as specific cognitive abilities. Twenty individual tests and 20
Cluster scores provide broad estimates of cognitive abilities.
73
Tests of Cognitive The Verbal Ability Cluster Score is a measure of language development that
Functions includes the comprehension of individual words and the comprehension of
relationships among words. The Thinking Ability Cluster Score represents a
sampling of the thinking processes that may be invoked when information in short-
term memory cannot be processed automatically. The scale includes samples of
long-term retrieval, visual-spatial thinking, auditory processing, and fluid reasoning.
The Cognitive Efficiency Cluster is derived from a sampling of two factors of
automatic cognitive processing, processing speed, and short-term memory.

4.6 LET US SUM UP

Tests of cognitive ability are use to answer a wide variety of important clinical
questions. In addition to identifying over all intellectual skills and cognitive strengths
and weaknesses, these tests are frequently employed to assess the presence of
learning disabilities, predict academic success in school, examine brain dysfunction,
and assess personality. Any competent psychologist must be cautious in the use
of intellectual, neuropsychological, achievement, and all other forms of cognitive
testing. Professionals must be aware of the limitations of the testing situation and
the limitations of the particular test they have chosen. They must be careful to use
tests for the purpose for which the test was developed and researched and in
conjunction with other appropriate tests. They must also be able to understand
the results in terms of the context of the individual's testing response style and the
bio psychosocial influences that might affect particular scores. For instance, scores
may not accurately reflect potential if a child is distracted due tosevere stress or
family conflict, chronic illness; compromised by poor nutrition; or disadvantaged
due to poverty or frequent school disruption. In fact, some research as indicated
that stress level and coping abilities are significantly associated with performance
on intelligence and other tests of cognitive abilities.

4.7 UNIT END QUESTIONS

1) True and False Q!lestions

i) Cognitive testing is a general term referring to the

assessment of a wide range of information processing
or thinking skills and behaviours. (TruelFalse)

ii) IQ tests are excellent predictors of academic achievement,

occupational performance and are sensitive to the
presence of neuropsychological deficit. (TruelFalse)

iii) When children are evaluated, clinicians attempt to

infer change from pre morbid abilities. (TruelFalse)

iv) One of the most useful applications of neuropsychological assessment

is to track improvements and decrements in performance over time.
(TruelFalse)

v) Quantitative Reasoning is the ability to solve verbal

and nonverbal problems using inductive or deductive
reasomng. (TruelFalse)

vi) The Leiter International Performance Scale-Revised is a

verbal test designed to assess cognitive functions in
74
children and adolescents ages 2-0 to 20-11 years. (TruelFalse)
 Utility of Data from the
2) Discuss the clinical use of intelligence tests? Test of Cognitive
Functions

3) Discuss in detail the uses of neuropsychological tests?

4) Provide an overview of various instruments to assess cognitive functions?

5) Describe the test Wide Range Assessment of Memory and Learning-Second

Edition (WRAML-2)

•••• i ••••.•..••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

\ 6) How are the Woodcock-Johnson Tests of Cognitive Abilities-Third Edition!

Normative update (Wl-Ill COGINU) useful?

4.8 SUGGESTED READINGS

Groth-Marnat, Gary. (2003). Handbook of Psychological Assessment (4thed.).
New Jersey: John Wiley & Sons, Inc.

Murphy, K.R., Davidshofer, e.O. (2005). Psychological Testing: Principles

and Applications (6thed.). New Jersey: Pears on Education International.

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Baddeley, A.D., Wilson, B.A. & Watts, F.N. (1995). Handbook of Memory
Disorders. Chichester: Wiley.

Binet, A. & Henri, V. (1895). La psychologieindividuelle.

L'AnneePsychologique, 2, 411-465.
75
Tests of Cognitive Boume. L.E. Jr. (1966). Human conceptual behavior. Boston: Allyn& Bacon.
Functions
Bracken, B. A, & McCallum, R S. (1998). Universal Nonverbal Intelligence
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Craik, F.LM., Anderson, N.D., Kerr, S.A & Li, K (1995). Memory 'changes
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Crarnrnond, Bonnie (1994). The Torrance tests of creative thinking: from

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Das, lP., Naglieri, J.A & Kirby, J.R (1994). Assessment of Cognitive
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Davis, GA (1975). In frumious pursuit of the creative person. Journal of

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Elliott, C. D. (2007). Differential Ability Scales, Second Edition. San Antonio,

TX: Psychological Corporation.

Elliott, C.D. (1990). Differential Ability Scales (DAS) Administration and

Scoring Manual. San Antonio, TX: Psychological Corporation.

Galton, Francis (1869). Hereditary Genius: An Inquiry into its Laws and
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Gazzaniga, M.S. (1995). The Cognitive Neurosciences. Cambridge, MA:

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Gioia, G A, Isquith, P. K, Guy,' S. c., &Kenworthy, L. (2000). Behavior

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Graf, P. &Schacter, D.L. (1985). Implicit and explicit memory for new
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Grant, D.A., & Berg, E.A. (1948). A behavioral analysis of the degree of
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Guilford, J.P. (1967). The Nature of Human Intelligence. New York: McGraw-
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Guy, S. e., Isquith, P. K., &Gioia, G A. (2005). Behavior Rating Inventory

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81
NOTES
 ~-""lignOU GROUP A
~ THE PEOPLE'S
~ UNIVERSITY MPCE·012
Indira Gandhi
National Open University Psychodiagnostics
School of Social Sciences

Block

4
PROJECTIVE TECHNIQUES IN
PSYCHODIAGNOSTICS
UNIT 1
Introduction to Projective Techniques and
Neuropsychological Test 5

UNIT 2
Principles of Measurement and Projective
Techniques, Current Status with Special
Reference to the Rorschach Test 19
UNIT 3
The Thematic Apperception Test and Children's
Apperception Test 35
UNIT 4
Personality Inventories 51

:"l
...-
I

W
U
0..
::
 Expert Committee
Prof. A. V. S. Madnawat Dr. Madhu Jain Dr. Vijay Kumar Bharadwas
Professor & HOD Department Reader, Psychology Director
of Psychology, University of Department of Psychology Acadernie Psychologie, Jaipur
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Associate' Professor, Psychology Lecturer, G D. Government Psychology, Calcutta University
University of Rajasthan, Jaipur Girls College, Alwar, Rajasthan Kolkata
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Associate Professor Professor and Head of Assistant Professor
Department of Applied Psychology Department Department of Psychology
Calcutta University, Kolkata of Psychology Punjabi University, Patiala
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Professor and Head of the Prof. Varsha Sane Godbole Senior Lecturer
Department of Psychology Professor and Head of Bombay University, Mumbai
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Humanities and Social Sciences Associate Professor and Incharge Educational Studies, Jawaharlal
Indian Institute of Technology Department of Applied Nehru University, New Delhi
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Road. New Delhi
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Professor and Head of
• Professor and Head Department
of Psychology -Prof. Manas K. Mandal
Department of Psychology
Lady Sri Ram College,
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Professor, Tata Institute of Department of Psychology (Rtd.)
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Lecturer, Department of Varanasi
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' .
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BLOCK 4 INTRODUCTION
Projective methods of personality assessment provide the clinician with a window
through which to understand an individual by the analysis of responses to ambiguous
or vague stimuli. These methods are generally unstructured and also call on the
indiv~a.ualto create the data from his or her personal experience.

An iri~vidual's response(s) to these stimuli can reflect internal needs, emotions,

past e~:p~riences, thought processes, relational patterns, and various aspects of
behavlour, Moreover, projective methods involve the presentation of a stimulus
designed to evoke highly individualised meaning and organisation. It will suffice to
say th~,twhile the instruments may differ, the results of these methods provide
readyaccess to a variety of rich conscious and unconscious material.

Unit 1 first deals with what projective testing is. Here the categories and
assumptions of projective tests are discussed. The main projective tests used to
assess personality are described. Next some of the core concepts of the discipline
of neuropsychological assessment are explained. In this unit we will briefly review
the major testing approaches used in contemporary neuropsychology practice.

In U~~;2 the measurement principles or psychometric properties of projective

tests w~re discussed and a brief discussion of Rorschach along with its psychometric
prope~~es and current status was explained.

Unit 3deflis with Thematic Apperception Test. The description, administration,

scoringand psychometric properties of TAT and CAT were explained briefly.

In Uriif.4 we have looked at a variety of measures of personality. Most have been

personality inventories, made up of a number of scales that are widely used and
commercially available.

1
UNIT 1 INTRODUCTION TO
PROJECTIVE TECHNIQUES AND
NEUROPSYCHOLOGICAL TEST
Structure
1.0 Introduction

1.1 Objectives

1.2 Projective Techniques

1.2.1 Important Projeactive Techniques

1.3 Categories of Projective Techniques

1.4 Basic Assumptions

1.5 Projective Testing

1.5.1 The Rorschach Test
1.5.2 The Thematic Apperception Test (TAT)
1.5.3 Projective Drawings
1.5.4 Sentence Completion Techniques

1.6 Merits of Projective Tests

1.7 Neuropsychological Assessment

1.8 Purposes of Neuropsychological Assessment

1.9 Dimensions and Level of Assessment

1.10 Neuropsychological Testing

1.11 Limitations

1.12 Let Us Sum Up

1.13 Unit End Questions

1.14 Suggested Readings

1.0 INTRODUCTION
In this unit, we willfirst consider what projective testing is. Then we will discuss
the categories and assumptions of projective tests. The main projective tests used
to assess personality are described. Next we will explain some of the core
concepts of the discipline of neuropsychological assessment. In this unit we will
briefly review the major testing approaches used in contemporary neuropsychology
practice.

1.1 OBJECTIVES
After completing this unit, you will be able to: 5
Projective Techniques in • Provide the definition and characteristics of projective techniques;
Psychodiagnostics
• Discuss the categories and basic assumptions of projective techniques;
<,

• Describe the different types of projective tests used;

• Explain what neuropsychological assessment is;

• Discuss the purposes and dimensions of neuropsychological assessment; and

• Discuss the most widely used neuropsychological tests.

1.2 PROJECTIVE TECHNIQUES

Projective Techniques are indirect and unstructured methods of investigation
which have been developed by the psychologists and use projection of respondents
for inferring about underline motives, urges or intentions which cannot be secure
through direct questioning as the respondent either resists to reveal them or is
unable to figure out himself. These techniques are useful in giving respondents
opportunities to express their attitudes without personal embarrassment. These
techniques helps the respondents to project his own attitude and feelings
unconsciously on the subject under study. Thus Projective Techniques play a
important role in motivational researches or in attitude surveys.

Projective technique is any personality test designed to yield information about

someone's personality on the basis of their unrestricted response to ambiguous
objects or situations .. Projective techniques are a set of instruments whose main
objective is to describe and characterise personality. The adjective projective is
a derivative of 'projection', a concept introduced by Freud in the vocabulary of
psychology to describe the design of a defense mechanism leading the subject to
transfer to another person, or thing, his urges, feelings, etc., that he cannot accept
as belonging to him. However, this concept is not commonly used in the field of
projective techniques. Rather, another concept with a less restrictive and specific
meaning is used. This means that, in responding to the stimulus situation, the
subject reveals or externalises aspects of his own personal life, such as motives,
interests, feelings, emotions, conflicts and the like.

To a large extent, the characteristics of the stimuli of the projectives are responsible
for this.externalisation and have an important effect on the nature and content of
the subject's responses. Two such characteristics are the structure and ambiguity
of stimuli. The structure refers to the degree of organisation of the stimulus:
incompleteness, nearly an organised whole or fully divided, close to or far from
being a real representation, etc. The ambiguity concerns the number and variability
of responses each stimulus elicits.

1.2.1 Important Projective Techniques

The following are some of the major projective techniques:

I) Word Association Test.

2) Completion Test.

3) Construction Techniques

4) Expression Techniques
6
1) Word Association Test: An individual is given a clue or hint and asked to Introduction to Projective
respond to the fIrst thing that comes to mind. The association can take the Techniques and
Neuropsychological Test
shape of a picture or a word. There can be lllany interpretations of the same
thing. A list of words is given and you don't know in which word they are
most interested. The interviewer records the responses which reveal the
inner feeling of the respondents. The frequency with which any word is given
a response and the amount of time that elapses before the response is given
. are important for the researcher. For example: Out of 50 respondents 20
people associate the word" Fair" with "Complexion".
2) Completion Test: In this the respondents are asked to complete an
incomplete sentence or story. The completion will reflect their attitude and
state of mind.
3) Construction Test: This is more or less like completion test. They can give
you a picture and you are asked to write a story about it. The initial structure
is limited and not detailed like the completion test. For eg: 2 cartoons are
given and a dialogue is to written.
4) Expression Techniques: In this the people are asked to express the feeling
or attitude of other people.
Disadvantages of Projective Techniques
1) Highly trained interviewers and skilled interpreters are needed.
2) Interpreters bias can be there.
3)' It is a costly method.
4) The respondent selected may not be representative of the entire population.

1.3 CATEGORIES OF PROJECTIVE

TECHNIQUES
For many years, the primary testing tools of clinical psychologists were projective
techniques such as the Rorschach Inkblot Technique. These techniques have in
common the presentation of ambiguous and malleable stimuli to which a large
number of different responses can be made. Presumably, the specific responses
given by a client reflect something about that individual's psychodynamic functioning.
Projective techniques no longer occupy the dominant position they did years ago,
but nevertheless continue to be used in clinical practice and research.
Most projective techniques fall into one of five categories, viz.,
i) Associative techniques: The subject responds to a particular stimulus, such
as an inkblot or a word, by indicating what the stimulus suggests. The
Rorschach Inkblot Technique is a prime example.
ii) Construction techniques: The subject constructs a response, usually in the
form of a story, to a stimulus, usually a picture. The prime example here is
the Thematic Apperception Test(TAT). /

iii) Ordering techniques: This involves placing a set of stimuli in a particular

order. Typically the stimuli are a set of pictures, very much like the panels
of a newspaper comic strip but the panels are presented in random order,
and they need to be placed in order to make a coherent sequence. The
Picture Arrangement subtest of the WAIS is sometimes used as an ordering
technique. 7
Projective Techniques in iv) Completion techniques: Here the subject responds to a "partial" stimulus.
Psychodiagnostics For example, the subject may be given the beginning of a story to complete
or a set of sentence stems (e.g., I am always ... ) to complete. Sentence
completion tests are a prime example here.

v) Expressive techniques: The subject engages in some "creative" activity, such

as drawing, finger painting, acting out certain feelings or situations (as in
psychodrama). The Draw-A-Person test is a good example.

1.4 BASIC ASSUMPTIONS

In general, psychologists believe that behaviour is determined or can be explained
by specific principles. If we observe a person verbally or physically attacking
others, we label the behaviours as aggressive and we seek explanations for the
behaviour, perhaps postulating ''frustration'' or looking for childhood developmental
explanations or antecedent conditions. With projective tests, the assumption is
that specific responses reflect the person's personalityand / or psychodynamic
functioning. This is based, however, on the questionable assumption that the test
protocol presents a sufficiently extensive sampling of the client.

Second, we know that specific behaviours can be strongly influenced by transitory

aspects. A person can do well academically in all courses except one, with
performance in that course influenced by a dislike for the instructor or some
other "chance" factor. Projective tests however, assume that each and every
response is indeed basic and reflective of some major personal themes.

The projective viewpoint further assumes that perception is an active and selective
process, and thus what is perceived is influenced not only by the person's current
needs and motivation, but by that person's unique history and the person's habitual
ways of dealing with the world. The more ambiguous a situation the more the
responses will reflect individual differences in attempting to structure and respond
to that situation. Thus, projective tests are seen as ideal miniature situations,
where presentation can be controlled and resulting responses carefully observed.

Self Assessment Questions

1) Define projective tests.

2) What are the characteristic features of a projective test?

8
 Introduction to Projective
3). What ar the five categories of projective tests? Techniques and
Neuropsychological Test

4) What are the basic assumptions underlying projective tests?

