Introduction to

Psychopathology UNIT 4 ASSESSMENT OF

PSYCHOPATHOLOGY, INTERVIEW
AND TESTING

Structure
4.0 Introduction
4.1 Objectives
4.2 Concept of Assessment
4.3 Basic Requirements of Assessment Measures
4.4 Methods of Assessment
4.4.1 The Clinical Interview
4.4.2 Format of Clinical Interview
4.4.3 Types of Clinical Interviews
4.4.4 Limitations of Clinical Interviews
4.5 Psychological Tests
4.5.1 Intelligence Tests
4.5.2 Personality Inventories
4.5.3 Rating Scales
4.5.4 Projective Tests
4.5.5 The Rorschach Test
4.5.6 The Thematic Apperception Test
4.5.7 Sentence Completion Test
4.5.8 Drawings
4.6 Neuropsychological Assessment
4.7 Clinical Observations
4.7.1 Naturalistic and Analogue Observation
4.7.2 Self-monitoring
4.8 Socio-cultural and Ethnic Factors in Assessment
4.9 Let Us Sum Up
4.10 Unit End Questions
4.11 Glossary
4.12 Suggested Readings and References

4.0 INTRODUCTION
From the last units we have now a fairly good idea about what abnormal behaviour
is and what are the different causes of this behaviour. Clinical practitioners apply
this general information in their work. To help a particular client overcome his
or her problems, a psychologist must have the fullest possible understanding of
that person and know the circumstances under which the problems arose. Only
after thoroughly examining the person can the therapist effectively apply relevant
information. When faced with a new client clinicians use the procedures of
assessment and diagnosis to gather individual information about a client. Then
they would be in a position to apply treatment.
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Let us consider in this unit the various ways of assessing abnormal behaviour. Assessment of
Psychopathology, Interview
We will first begin by trying to understand the concept of assessment and the and Testing
basic requirements for methods of assessment—that they be standardised, reliable
and valid. Then we would be discussing in detail the types of assessment methods
like clinical interviews and psychological tests.

4.1 OBJECTIVES
After studying this unit, you will be able to:
• Define assessment;
• Indicate the basic requirements of assessment measures;
• Elucidate the methods of assessment;
• Define the Psychological Tests to be administered;
• Elucidate the Neuropsychological Assessment;
• Analyse the Clinical Observations; and
• Explain the Socio-cultural and Ethnic factors in Assessment.

4.2 CONCEPT OF ASSESSMENT

Assessment is simply the process of gathering relevant information in an effort
to reach a conclusion. It goes on in every aspect of life. We make assessments
when we decide what product to buy, what subject and which college to choose
or which candidate to vote for. College admissions officers, who have to select
the “best” of the students applying to their college, depend on academic records,
recommendations, entrance test scores, interviews, and application forms to help
them decide. Employers, who have to predict which applicants, are most likely
to be effective workers, collect information from résumés, interviews, references,
and perhaps on the job observations. This type of assessment is used for the
daily and routine activities, in order to choose the best which is reliable, long
lasting and effective. In contrast, the clinical assessment is done with a specific
target.

Clinical assessment is used to determine how and why a person is behaving

abnormally and how that person may be helped. It also helps clinicians to evaluate
people’s progress after they have been in treatment for a while and decide whether
the treatment should be changed.

There are hundreds of clinical assessment techniques and tools that have been
developed. These techniques fall into three categories: clinical interviews, tests,
and observations. To be useful, these tools must be standardised and have clear
reliability and validity.

4.3 BASIC REQUIREMENTS OF ASSESSMENT

MEASURES
In explaining the criteria of a good psychological test or any assessment, tools
have to be objective, standardised, reliable, and valid and should have norms.
This criterion could be followed here because crucial decisions are made on the
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Introduction to basis of assessment. For example, recommendations for specific treatment
Psychopathology
techniques may vary according to our assessment of the problems client exhibits.
Therefore, methods of assessment must be standardised, reliable and valid.

To standardise a measure the technique used is to have common steps to be

followed whenever it is administered. Similarly, clinicians must standardise the
way they interpret the results of an assessment tool in order to be able to understand
what a particular score means. They may standardise the scores of a test, for
example, by first administering it to a group of subjects whose performance will
then serve as a common standard, or norm, against which later individual scores
can be measured. The group that initially takes the test is called the standardisation
sample. This sample must be typical or representative of the larger population
the test is intended for. For example, If a social support test meant for the public
at large were standardised on a group living on ship, for example, the resulting
“norm” might turn out to be misleading.

