Q3. Discuss in detail the different stages of psychological assessment.
Psychological assessment is a process of testing that uses a combination of techniques to help arrive at some hypotheses about a person and their behavior, personality and capabilities. The process involves various stages or steps as outlined below. A psychological assessment can be most useful when it addresses specific individual problems and provides guidelines for decision making regarding these problems. Therefore, throughout these phases, psychologist integrates data and serves as an expert on human behavior rather than merely an interpreter of test scores.
These steps are looked at separately so that they are easy to understand. However, practically they often occur together and may interact with each other:
- Prepare for the assessment: The psychologist prepares to undertake the assessment. For this he understands the patient’s problem, evaluates the referral question and plans rest of the assessment process.
- Understand the problem: The clinician goes through the history of the patient, and uses other methods to develop a perspective on the problem. Clinician is aware of the advantages and limitations of psychological tests, and they are responsible for providing useful information, therefore, it is his duty to clarify the received requests. He may need to uncover hidden agendas, unspoken expectations, and complex interpersonal relationships, as well as explain the specific limitations of psychological tests.
- Evaluating the Referral Question: Many of the practical limitations of psychological evaluations result from an inadequate clarification of the problem. 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. The information derived from such an observation might be relayed back to the referral source for further clarification or modification of the referral question.
- Plan the assessment process: Based on his learning from the previous steps the clinician plans the rest of the assessment process. He needs to take decisions regarding gathering data, and how to interpret it and finally how to use the output.
- Gather Inputs: Once he has sufficient understanding of the problem, the next step for the clinician is to gather inputs related to the problem. For this he conducts a Mental Status Examination and deploys measures to acquire knowledge related to the content of the problem. The data collected during the process contributes to the differential diagnosis for the patient.
- Mental Status Examination: MSE is a subjective method of collecting data about the patient. It starts with observing the patient the minute he enters the office and moves onto an interview. The clinician tries to gather data related to patient’s thought process, patient history, social history, the patient’s affect, his sensorium and cognition.
- Build content knowledge: It is essential that clinicians have in-depth knowledge about the variables they are measuring or their evaluations are likely to be extremely limited.
Clinicians may need to refer both the test manual and additional outside sources. Clinicians should be familiar with operational definitions for problems such as anxiety disorders, psychoses, personality disorders, or organic impairment so that they can be alert to their possible expression during the assessment procedure.
Examiner also needs to 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, 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: Next the clinicians 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, behavioral observations, and interview data. Clinicians may also find it useful to obtain school records, previous psychological observations, medical records, police reports, or discuss the client with parents or teachers.
The case history provides a context for understanding the client’s current problems and, through this understanding, renders the test scores meaningful. For specific problem solving and decision making, clinicians must rely on multiple sources and, using these sources, assess the consistency of the observations they make.
- Processing the data and interpreting it to get the output: Once the data is collected. It is organized, analyzed and then interpreted to get output. Once the output is ready it is to be communicated and decisions on further clinical actions are made.
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. Further elaborations may also attempt to assess the person from a systems perspective - patterns of interaction, mutual two-way influences, and the specifics of circular information feedback.
An additional crucial area is to use the data to develop an effective plan for intervention.
The description should rather provide a deeper and more accurate understanding of the person which allows 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.
The process of developing hypotheses, obtaining support for these hypotheses, and integrating the conclusions is dependent on the experience and training of the clinician. Maloney and Ward (1976) have conceptualized a seven-phase approach to evaluating data as explained below:
- Phase 1: Collect data about the client
- Phase 2: Develop inferences about the client
- Phase 3: Accept, reject or modify the inferences
- Phase 4: Develop and begin to elaborate on statements relating to the client.
- Phase 5: Integration and correlation of the client’s characteristics to develop a dynamic model of the person
- Phase 6: place this comprehensive description of the person into a situational context
- Phase 7: makes specific predictions regarding his or her behavior.
* * *
The various stages of psychological assessment are preparation for the assessment, gathering inputs, and the processing the data and interpreting it to get the output. Preparation includes understanding problem, evaluating referral question and planning the process. Gathering inputs includes a Mental Status examination, building content knowledge and data collection. The final stage of developing inferences involves generating and proving hypothesis that could help in further diagnosis. Unless inferences can be made that effectively enhance decision making, the scope and relevance of testing are significantly reduced.
Psychological Assessment: A Conceptual Approach, by M. P. Maloney and M. P. Ward, New York: Oxford University Press, 1976.
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