1.5 PROJECTIVE TESTING

Just as there are numerous objective personality and psychological functioning
instruments, there are many projective instruments. Most psychologists use a
small number of preferred projective tests-typically the Rorschach, the Thematic
Apperception Test (TAT), Projective Drawings, and Incomplete Sentences.

1.5.1 The Rorschach Test

The Rorschach Test is the famous inkblot test (Rorschach, 192111942, 1951).
Many people are fascinated by the idea of using inkblots to investigate personality
and psychological functioning, Of course, many people (including psychologists)
are skeptical of projective techniques such as the Rorschach, questioning its
validity as a measure of psychological functioning.

The Rorschach consists of 10 inkblots that are symmetrical; that is, the left side
of each card is essentially a mirror image of the right side. The same 10 inkblots
have been used (in the same order of presentation) since they were first developed
by Herman Rorschach in1921 (Rorschach, 192111942). Half of the cards are
black, white, and gray, and half use color. While there are several different ways
to administer the Rorschach and score, the vast majority of psychologists today
use the method developed by John Exner (Exner, 1974, 1976, 1986, 1993,
2003; Exner & Weiner, 1995). Each card is handed to the patient with the
question, "What might this be?" The psychologist writes down everything the
patient says verbatim. During this free association portion of the test, the
psychologist does not question the patient. After all 10 cards are administered; the
psychologist shows the patient each card a second time and asks questions that
will help in scoring he test. For exaniple, the psychologist might say, "Now I'd
like to show you the cards once again and ask you several questions about each
card so that I can be sure that I see it as you do."

With each card, he or she asks a non leading question such as, "What about the
card made it look like a to you ?"The psychologist looks for
answers that will help him or her score the test in several categories such as
location (i.e., the area of the blot being used), content (i.e., the nature of the
object being described, such as a person, animal, or element of nature), determinants 9
Projective Techniques in (i.e., the parts of the blot that the patient used in the response, such as form,
Psychodiagnostics colour, shading, and movement), and populars (i.e., the responses typically seen
by others). This portion of the test is referred to as the inquiry. Once the test is
completed, scoring involves a highly complex system and analysis. Each response
is carefully scored based on the content, location, determinants, and quality of the
response.

Various aspects of the Rorschach responses are associated with psychological

functioning. For example, the frequent use of shading is generally considered to
be reflective of anxiety and depression. The use of human movement and adequate
nuinber of popular responses are usually associated with adaptive and well-
integrated psychological functioning. Numerous responses that attend to minor
details of the blots often reflect obsessive compulsive traits. Frequent use of the
whitespace around the blot is generally associated with oppositionality and/or
avoidance.

1.5.2 The Thematic Apperception Test (TAT)

The TAT (Murray & Bellack, 1942; Tomkins, 1947) was developed during the
late 1930s by Henry Murray and Christiana Morgan at Harvard University, The
TAT was originally designed to measure personality factors in research settings.
Specifically, it was used to investigate goals, central conflicts, needs, press (i.e.,
factors that facilitate or impede progress towards reaching goals) and achievement
strivings associated with Henry Murray's theory of personology (Murray,1938).
The TAT consists of 31 pictures (one of which is blank), most all of which depict
people rather than objects. Some of the pictures are designed to he administered
to males, some to females, and others to both genders (Figure below). Generally
only a selected number of cards (e.g., 10) are administered to anyone patient.

Fig. 1.1: An example of a TAT card

The psychologist introduces the test by telling the patient that he or she will be
given a series of pictures and requested to tell a story about each. The patient is
instructed to make up a story that reflects what the people in the picture are
thinking, feeling, and doing and also to speculate on what led up to the events
depicted in the picture and what will happen in the future. After each card is
10
presented to the patient, the psychologist writes down everything that is said Introduction to Projective
verbatim. Techniques and
Neuropsychological Test
Although a variety of complex scoring approaches have been developed
(Murray,1943; Shneidman, 1951), most clinicians use their clinical experience and
judgment to analyse the themes that emerge from the patient's stories. Since
clinicians generally do not officially score the TAT,conducting reliability and validity
research is challenging.

Other tests similar to the TAT have been developed for special populations, such
as the Robert's Apperception Test for Children (RATC; McArthur & Roberts,
1982)·for use with elementary school children. The 27 pictures depict children
interacting with parents, teachers, and peers. The Children's Apperception Test
(CAT; Bellak, 1986) was developed for very young children and depicts animals
interacting in various ways.
,

1.5.3 Projective Drawings

Many clinician's ask both children and adults to draw pictures in order to assess
their psychological functioning. Typically, people are asked to draw a house, a
tree, a person, and their family doing something together. For the Draw a Person
test (Machover, 1949), the House Tree Person Technique (Buck, 1948), and the
Kinetic Family Drawing Technique, the patient is instructed to draw each picture
in pencil on a separate blank piece of paper and to avoid the use of stick figures.

On the assumption that a drawing tells us some thing about its creator, clinicians
often ask clients to draw human figures and talk about them. Evaluations of these
drawings are based on the details and shape of the drawing, solidity of the pencil
line, location of the drawing on the paper, size of the figures, features of the
figures, use of background, and comments made by the respondent during the .
drawing task. In the Draw a Person (DAP) Test, the most popular of the
drawing tests, subjects are first told to draw "a person," and then are instructed
to draw another person of the opposite sex.

1.5.4 Sentence Completion Techniques

Another projective technique involves the use of sentence completion. There are
many different versions of this technique (e.g., Forer,1957; P. A. Goldberg, 1965;
Lanyon & Lanyon,1980; Rotter, 1954; Rotter & Rafferty, 1950).The patient is
presented (either orally by the examiner or in writing through a questionnaire) a
series of sentence fragments. These might include items such as, "When he answered
the phone he " or "Most mothers are "
The patient is asked to give the first response that he or she thinks of and
complete the sentence. Again, like projective drawings and the TAT, several
scoring systems have been developed to assist in interpretation.

However, these scoring approaches are generally used only in research settings.
Most clinicians prefer to use their own experience and clinicaljudgment to interpret
the themes that emerge from the completed sentences.

1.6 MERITS OF PROJECTIVE TESTS

Until the1950s, projective tests were the most common technique for assessing
personality. In recent years, however, clinicians and researchers have relied on
them largely to gain "supplementary" insights. One reason for this shift is that 11
Projective Techniques in practitioners who follow the newer models have less use for the tests than
Psychodiagnostics psychodynamic clinicians do. Even more important, the tests have rarely
demonstrated much reliability or validity.

In reliability studies, different clinicians have tended to score the same person's
projective test quite differently. Standardized procedures for administering and
scoring the tests have been developed in order to improve scoring consistency,
but research suggests that the reliability of projective tests remains weak even
when such procedures are used (Wood et al., 2000; Lilienfeld et al., 2000).

Research has also challenged the validity of projective tests. When clinician's try
to describe a client's personality and feelings on the basis of responses to projective
tests, their conclusions often fail to match the self-report of the client, the view of
the psychotherapist, or the picture gathered from an extensive case history. Another
validity problem is that projective tests are sometimes biased against minority
ethnic groups. For example, people are supposed to identify with the characters
in the Thematic Apperception Test (TAT) when they make up stories about them,
yet no members of minority groups are in the TAT pictures. In response to this
problem, some clinicianshave developed other TATlike tests with African American,
Hispanic or Indian figures.

Self Assessment Questions

1) Projective techniques typically involve

a) a set of inkblots
b) an ambiguous set of stimuli
c) true-false statements

d) multiple choice items

2) The Rorschach Inkblot Technique is an example of a(n) technique.
a) associative
b) construction
c) ordering
d) completion
3) In presenting the Rorschach Inkblots to a client, the sequence of
presentation:
a) is always the same
b) is up to the administrator

c) changes with the client's gender

d) does not much matter
4) The TAT consists of
a) two sets of 45 inkblots
b) a series of stories chosen for their emotional impact
c) a series of pictures depicting the adventures of Blacky

d) a set of 31 pictures, most of which are ambiguous

12
 Introduction to Projective
5) The theory behind the TAT focuses on: Techniques and
Neuropsychological Test
a) achievement and failure

b) castration anxiety

c) needs and presses

d) self-esteem and competence

6) What are the merits of projective techniques?

a) When the Draw-A-Man is used as a measure of intelligence, using

modem scoring systemslike Naglieri's, the results indicate:

b) low but generally satisfactory reliability

,
c) higher reliability for each of the drawings than for total score

d) poor inter-rater reliability but acceptable test-retest

e) substantially high reliability with typical coefficients in the,low .90s

1.7 NEUROPSYCHOLOGICAL ASSESSMENT

Organic injury to the brain can have complex and interacting psychological effects,
not only at the level.of intellectual impairment but also at the levels of affective and
behavioural1disturbance. These sequel may be directly or indirectly caused by the
brain injury, and may vary in severity from those which are gross and obvious to
those which are subtle and detectable only on detailed assessment. Nevertheless,
even those which are subtle can have pervasive effects on a patient's social and
occupational functioning, whilst those which are gross may arise from a variety of
causes with different treatment implications. In either case, neuropsychological
assessment can be highly important to clarification of the problem, to prediction
of the functional consequences and to the development of appropriate interventions
or environmental adaptations.

To illustrate this, consider the case of a young man who has sustained a head
injury in an assault. A year after the incident he has made a good physical
recovery, but is very aggressive and has lost his job as a sales manager because
of hostility towards colleagues and a general lack of organisation in his work.
These problems might, on the one hand, arise from organic damage to regions of
the brain involved in the genesis or inhibition of aggression, or, on the other, be
a psychological reaction to some more subtle cognitive deficit such as a generalised
reduction in the efficiency with which information is processed or a mild but
specific impairment of memory. In the former case, a pharmacological treatment
to control the emotional reactions might be most appropriate, whilst in the latter
it would be more relevant to address the underlying cognitive deficit directly and!
or help the patient adjust his lifestyle and outlook to his new limitations.

1.8 PURPOSES OF NEUROPSYCHOLOGICAL

ASSESSMENT
The form taken by any neuropsychological assessment wills depend critically on
the question which is to be answered. Frequent purpose for assessment includes
13
the following:
Projective Techniques in • Description and measurement of organically based cognitive deficits.
Psychodiagnostics
• Differential diagnosis (e.g. to ascertain whether memory problems arise from
organic injury or mood disturbances).

• Prediction of the consequences of neurosurgical excision of brain tissue (e.g.

the cost-benefits likely to accrue from a temporal lobectomy).

• Monitoring improvement or deterioration associated with recovery from, or

exacerbation of, a neurological condition.

• Evaluation of the neuropsychological effects, positive or adverse, of

pharmacological and non-pharmacological treatments (e.g. to determine
whether a psychological intervention has improved attention, or whether an
anticonvulsant might impair learning).

• Guiding rehabilitation strategies.

I

• Predicting or explaining deficits in social, educational, or occupational

functioning.

• Medico-legal evaluations (e.g. contributing to determination of compensation

awards, ascertaining fitness to plead, etc.).

1.9 DIMENSIONS AND LEVEL OF ASSESSMENT

The extensiveness of, and methods employed within, any individual assessment
will be largely determined by the specific referral question, though a wide range
of other factors will also be influential. These will include characteristics of the
patient which affect his or her ability or willingness to carry out certain tests, as
well as resource based considerations, such as the location in which the assessment
is to take place, or the amount of time which is available.

A major element of many neuropsychological assessments is evaluation of the

patient's intellectual functioning, usually tested via formal pen and paper or
computerized test procedures. However, this is neither the only form of assessment
used nor necessarily the most important. If the presenting problem is one of
behavioural or emotional disturbance, assessment may concentrate on the
systematic collection of information either from the patient or from others concerning
factors which may influence its occurrence. Thus, although neuropsychological
assessment is often perceived as a special form of cognitive assessment, it is very
often much broader than this. In practice, a referral to a neuropsychologist will
often result in a multidimensional assessment in which the presenting problem is
analysed from a number of perspectives rather than just one. Sometimes there
may be no formal testing, if the pertinent information can be gleaned from systematic
behavioural observations and interviews.

At a general level, the purpose of neuropsychological assessment may be

categorized into those which are primarily descriptive and those which are
explanatory. The former represents an attempt to identify the type and severity of
any problems, while the latter entails more theoretically driven procedures designed
to illuminate the causes or consequences of an observed deficit. These two aspects
will be differentially important depending on the nature of the initial question. So,
if the purpose of the assessment is to quantify the extent of any memory deficits
(e.g. for the purposes of monitoring change over time, or for medica-legal purposes),
14 then a standardized measurement of different aspects of the patient's memory
 relative to their general intellectual level may suffice. By contrast, if the purpose Introduction to Projective
of the assessment is to determine why the patient has difficulty in remembering Techniques and
Neuropsychological Test
information in daily life and to make therapeutic recommendations, then more
detailed probing of potential causes for the memory problem become relevant.
For instance, it may be that the memory deficit is secondary to poor concentration
or impaired perception, or that it is related to the form in which the information
is presented (e.g. verbally vs. visually). If the assessment clarifies the mechanisms
underlying the patient's problems, then treatment can focus specifically on these.

Descriptive assessments will also vary in terms of their breadth, and this again is
likely to reflect the referral question. In one case the requirement may be to
determine whether a brain injury has resulted in any impairment, whilst in another
-the emphasis maybe particularly on a certain aspect of the patient's functioning.
The basis for focusing on one aspect more than on others may consist in
observations which have already been made (e.g. that the patient appears forgetful)
or on the basis of what is known about the etiology or location of the brain injury
(e.g. that there is' a focal lesion to a part of the brain which is implicated in
memory functions). The prediction of neuropsychological sequelae which are
likely to arise from damage to specified areas of the brain has become an increasingly
sophisticated exercise over the last decade with the emergence of complex
3 information processing models of cognitive function.

1.10 NEUROPSYCHOLOGICAL TESTING

Brain impairment due to head injury, substance abuse, stroke, or other illnesses
and injuries often impact the cognitive ability to use language, think and make
appropriate judgments, adequately perceive and respond to stimuli, and remember
old or new information. Neuropsychological testing assesses brain behaviour skills
such as intellectual, abstract reasoning, memory, visual-perceptual, attention,
concentration, gross and fine motor, and language functioning.

Neuropsychological tests include test batteries as well as individual tests. The

Halstead Reitan Battery (Boll, 1981; Halstead, 1947; Reitan& Davison, 1974)
and the Luria Nebraska Battery (Golden, Hammeke, & Purisch, 1980) are the
most commonly used test batteries with adults. The Halstead Reitan Battery can
be administered to persons aged 15through adulthood and consists of 12 separate
tests along with the administration of the MMPI-2 and the WAIS-III. The battery
takes approximately 6 to 8 hours to administer and provides an overall impairment
index as well as separate scores on each subtest assessing skill such as memory,
sensory-perceptual skills, and the ability to solve new learning problems. Other
versions of the test are available for children between ages Sand 14.

The Luria Nebraska, Battery consists of11 subtests for a total of 269 separate
testing tasks. The subtests assess reading, writing, receptive and expressive speech,
memory, arithmetic, and other skills. The Luria Nebraska battery takes about 2.5
hours to administer.

Another neuropsychological testing approach is represented by the Boston Process

Approach (Delis, Kaplan, & Kramer, 2001;Goodglass, 1986; E. Kaplan et al.,
1991; Milberg, Hebben, & Kaplan, 1986). The Boston process approach uses
a variety of different tests depending upon the nature of the referral question.
Rather than using a standard test battery, the Boston Process Approach uses a
subset of a wide variety of tests in order to answer specific neuropsychological 1~
questions. Performance on one test determines which tests or subtests, if any, will
Projective Techniques in be used next. The testing process could be short or long involving few or many
Psychodiagnostics tests and subtests depending upon what is needed to adequately evaluate strengths
and weaknesses in functioning. For example, if a neuropsychological evaluation of
a head injured patient was to focus on memory skills following a car accident,
several tests would be considered for use. These might include the Benton Visual
Retention Test, the Wechsler Memory Scale-Ill, and the Wisconsin Card Sorting
Test. Each of these tests measure a different facet of memory functioning. Results
provide a clearer picture of short and long term memory as well as visual,
auditory, and sensory memory. If, during testing, language problems were detected,
the receptive and expressive language sections of the Luria Nebraska might be
added to the battery to assess language skills. The language assessment might
help to better understand the relationship between memory and language skills in
this patient.