The reliability of a method of assessment refers to its consistency. A measure of

height would be unreliable if people looked taller or shorter at every measurement.
A reliable measure of abnormal behaviour must also yield the same results on
different occasions. Also, different people should be able to use the measure and
agree on the result. For example, two teachers may be asked to use a behavioural
rating scale to evaluate a child’s aggressiveness, hyperactivity, and sociability.
The scale would have good reliability if both teachers rated the same children in
similar ways.

Assessment techniques must also be valid; that is, instruments used in assessment
must measure what they intend to measure. Suppose a measure of depression
actually turned out to be measuring anxiety. Using such a measure may lead an
examiner to a wrong diagnosis.

4.4 METHODS OF ASSESSMENT

Psychologists use different methods of assessment to arrive at diagnoses, including
interviews, psychological testing, self-report questionnaires, behavioural
measures, and physiological measures. A careful assessment provides a wealth
of information about client’s personality and cognitive functioning. This
information helps clinicians develop a broader understanding of their clients’
problems and helps to recommend appropriate forms of treatment. In most cases,
the formal assessment involves one or more clinical interviews with the client,
leading to a diagnostic impression and a treatment plan.

In some cases, more formal psychological testing might be needed to probe the
client’s psychological problems relating to intellectual, personality, and
neuropsychological functioning. The various methods of assessment are discussed
below.

4.4.1 The Clinical Interview

The clinical interview is the most widely used means of assessment. The interview
is usually the client’s first face-to-face contact with a clinician. Clinicians often
begin by asking clients to describe the presenting complaint in their own words,
saying something like, “Can you describe to me the problems you’ve been having
56
lately?” (Therapists should learn not to ask, “What brings you here?” to avoid Assessment of
Psychopathology, Interview
receiving answers such as, “A car,” “A bus,” or “My parents.”). and Testing

The clinician will then usually probe different aspects of the presenting complaint,
such as behavioural abnormalities and feelings of discomfort, the circumstances
regarding the onset of the problem, history of past episodes, and how the problem
affects the client’s daily functioning. The clinician may explore possible
precipitating events, such as changes in life circumstances, social relationships,
employment, or schooling. The interviewer encourages the client to describe the
problem in her or his own words in order to understand it from the client’s
viewpoint.

4.4.2 Format of Clinical Interview

Although the format may vary, most interviews cover these topics:

i) Identifying data: Information regarding the client’s socio-demographic

characteristics like address and telephone number, marital status, age, gender,
racial/ethnic information, religion, employment, family composition, and
so on.
ii) Description of the presenting problem(s): How does the client perceive
the problem? What troubling behaviours, thoughts, or feelings are reported?
How do they affect the client’s functioning? When did they begin?
iii) Psychosocial history: Information describing the client’s developmental
history like educational, social, and occupational history; early family
relationships.
iv) Medical/psychiatric history: History of medical and psychiatric treatment
and hospitalisations: Is the present problem a recurrent episode of a previous
problem? How was the problem handled in the past? Was treatment
successful? Why or why not?
v) Medical problems/medication: Description of present medical problems
and present treatment, including medication. The clinician is alert to ways
in which medical problems may affect the presenting psychological problem.
For example, drugs for certain medical conditions can affect people’s moods
and general levels of arousal.
The interviewer should be attentive to the client’s nonverbal as well as verbal
behaviour, forming judgments about the appropriateness of the client’s attire
and grooming, apparent mood, and ability to focus attention. Clinicians should
also judge the clarity or soundness of clients’ thought and perceptual processes
and level of orientation, or awareness of themselves and their surroundings (who
they are, where they are, and what the present date is). These clinical judgments
form an important part of the initial assessment of the client’s mental state.

4.4.3 Types of Clinical Interviews

There are three general types of clinical interviews. The unstructured, semi-
structured and structured interviews:

In an unstructured interview, the clinician adopts his or her own style of

questioning rather than following a standard format. The major advantage of the
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Introduction to unstructured interview is its spontaneity and conversational style. Because the
Psychopathology
interviewer is not bound to follow any specific set of questions, there is an active
give-and-take with the client. The major disadvantage is the lack of
standardisation. Also, the conversational flow of the interview may fail to touch
on important clinical information needed to form diagnostic information, such
as suicidal tendencies.

