Overview
Psychological assessment is considered one of the most important functions in applied psychology. In psychological assessment the practitioner uses observation, interviews, and psychological tests to gain information about the client’s personality characteristics, symptoms, and problems in order to arrive at practical decisions about their behavior. In an assessment study the practitioner identifies the main sources of a client’s problems and attempts to predict the likely course of events under various conditions.
Mental health patients may present with behavioral, emotional, or physical discomforts that are often difficult for a clinical practitioner to understand initially. Usually, in mental health settings a clinical psychologist attempts to understand the nature and extent of the patient’s problem through a process of inquiry that is similar to the way a detective might approach a case: by collecting evidence and using inductive and deductive logic to focus on the most likely factors. Assessment of mental disorders is usually more difficult, more uncertain, and more protracted than it is for evaluation of many physical diseases. Yet early assessment of mental health problems is extremely important in clinical practice—no rational, specific treatment plan can be instituted without at least some general notion of what problems need to be addressed.
In order for psychological assessment to proceed effectively, the person being evaluated must feel a sense of rapport with the clinician. The assessor needs to structure the testing situation so that the person feels comfortable. Clients need to feel that the testing will help the practitioner gain a clear understanding of their problems, to understand how the tests will be used, and to understand how the psychologist will incorporate test results in the clinical evaluation.
What does a clinician need to know in a psychological assessment? First, of course, the problems must be identified. Are they of a situational nature; that is, have they been precipitated by some environmental stressor, or are the problems more pervasive and long-term? Or is it perhaps some combination of the two? Is there any evidence of recent deterioration in cognitive functioning? How long has the person had the symptoms and how is he or she dealing with the problem? What, if any, prior help has been sought? Are there indications of self-defeating behavior or low self-esteem, or is the individual using available personal and environmental resources? Following are several important areas to be considered in a psychological assessment.
Personal History
It is important to have a basic understanding of the individual’s history and development, family history (whether the person has relatives with a history of mental illness), intellectual functioning, personality characteristics, and environmental pressures and resources. For example, how does the person characteristically respond to other people? Are there excesses in behavior present, such as eating or drinking too much? Are there notable deficits, for example in social skills? Does the person show any inappropriate behavior?
Personality Factors
Assessment needs to include a description of any relevant long-term personality characteristics. Has the person behaved in deviant or bizarre ways in particular situations; for example, in circumstances requiring submission to legitimate authority? Do there seem to be personality traits or behavior patterns that predispose the individual to behave in maladaptive ways across a broad range of situations? Does the person tend to become dependent on others to the point of losing his or her identity? Is the person able to accept help from others? Is the person capable of accepting appropriate responsibility for others’ welfare? Such questions are necessarily at the heart of many assessment efforts.
Social Situations
It is also important to evaluate the social contexts in which the individual functions. What environmental demands does the person face? What emotional support or special stressors exist in the person’s life?
The diverse information about the individual’s personality traits, behavior patterns, and environmental demands must be integrated into a consistent and meaningful picture often referred to as a dynamic formulation because it describes the current situation and provides hypotheses about what is driving the person to behave in maladaptive ways. The clinician should try to arrive at a plausible explanation; for example, a reason why a normally passive and mild-mannered man suddenly flew into a rage and became physically abusive toward his wife. The formulation will allow the clinician to develop hypotheses that might explain the client’s future behavior. What is the likelihood that the person would get worse if the problems are left untreated? Which behaviors should be the initial focus of change, and what treatment methods are likely to be most efficient in producing this change? What changes might reasonably be expected if the person were provided a particular type of therapy?
Clients who are being assessed in a clinical situation are usually highly motivated to be evaluated and usually like to know the results of the testing. They usually are eager to give some definition to their discomfort. In many situations it is important to incorporate information from a medical evaluation into the psychological assessment in order to rule out physiological abnormalities that may be causing or contributing to the problem.
Clinical assessment attempts to provide a comprehensive picture of an individual’s psychological functioning and the stressors and resources in his or her life situation. In the early stages of the process, the assessment psychologist attempts to obtain as much information about the client as possible—including present feelings, attitudes, memories, demographic facts, and important formative life events—and trying to fit the diverse pieces together into a meaningful pattern. Starting with a global technique, such as a clinical interview, clinicians may later select more specific assessment tasks or tests. The following procedures are some of the methods that may be used to obtain the necessary data.
Assessment Interview
The assessment interview is usually the initial and often the central information source in the assessment process. This is usually a face-to-face interaction in which information about various aspects of a patient’s situation, behavior, past history characteristics, and personality is acquired. The initial interview may be relatively open in format, with an interviewer deciding about his or her next question based on the client’s answers to other ones, or it may be more structured so that a planned set of questions is followed. In structured interviewing the clinician may choose from a number of possible interview formats whose reliability has been established in research. The structured interviewing approach is likely to be more reliable but may be less spontaneous than the free-response interview.
Clinical interviews can be subject to error because they rely upon human judgment to choose the questions and process the information. The assessment interview can be made more reliable by the use of rating scales that serve to focus inquiry and quantify the interview data. For example, the person may be rated on a three-, five-, or seven-point scale with respect to suicide potential, violence potential, or other personality characteristics, depending upon the goals of the assessment.
Clinical Observation
One of the most useful assessment techniques that a clinician has for gaining patient-relevant information is direct observation. Observation can enable the clinician to learn more about the person’s psychological functioning; for example, personal hygiene, emotional responses, and such pertinent characteristics as depression, anxiety, aggression, hallucinations, or delusions. Clinical observation is probably more effective if conducted in the natural environment (such as a classroom or home); however, it is more likely to take place upon admission to or in the clinic or hospital ward.
Clinical observation can provide more valuable information in the clinical situation if it is objectively structured; for example, the use of structured rating scales helps maintain objectivity. The most useful rating scales are those that enable a rater to indicate not only the presence or absence of a particular behavior but also its prominence. Standard rating scales can provide a quantifiable format for rating clinical symptoms. For example, the Hamilton Anxiety Rating Scale (Hamilton, 1959) specifically addresses behavior related to the experience of intense anxiety and has become almost the standard for assessing anxiety states. Observations made in clinical settings by trained observers can provide behavioral data useful in ongoing clinical management of patients, for example, to focus on specific patient behaviors to be changed.
Clinical Observation
Psychological tests are standardized sets of procedures or tasks for obtaining samples of behavior. A client’s responses to the standardized stimuli are compared with those of other people having comparable demographic characteristics, usually through established test norms or test score distributions. Psychological tests are useful diagnostic tools for clinical psychologists in much the same way that blood tests or X-ray films are useful to physicians in diagnosing physical problems. In all these procedures, problems may be revealed in people that would otherwise not be observed. The data from tests allow a clinician to draw inferences about how much the person’s psychological qualities differ from those of a reference norm group, typically a sample of “normal” persons. Psychological tests have been developed to measure many psychological attributes in which people vary. Tests have been devised to measure such characteristics as coping patterns, motive patterns, personality factors, role behaviors, values, levels of depression or anxiety, and intellectual functioning.
Two types of psychological tests are typically incorporated in psychological assessments in clinical practice — intelligence tests and personality tests.