Some of the commonly used individual neuropsychological tests include the

Wechsler Memory Scale-Ill (Wechsler, 1997), the Benton Visual Retention Test
(Benton, 1991), the WAIS-R as a Neuropsychological Instrument(E. Kaplan et
al., 1991), the WISC-IIl as a Process Instrument (E. Kaplan et al., 1999),the
Kaufman Short Neuropsychological Assessment Procedure (K-SNAP; Kaufman
& Kaufman, 1994), the California Verbal Learning Test (Delis, Kramer, Kaplan,
&Ober,1987, 2000) and the California Verbal Learning Test Children's Version
(Delis, Kramer, Kaplan, & Ober, 1994), and the Wisconsin Card Sorting Test
(Grant & Berg, 1993).
The Delis Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer,
2(01) provides a comprehensive evaluation of executive functioning or high level
thinking and processing as well as cognitive flexibility. It can be administered to
both children and adults from ages 8 through 89. It assesses the integrity of the
frontal lobe area of the brain, and examines potential deficits in abstract and
creative thinking. The D-KEFS consists of9 subtests including the Sorting, Trail
Making, Verbal Fluency, Design Fluency, Color- Word Interference, Tower, 20
Questions, Word Context, and the Proverb tests. These tests measure various
aspects of cognitive functioning that reflect strengths and weaknesses associated
with brain behaviour relationships. Results from these tests are compared with
norms to develop a clearer understandingof the interactionbetween brain functioning
and behaviour, emotions, and thoughts as well as to help locate the site of brain
impairment

Some authors have suggested that physiological tests such as evoked potentials,
electroencephalography (EEG), and reaction time measures may be useful in the
assessment of intelligence and cognitive abilities (Matarazzo,1992; Reed & Jensen,
1991). Evoked potentials assess the brain's ability to process the perception of
a stimulus, and EEG measures electrical activityof the brain. Although psychologists
are currently not licensed to administer or interpret neuro imaging techniques such
as computerized axial tomography (CAT), magnetic resonance imaging (MRI),
and positron emission tomography (PET), these techniques allow examination of
brain structureand function, which is useful in assessingbrain behaviour relationships
such as cognitive abilities. For example, cortical atrophy, shrinkage, or actual loss
of brain tissue has been associated with schizophrenia,Alzheimer's disease, anorexia
nervosa, alcoholism, and mood disorders.
Contemporary neuropsychological testing integrates specialized tests along with
additional sources of information. The tests are often used in conjunction with
16 data obtained from clinical interviews, behavioural observations, and other cognitive,
 personality, and physiological assessment tools. Thus, neuropsychological testing Introduction to Projective' •
is not isolated from other evaluation techniques used by contemporary clinical Techniques and
Neuropsychological Test
psychologists. While neuropsychological assessment is a subspecialty of clinical
psychology, it overlaps with many of the skills and techniques of general clinical
psychologists. In addition to specialised testing, neuropsychologists must have a
high level of understanding of brain structure and functioning.

1.11 LIMITATIONS
Neuropsychological tests in general have a number of limitations. Prigatano and
Redner (1993) identify four major ones:

• Not all changes associated with brain injury are reflected in changed test
performance;

• Test findings do not automatically indicate the reason for the specific
perfonnance;,

• Neuropsychological test batteries are long to administer and therefore

expensive; and

• A patient's performance is influenced not just by brain dysfunction but also

by a variety of other variables such as age and education.

Self Assessment, Questions

1) The Halstead-Reitan battery takes about to administer.

a) 15 'minutes

b) two hours

c) five hours

d) eight hours

2) Most of the subtests used in the Halstead-Reitan

a) were developed specifically for this battery

•
b) were actually borrowed from other procedures

c) are very sound psychometrically

d) are easy to administer and score

3) The Luria-Nebraska Battery consists of subtests.

a) 11

b) 8

c) 10

d) 5
I

iJ 4) The Delis- Kaplan Executive Function System assesses the integrity of the-
)
I" -- area of the brain.

a) Temporallobe

b) Parietal lobe 17
Projective Techniques in c) Frontallobe
Psychodiagnostics
d) Occipital lobe

. 5) Physiological tests such as evoked potentials, electroencephalography

(EEG), and reaction time measures may be useful in the assessment of

a) personality

b) intelligence and cognitive abilities

c) motivation

d) stress

1.12 LET US SUM UP

Projective tests use ambiguous or unstructured testing stimuli. Subjects are asked
.to respond freely to the testing stimuli such as telling stories about pictures,
describing what they see in an inkblot, or saying the first thing that comes to their
mind when hearing a word or sentence fragment. The most common projective
tests used include the Rorschach, the TAT,Incomplete Sentences, and Drawings.

The neuropsychological approach relies on the use of tests in which poor

performance may indicate either focal (localised) or diffuse (widespread) brain
damage. Neuropsychological assessment serves several purposes. First, it can
give a 'neurocognitive' profile of an individual, identifying both strengths and
weaknesses. A second advantage is that repeated testing over time can give an
insight into changes in cognitive functioning that may relate either to recovery after
accident/injury or the progression of a neurological illness. Usually, a series of
tests (called a test battery) will be given. The most widely used batteries are the
Halstead Reitan and The Luria Nebraska test battery.

1.13 UNIT END QUESTIONS

1) What is projective testing and discuss the categories of projective tests?

2) Discuss in brief the major projective tests used in clinical psychology?

3) What is neuropsychological assessment?

4) Discuss the purpose and dimensions of neuropsychological assessment?

5) Briefly describe some of the widely used neuropsychological tests?

6) Why use batteries like the Halstead-Reitan when brain functioning can now
be assessed through a number of medical procedures?

1.14 SUGGESTED READINGS

Groth- Marnat, Gary. (2003). Handbook of Psychological Assessment (4thed.).
New Jersey: John Wiley & Sons, Inc.

Hebban, N., Milberg, W. (2002). Essentials of Neuropsychological Assessment.

New York: John Wiley & Sons, Inc.

18
UNIT 2 PRINCIPLES OF MEASUREMENT
AND PROJECTIVE TECHNIQUES,
CURRENT STATUS WITH
SPECIAL REFERENCE TO THE
RORSCHACH TEST
Structure
2.0 Introduction

2.1 Objectives

2.2 The Nature of Projective Tests

2.3 Clinical Usefulness

2.4 Measurement and Standardization

2.4.1 Standardization
2.4.2 Reliability
2.4.3 Validity

2.5 The Rorschach Test

2.5.1 Description
2.5.2 'Administration
2.5.3 Scoring

2.6 Reliability and Validity of Rorschach Scores

2.7 Rorschach Inkblot "Method"

2.8 Current and Future Status

2.9 Let Us Sum Up

2.10 Unit End Questions

2.11 Suggested Readings

2.0 INTRODUCTION
This unit deals with principles of measurement and projective techniques, current
status with special reference to the Rorschach Test. We being the unit with the
Nature of Projective Tests, followed by the clinical Usefulness of the Rorschach
Test. Then we take up the measurement and standardization of the Rorschach
Test and within which we discuss the standardization of the test, its reliability and
validity. Then we take up the Rorschach Test descriptuion under which we
present the description of the test, how to administer, score and interpret. Then
we discuss the reliability, validity of the Rorschach Test scores. Then we proceed
with the discussion of the Rorschach Inkblot method, its current and future status.

2.1 OBJECTIVES
After reading this unit, you should be able to:
19
Projective Techniques in • Describe and discuss the nature of projective tests;
Psychodiagnostics
• Discuss the measurement principles such as reliability,validity etc. of projective
tests;

• Provide the description, administration and scoring of Rorschach;

• Discuss the reliability and validity of Rorschach; and

• Discuss the current and future status of Rorschach.

2.2 THE NATURE OF PROJECTIVE TESTS

Projective techniques have a long and rich history. William Shakespeare wrote
about the projective qualities of clouds, and William Stem used clouds as test
stimuli before Rorschach and his inkblots. Sir Francis Galton (1879) suggested
word association methods and Kraepelin made use of them. Binet and Henri
(1896) experimented with pictures as projective devices. Alfred Adler asked
patients to recall their first memory, which is also a kind of projective approach.
However, the real impetus for projective techniques can be traced to Hermann
Rorschach's classic 1921 monograph, in which he described the use of inkblots
as a method for the differential diagnosis of psychopathology. Later in the 1920s,
. David Levy brought the inkblot test to America, and it was not long before Beck,
Klopfer, and Hertz all began teaching Rorschach courses. In 1935, Morgan and
Murray introduced the Thematic Apperception Test (TAT), and in 1938, Murray
carefully described the process of projection. The term projective really came
. into popular use following L. K. Frank's widely discussed 1939 paper on
projective methods.

For some, the definition of a projective test resides in Freudian notions regarding
the nature of ego defenses and unconscious processes. However, these do not
seemto be essential characteristics.

Over the years, many definitions have been offered. Perhaps the easiest solution
is a pragmatic one that comes from consulting the English and English (1958)
psychological dictionary, which defmes a projective technique as "a procedure for
discovering a person's characteristic modes of behaviour by observing his behaviour
in response to a situation that does not elicit or compel a particular response."
Projective techniques, taken as a whole, tend to have the following distinguishing
characteristics (Rotter, 1954):

1) In response to an unstructured or ambiguous stimulus, examinees areforced

to impose their own structure and, in so doing, reveal something of
themselves (such as needs, wishes, or conflicts).

2) The stimulus material is unstructured. This is a very tenuous criterion, even

though it is widely assumed to reflect the essence of projective techniques.
For example, if 70% of all examinees perceive Card V on the Rorschach as
a bat, then we can hardly say that the stimulus is unstructured. Thus, whether
a test is projective or not depends on the kinds of responses that the individual.
is encouraged to give and on how those responses are used. The instructions
are the important element. If a patient is asked to classify the people in a set
of TAT cards as men or women, then there is a great deal of structure, that
is the test is far from ambiguous. However, if the patient is asked what the
20
 people on the card are saying, the task has suddenly become quite ambiguous Principles of Measurement and
indeed. Projective Techniques, Current
Status with Special Reference to
3) The method is indirect. To some degree or other, examinees are not aware the Rorschach Test
of the purposes of the test; at least, the purposes are disguised. Although
patients may know that the test has something to do with adjustment-
maladjustment, they are not usually aware in detail of the significance of their
responses. There is no attempt to ask patients directly about their needs or
troubles; the route is indirect, and the hope is that this very indirectness will
make it more difficult for patients to censor the data they provide.

4) There is freedom of response. Whereas questionnaire methods may allow

only for a "yes" or a "no", response, projectives permit a nearly infinite
range of responses.

5) Response interpretation deals with more variables. Since the range of possible
responses is so broad, the clinician can make interpretations along multiple
dimensions (needs, adjustment, diagnostic category, ego defenses, and so
on). Many objective tests, in contrast, provide but a single score (such as
degree of psychological distress), or scores on a fixed number of dimensions
or scales.

2.3 CLINICAL USEFULNESS

_There is little doubt that in the hands of a skilled and sensitive clinician, projective
techniques can yield useful information and individual practitioners can utilise these
measures to elicit superb psychodynamic portraits of a patient, and to make
accurate predictions about future behaviour. Given this, why is there need for
scientific validation? MacFarlane and Tuddenham (1951) provided five basic
answers to this question:

1) A social responsibility
Projective tests are misused, and we need to know which types of statements can
be supported by the scientific literature and which cannot.

2) A professional responsibility
Errors of interpretation can be reduced and interpretive skills sharpened by having
objective validity data.

3) A teaching responsibility
If we cannot communicate the basis for making specific inferences, such as "this
type of response to card 6 on the Rorschach typically means that ... ," then we
cannot train future clinicians in these techniques.

4) Advancement of knowledge
Validity data can advance our understanding of personality functioning,
psychopathology, etc.

5) A challenge to research skills .

As scientists, we ought to be able to make explicit what clinicians use intuitively
and implicitly.
21
Projective Techniques in
Self Assessment Questions
Psychodiagnostics
1) Define projective tests.

2) What are the characteristics of projective techniques?

3) In what ways projective techniques are clinically useful?

4) Why is there a need for scientific validation of the projective techniques?

2.4 MEASUREMENT AND STANDARDIZATION

The contrasts between objective tests and projective tests are striking. The former,
by their very nature, lend themselves to an actuarial interpretive approach. Norms,
reliability, and even validity seem easier to manage. The projective tests, by their
very nature, seem to resist psychometric evaluation. Indeed, some clinicians reject
even the suggestion that a test such as the Rorschach should be subjected to the
indignities of psychometrics; they would see this as an assault upon their intuitive
art. In this section, we offer several general observations about the difficulties
involved in evaluating the psychometric properties of projective tests.

2.4.1 Standardization
Should projective techniques be standardized? There are surely many reasons for
doing so. Such standardization would facilitate communication and would also
serve as a check against the biases and the interpretive zeal of some clinicians.
Furthermore, the enthusiastic proponents of projective tests usually act as if they
22 have norms (implicit though these may be) so that there seems to be no good
reason not to attempt the standardization of those norms. Of course, research Principles of Measurement and
Projective Techniques, Current
problems with projective tests can be formidable. Status with Special Reference to
the Rorschach Test
The dissenters argue that interpretations from projective tests cannot be
standardized. Every person is unique, and any normative descriptions will inevitably
be misleading. There are so many interacting variables that standardized interpretive
approaches would surely destroy the holistic nature of projective tests. After all,
they say, interpretation is an art.

2.4.2 Reliability
Even the determination of reliability turns out not to be simple. For example, it is
surely too much to expect an individual to produce, word for word, exactly the
same TAT story on two different occasions. Yet how many differences between
two stories are permissible? Of course, one can bypass test responses altogether
and deal only with the reliability of the personality interpretationsmade by clinicians.
However, this may confound the reliability of the test with the reliability of the
judge. Also, test retest reliability may be affected by psychological changes in the
individual, particularly when dealing with patient populations.It is true that clinicians
can opt for establishing reliability through the use of alternate forms. However,
how do they decide that alternate forms for TAT cards or inkblots are equivalent?
Even split-half reliability is difficult to ascertain because of the difficulty of
demonstrating the equivalence of the two halves of each test.

2.4.3 Validity
Because projective tests have been used for such a multiplicity of purposes, there
is little point in asking general questions: Is the TAT valid? Is the Rorschach a
good personality test? The questions must be more specific:

Does the TAT predict aggression in situation A?

Does score X from the Rorschach correlate with clinical judgments of anxiety?

With these issues in mind, we turn now to a discussion of the Rorschach Test.

Self Assessment Questions

1) What is meant by standardization?

2) What is reliability of a test?

23
Projective Techniques in
Psychodiagnostics 3) What is validity of a test?

4) Why is measurement and standardization of tests important?

2.5 THE RORSCHACH TEST

The Rorschach is often mentioned in television shows or in films depicting
psychological evaluations. Curiously, the idea of seeing objects in inkblots came
from a common game in the 1800s called Blotto. Someone would put a drop of
ink on a blank piece of paper and fold the paper in half, creating a unique inkblot.
Others would then take turns identifying objects in the inkblots. Alfred Binet used
this technique to examine imagination among children. Swiss psychiatrist Hermann
Rorschach noticed that mental patients tended to respond very differently to this
game relative to others. Thus, Blotto became the basis for the Rorschach test.
Although the origins of the Rorschach Test lies in Europe, its subsequent
development and elaboration occurred in the United States (Exner, 1993).
Disenchantment with objective inventories probably facilitated this development
(Shneidman, 1965). However, the general rise of the psychodynamic,
psychoanalytic movement and the emigration of many of its adherents from Europe
to the United States in the 1930s were also important.
What has confused many and perhaps impeded efforts to demonstrate reliability
and validity is the fact that there are several different general Rorschach approaches.
For example, in the past, Klopfer, Beck, Hertz, Piotrowski, and Rapaport each
offered the scoring and the interpretation of Rorschach systems (Exner,1993).
The systems differ in the manner in which they administer, score, and interpret the
results of the test and in the instructions they provide to examinees. This has
created many problems in interpreting the results of research studies and in
generalising from one study to another. In addition, Exner and Exner (1972)
discovered that 22% of the clinicians they surveyed did not formally score the
Rorschach at all, and75% reported that when they did use a scoring system, it
was a highly idiosyncratic one. However, it is now virtually a requirement for
research publication that Rorschach protocols should be scored in a systematic
fashion and that adequate inter scorer agreement be demonstrated (Weiner,1991).
At a minimum, it is expected that the Rorschach responses should be scored
similarly by independent raters.