In a semi-structured interview, the clinician follows a general outline of questions

designed to gather essential information but is free to ask the questions in any
particular order and to branch off into other directions to follow up on important
information.

In a structured interview, the interview follows a preset series of questions in a

particular order. For example the mental status exam, in which a set of questions
and observations are used to systematically evaluate the client’s awareness,
orientation with regard to time and place, attention span, memory, judgment and
insight, thought content and processes, mood, and appearance. Structured
interviews (also called standardised interviews) provide the highest level of
reliability and consistency in reaching diagnostic judgments, which is why they
are used frequently in research settings.

4.4.4 Limitations of Clinical Interviews

Although interviews often produce valuable information about people, there are
limits to what they can accomplish. One problem is that they sometimes lack
validity, or accuracy. Individuals may intentionally mislead in order to present
themselves in a positive light or to avoid discussing embarrassing topics. Or
people may be unable to give an accurate report in their interview. Individuals
who suffer from depression, for example, take a pessimistic view of themselves
and may describe themselves as poor workers or inadequate parents when that
isn’t the case at all.

Clinicians too may make mistakes in judgments that slant the information they
gather. They usually rely too heavily on first impressions, for example, and give
too much weight to unfavourable information about a client (Meehl, 1996, 1960).
Interviewer biases, including gender, race, and age biases, may also influence
the interviewers’ interpretations of what a client says (Plante, 1999). Interviews,
particularly unstructured ones, may also lack reliability. People respond differently
to different interviewers, providing less information to a distant interviewer than
to a warm and supportive one. Similarly, a clinician’s race, sex, age, and
appearance may influence a client’s responses (Paurohit, Dowd, & Cottingham,
1982). Because different clinicians can obtain different answers and draw different
conclusions, even when they ask the same questions of the same person, some
researchers believe that interviewing should be discarded as a tool of clinical
assessment.

4.5 PSYCHOLOGICAL TESTS

A psychological test is a structured method of assessment used to evaluate
reasonably stable traits, such as intelligence and personality. Tests are usually
standardised on large numbers of subjects and provide norms that compare clients’
scores with the average. By comparing test results from samples of people who
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are free of psychological disorders with those of people who have psychological Assessment of
Psychopathology, Interview
disorders, we may gain some insights into the types of response patterns that are and Testing
indicative of abnormal behaviour. Although we tend to think of medical tests as
a “gold standard” of testing, a recent analysis showed that many psychological
tests were on par with many medical tests in their ability to predict variables,
such as underlying conditions or future outcomes (Daw, 2001; Meyer et al., 2001).

Psychological testing is done primarily with four objectives:

1) To screen for certain traits or behaviours like psychoticism, extroversion,

neuroticism, poor coping resources etc. Emotionally unstable individuals
are more prone to develop emotional or behavioural disorders. Psychological
tests are used for screening individuals who are at risk for developing these
disorders.
2) To assess psychopathology and to help in making a diagnosis.
3) To elicit factors which are causative as well as maintaining maladaptive
disorders.
4) To plan rehabilitation programme for patients with psychological or
neurological disorders, handicaps and head injury patients.
Here we will examine major kinds of psychological tests: Intelligence tests,
Personality inventories, projective tests, neuropsychological, and psycho-
physiological tests.

4.5.1 Intelligence Tests

The assessment of abnormal behaviour often includes an evaluation of
intelligence. Formal intelligence tests are used to help diagnose mental retardation.
They evaluate the intellectual impairment that may be caused by other disorders,
such as organic mental disorders caused by damage to the brain. They also provide
a profile of the client’s intellectual strengths and weaknesses to help develop a
treatment plan suited to the client’s competencies. The general score derived
from intelligence tests is termed an intelligence quotient, or IQ, so called because
initially it represented the ratio of a person’s “mental” age to his or her
chronological” age, multiplied by 100.

