Learn how psychological assessments are helping to more accurately diagnose mental illnesses
Physicians run “tests” to identify illnesses or 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 psychologists similarly use various tools, called psychological tests to help diagnose mental illness and disease. These 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 avocational likes and dislikes.
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.
Psychologists as Detectives
Psychologists conducting assessments are like 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 behaviors. 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 of the particular client.
For example, an assessment done on a child struggling in school will be quite different from an assessment conducted with a suspected 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.
The strength of the psychological assessment process stems from its comprehensive, scientific methodology.
In an article for the American Psychological Association’s journal “Monitor,” writer Rebecca Clay interviewed Bruce L. Smith, Ph.D., an assessment advocacy coordinator for the Society for Personality Assessment. Smith said that psychological assessments go far beyond simple testing.
“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.”
Grasping empirical frameworks, forming hypotheses and how to test them, and knowing robust research methodology and practice are imperative skills taught to clinical psychology students in graduate school. 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.
Additionally, a post-assessment must occur after a psychological intervention has been applied, assessing the impact on the client’s behavior and progress toward healing.
Psychological Assessments 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.
Yet 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 (PAWG).
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.
And 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 MRI.
What is reliability and validity?
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 generalizable.
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 generalizable; internal validity concerns the rigor of the study’s design and procedures.
Types of Psychological Assessments
Thousands of psychological tests exist, all falling in one of the following categories:
- Intelligence or IQ tests, such as WAIS-IV, WISC-IV, Stanford-Binet, Cattell Culture Fair III, Woodcock-Johnson Tests of Cognitive Abilities-III.
- Attitude tests, such as the Thurston Scale or Likert Scale.
- Personality tests, such as MMPI, MCMI-III, Beck Depression Inventory and Child Behavior Checklist. The Rorschach test, used less frequently, is also a personality test.
- Direct Observation tests, such as the Parent-Child Interaction Assessment-II, the MacArthur Story Stem Battery and the Dyadic Parent-child Interaction Coding System-II.
Careers in Psychological Assessment
Not only do most clinical psychologists perform some form of psychological assessment, but also psychology careers are now built entirely around psychology assessment and diagnosis.
Careers in hospitals, medical centers, mental health facilities, and private practices are now available for clinical psychologists who specialize in assessment. Many clinical psychologists also work as consultants to industry, government, and schools giving and interpreting psychological assessments. The field of forensic clinical assessment also needs psychological assessment professionals.
Graduate programs in psychology train students in assessment and diagnosis, and teach students how to analyze empirical data. Some schools offer more in-depth studies and specializations in assessment.
For more information on a career in clinical psychology, and clinical psychology assessment, request information from schools offering master's degree programs or doctoral degree programs in psychology.
Unless an addicted individual seeks out a professional who specializes in addictions -readily admitting to the addiction and seeking help to overcome it -mental health professionals often don’t know how to assess for these disorders, according to psychotherapist and addiction assessment expert Marilyn Freimuth.
Friemuth, Ph.D., and professor of clinical psychology at Fielding Graduate University in Santa Barbara, Calif., said that unless psychotherapists are attuned to behavioral and substance addictions, these disorders often remain masked by other conditions, such as depression, anxiety (see Anxiety), and insomnia.
“Most people in private practice don’t routinely assess for addictions, and those that do only assess for substances, and addictions are so much broader than that,” Freimuth said, referring to clinical psychologists who work for themselves or in private settings.
Gambling, sex, Internet usage, exercise and shopping are all behavioral addictions that are prevalent problems in today’s world, yet psychotherapists lack readily available assessment tools and techniques for these issues.
Even public medical or mental health clinics that require surveys or questionnaires, asking clients routine questions about possible addictions, don’t ask the right questions. And they almost never ask questions concerning behavioral addictions.
Typical questions about addictions take the form of: “How many drinks a day/week do you drink?” and “Have you ever used any illegal substances?”
Even when answers to these questions send warning signals, those asking the questions don’t know what to do with the answers, Freimuth said.
For that reason, Freimuth has written two books on how to properly assess and identify substance and behavioral addictions. “Addicted?” is for anyone suspecting that they might have risky behaviors that could lead to addictions, or perhaps might already be addicted.
“Hidden Addictions: Assessment Practices for Health Care Professionals, Psychotherapists, and Counselors” guides health and mental health providers through the knowledge, tools, and techniques needed to properly assess and diagnose addictions. This book, Freimuth said, recommends assessment tools that help identify addictions at all levels - not just the extreme or severe forms.
It also contains tools for the most common behavioral addictions, tools for “recognizing them not only when they’re diagnosable, but also when they’re at risk of becoming more problematic.”