2.5.1 Description
The Rorschach consists of ten cards on which are printed inkblots that are
24
symmetrical from right to left. Five of the ten cards are black and white (with
 Principles of Measurement and
shades of gray), and the other five are colored. A simulated Rorschach card is Projective Techniques, Current
shown in Figure below. Status with Special Reference to
the Rorschach Test

Fig. 2.1 : An inkblot similar to those used in the Rorschach test

(Source: net)
2.5.2 Admi,itistration
There are various techniques for administering the Rorschach Test. However, for
many clinicians, the process goes something like this. The clinician hands the
patient the first card and 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."

All of the subsequent cards are administered in order. The clinician takes down
verbatim everything the patient says. Some clinicians also record the length of time
it takes the patient to make the first response to each card as well as the total
time spent on each card. Some patients produce many responses per card, and
others produce very few. The clinician also notes the position of the card as each
response is given (right side up, upside down, or sideways). All spontaneous
remarks or exclamations are also recorded.
Following this phase, the clinician moves to what is called the Inquiry. Here, the
patient is reminded of all previous responses, one by one, and asked what it was
that prompted each response. The patient is also asked to indicate for each card
the exact location of the various responses. This is also a time when the patient
may elaborate or clarify responses.

2.5.3 Scoring
Although Rorschach scoring techniques vary, most employ three major criteria.

i) Location refers to the area of the card, to which the patient responded.
The whole blot, a large detail, a small detail, white space, and so on.

ii) Content refers to the nature of the object seen (an animal, a person, a rock,
fog, clothing, etc.).
iii) Determinants refer to those aspects of the card that prompted the patient's
response (the form of the blot, its color, texture, apparent movement, shading, 25
etc.).
Projective Techniques in Some systems also score popular responses and original responses (often based
Psychodiagnostics on the relative frequency of certain responses in the general population). Currently,
Exner's Comprehensive System of scoring is the most frequently used (Exner,
1974, 1993). Although the specifics of this scoring system are beyond the scope
of this unit (a total of 54 indices are calculated in Exner's Structural Summary),
a number of resources are available that provide details on the Comprehensive
System (including Exner, 1991, 1993). The actual scoring of the Rorschach Test
involves such things as compiling the number of determinants, computing their
percentages based on the total number of responses, and computing the ratio of
one set of responses to another set (e.g., computing the total number of movement
responses divided by the number of color responses).
Indeed, the layperson is often surprised to learn that orthodox scoring of the
Rorschach Test is much more concerned with the formal determinants than with
the actual content of the responses. However, many contemporary cliniciansdo
not bother with formal scoring at all, preferring to rely on the informal notation of
determinants. Furthermore, these clinicians tend to make heavy use of content in
their interpretations.
As mentioned earlier, the Rorschach Test interpretation can be a complex process.
For example, a patient's over use of form may suggest conformity. Poor form,
coupled with unusual responses, may hint at psychosis. Color is said to relate to
emotionality, and if it is not accompanied by good form, it may often indicate
impulsivity. Extensive use of white spaces has been interpreted as indicative of
oppositional or even psychopathic qualities. Use of the whole blot points to a
tendency to be concerned with integration and to be well organized. Extensive use
of details is thought to be correlated with compulsivity or obsessional tendencies.
But content is also important. Seeing small animals might mean passivity.Responses
of blood, claws, teeth, or similar images could suggest hostility and aggression.
Even turning a card over and examining the back might lead to an interpretation
of suspiciousness. However, it is important that the student should treat these as
examples of potential interpretations or hypotheses and not as successfully validated
facts!
We conclude our discussion of the Rorschach Test with some general evaluative
comments. As previously mentioned, the most comprehensive approach to scoring
has been developed by Exner (1974, 1993). His system incorporates elements
from the scoring systems of other cliJ;licians.Exner and his associates have offered
a substantial amount of psychometric data, evidence of stable test retest reliability,
and construct validity studies. It is a promising, research based approach that
warrants careful attention from clinicians who choose to use the Rorschach Test.
However, it is also important to note that many of the reliability and validity
studies cited by Exner have been challenged (Wood, Nezworski, Lilienfeld, &
Garb, 2003; Wood, Nezworski, & Stejskal,1996). Next we discuss current
perspectives on the reliability and validity of Rorschach Test scores.
Self Assessment Questions
1) Define the Rorschach Test.

26
 Principles of Measurement and
2) Give a description opf the Rorschact Test.
Projective Techniques, Current
Status with Special Reference to
the Rorschach Test

3) How is the Rorschach Test administered?

.................................... ~ , , .

4) What are the various categories of scoring in the Rorschach Test?

,
2.6 RELIABILITY AND VALIDITY OF
RORSCHACH SCORES
Research oriented clinical psychologists have questioned the reliability of the
Rorschach Test scores for years (Wood et al., 2003). As we mentioned previously,
at the most basic level, one should be confident that the Rorschach Test responses
can be scored reliably across raters. If the same Rorschach Test responses
cannot be scored similarly by different raters using the same scoring system, then
it is hard to imagine that the instrument would have much utility in clinical prediction
situations. Unfortunately, the extent which the Rorschach Test scoring systems
meet acceptable standards for this most basic and straightforward form of reliability
remains contentious. For example, in a recent rather heated exchange, Meyer
(1997a, 1997b) reported that evidence indicates "excellent" inter rater reliability
for Exner's scoring system, but Wood, Nezworski, and Stejskal (1997) remained
unconvinced by his new reliability analyses and results.

Although inter scorer reliability is irn:portantto address, we must also evaluate the
consistency of an individual's scores across time or test conditions as well as the
reliability of score interpretations. Weiner (1995) argues that frequent retests
(even on a daily basis) are possible because "the basic structure and thematic
focus of their Rorschach data tends to remain the same" (p. 335). However, we
are not aware of a large body of empirical studies that support the stability of
Rorschach summary scores. The limited available evidence does tend to support
the stability over time of summary scores believed to reflect trait-like dispositions.
(Meyer, 1997a;Weiner, Speilberger, & Abeles, 2002), but more evidence is needed
to address this question.
27
Of crucial importance is the reliability of clinicians' interpretations. This important
Projective Techniques in but relatively neglected type of reliability is crucial for measures like the Rorschach.
Psychodiagnostics It is quite probable that two clinicians trained together over several years can
achieve reliability in their interpretations. However, what about two clinicians with
no common training? The proliferation of formal scoring systems, coupled with the
tendency of so many clinicians to use freewheeling interpretive approaches, makes
the calculation of this type of reliability difficult.

As for validity of the Rorschach Test scores and interpretations, there have been
many testimonials over the years. When skilled, experienced clinicians speak
highly of an instrument, those in the field listen. But at some point, these testimonials
·must give way to hard evidence. From the vast Rorschach literature, it is apparent
that the test is not equally valid for all purposes. In a very real sense, the problem
·is not one of determining whether the Rorschach is valid but of differentiating the
conditions under which it is useful from those under which it is not. For many
.years, a procedure involving interpretation of the Rorschach Test responses with
almost no other information about the patient was used to assess Rorschach Test
·validity. Even when Rorschach response protocols are submitted for analysis in
this manner, however, identifying cues are often present. For example, the Rorschach
protocols of l O-year olds may be combined in one study with those of 60 year
olds. Sometimes the protocols are sent to former teachers or to friends so that
there maybe a higher than usual level of agreement. Just knowing that the protocols
came from Hospital X may provide important cues about the nature of the patients.

Other studies have used a matching technique, that is specifically, the matching of
the Rorschach Test protocols with case histories, so as to assess the validity of
the Rorschach test results interpretations. However, there are also problems with
these studies. Correct matching may be a function of one or two strikingly deviant
variables. Consequently, what has really been validated? There have even been
instances in which the person who had administered the Rorschach Test was
subsequently asked to match it with the correct case history. Thus, a correct
match may have been determined by the recall of patient characteristics observed
during the testing.

Despite the questions raised about the validity of the Rorschach Test, several
surveys have placed the Rorschach Test in a favourable light (e.g., Atkinson, 1986;
Parker, 1983; Parker et al., 1988). For example, Parker et al. (1988), in a broad
survey of Rorschach studies, found the average validity coefficient across a variety
of Rorschach scales to be .41. Also, both inter judge reliability and test retest
reliability were in the mid 80s. Still, many remain critical of the quality of the
individual studies that have been cited as supporting the validity of the Rorschach
Test scores (e.g., Wood et al.,1996; Wood et al., 2003). Perhaps most
important, a recent reanalysis of the studies included in Parker et al. 's (1988)
meta analysis arrived at a different conclusion. Garb et al. (1998), using data from
the same studies reviewed by Parker et al., reported significantly lower validity
estimates for the Rorschach Test scores (validity coefficient of.29 vs. previous
estimate of .41). Further, the revised, corrected estimate of the Rorschach Test
validity was significantly lower than that of the MMPI (.48). These findings, in
addition to fmdings that fail to support the incremental validity of the Rorschach
Test scores (Archer & Krishnamurthy, 1997; Garb, 1984, 1998), led the authors
to "recommend that less emphasis be placed on training in the use of the Rorschach"
(p. 404). It remains to be seen whether clinical psychology programs will heed
this call.
28
. The debate over the utility of the Rorschach Test in clinical assessment continues Principles of Measurement and
Projective Techniques, Current
(Meyer, 1999, 2001; Wood et al. 2003). Advocates (Stricker & Gold, 1999;
Status with Special Reference to
Viglione, 1999; Viglione & Hilsenroth, 2001; Weiner et al. 2002) argue that the the Rorschach Test
Rorschach Test is useful when the focus is on the unconscious functioning and
problem solving styles of individuals. However, critics remain skeptical of the
clinical utility of Rorschach scores ( Hunsley & Bailey, 1999,2001) or their
incremental validity (Dawes, 1999; Garb, 2003).

2.7 RORSCHACH INKBLOT "METHOD"

Weiner (1991) has argued that the Rorschach Test is best conceptualised as a
method of data collection, not a test.

The Rorschach is not a test because it does not test anything. A test is intended
to measure whether something is present or not and in what quantity. But with the
Rorschach Test, which has traditionally been classified as a test of personality, we
do not measure whether people have a personality or how much personality they
have.(p. 499).

The several implications are as follow :

First, Weiner argues that data generated from the Rorschach Test method can be
interpreted from a variety of theoretical positions. These data suggest how the
respondent typically solves problems or makes decisions (cognitive structuring
processes) as well as the meanings that are assigned to these perceptions
(associational processes). Weiner calls this an "integrationist" view of the Rorschach
Test because the method provides data relevant to both the structure and dynamics
of personality. According to Weiner, a second, practical implication is that viewing
the Rorschach as a method allows one to fully use all aspects of the data that are
generated, resulting in a more thorough diagnostic evaluation.

The influence and utility of this re conceptualisation remain to be seen. In any

. case, empirical data supporting the utility and incremental validity of data generated
by the Rorschach Test "method" are still necessary before its routine use in
clinical settings can be advocated.

2.8 CURRENT AND FUTURE STATUS

The status of assessment instruments is typically reflected in the frequency with
which they are used and studied. As reviewed by Camara, Nathan, and Puente
(2000); Viglione and Hilsenroth (2001); and Weiner (1999b), numerous surveys
over the past 40 years have consistently shown substantial endorsement of
Rorschach testing as a valuable skill to teach, learn, and practice. These surveys
indicate that over 80% of clinical psychologists engaged in providing assessment
services use the Rorschach inkblot Test method (RIM) in their work and believe
that clinical students should be competent in Rorschach assessment, that over
80% of graduate programs teach the RIM, and that students find this training
helpful in improving their understanding of their patients and developing other
clinical skills. In recent comprehensive surveys of pre doctoral internship sites,
training directors commonly assigned considerable value to the Rorschach testing,
indicated that it was one of the three measures most frequently used-in their test
batteries (along with the Wechsler Adult Intelligence Scale [WAIS] / Wechsler
Intelligence Scale for Children [WISC] and Minnesota Multi phasic Personality 29
Projective Techniques in Inventory-2 [MMPI-2]/ MMPI Adolescent [MMPI-A], and expressed a desire
Psychodiagnostics for their incoming interns to have had a Rorschach Test course or arrive with a
good working knowledge of the instrument (Clemence & Handler, 2001;Stedman,
Hatch, & Schoenfeld, 2000).

Survey findings indicate that the Rorschach Test assessment has gained an
established place in forensic as well as clinical practice. Data collected from
forensic psychologists by Ackerman and Ackerman (1997), Boccaccini and
Brodsky (1999), and Borum and Grisso (1995) showed 30% using the RIM
in evaluations of competency to stand trial, 32% in evaluations of criminal
.responsibility, 41 % in evaluations of personal injury, and 48% in evaluations of
adults involved in custody disputes.

As for study of the instrument, the scientific status of the RIM has been attested
over many years by a steady and substantial volume of published research
concerning its nature and utility. Buros (1974) Tests in Print II identified 4,580
Rorschach references through 1971, with an average yearly rate of 92 publications.
In the 1990s, Butcher and Rouse (1996) found an almost identical trend continuing
from 1974 to 1994. An average of 96 Rorschach Test research articles appeared
annually during this 20 year period in journals published in the United States, and
the RIM was second only to the MMPI among personality assessment measures
in the volume of research it generated. There is also a large international community
of Rorschach scholars and practitioners whose research published in languages
other than English has for many years made important contributions to the literature
(see Weiner,1999a). The international presence of the RIM is reflected in a
survey of test use in Spain, Portugal, and Latin American countries by Muniz,
Prieto, and Almeida (1998), in which the Rorschach Test emerged as the third
most widely used psychological assessment instrument, following the Wechsler
intelligence scales and versions of the MMPI. Finally of note in this regard, an
international society for the Rorschach Test and projective methods has been in
existence since 1947, and triennial congresses sponsored by this society typically
attract participants from over 30 countries.

Despite the information presented in this unit concerning the psychometric soundness
and numerous applications of the RIM and the frequency with which it is used and
studied, not all psychologists look favorably on Rorschach assessment. Particularly
in academic circles, there are some who remain unconvinced of its reliability and
validity and argue against its being taught or studied in university programs(see
Lilienfeld, Wood, & Garb, 2000). Let it be said that the RIM, like virtually all
instruments used in psychological assessments, is neither perfectly understood nor
the ultimate answer to all questions. Like all widely used tests in psychology, it
is more valid for some purposes than others and awaits further research to clarify
its characteristics and corollaries. As Meyer and Archer (2001) conclude in the
most recent summary of the empirical evidence available at the time of this writing,
"Given this evidence, and the limitations inherent in any assessment procedure,
there is no reason to single out the Rorschach Test for praise or criticism"(p ..
499). Regrettably, however, intractable Rorschach Test critics often appear immune
to persuasion by the continuing accumulation of research data confirming the
scientific merit of the instrument, and they often seem unacquainted with the
practical utility of Rorschach Test findings, which would not exist if it were an
unreliable or invalid instrument. Reviewing the Rorschach Test in the edition of the
Mental Measurements Year book, Hess, Zachar, and Kramer (2001) concur
that "the Rorschach, employed with the Comprehensive System, is a better
30 personality test than its opponents are willing to acknowledge"(p. t037).
 The future of the Rorschach Test assessment holds some risk that its critics will Principles of Measurement and
curtail its teaching in those academic settings where their views are influential. Any Projective Techniques, Current
Status with Special Reference to
such silencing of the Rorschach Test instruction would be regrettable. As would
the Rorschach Test
be true for any widely used and apparently helpful method that is not yet perfectly
understood or completely validated, who will be capable of pursuingan appropriate
research agenda if no one is being taught to use it appropriately? Among •.
knowledgeable assessment psychologists, however, there is no indication of flagging
interest in using the RIM clinically or doing research with it. The literature is
providing a constant flow of fresh ideas and improved guidelines for the practical
application of Rorschach findings, and accumulating research results are steadily
strengthening the psychometric foundations .of the instrument and expanding
comprehension of how it works. Societies. around the world concerned with
Rorschach assessment are thriving, and seminars and workshops on the Rorschach
Test method continue to attract a large audience. The current status of the Rorschach
Test assessment appears healthy, vigorous, and poised for continued enhancement
in the twenty first century.