There are now more than 100 intelligence tests available. The most widely used
are Wechsler Adult Intelligence Scale, Wechsler Intelligence Scale for Children,
and Stanford-Binet Intelligence Scale. Some of the tests are

Wechsler’s intelligence scales are the most widely used intelligence tests. Different
versions are used for different age groups. The Wechsler scales group questions
into subtests or subscales, with each subscale measuring a different intellectual
ability. The Wechsler scales are thus designed to offer insight into a person’s
relative strengths and weaknesses, and not simply yield an overall score.
Wechsler’s scales include both verbal and performance subtests to compute verbal
and performance IQs. Verbal subtests generally require knowledge of verbal
concepts; performance subtests rely more on spatial relations skills.

The Malin’s Intelligence Scale for Indian Children (MISIC) is an Indian adaptation
of the Wechsler’s Intelligence Scale for Children (WISC). The MISIC test is
used for children aged 6–15 years and consists of a questionnaire in Hindi/English.
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Introduction to Like the original scale these tests also have two groups called verbal and
Psychopathology
performance which have different subtests. Malin’s adaptation omits one subtest
called the picture arrangement of the performance scale as it proved to be too
culturally biased. Based on the answers given by the patient the ‘raw scores’ are
calculated. The norms for different age groups, derived from an Indian population
are available along with the questionnaire. These norms give the weighted scores
for the corresponding raw scores in individuals of different age groups. Verbal,
performance and full scale IQ can be derived from the scale.

Bhatia’s Battery of performance test of intelligence, devised by Dr. [Link]

in India, measures performance intelligence. The test consists of five sub-tests
that are loaded that are loaded with the general factor (G) and a specific factor
(S). The sub-tests are Kohs block design test, Alexander’s pass along test, Pattern
drawing test, immediate memory test and picture construction test.

Standard Progressive Matrices (SPM) was developed by Raven and has three
forms. Besides standard progressive matrices the other two are coloured and
advanced progressive matrices. The test has five sets of matrices with 12 patterns
in each set. This test is considered culture fair test as familiarity with any specific
language is not needed. Intelligence is expressed in terms of percentile ranks in
this test (see figure below).

Intelligence tests are among the most carefully produced of all clinical tests.
Because they have been standardised on large groups of subjects, clinicians have
a good idea how each individual’s score compares with the performance of the
population at large. These tests have also shown very high reliability: people
who repeat the same IQ test years later receive approximately the same score.
Finally, the major IQ tests appear to have fairly high validity: for example
children’s IQ scores often correlate with their performance in school.

Intelligence tests also have some key shortcomings. Factors that have nothing to
do with intelligence, such as low motivation and high anxiety, can greatly
influence a performance. In addition, IQ tests may contain cultural biases in
their language or tasks that place people of one background at an advantage over
those of another.

Fig. Object Assembly test in MISIC

Standard Progressive Matrices

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4.5.2 Personality Inventories Assessment of
Psychopathology, Interview
Personality inventories are also called Objective tests. We consider these tests and Testing
objective because they limit the range of possible responses and so can be scored
objectively. They are also considered objective because they were developed
based on empirical evidence supporting their validity. Personality inventory
asks subjects a wide range of questions about their behaviour, beliefs, and feelings.
In a typical personality inventory, individuals indicate whether or not each of a
long list of statements applies to them. Psychologists then use the responses to
draw conclusions about the person’s personality and psychological functioning.
By far the most widely used personality inventory is the Minnesota Multiphasic
Personality Inventory (MMPI). Some of the tests are:

Minnesota Multiphasic Personality Inventory (MMPI): The MMPI contains

more than 500 true-false statements that assess interests, habits, family
relationships, physical (somatic) complaints, attitudes, beliefs, and behaviours
characteristic of psychological disorders. It is widely used as a test of personality
as well as to assist clinicians in diagnosing abnormal behaviour patterns. The
items in the MMPI make up 10 clinical scales:
1) Hypochondriasis (HS): Items showing abnormal concern with bodily
functions (“I have chest pains several times a week”).
2) Depression (D): Items showing extreme pessimism and hopelessness (“I
often feel hopeless about the future”).
3) Conversion hysteria (CH): Items suggesting that the person may use
physical or mental symptoms as a way of unconsciously avoiding conflicts
and responsibilities (“My heart frequently pounds so hard I can feel it”).
4) Psychopathic deviate (PD): Items showing a repeated and gross disregard
for social customs and an emotional shallowness (“My activities and interests
are often criticized by others”).
5) Masculinity femininity (MF): Items that are thought to distinguish male
and female respondents (“I like to arrange flowers”).
6) Paranoia (Pa) Items that show abnormal suspiciousness and delusions of
grandeur or persecution (“There are evil people trying to influence my
mind”).
7) Psychasthenia (Pt) Items that show obsessions, compulsions, abnormal
fears, and guilt and indecisiveness (“I save nearly everything I buy, even
after I have no use for it”).
8) Schizophrenia (Sc) Items that show bizarre or unusual thoughts or behaviour,
including extreme withdrawal, delusions, or hallucinations (“Things around
me do not seem real”).
9) Hypomania (Ma) Items that show emotional excitement, over activity, and
flight of ideas (“At times I feel very ‘high’ or very ‘low’ for no apparent
reason”).
10) Social Introversion (Si) These items asssess a person’s tendency to withdraw
from social contacts and responsibilities. ((“I am easily embarrassed”).

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Introduction to Scores for each scale can range from 0 to 120. When people score above 70,
Psychopathology
their functioning on that scale is considered deviant. When the scores are
connected on a graph, a pattern called the profile takes shape, indicating the
person’s general personality and underlying emotional needs. In addition to such
clinical measures, questions have been built into the MMPI to detect whether
respondents are lying, defensive, or careless in their answers.

Eysenck’s Personality Questionnaire (EPQ): This questionnaire measures

only three dimensions of personality namely, introversion-extroversion,
neuroticism, psychoticism and has a lie score which provides validity to the
scores. This questionnaire consists of 86 items and has been commonly used in
research studies in India.

The MMPI and other personality inventories have several advantages over
projective tests. Because they are paper-and-pencil tests, they do not take much
time to administer, and they are objectively scored. Most of them are standardised,
so one person’s scores can be compared to those of many others. They often
show greater test retest reliability than projective tests. For example, people who
take the MMPI a second time after a period of less than two weeks receive
approximately the same scores. Personality inventories also appear to have greater
validity, or accuracy, than projective tests. However, they cannot be considered
highly valid. When clinicians have used these tests alone, they have not been
able to judge a person’s personality accurately.

One problem is that the personality traits that the tests seek to measure cannot be
examined directly. How can we fully know a person’s character, emotions, and
needs from self-report alone? Another problem is the frequent failure of the
tests to allow for cultural differences in people’s responses. Responses indicative
of a psychological disorder in one culture may be normal responses in another
(Butcher, 2000; Dana, 2000). Despite their limited validity, personality inventories
continue to be popular. Research indicates that they can help clinicians learn
about people’s personal styles and disorders as long as they are used in
combination with interviews or other assessment tools.

4.5.3 Rating Scales

To measure psychopathology objective rating scales can be used. Rating scales
enable the observer to indicate not only the presence or absence of a trait or
behaviour but also its prominence. The rating scales are generally of two types:
self rating scales and observer rating scales. Beck’s Depression rating scale and
Hamilton rating scales are commonly used to measure depression. Anxiety can
be measured on State and Trait Anxiety Scale and Hamilton Anxiety scale.
Brief psychiatric rating scale (BPRS) is one of the most widely used rating scale
for recording observations in clinical practice and in research. The BPRS provides
a structured format for rating clinical symptoms such as somatic concern, anxiety,
emotional withdrawal, hostility, guilt feelings, suspiciousness and unusual thought
patterns. It contains 18 scales that are scored from ratings made by clinician
following an interview with the patient.

4.5.4 Projective Tests

The word projective is used because these personality tests derive from the
psychodynamic belief that people impose, or “project,” their own psychological
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needs, drives, and motives, much of which lie in the unconscious, onto their Assessment of
Psychopathology, Interview
interpretations of ambiguous stimuli. A projective test, unlike an objective test, and Testing
offers no clear, specified response options. Clients are presented with ambiguous
stimuli, such as inkblots, and asked to respond to them.

The psychodynamic model holds that potentially disturbing impulses and wishes,
often of a sexual or aggressive nature, are often hidden from consciousness by
our defence mechanisms. Indirect methods of assessment, however, such as
projective tests, may offer clues to unconscious processes. More behaviourally
oriented critics say that the results of projective tests are based more on clinicians’
subjective interpretations of test responses than on empirical evidence.