Self Assessment Questions

1) Discuss critically the reliability and validity of the Rorschach Test.

17

2) Describe the Importance and characteristic features of the Rorschach inkblot

method.

3) Discuss the curren and future prospects of the Rorschach test.

N
"""•
2.9 LET US SUM UP
W
o
0... Among projective techniques, we focused most of our discussion on the Rorschach
:E Test. In many respects, clinical psychologists' allegiance to this test divides the
field along the lines of believers versus nonbelievers.Academic clinicalpsychologists
tend to be highly critical of the Rorschach and the acrimonious debate over its 31
 Projective Techniques in legitimacy and merits rages on. Projective techniques, as methods of assessing
Psychodiagnostics and describing personality, are alive and well, and do not seem to have been
relegated to second place in favour of the so called objectiveassessment methods.
They continue to be preferred and used by a large number of psychologists in
both the former and the new fields of psychological assessment.

2.10 UNIT END QUESTIONS

1) The reliability of qualitative data is often assessed by:

a) test-retest
.'
'"
b) accuracy of protocol matches

c) interrater reliability

d) internal consistency methods

2) The purpose of the inquiry phase on the Rorschach is to obtain information

!,.
a) about the client and his/her background

b) so the responses can be scored

c) that determines which inkblots will be administered

d) as to how normal or psychotic the client is

3) Form, colour, and shading aspects of the Rorschach are known as:

a) testing the limits

b) content variables

c) determinants

d) location

4) The fact that there are only 10 inkblots in the Rorschach means that
a) validity cannot be established

b) reliability is inherently limited

c) only alternate form reliability can be computed

d) reliability cannot be determined

5) Parker's (1983) meta-analysis of Rorschach studies indicated that reliabilities

of about can be expected in well-designed studies .

a) .50

b) .60

c) .70

d) .80

6) Percentage of agreement is a poor measure of reliability because:

a) . it does not take into accountchance agreement

32
 b) it requires too many experts to calculate Principles of Measurement and
Projective Techniques, Current
c) it is confounded by validity results Status with Special Reference to
the Rorschach Test
d) experts typically do not agree

7) The reliability of qualitative data is often assessed by:

a) test-retest

b) accuracy of protocol matches

c) interrater reliability

d) internal consistency methods

8) The purpose of the inquiry phase on the Rorschach is to obtain information

a) about the client and hislher background

b) so the responses can be scored

c) that deterinines which inkblots will be administered

d) as to how normal or psychotic the client is

9) Form, color, and shading aspects of the Rorschach are known as:

a) testing the limits

b) content variables

c) determinants

d) location

10) The fact that there are only 10 inkblots in the Rorschach means that

a) validity cannot be established

b) reliability is inherently limited

c) only alternate form reliability can be computed

d) reliability cannot be determined

11) Parker's (1983) meta-analysis of Rorschach studies indicated that reliabilities

of about can be expected in well-designed studies .

a) .50

b) .60

c) .70

d) .80

12) Percentage of agreement is a poor measure of reliability because:

••••
---,
I a) it does not take into account chance agreement
u
)
I.. b) it requires too many experts to calculate
E
c) it is confounded by validity results

d) experts typically do not agree 33

Projective Techniques in
13) What are the differences between objective and projective psychological
Psychodiagnostics testing?

14) Describe in brief the Rorschach?

15) Are projective tests valid?

16) If someone asked, "Is the Rorschach valid" how would you answer?

17) Discuss the current and future status of Rorschach?

2.11 SUGGESTED READINGS

Groth Marnat, Gary. (2003). Handbook of Psychological Assessment (4thed.).
New Jersey: John Wiley & Sons, Inc.

Murphy, K.R., Davidshofer, e.O. (2005). Psychological Testing: Principles

and Applications (6thed.J. New Jersey: Pears on Education International.

34
UNIT 3 THE THEMATIC APPERCEPTION
TEST AND CHILDREN'S
APPERCEPTION TEST
Structure
3.0 Introduction

3.1 Objectives

3.2 The ThematicApperception Test

3.2.1 Description
3.2.2 Administration
,
3.2.3 Pull of TAT Cards
3.2.4 Scoring
3.2.5 What Does the TAT Measure?
3.2.6 Reliability
3.2.7 \Talidi~

3.3 Apperception of TAT

3.4 Alternative ~pperception Procedures

3.4.1 Tell Me a Story Test
3.4.2 ; The Children's Apperception Test (The CAT)
3.4.3 Description of CAT
3.4.4 Scoring of CAT
3.4.5 Precautions

3.5 Let Us Sum Up

3.6 Unit End Questions

3.7 Suggested Readings

3.0 INTRODUCTION
When we read a story, we not only learn about the fictitious characters but also
about the author. The personality of a Sidney Sheldon is distinctly different from
that of a Charles Dickens, and one need not have a doctorate in literature to
perceive the major differences between these two authors from their writings. It
was this type of observation that led Murray and Morgan to develop the TAT,
where the respondent is asked to makeup stories in response to a set of pictures.
Like the Rorschach, the TAT is used extensively and also has received a great
deal of criticism. This unit will provide a comprehensive discussion of TAT in
terms of its description, administration, scoring and psychometric properties. The
last part of the unit will give a brief description and discussion of CAT.

3.1 OBJECTIVES
After completing this unit, you will be able to :

• Discuss the main differences between Rorschach and TAT;

35
Projective Techniques in • Describe the TAT, its administration, scoring and psychometric properties;
Psychodiagnostics
• Explain the different variations of TAT; and

• Elucidate the CAT test, scoring and interpretation

3.2 THE THEMATIC APPERCEPTION TEST

A thematic apperception test (TAT) is a projective psychological analysis used to
investigate a person's unconscious self. More specifically, a thematic apperception
.test can uncover a person's true personality, their capacity for emotional control,
and their attitudes towards aspects they encounter in everyday life (wealth, power,
gender roles, racial and religious attitudes, intimacy, etc.). In this way, a thematic
apperception test is similar to a Rorschach (ink blot) test. Both are projective
tests that assess the types of information that a: subject projects onto a set of
ambiguous images.

, Procedurally, a thematic apperception test involves showing the subject several

pictures (which are engaging but broad and open to interpretation) and having the
subject tell a story for each picture. The subject is encouraged to use as much
detail as possible. For example: What is happening in the picture? What events
occurred prior to what is happening in the picture? What will happen afterwards?
Why are the characters acting and feeling the way they are?

The results of a thematic apperception test are difficult to generalise. The results
are often subjective and do not use any formal type of scoring system. However,
a close analysis of the stories told by the subject normally gives the tester a decent
idea of the traits mentioned above (personality, emotional control, and attitudes
towards aspects of everyday life).

Companies sometimes use thematic apperception tests to screen potential

employees. These tests can determine (to a certain extent) whether the potential
employee is likely to succeed at a certain position. For example: Can they handle
stressful situations? How will they react to emotional conflicts? Will they fit in well
with the general atmosphere and attitude of the company?

The Thematic Apperception Test (TAT) was introduced in 1935 by Christina

Morgan and Henry Murray of Harvard University. It is comparable to the Rorschach
Test in many ways, including its importance and psychometric problems. As with
the Rorschach Test, use of the TAT grew rapidly after its introduction. With the
exception of the Rorschach Test, the TAT is used more than any other projective
test (Wood et al., 2003). Though its psychometric adequacy was (and still is)
vigorously debated, unlike the Rorschach, the TAThas'been relatively well received
by the scientific community.

Also, the TAT is based on Murray's (1938) theory of needs, whereas the Rorschach
is basically a theoretical. The TAT and the Rorschach differ in other respects as
well. The TAT authors were conservative in their evaluation of the TAT and
scientific in their outlook. The TAT was not oversold as was the Rorschach, and
no extravagant claims were made. Unlike the Rorschach, the TAT was not billed
as a diagnostic instrument, that is, a test of disordered emotional states. Instead,
the TAT was presented as an instrument for evaluating human personality
characteristics. This test also differs from the Rorschach Test because the TAT's
non clinical uses are just as important as its clinical ones. Indeed, the TAT is one
36
 The Thematic Apperception
of the most important techniques used in personality research (Abrams, 1999;
Test and Children's
Bellak, 1999; Cramer & Blatt, 1990; McClelland, 1999). Apperception Test
As stated, the TAT is based on Murray's (1938) theory, which distinguishes 28
human needs, including the needs for sex, affiliation, and dominance. Many of
these needs have been extensively researched through use of the TiXf (McClelland,
1999). The theoretical need for achievement that is "the desire or tendency to do
things as rapidly and/or as well as possible" (Murray, 1938, p. 164)-alone has
generated a very large number of studies involving the TAT.
The TAT measure of the achievement need has been related to factors such as
parental perceptions, parental expectations, and parental attitudes toward offspring.
Need achievement is also related to the standards that you as a student set for
yourself (for example, academic standards). The higher your need for achievement,
the more likely you are to study and ultimately achieve a high economic and social
position in society. Studies such as those on the achievement motive have provided
construct related evidence for validity and have increased the scientific respectability
of the TAT.

3.2.1 Description
The TAT is more structured and less ambiguous than the Rorschach Test. TAT
stimuli consist of pictures that depict a variety of scenes. There are 30 pictures
and one blank card. Specific cards are designed for male subjects, others for
female. Some of the cards are appropriate for older people, others for young
ones. A few of the cards are appropriate for all subjects, such asCard 1.

An Example of a TAT card .

(Source: net)
This card shows a boy, neatly dressed and groomed, sitting at a table on which
lies a violin. In his description of Card 1, Murray stated that the boy is
"contemplating" the violin. According to experts such as Bellak (1986), Card
1 of the TAT tends to reveal a person's relationship toward parental figures.

Other TAT cards tend to elicit other kinds of information. Card 4 is a picture of
a woman "clutching the shoulders of a man whose face and body are averted as
if he were trying to pull away from her" (Bellak, 1975, p. 51). This card elicits 37
Projective Techniques in information concerning male female relationships. Bellak (1986, 1996) and others
Psychodiagnostics provide a description of the TAT cards along with the information that each card
tends to elicit. This knowledge is essential in TAT interpretation. Card l2F,
sometimes elicits coriflicting emotions about the self. Other feelings may also be
elicited.

3.2.2 Administration
Although theoretically the TAT could be used with children, it is typically used
with adolescents and adults. The original manual (H. A. Murray, 1943) does have
standardized instructions; but typically examiners use their own versions. What is
necessary is that the instructions include the points that:

• the client is to make up an imaginative or dramatic story;

• . the story is to include what is happening, what led to what is happening, and
what will happen;

• Finally, it should include what the story characters are feeling and thinking.

As part of the administration, the examiner unobtrusively records the response

latency of each card, i.e., how long it takes the subject to begin a story. The
examiner writes down the story as accurately as possible, noting any other responses
(such as nervous laughter, facial expressions, etc.). Some examiners use a tape
recorder, but such a device may significantly alter the test situation (R. M. Ryan,
1987). The examiner also records the reaction time that is the .time interval
between the initial presentation of a card and the subject's first response. By
recording reaction time, the examiner can determine whether the subject has
difficulty with a particular card. Because each card is designed to elicit its own
themes, needs, and conflicts, an abnormally long reaction time may indicate a
specific problem. If, for example, the reaction time substantially increases for all
cards involving heterosexual relationships, then the examiner may hypothesize that
the subject is experiencing difficulty in this area.

Often, after all the stories have been elicited, there is an inquiry phase, where the
examiner may attempt to obtain additional information aboutthe stories the client
has given. A variety of techniques are used by different examiners, including
asking the client to identify the least preferred and most preferred cards.

3.2.3 Pull of TAT Cards

TAT cards elicit "typical" responses from many subjects, somewhat like the popular
responses on the Rorschach Test. This is called the "pull" of the card, and some
have argued that this pull is the most important determinant of a TAT response
(Murstein, 1963). Many of the TAT cards are from wood cuts and other art
media, with lots of shadings and dark, sometimes indistinguishable details. Because
of this stimulus pull, many of the cards elicit stories that are gloomy or melancholic.
There is some evidence to suggest that the actual TAT card may be more important
than the respondent's "projections" in determining the actual emotional tone of the
story (Eron, Terry, & Callahan, 1950).

3.2.4 Scoring
H. A. Murray (1938) developed the TAT in the context of a personality theory
that saw behaviour as the result of psychobiological and environmental aspects.
38 Thus not only are there needs that a person has (both biological needs, such as
the need for food, and psychological, such as the need to achieve or the need for TheThematicAppe~ption
Test and Children's
control), but there are also forces in the environment, called press, that can affect
Apperception Test
the individual. Presumably, the stories given by the individual reflect the combination
of such needs and presses, both in an objective sense and as perceived by the
person.

There were a number of attempts to develop comprehensive scoring systems for

the TAT.A number of manuals are available that can be used (Henry, 1956;Stein,
1981), although none have become the standard way, and ultimately the scoring
reflects the examiner's clinical skills and theoretical perspective.

Almost all methods of TAT interpretation take into account the hero, needs,
press, themes, and outcomes. The hero is the character in each picture with
whom the subject seems to identify. In most cases, the story revolves around one
easily recognisable character. If more than one character seems to be important,
then the character most like the storyteller is selected as the hero. Of particular
importance are the motives and needs of the hero. Most systems, including
Murray's original, consider the intensity, duration, and frequency of each need to
indicate the importance and relevance of that need. In TAT interpretation, press
refers to the environmental forces that interfere with or facilitate satisfaction of
the various needs, Again, factors such as frequency, intensity, and duration are
used to judge the relative importance of these factors. The frequency of various
themes (for example, depression) and outcomes (for example, failures) also
indicates their importance.

Analysis ofrrAT protocols is often impressionistic that is a subjective, intuitive

approach where the TAT protocol is perused for such things as repetitive themes,
conflicts, slips of the tongue, degree of emotional control, sequence of stories, etc.
As with the Rorschach, the interpretation is not to be done blindly but in accord
with other information derived from interviews with the client, other test results,
etc.

In effect then, the utility of the TATis, in large part, a function of both the specific
scoring procedure used and the talent and sensitivity of the individual clinician.
Many specific scoring guide lines have also been developed that focus on the
measurement of a specific dimension, such as gender identity (May, 1966) or
achievement motivation (McClelland, Atkinson, Clark, et aI., 1953). A recent
example is a scoring system designed to measure how people are likely to resolve
personal problems; for each card a total score as well as four subscale scores are
obtained, and these are aggregated across cards (Ronan, Colavito,
&Harnmontree, 1993).

3.2.5 What does the TAT Measure?

First and fore most TAT stories are samples of the subject's verbal behaviour.
Thus, they can be used to assess the person's intellectual competence, verbal
fluency, capacity to think abstractly, and other cognitive aspects. Second, the TAT
represents an ambiguous situation presented by an "authority" figure, to which the
subject must somehow respond. Thus some insight can be gained about the
person's coping resources, interpersonal skills, and so on. Finally, the TAT
responses can be assumed to reflect the individual's psychological functioning,
and the needs, conflicts, feelings, etc., expressed in the stories are presumed to
reflect the client's perception of the world and inner psychodynamic functioning.
TAT stories are said to yield information about the person's: 39
 Projective Techniques in 1) thought organisation,
Psychodiagnostics
2) emotional responsiveness,
3) psychological needs,

4) view of the world,

5) interpersonal relationships,

6) self-concept, and
,7) coping patterns.