Many projective tests have been developed, including tests based on how people
fill in missing words to complete sentence fragments or how they draw human
figures and other objects. The two most prominent projective techniques are the
Rorschach Inkblot Test and the Thematic Apperception Test (TAT).

4.5.5 The Rorschach Test

The Rorschach test was developed by a Swiss psychiatrist, Hermann Rorschach
(1884–1922). He had experimented with the use of ink-blots in his clinical
practice. He noted that people saw different things in the same blot, and he
believed their “percepts” reflected their personalities as well as the stimulus
cues provided by the blot. He had selected 10 ink blots and published them in
1921 for use in assessment. Five of the inkblots are black and white, and the
other five have colour. Each inkblot is printed on a separate card, which is handed
to subjects in sequence. Subjects are asked to tell the examiner what the blot
might be or what it reminds them of. Then, they are asked to explain what features
of the blot (its colour, form, or texture) they used to form their perceptions.

Clinicians who use the Rorschach form their interpretations based on the content
and the form of the responses. For example, they may infer that people who use
the entire blot in their responses show an ability to integrate events in meaningful
ways. Those who focus on minor details of the blots may have obsessive–
compulsive tendencies, whereas clients who respond to the negative (white)
spaces may see things in their own idiosyncratic ways, suggesting underlying
negativism or stubbornness. A response consistent with the form or contours of
the blot is suggestive of adequate reality testing. People who see movement in
the blots may be revealing intelligence and creativity. Content analysis sheds
light on underlying conflicts. For example, adult clients who see animals but no
people may have problems relating to people. Clients who appear confused about
whether or not percept of people are male or female may, according to
psychodynamic theory, be in conflict over their own gender identity.

4.5.6 The Thematic Apperception Test (TAT)

The Thematic Apperception Test (TAT) was developed by psychologist Henry
Murray (1943) at Harvard University in the 1930s. Apperception is a French
word that can be translated as “interpreting (new ideas or impressions) on the
basis of existing ideas (cognitive structures) and past experience.” The TAT
consists of a series of cards, each depicting an ambiguous scene It is assumed
that clients’ responses to the cards will reflect their experiences and outlooks on
life—and, perhaps, shed light on their deep-seated needs and conflicts.
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Introduction to Subjects are asked to describe what is happening in each scene, what led up to it,
Psychopathology
what the characters are thinking and feeling, and what will happen next.
Psychodynamic theorists believe that people will identify with the protagonists
in their stories and project underlying psychological needs and conflicts into
their responses. More superficially, the stories suggest how clients might interpret
or behave in similar situations in their own lives. TAT results may also suggest
clients’ attitudes toward others, particularly family members.

The Indian adaptation of this test is also available which had been developed by
Uma Choudary.

Fig.: An inkblot used in Rorschach

Fig. A picture used in TAT

4.5.7 Sentence Completion Test

The sentence-completion test, first developed in the 1920s (Payne, 1928), asks
people to complete a series of unfinished sentences, such as “I wish ________”
or “My father ________.” The test is considered a good springboard for discussion
and a quick and easy way to pinpoint topics to explore in treatment.

4.5.8 Drawings
On the assumption that a drawing tells us something 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 subject 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.

Until the 1950s, 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
practitioners who follow the newer models have less use for the tests than
psychodynamic clinicians do. Even more important, the tests have rarely
demonstrated much reliability or validity (Wood et al., 2002; Meyer, 2001).
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 Assessment of
4.6 NEUROPSYCHOLOGICAL ASSESSMENT Psychopathology, Interview
and Testing
Neuropsychological assessment involves the use of tests to help determine
whether psychological problems reflect underlying neurological impairment or
brain damage. When neurological impairment is suspected, a neurological
evaluation may be requested from a neurologist—a medical doctor who
specialises in disorders of the nervous system.

A clinical neuropsychologist may also be consulted to administer

neuropsychological assessment techniques, such as behavioural observation and
psychological testing, to reveal signs of possible brain damage.
Neuropsychological testing may be used together with brain-imaging techniques
such as the MRI and CT to shed light on relationships between brain function
and underlying abnormalities. The results of neuropsychological testing may not
only suggest whether patients suffer from brain damage but also point to the
parts of the brain that may be affected.