Holt pointed out that the responses to the TAT not only are potentially reflective
of a person's unconscious functioning, in a manner parallel to dreams, but there
are a number of "determinants" that impact upon the responses obtained. For
example, the situational context is very important. Whether a subject is being
evaluated as part of court-mandated proceedings or whether the person is an
'. .introductory psychology volunteer can make a substantial difference. The "directing
set" is also important, i.e., the preconceptions that the person has of what the test,
tester, and testing situations are like.

3.2.6 Reliability
The determination of the reliability (and validity) of the TAT is a rather complex
matter because we must ask which scoring system is being used, which variables
are scored, and perhaps even what aspects of specific examinees and examiners
are involved.
Eron (1955) pointed out that the TAT was a research tool, one of many techniques
used to study the fantasy of normal individuals, but that it was quickly adopted
for use in the clinic without any serious test of the reliability and validity of the
many methods of analysis that were proposed. He pointed out that there are as
many ways of analysing TAT stories as there are practitioners, and that few of
these methods have been demonstrated to be reliable.
Some would argue that the concept of reliability is meaningless when applied to
projective techniques. Even if we don't accept that argument, it is clear that the
standard methods of determining reliability are not particularly applicable to the
TAT. Each of the TAT cards is unique, so neither split-half nor parallel-form
reliability is appropriate. Test-retest reliability is also limited because on the one
hand the test should be sensitive to changes over time, and on the other, the
subject may focus on different aspects of the stimulus from one time to another.
The determination of reliability also assumes that extraneous sources of variation
are held in check, i.e., the test is standardized. This is clearly not the case with
the TAT,where instructions, sequence of cards, scoring procedure, etc., can vary.

3.2.7 Validity
Validity is also a very complex issue, with studies that support the validity of the
TAT and studies that do not. Varble (1971) reviewed this issue and indicated
that:

1) the TAT is not well suited or useful for differential diagnosis;

2) the TAT can be useful in the identification of personality variables, although

there are studies that support this conclusion and studies that do not;
40
3) different reviewers come to different conclusions ranging from "the validity of The Thematic Apperception
the TAT is practically nil" to "there is impressive evidence for its validity." Test and Children's
Apperception Test
Holt (1951) pointed out that the TAT is not a test in the same sense that an
intelligence scale is, but that the TAT really reflects a segment of human behaviour
that can be analysed in many ways. One might as well ask what is the reliability
and validity of everyday behaviour. It is interesting to note that Bellak's (1986)
book on the TAT, which is quite comprehensive '!lld often used as a training
manual, does not list either reliability or validity in its index. But the TATcontinues
to be of interest to both practitioners and researchers.

Self Assessment Questions

1) What is Thematic Apperception Test?

••••••••••••••••• J..,•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

..................................................................•.............................................
.................................................................................................................

2) Give a detailed description of the TAT.

3) What is meant by Pull of TAT cards?

4) What does the TAT measure?

5) Describe the reliability and validity of TAT.

41
Projective Techniques in
Psychodiagnostics 3.3 APPLICATION OF TAT
The TAT is often administered to individuals as part of a battery, or group, of tests
intended to evaluate personality.It is considered to be effective in elicitinginformation
about a person's view of the world and his or her attitudes toward the self and
others. As people taking the TAT proceed through the various story cards and tell
stories about the pictures, they reveal their expectations of relationships with
peers, parents or other authority figures, subordinates, and possible romantic
,partners.

In addition to assessing the content of the stories that the subject is telling, the
examiner evaluates the subject's manner, vocal tone, posture, hesitations, and
other signs of an emotional response to a particular story picture. For example,
a person who is made anxious by a certain picture may make comments about '
the artistic style of the picture, or remark that he or she does not like the picture;
this is a way of avoiding telling a story about it.

The TAT is often used in individual assessments of candidates for employment in

fields requiring a high degree of skill in dealing with other people,and/or ability to
cope with high levels of psychological stress as for example, law enforcement,
military leadership positions, religious ministry, education, diplomatic service, etc.

Although the TATshould not be used in the differentialdiagnosis of mental disorders,

it is often administered to individuals who have already received a diagnosis in
order to match them with the type of psychological treatment that is best suited
to their personalities.

Lastly,the TATis sometimes used for forensic Pllf(JOsesin evaluating the motivations
and general attitudes of persons accused of violent crimes. For example, the TAT
was recently administered to a 24 year old man in prison for a series of sexual
murders. The results indicated that his attitudes toward other people are not only
outside normal limits but are similar to those of other persons found guilty of the
same type of crime.

The TAT can be given repeatedly to an individual as a way of measuring progress

in psychotherapy or, in some cases, to help the therapist uriderstand why the
treatment seems to be stalled or blocked.

In addition to its application in individual assessments, the TAT is frequently used

for research into specific aspects of human personality, most often needs for
achievement, fears of failure, hostility and aggression, and interpersonal object
relations. "Object relations" is a phrase used in psychiatry and psychology to refer
to the ways people internalise their relationships with others and the emotional
tone of their relationships.

Research into object relations using the TAT investigates a variety of different
topics, including

i) the extent to which people are emotionally involved in relationships with

others.

ii) their ability to understand the complexities of human relationships.

iii) their ability to distinguish between their viewpoint on a situation and the
perspectives of others involved.
42
iv) their ability to control aggressive impulses. The Thematic Apperception
Test and Children's
v) Self esteem issues; and issues of personal identity. Apperception Test

For example, one recent study compared responses to the TAT from a group of
psychiatric inpatients diagnosed with dissociative disorders with responses from
a group of non dissociative inpatients, in order to investigate some of the
controversies about dissociative identity disorder (formerly called multiple
personality disorder).

3.4 ALTERNATIVE APPERCEPTION

PROCEDURES
An alternative thematic apperception test (Ritzier, Sharkey, & Chudy, 1980;
Sharkey & Ritzler, 1985) has been constructed with pictures from the Family
of Man photo-essay collection (Museum of Modern Art, 1955). According to
these authors, the relatively new procedure can be scored quantitatively. It provides
a balance of positive and negative stories and a variety of action and energy levels
for the main character. In comparison, the TAT elicits predominantly negative and
low-energy stories. Preliminary results with this new procedure, known as the
Southern Mississippi TAT (or SM-TAT), have been encouraging. These results
indicate that the SM- TAT preserves many of the advantages of the TAT while
providing a more rigorous and modern methodology. Naturally, more research is
needed, but this attempt to modernize the T~T is to be applauded.

The versatility and usefulness of the TAT approach are illustrated not only by
attempts such as those of Ritzler et al. (1980) to update the test but also by the
availability of special forms of the TAT for children and others for the elderly. The
Children's Apperception Test (CAT) was created to meet the special needs of
children ages 3 through 10 (Bellak, 1975). The CAT stimuli contain animal rather
than human figures as in the TAT.A special children's apperception test has been
developed specifically for Latino and Latina children (Malgady, Constantino, &
Rogler, 1984).

3.4.1 Tell Me A Story Test

This is a multicultural thematic apperception test designed to use with minority and
non minority children and adolescents with a set of stimulus cards and extensive
normative data for each group. The stimulus cards are structured to elicit specific
responses and are in colour to facilitate verbalization and projection of emotional
states. It differs from the TAT is the following aspects:

1) It focuses on personality functions as manifested in internalised interpersonal

relationships rather than on intra psychic dynamics.

2) It consists of 23 cards with chromatic pictures while the TAThas 19 achromatic

pictures and one blank card.

3) Tell me a story test attempts to elicit meaningful stories indicating conflict

resolution of bipolar personality functions while the TAT uses ambiguous
stimuli to elicit meaningful stories.

4) The Tell me a story stimuli represents the polarities of negative and positive
emotions cognitions and.interpersonal functions, while the TAT is primarily
weighted to represent negative emotions, depressive mood and hostility. 43
 Projective Techniques in 5) The Tell Me a Story test stimulus cards are culturally relevant, gender sensitive
Psychodiagnostics and have diminished ambiguity.

The Gerontological Apperception Test uses stimuli in which one or more elderly
individuals are involved in a scene with a theme relevant to the concerns of the
elderly, such as loneliness and farnilyconflicts (Wolk & Wolk, 1971). The Senior
Apperception Technique is an alternative to the Gerontological Apperception
Test and is parallel in content (Bellak, 1975; Bellak & Bellak, 1973).

This test measures the experience es of the older persons. The wcoring criteria
,was developed to reflect the interpersonal, health related and intrapsychic dimensions
of the experience of later life. There are a total of 20 items. Stories based on
the pictures were written down verbatim. The stories received a score of 0 for
tolerance and 1 for lack of tolerance. The sample items for the elderly included
the following:

• Tolerates loneliness/separateness

• Concern for affiliation with others

• Fear of losing one's place/status in the community

• Concern for heterosexuality-sexual

• Concern for heterosexuality-companionship/ sociability

3.4.2 The Children's Apperception Test (The CAT)

The Children's Apperception Test, often abbreviated as CAT, is an individually
administered projective personality test appropriate for children aged three to 10
years.

The CAT is intended to measure the personality traits, attitudes, and psychodynamic
processes evident in pre pubertal children. By presenting a series of pictures and
asking a child to describe the situations and make up stories about the people or
animals in the pictures, an examiner can elicit this information about the child.

The CAT was originally developed to assess psychosexual conflicts related to

certain stages of a child's development. Examples of these conflicts include
relationship issues, sibling rivalry, and aggression. Today, the CAT is more often
used as an assessment technique in clinical evaluation. Clinical diagnoses can be
based in part on the Children's Apperception Test and other projective techniques.

3.4.3 Description of CAT

The Children's Apperception Test was developed by Leopold Bellak and Sonya
Sorel Bellak. It was an offshoot of the Thematic Apperception Test(TAT), which
was based on Henry Murray's need-based theory of personality. Bellak and
Bellak developed the CAT because they saw a need for an apperception test
specifically designed for children. The most recent revision of the CAT was
published in 1996.

The original CAT featured ten pictures of animals in such human social contexts
,. as playing g~es or sleeping in a bed. Today, this version is known as the CAT
or the CAT-A (for animal). Animals were chosen for the pictures because it was
believed that young children relate better to animals than humans. Each picture is
presented by a test administrator in the form of a card. The test is always
44
administered to an individual child; it should never be given in group form. The The Thematic Apperception
test is not timed but normally takes 20-30 minutes. It should be given in a quiet Test and Children's
Apperception Test
room in which the administrator and the child will not be disturbed by other
people or activities.

The second version of the CAT, the CAT-H includes ten pictures of human beings
in the same situations as the animals in the original CAT. The CAT-H was designed
for the same age group as the CAT-A but appeals especially to children aged
seven to 10, who may prefer pictures of humans to pictures of animals.

The pictures on the CAT were chosen to draw out children's fantasies and
encourage storytelling. Descriptions of the ten pictures are as follows: baby chicks
seated around a table with an adult chicken appearing in the background; a large
bear and a baby bear playing tug-of-war; a lion sitting on a throne being watched
by a mouse through a peephole; a mother kangaroo with a joey (baby kangaroo)
in her pouch andan older joey beside her; two baby bears sleeping on a small
bed in front of a larger bed containing two bulges; a cave in which two large bears
are lying down next to a baby bear; a ferocious tiger leaping toward a monkey
who is trying to climb a tree; two adult monkeys sitting on a sofa while ~other
adult monkey talks to a baby monkey; a rabbit sitting on a child's bed viewed
through a doorway; and a puppy being spanked by an adult dog in front of a
bathroom. The cards in the human version substitute human adults and children
for the animals but the situations are the same. Gender identity, however, is more
ambiguous in the animal pictures than in the human ones. The ambiguity of gender
can allow for children to relate to all the child animals in the pictures rather than
just the human beings of their own sex.
,
The pictures are meant to encourage the children to tell stories related to
competition, illness, injuries, body image, family life, and school situations. The
CAT test manual suggests that the administrator should consider the following
variables when analysing a child's story about a particular card: the protagonist
(main character) of the story; the primary needs of the protagonist; and the
relationship of the main character to his or her personal environment. The pictures
also draw out a child's anxieties, fears, and psychological defenses.

3.4.4 Scoring of CAT

Scoring of the Children's Apperception Test is not based on objective scales; it
must be performed by a trained test administrator or scorer. The scorer's
interpretation should take into account the following variables: the story's primary
theme; the story's hero or heroine; the needs or drives of the hero or heroine; the
environment in which the story takes place; the child's perception of the figures
in the picture; the main conflicts in the story; the anxieties and defenses expressed
in the story; the function of the child's superego; and the integration of the child's
ego.

Consider, for example, the card in which a ferocious tiger leaps toward a monkey
who is trying to climb a tree. A child may talk about his or her fears of aggression
or punishment. The monkey may be described as a hero escaping punishment
from the evil tiger. This story line may represent the child's perceived need to
escape punishment from an angry parent or a bully. Conversely, a child may
perceive the picture in a relatively harmless way, perhaps seeing the monkey and
tiger playing an innocent game.
45
Projective Techniques in A projective test like the CAT allows for a wide variety of acceptable responses.
Psychodiagnostics There is no "incorrect" response to the pictures. The scorer is responsible for
interpreting the child's responses in a coherent way in order to make the test
useful as a clinical assessment technique. It .is recommended practice for the
administrator to obtain the child's personal and medical history before giving the
CAT, in order to provide a context for what might otherwise appear to be
abnormal responses. For example, it would be normal under the circumstances
for a child whose pet has just died to tell stories that include themes of grief or
loss even though most children would not respond to the cards in that way.

. A person scoring the CAT has considerable flexibility in interpretation. He or she

can use the analysis of a child's responses to support a psychological diagnosis,
provide a basis for a cli'nical evaluation, or gain insight into the child's internal
psychological structure.

3.4.5 Precautions
A psychologist or other professional person who is administering the CAT must
be trained in its usage and interpretation, and should be familiar with the
psychological theories underlying the pictures. Because of the subjective nature of
interpreting and analysing CAT results, caution should be used in drawing
conclusions from the test results. Most clinical psychologists recommend using the
CAT in conjunction with other psychological tests designed for children.

The CAT is frequently criticized for its lack of objective scoring, its reliance on
the scorer's own scoring method and bias, and the lack of accepted evidence for
its reliability (consistency of results) and validity (effectiveness in measuring what
it was designed to measure). For example, no clear evidence exists that the test
measure's needs, conflicts, or other processes related to human motivations in a
valid and reliable way.

An Example of CAT Card

(Source: Net)
46
 The Thematic Apperception
Sel! Assessment Questions Test and Children's
Apperception Test
1) Describe the various applications of the TAT test.

2) What are the various alternative procedures to TAT do we have? Describe,

3) Describe the Tell me a Story Test.

18

4) What is the significance of children's Apperception Test?

5) How is the CAT scored and interpreted?

6) What precautions need to be followed in regard to CAT?

..-
N
I

LU
U
0...
:E

47
Projective Techniques in
Psychodiagnostics 3.5 LET US SUM UP
The TAT,enjoys wide research as well as clinical use. The TAT stimuli consist of
30 pictures, of various scenes, and one blank card. Specific cards are suited for
.adults, children,
.
men, and women. In
.
administering the TAT,the examiner,asks the
subject to make up a story; he or she looks for the events that led up to the
scene, what the characters are thinking and feeling, and the.outcome. Almost all
methods of TAT intetpretation take into account the hero, needs, press, themes,
and outcomes. Like the Rorschach, the TAT has strong supporters but has also
been .attacked on a variety of scientific grounds. Though not psychometrically
sound by traditional standards, the TAT is in widespread use. The TAT is based
on Murray's (1938) theory of needs .
•
Many variants of the TAT approaches have been developed, including sets ~f
cards that depict animal characters for use with children e.g., the Children's
Apperception Test, sets for use with the elderly the Gerontological Apperception
Test, with families and with specific ethnic or cultural groups.

3.6 UNIT END QUESTIONS

1) The TAT consists of

a) two sets of 45 inkblots

b) a series of stories chosen for their emotional impact

c) a series of pictures depicting the adventures of Blacky

d) a set of 31 pictures, most of which are ambiguous

2) In administering the TAT most clinicians

a) have a favorite subset of cards that they administer to every client

b) administer the entire set of pictures

c) select a subset of 6 to 10 cards related to the specific client

d) ask the client which pictures are best and least liked

3) The "pull" of the card refers to:

a) ~mmon themes elicited by a particular card

b) whether a subject touches a card and thus shows compliance

c) the influence of a picture on subsequent stories

d) how often that card is selected for administration

4) The theory behind the TAT focuses on:

a) achievement and failure

b) castration anxiety

c) needs and presses

d) self esteem and competence

48
 In regards to the hero of TAT stories, it is assumed that The Thematic Apperception
5)
Test and Children's
Apperception Test
a) the hero represents what Freud called the Id

b) the client identifies psychologically with the hero

c) the hero is always a masculine figure

d) in each story there are several heroes

6) In a clinical setting, the analysis of the TAT

a) follows a strict scoring procedure based on 36 needs

b) assesses such aspects as determinants and form quality

c) requires, a content analysis of both needs and presses

d) usually reflects an impressionistic, holistic approach

7) In regards to the reliability of the TAT we can conclude that:

a) standard methods of determining reliability are not fully applicable

b) test-retest is unusually high for a projective technique

c) both split-half and parallel form reliabilities are adequate

d) the TAT is a research tool not a psychological test

8) The CAT stimuli contain figures

a) Human

b) Cartoon

c) Animal

d) Toys

9) The Children's Apperception Test is administered for children aged

a) 3-10 years

b) 5-15 years

c) 5-20 years

d) 3-15 years

10) The Gerontological Apperception Test has themes relevant to the concerns
of the elderly, such as

a) relationships

.••
I
'
b) loneliness and family conflicts
'J
:> c) career
I-

E : d) education

11) Write about the main differences between the Rorschach and TAT? 49
Projective Techniques in 12) Write about TAT and also discuss its psychometric properties?
Psychodiagnostics
13) What are the different variations of TAT? Briefly discuss CAT?

3.7 SUGGESTED READINGS

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

Trull, T.J. (2005). Clinical Psychology (7th Ed.). USA: Thomson Learning, Inc.

50
UNiT 4 PERSONALITY INVENTORIES
Structure
4.0 Introduction

4.1 Objectives

4.2 Personality Testing

4.2.1 Personality and Psychological Functioning
4.2.2 Is Personality Really Enduring

4.3 Measurement of Personality and Psychological Functioning

4.3.1 Objective Testing
4.3.2 The Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2, MMPIA)
4.3.3 The Minnesota Multiphasic Personality Inventory-Adolescents
4.3.4 The Millon Clinical Multiaxial Inventories
4.3.5 The Sixteen Personality Factors (16PF)
4.3.6 The NEO-Personality Inventory Revised

4.4 Other Objective Tests

4.4.1 The Edwards Personal Preference Schedule (EPPS)
4.4.2 The California Psychological Inventory (CPI)

4.5 Let U.SSum Up

4.6 Unit End Questions

4.7 Suggested Readings

4.0 INTRODUCTION
An alternative way to collect information about individuals is to ask them to assess
themselves. The personality inventory asks respondents a wide range of questions
about their behaviour, beliefs, and feelings. In the typical personality inventory,
individuals indicate whether each of a long list of statements applies to them.
Clinicians then use the responses to draw conclusions about the person's personality
and psychological functioning. In this unit we will consider some of the most
widely used objective measures of personality such as MMPI, MCMI, 16 PF,
EPPS, CPI and NEO-PI-R.

4.1 OBJECTIVES
After reading this unit, you will be able to:

• Defme personality;

• Describe personality testing;

• Explain the relationship between personality and psychological functioning;

• Explain what personality testing is;

• Elucidate the concepts of measurement of personality and psychological

functioning;
51
Projective Techniques in • Describe the most widely used objective tests of personality such as the
Psycho<Uagnostics MMPI;and

• Analyse the other objective tests.

4.2 PERSONALITYTESTING
Before taking up personality testing, let us see what is personality. Personality
concerns the most important, most noticeable parts of an individual's psychological
life. Personality concerns whether a person is happy or sad, energetic or apathetic,
smart or dull. Over the years, many different definitions have been proposed for
personality. Most of the definitions refer to a mental system - a collection of
psychological parts including motives, emotions, and thoughts. The definitions
vary a bit as to what those parts might be, but they come down to the idea that
personality involves a pattern or global operation of mental systems. Here are
some definitions:

"Personality is the entire mental organisation of a human being at any stage of his
development. It embraces every phase of human character: intellest, temperament,
skill, morality, and every attitude that has been built up in the course of one's life."
(Warren & Carmichael, 1930, p. 333)
,
"Personality is the essence of a human being." (Hall & Lindzey, 1957, p. 9)"

An individual's pattern of psychological processes arising from motives, feelings,

thoughts, and other major areas of psychological function. Personality is expressed
through its influences on the body, in conscious mental life, and through the
individual's social behavior." (Mayer, 2005)
--/1

Personality testing in a sense accesses the heart and soul of an individual's psyche.,
.

Personality testing strives to observe and describes the structure and content of
personality, which can be defined as the characteristic ways in which an individual
thinks, feels, and behaves. Personality testing is particularly useful in clarifying
diagnosis, problematic patterns and symptoms, intra psychic and interpersonal
dynamics, and treatment implications.

4.2.1. Personality and Psychological Functioning

Each human being has a unique manner of interacting with the world. Some .
people tend to be shy and withdrawn, while others are generally outgoing and
gregarious. Some tend to be anxious worriers, while-others are generally calm and
relaxed. Some' are highly organised and pay attention to detail, while others are
disorganized and impressionistic. ~

Personality refers to the enduring styles of thinking and behaving when interacting
,. o

with the world (Hogan, Hogan, & Roberts, 1996; MacKinnon,1944; McCrae &
Costa,2003). Thus, it includes characteristic patterns that make each person
_unique. These characteristics can be assessed and compared with those of others.
Personality is influenced by biological, psychological, and social factors. For
example, research has shown that between 20% and 60%of the variance in
personality traits (e.g., extroversion, sociability) are influenced by genetic factors,
with the remainder influenced by psycho social factors (e.g., relationships that
develop with parents, siblings, and friends, as well as life events. While the nature
versus nurture debate rages on well beyond statistical models, personality
52 development clearly reflects biological, psychological and social factors.
'"--P~~nality theories provide a way to understand how people develop, change, Personality ~ventories
and experience generally stable and enduring behaviour and thinking patterns.
These theories also help us to understand the differences among people~ that make
" ,
each person unique. Ultimately personality theory is used to understand and
predict behaviour. This understanding is then used to develop intervention strategies
to help people change problematic patterns.

Psychological functioning is a more general term referring to the individual's

cognitivepersonality,and emotional worlds. Thus, psychological functioning includes
personality as well as other aspects of emotional, behavioural, cognitive, and "
interpersonal functioning.

Here psychological functioning refers to particularly non cognitive areas of

functioning such as mood and interpersonal relationships. For example, while
anxiety, depress~oh,and anger may all be enduring personality traits, they can also
be temporary mood states. Someone facing stressful life events, such as the death
of a loved oneor criminal victimization, may experience severe anxiety, depression,
or anger. However, these· mood states may not be associated with enduring
an
personality characteristics. Thus, the individual may feel and behave in anxious
or depressed manner as a reaction to the stressful event(s) but does not tend to
be anxious or depressed most of the time. Therefore, psychological functioning
as
can be viewed encompassing the gamut of component psychological processes
as they impact one's ability to cope with life's pleasures and demands and uniquely
combine to define personality.

"A review of the empirical literature on the dimensional models pertinent to

individuals' mental representations of self and others and subsequent empirical
analyses suggest that the following components are most central in comprising.a
personality functioning continuum:

Self
1) Identity: Experience of oneself as unique, with boundaries between self and
others; coherent sense of time and personal history; stability and accuracy of
~ self-appraisal "andself-esteem; capacity for a range of emotional experience
and its regulation.

2) Self-direction: Pursuit of coherent and meaningful short-term and life 'goals;

utilization of constructive and prosocial internal standards of behavior; ability
to self-reflect productively.

Interpersonal
1) Empathy: Comprehension and appreciation of others' experiences and
motivations; tolerance of differing perspectives; understanding of social
causality.

2) Intimacy: Depth and duration.of connection with others; desire and capacity
for closeness; mutuality of regard reflected in interpersonal behaviour.

In applying these dimensions, self and interpersonal difficulties should not be

better understood as a norm within an individual's dominant culture.

Self and Interpersonal Functioning Continuum

Although the degree of disturbance of the self and interpersonal domains is
continuously distributed, in practice it is useful to consider levels of impairment in 53
Projective Techniques in functioning for efficient clinical characterisation and for treatment planning and
Psychodiagnostics prognosis. Patients' conceptualisation of self and others affects the nature of
interaction with mental health professionals and can have a significant impact on
treatment efficacy and outcome. The following continuum uses each of the
dimensions listed above to differentiate five levels of self-interpersonal functioning
impairment:

• No impairment

• Mild impairment

• Moderate impairment

• Serious impairment

• Extreme impairment

4.3 MEASUREMENT OF PERSONALITY AND

PSYCHOLOGICAL FUNCTIONING
In addition to using interviews, observations, checklists, inventories, and even
biological assessments (e.g., neuro imaging techniques such as PET scans), clinical
psychologists generally use a range of tests to assess personality and psychological
functioning. Most of these tests can be classified as either objective or projective.

Objective testing presents very specific questions (e.g., Do you feel sad more
days than not?) or statements (e.g., I feel rested) to which the person responds
by using specific answers (e.g., yes / no, true / false, multiple choice) or a rating
scale (e.g., 1 = strongly disagree, 10 = strongly agree). Scores are tabulated and
then compared with those of reference groups, using national norms. Thus, scores
that reflect specific constructs (e.g., anxiety, depression, psychotic thinking, stress)
may be compared to determine exactly how anxious, depressed, psychotic, or
stressed some one might be relative to the norm.

Projecti ve testing uses ambiguous or unstructured testing stimuli such as inkblots,

incomplete sentences, or pictures of people engaged in various activities. Rather
than answering specific questions using specific structured responses (e.g., yes/no,
true/false, agree/disagree) subjects are asked to respond freely to the testing
stimuli. For example, they are asked to tell stories about pictures, or describe
what they see in an inkblot, or say the first thing that comes to their mind when
hearing a word or sentence fragment. The theory behind projective testing is that
unconscious or conscious needs, interests, dynamics, and motivations are projected
onto the ambiguous testing stimuli, thereby revealing the internal dynamics or
personality. Projective responses are generally much more challenging to score
and interpret than objective responses.

4.3.1 Objective Testing

There are hundreds of objective tests of personality and psychological functioning.
Clinical psychologists usually employ a small set of objective tests to evaluate
personality and psychological functioning. By far the most commonly used testis
the Minnesota Multi Phasic Personality Inventory(MMPI), now in its second
edition(MMPI-2). The MMPI also includes an adolescent version called the
Minnesota Multiphasic Personality Inventory-Adolescents (MMPIA).
Other objective tests such as the Millon Clinical Multiaxial Inventory-ill (MCMI-
54 Ill), the 16 Personality Factors Questionnaire, Fifth Edition (16PF), and the
NEO-Personality Inventory-Revised (NEO-PI-R) will also be briefly discussed Personality Inventories
below.

4.3.2 The Minnesota Multiphasic Personality Inventory

(MMPI, MMPI-2, MMPIA)
The original MMPI was developed duringthe late 1930s and published in 1943
by psychologist Starke Hathaway and psychiatrist 1. C. McKinley. The MMPI
was revised and became available as the MMPI-2 in 1989. The original MMPI
consisted of 550 true / false items. The items were selected from a series of other
personality tests and from the developers' clinical experience in an effort to provide
psychiatric diagnoses for mental patients. The original pool of about 1000 test
items were considered and about 500 items were administered to psychiatric
patients and visitors at the University of Minnesota hospitals. The MMPI was
designed to be used with individuals ages 16 through adulthood. However, the test
has been frequently used with adolescents younger than 16. The MMPI takes
about one to-one-and-a-half hours to complete.

Scoring the MMPI results in four validity measures and ten clinical measures. The
validity measures include the? (Cannot Say), L(Lie), F (Validity), and K
/

(Correction) scales. Admitting to many problems or "faking bad" is reflected in

an inverted V configuration with low scores on the Land K scales and a high
score on the F scale. Presenting oneself in a favorable light or "faking good" is
reflected in a V configuration with high scores on the Land K scales and a low
score on the F scale. The clinical scales include Hypochondriasis (Hs), Depression
(D), Convetsion Hysteria (Hy), Psychopathic deviate (Pd), Masculinity/femininity
(Mt), Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), Hypomania (Ma),
and Social Inttoversion (Si). Scores are normed using standardized T-scores,
meaning that each scale has a mean of 50 and a standard deviation of 10. Scores
above 65 (representing one and one half standard deviations above the mean) are
considered elevated, and in the clinical range. While 65 is the cut off score on the
MMPI-2 and MMPI-A, 70 is used with the original MMPI. Since the MMPI
was originally published, a number of additional subscales have been developed,
including measures such as Repression, Anxiety, Ego Strength,· Over controlled
Hostility, and Dominance. It has been estimated that there are over 400 subtests
of the MMPI (Dahlstrom, Welsh, & Dahlstrom, 1975). The MMPI has been
used in well overlO,OOOstudies that examine a wide range of clinical issues and
problems (Graham, 1990).

Although the original MMPI was the most widely used psychological test, a
revision was needed. For example, the MMPI did not use a representative sample
when it was constructed. The original sample included Caucasians living in the
Minneapolis, Minnesota, area who were either patients or visitors at the University
of Minnesota hospitals. Also, many of the more sophisticated methods of test
construction and analysis used today were not available in the late 1930s when
the test was developed. Therefore, during the late1980s, the test was re-
standardized and many of the test items were rewritten. Furthermore, many new
test items were added, and outdated items were eliminated. The resulting MMPI-
2 consists of 567 items and can be used with individuals aged 18through adulthood.
The MMPI-2 uses the same validity and clinical scale names as the MMPI.
Importantly, many have noted that the names reflecting each of the MMPI (or
MMPI-2) scales are misleading. For example, a high score on the Schizophrenia
(Se) scale does not necessarily mean that the person who completed the test is 55
 Projective Techniques in schizophrenic. Therefore, many clinicians and researchers prefer to ignore the
- Psychodiagnostics scale names and use numbers to reflect each scale instead. For example, the .
Schizophrenia (Se) scale is referred to as Scale 8.
-
Like the original MMPI, theMMPI-2 has numerous subscales, including measures
such as Type A behaviour, post traumatic stress, obsessions, and fears.

4.3.3 The Minnesota Multiphasic Personality Inventory-

Adolescent (MMPI-A) (Butcher,et al., 1992)
This was developed for use with teens between the ages of 14 and 18. The
MMPI-A has 478 true / false items and includes a number of validity measures
in addition to those-available in the MMPI and MMPI-2. The MMPI, MMPI-
2, and MMPI-A can be scored by hand using templates for each'scale or they
can be computer scored. Most commercially available computer scoring programs
offer in depth interpretive reports that fully describe the testing results and offer
, suggestions for treatment Of other interventions. Scores are typically interpreted
by reviewing the entire resulting profile rather than individualscale scores. Profile
analysis is highlighted by examining pairs of high scores combinations. For example,
high scores on the first three scales of the MMPI are referred to as the neurotic
triad reflecting anxiety, depression, and somatic. complaints. Research indicates .
that the MMPI, MMPI-2, and MMPI-A have acceptable reliability, stability; and
validity(Butcher et al., 1989; Butcher et al., 1992;Qraham, 1990; Parker et al.,
1988). /' .

However, controversy exits concerning many aspects of the test. For example,
the Mac Andrew ,Scale was designed as a supplementary scale to classify those
, people with alcohol related problems. The validity of the scale has been criticized
and some authors have suggested that the scale no longer be used to examine
alcohol problems (Gottesman & Prescott, 1989).

4.3.4 The Millon Clinical Multiaxial Inventories

The Millon Clinical Multiaxial Inventories (MCMI) include several tests that
assess personality functioning using the DSM-IV classification system and the
Theodore Millon theery of personality (Millon,1981). Unlike the MMPI-'2, the
,Millon was specifically designed to assess personality disorders outlined in the _
DSM such as histrionic, borderline, paranoid, and obsessive compulsive
personalities. The first Millon test was published in 1982; additional tests and
revisions quickly developed during the 1980sand 1990s. The current tests include
the Millon Clinical Multiaxial Inventory-Ill (MCM IIII; Millon, Millon, & Davis,
1994), the Millon Adolescent Clinical Inventory (MACI; Milionet al., 1994),.the
Millon Behavioural Health Inventory (MBm; Millon, Green, & Meagher, 1982),
the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1987), and the'
Millon Adolescent Personality Inventory (MAPI; Millon, Mil.lon, & Davis, 1982).
The MBm, however, is a health behaviour inventory and not a measure of
personality or psychological functioning per se. The MCMI-I11will be highlighted
here. The MCMI-I11 is a 175 true/false item questionnaire designed for persons
aged 18 through adulthood and takes approximately 30 minutes to complete. It
was designed to assess personality disorders and syndromes based on the DSM-
IV system of classification. The MCMI-ill includes 24scales, including 14
personality pattern scales and 10 clinical syndrome scales. Further more, the
MCMI-I11 also includes several validity measures.
56
 4.3.5 The Sixteen' Personality Factors (16PF) Personality Inventories
/

The 16PF was developed by Raymond Cattell and colleagues and is currently in
its fifth edition (Cattell, Cattell, &Cattell,1993).1t is a 185 itemmultiple-choice
questionnaire that takes approximately 45 minutes to complete. The 16 PF is
administered to individuals aged 16 years through adulthood. Scoring the 16PF
results in 16 primary personality traits (e.g., apprehension prone) and five global
factors that' assess second order personality characteristics (e.g., anxiety).
Standardized scores from 1 to 10 or sten scores are used with means set at 5
and a standard deviation of 2. The 16 PF has been found to have acceptable
stability, reliability, and validity (Anastasi & Urbina,1996; Cattell et al., 1993).

4.3.6 The Neo-Personality Inventory Revised,

The NEO-PI.,R(Costa & McCrae, 1985, 1989, 1992) is a 240 item questionnaire
that uses a 5-pointrating system. A brief 60-item version of the NEO-PI-R
called the NEO.Five Factor Inventory (NEO-FF) is also available as well as an
observer rating version (Form R).

The NEO-PI-R measures the big five personality dimensions: neuroticism,

extroversion, openness, agreeableness, and conscientiousness. The big five or
the five factor model has been found to be consistent personality dimensions from
factor analytic research conducted for over 40 years and across many cultures
(Digman, 1990; McCrae & Costa,2003). TheNEO-PI waits are referred to as <::

the big five because in many research studies they have been found to account
for a great deal of variability in,personality test scores (McCrae & Costa, 2003;
Wiggins & Pincus, 1989). The NEO-PI-Rhas been found to be both reliable and
valid (Costa & McGrae, 1992). Unlike the other objective tests mentioned, the
NEO-PI-R does not include validity scales to assess subject response set. '

'/
4.4 OTHER OBJECTIVE TESTS
Additional objective personality tests include the Edwards Personal Preference
\ Schedule (EPPS: A. L. Edwards, 1959), a 225-item paired comparison test
assessing 15 personality variables, The.Eysenck Personality Questionnaire (Eysenck
& Eysenck, 1975), measuring three basic personality characteristics: psychoticism,
introversion extroversion, and emotionality stability and California psychological
inventory (CPI). Many other tests are available as well, however, they generally
are not as commonly used as those previously discussed.

4.4.1 The Edwards Personal Preference -Schedule'iEPPS)

There are two theoretical influences that resulted in the creation of the EPPS. The
first is the theory proposed by Henry Murray(1938) which.among other aspects,
catalogued a set of needs as primary dimensions of behaviour for example, need
achievement, need affiliation, need heterosexuality. A second theoretical focus is
the issue of social desirability. A. L. Edwards (1957) argued that a person's """
response to a typical personality inventory item may be more reflective of how
desirable that response is than the actual behaviour of the person. Thus a true '
response to the item, "I am loyal to my friends"may be given not because the
person is loyal.' but because the person perceives that saying "true" is socially
, desirable.

57 '
Projective Techniques in A. L. Edwards developed a pool of items designed to assess 15 needs taken
Psychodiagnostics from Murray's system. Each of the items was rated by a group of judges as to
how socially desirable endorsing the item would be. Edwards then placed together
pairs of items that were judged to be equivalent in social desirability, and the task
for the subject was to choose one item from each pair.

Each of the scales on the EPPS is then composed of 28 forced-choice items,

where an item to measure need Achievement for example, is paired off with items
representati ve of each of the other 14 needs, and this done twice per comparison.
Subjects choose from each pair the one statement that is more characteristic of
them, and the chosen underlying need is given one point. The EPPS, like most
other personality inventories, is commercially available, a group test, a self report
paper and pencil inventory, with no time limit, designed to assess what the subject
typically does, rather than maximal performance.

The EPPS is designed primarily for research and counseling purposes, and the 15
needs (such as Achievement, Deference, Order, Exhibition, Autonomy, Affiliation,
Interception) that are scaled are presumed to be relatively independent normal
personality variables. The EPPS is easy to administer and is designed to be
administered within the typical 50 minute class hour. There are two answer sheets
available, one for hand scoring and one for machine scoring. The test manual
gives both internal consistency (corrected split-half coefficients based on a sample
of 1,509 subjects), and test retest coefficients (l-week interval, n = 89); the
corrected split half coefficients range from +.60for the need Deference scale to
+.87 for the need Heterosexuality scale. The test-retest coefficients range from
+.74 for need Achievement and need Exhibition, to +.88 for need Abasement.
The test manual presents little data on validity, and many subsequent studies that
have used the EPPS have assumed that the scales were valid. The results do
seem to support that assumption, although there is little direct evidence of the
validity of the EPPS.

4.4.2 The California Psychological Inventory (CPI)

The CPI is considered an important instrument by clinicians, and indeed it is.
Surveys done with professional groups place the CPI in a very high rank of
usefulness, typically second after the MMPI.

The CPI, first published in 1956 and developed by Harrison Gough, originally .
contained 480 true false items and 18 personality scales. It was revised in 1987
to 462 items with 20 scales. Another revision that contains 434 items was completed
in 1995. Items that were out of date or medically related were eliminated. But
the same 20 scales were retained. The CPI is usually presented as an example
of a strictly empirical inventory, but that is not quite correct. First of all, of the 18
original scales, 5 were constructed rationally, and 4 of these 5 were constructed
using the method of internal consistency analysis. Second, although 13 of the
scales were constructed empirically, for many of them there was an explicit
theoretical framework that guided the development; for example, the Socialisation
scale came out of a role theory framework. Finally, with the1987 revision, there
is now a very explicit theory of human functioning incorporated in the inventory.

The 20 scales (for example Dominance, Capacity, Sociability, Responsibility,

Socialisation etc.) are arranged in four groups; these groupings are the result of
logical analyses and are intended to aid in the interpretation of the profile, although
the groupings are also supported by the results of factor analyses. Group I scales
58
measure interpersonal style and orientation, and relate to such aspects as self Personality Inventories
confidence, poise, and interpersonal skills. Group IT scales relate to normative
values and orientation, to such aspects as responsibility and rule respecting
behaviour. Group ill scales are related to cognitive intellectual functioning. Finally,
Group IV scales measure personal style.

The basic goal of the CPI is to assess those everyday variables that ordinary
people use to understand and predict their own behaviour and that of others.
This is termed by Gough as folk concepts. These folk concepts are presumed to
be universal, found in all cultures, and therefore relevant to both personal and
interpersonal behaviour. The CPI then is a personality inventory designed to be
taken by a "normal" adolescent or adult person, with no time limit, but usually
taking 45 to 60 minutes. In addition to the 20 standard scales, there are currently
some 13 "special purpose scales" such as, for example, a "work orientation"
scale (Gough, 1985) and a "creative temperament" scale (Gough, 1992). The
1987 revision of the CPI also included three "vector" or structural scales, which
taken together generate a theoretical model of personality.

The first vector scale called "vl"relates to introversion extraversion, while the
second vector scale, "v2," relates to norm accepting vs. norm questioning behaviour.
A classification of individuals according to these two vectors yields a four fold
typology. According to this typology, people can be broadly classified into one
of four types: the alphas who are typically leaders and doers, who are action
oriented, and rule respecting; the betas who are also rule respecting, but are more
reserved and benevolent; the garnmas, who are the skeptics and innovators; and
fmally, the deltas who focus more on their own private world and may be visionary
or maladapted.

Finally, a third vector scale, "v3," was developed with higher scores on this scale
relating to a stronger sense of self-realisation and fulfillment. These three vector
scales, which are relatively uncorrelated with each other, lead to what Gough
(1987) calls the cuboid model. The raw scores on "v3" can be changed into one
of seven different levels, from door to superior each level defined in terms of the
degree of self realisation and fulfillment achieved. Thus the actual behaviour of
each of the four basic types is also a function of the level reached on "v3";a delta
at the lower levels may be quite maladapted and enmeshed in conflicts while a
delta at the higher levels may be highly imaginative and creative.

As with other personality inventories described so far, the CPI requires little by
way of administrative skills. It can be administered to one individual or to hundreds
of subjects at a sitting. The directions are clear and the inventory can be typically
completed in 45 to 60 minutes. The CPI has been translated into a number of
different languages, including Italian, French, German, Japanese, and Mandarin
Chinese.

The CPI can be scored manually through the use of templates or by machine. A
number of computer services are available, including scoring of the standard
scales, the vector scales, and a number of special purpose scales, as well as
detailed computer-generated reports, describing with almost uncanny accuracy
what the client is like. The scores are plotted on a profile sheet so that raw scores
are transformed into T scores. Unlike most other inventories where the listing of
the scales on the profile sheet is done alphabetically, the CPI profile lists the
scales in order of their psychological relationship with each other, so that profile
interpretation of the single case is facilitated. Also each scale is keyed and graphed
59
so that higher functioning scores all fall in the upper portion of the profile.
 Projective Techniques in
-._Psychodiagnostics 4.5 LET US SUM UP
Many tests exist to measure personality and psychological functioning such as
.mood. Most of these tests can be classified as either objective or projective
instruments. Objective instruments present very specific questions or statements
to which the person responds to using specific answers. Scores are tabulated and
then compared with those of reference grOUpS,using national norms. The most
commonly used objective personality tests include the Minnesota Multi Phasic
Personality Inventory (MMPI, MMPI-2, MMPI-A), the Millon CliIiical Inventories
(MCMI-III, MCMI-II, MACI, MAPI,MBHI) and the 16 Personality Factors
Questionnaire (16PF).

4.6 UNIT END QUESTIONS

1) Self-report measures assume that the respondent
a) is probably the best observer of his/her own behaviour
b) will fake if given the opportunity
c) answers in a highly truthful manner

d) will give responses that deviate from the norm

2) The 16 PF is based on the notion that:

a) there are 16 basic personality dimensions scaled through factor analysis

b) personality is pretty much established once a person reaches age 16

c) there are 16 traits of pathology

d) there are 16 basic personality types

3) The 16 PF
a) is basically a self-administered test
b) requires a skilled examiner to administer
c) yields scores on three vector scales
d) is based on the theory of E. Erikson

4) The scales of the EPPS reflect:

a) types from Jungian theory
b) needs from Murray's theory
c) folk concepts
d) Eriksonian stages of life
5) CPI scales have two major purposes, one of which is:
a) to predict what people will say and do-in specific contexts

b) to assess the basic needs that people have

c) to identify how intuitive a person is

d) to determine how valid self-ratings are

60
6) The standard MMPI profile includes eight psychiatric scales and a(n) Personality Inventories

a) MF scale and a Social Introversion scale

b) Masculinity scale and a Femininity scale

c) Hypomania scale and-a Depression scale

"\

d) Depression scale and an Anxiety scale

7) The Lie scale on the MMPI is composed of items that:

a) have high correlations with social desirability

b) are quite heterogeneous but cover poor £.Pyslcal health

.
c) showed a significant response shift between lie and honest instructions

d) most people, if answering honestly, would not endorse

8) The K scale of the MMPI was developed by comparing psychiatric patients

andnormals:

a) both with abnormal proftles

b) both told to lie

c) both with normal profiles

d) who were related by marriage

9) One of the major concerns of the original MMPI:

a) the psychiatric diagnoses were not valid

o.

b) the inventory was too long -

c) the standardization sample was not representative

d) the original sample did not include children

10) The MMPI 2:

a) is highly similar to the original MMPI

b) can for all practical purposes be considered a new test

c) contains an entirely new set of scales )

d) is aimed at adolescents rather than adults

11) This test was developed as a better and more modem version of the MMPI:

a) Millon Clinical Multiaxial Inventory

b) State-Trait Anxiety Inventory

c) Center for Epidemiologic Studies Scale

d) Wisconsin Personality Disorders Inventory

12) As contrasted to the MMPI, the MCMI:

a) has a well-defined theoretical rationale

b) is substantially longer than the MMPI

61
Projective Techniques in c) does not use the DSM for diagnostic criteria
Psychodiagnostics
d) can be administered to a group

13) What are the differences between objective and projective psychological
testing?

14) List the major objective tests used in clinical psychology.

15) What are the main types of personality tests used?

4.7 SUGGESTED READINGS

Kaplan, R. M., & Saccuzzo, D. (2001). PsychoLogicaL Testing: Principles,
•
Applications, and Issues (5th Ed.). Pacific Grove, CA: Wadsworth.

Trull, TJ. (2005). Clinical PsychoLogy (Th Ed.).USA: Thomson Learning, Inc.

References
Abrams, D. M. (1999). Six decades of the Bellak Scoring System. In L. Gieser&
M. I. Stein (Eds.), Evocative images: The Thematic Apperception Test and
the art of projection. Washington: American Psychological Association.

Ackerman, MJ., & Ackerman, M.C. (1997). Custody evaluations in practice: A

survey of experience professionals (revisited). Professional Psychology, 28, 137-
145.
Anastasi, A., &Urbina, S. (1996). Psychology testing (7th ed.). New York:
Prentice-Hall.
Archer, R. P., & Krishnamurthy, R. (1997). MMPI-A and Rorschach indices
related to depression and conduct disorder: An evaluation of the incremental
validity hypothesis. Journal of Personality Assessment, 69, 517-533.

Atkinson, L. (1986). The comparative validities of the Rorschach and MMPI: A

meta-analysis. Canadian Psychology, 27, 238-247.

Bellak, L. (1975). The TAT, CAT, and SAT in clinical use (3rd ed.). New York:
Grune& Stratton.
s
Bellak, L. (1986). The Thematic Apperception Test, the Children Apperception
Test, and the Senior Apperception Technique in Clinical Use (4th ed.). New
York: Grune& Stratton.
Bellak, L. (1996). The TAT, CAT, and SAT in clinical use (6th ed.). New York:
Grune& Stratton.
Bellak, L. (1999). My perceptions of the Thematic Apperception Test in
psychodiagnosis and psychotherapy. In L. G Gieser& M. I. Stein (Eds.), Evocative
images: The Thematic Apperception Test and the art ofprojection. Washington,
DC: American Psychological Association.

Bellak, L., &Bellak, S. S. (1973). Manual: Senior Apperception Technique.

Larchmont, NY: CPS.
Benton, A. (1991). Benton Visual Retention Test. San Antonio, TX: Psychological
Corporation.
62
 Personality Inventories
Binet, A, & Henri, Y. (1896). Psychologieindividuelle. AnneePsychologie, 3,
296-332.
Boccaccini, M.T., & Brodsky, S.L. (1999). Diagnostic test usage by forensic
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