The Bender Visual Motor Gestalt Test

One of the first neuropsychological tests to be developed and still one of the
most widely used neuropsychological tests is the Bender Visual Motor Gestalt
Test, now in a second edition, the Bender-Gestalt II. “The Bender” consists of
geometric figures that illustrate various Gestalt principles of perception. The
client is asked to copy geometric designs, and signs of possible brain damage
include rotation of the figures, distortions in shape, and incorrect sizing of the
figures in relation to one another. The examiner then asks the client to reproduce
the designs from memory, because neurological damage can impair memory
functioning. Although the Bender remains a convenient and economical means
of uncovering possible organic impairment, more sophisticated test batteries have
been developed for this purpose, including the widely used Halstead-Reitan
Neuropsychological Battery and Luria-Nebraska Battery.

The Halstead-Reitan Neuropsychological Battery

Psychologist Ralph Reitan developed the battery by adapting tests used by his
mentor, Ward Halstead, an experimental psychologist, to study brain–behaviour
relationships among organically impaired individuals. The battery contains tests
that measure perceptual, intellectual, and motor skills and performance. A battery
of tests permits the psychologist to observe patterns of results, and various patterns
of performance deficits would suggest certain kinds of brain defects, such as
those occurring following head trauma.

PGI Memory Scale

This scale has been standardised by Pershad for Indian population. It is used on
both literate and illiterate, adults and older persons. It has 10 subtests, namely -
remote memory, recent memory, mental balance, attention and concentration,
delayed recall, immediate recall, verbal retention for similar pairs, verbal retention
for dissimilar pairs, verbal retention and recognition (See Figure). This test has
objective scoring and norms according to age and sex.

Memory Questionnaires
For assessment of working memory simple assessment questionnaires can also
be used. The content of these questionnaires is related to historical facts, important 65
Introduction to life events, memory of specific situations on the basis of repeated experience
Psychopathology
with everyday memory tasks. Generally immediate, recent and remote memory
is assessed.

Fig.: Recognition tests in PGI Memory Scale

4.7 CLINICAL OBSEVATIONS

In addition to interviewing and testing people, clinicians may systematically
observe their behaviour. In one technique, called naturalistic observation,
clinicians observe clients in their everyday environments. In another, analogue
observation, they observe them in an artificial setting, such as a clinic or laboratory.
Another technique is self-monitoring wherein clients are instructed to observe
themselves.

4.7.1 Naturalistic and Analogue Observations

Naturalistic clinical observations usually take place in homes, schools, institutions
such as hospitals and prisons, or community settings. Most of them focus on
parent-child, sibling-child, or teacher-student interactions and on fearful,
aggressive, or disruptive behaviour.

Often such observations are made by participant observers, key persons in the
client’s environment, and reported to the clinician. When naturalistic observations
are not practical, clinicians may resort to analogue observations, often aided by
special equipment such as a videotape recorder or one-way mirror. Analogue
observations have often focused on children interacting with their parents, married
couples attempting to settle a disagreement, speech-anxious people giving a
speech, and fearful people approaching an object they find frightening.

Although much can be learned from actually witnessing behaviour, clinical

observations have certain disadvantages. For one thing, they are not always
reliable. It is possible for various clinicians who observe the same person to
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focus on different aspects of behaviour, assess the person differently, and arrive Assessment of
Psychopathology, Interview
at different conclusions. and Testing

Another possible problem is observer bias—the observer’s judgments may be

influenced by information and expectations he or she already has about the person.

A client’s reactivity may also limit the validity of clinical observations; that is,
his or her behaviour may be affected by the very presence of the observer. If
clients are aware that someone is watching them, for example, they may change
their usual behaviour, perhaps in the hope of creating a good impression.

Finally, clinical observations may lack cross-situational, or external, validity. A

child who behaves aggressively in school is not necessarily aggressive at home
or with friends after school. Because behaviour is often specific to particular
situations, observations in one setting cannot always be applied to other settings
(Haynes, 2001; Simpson & Halpin, 1986).

4.7.2 Self-Monitoring
Training clients to record or monitor the problem behaviour in their daily lives is
another method of relating problem behaviour to the settings in which it occurs.
In self-monitoring, clients take up the responsibility for assessing the problem
behaviour in the settings in which it naturally occurs.
Behaviours that can be easily counted, such as food intake, cigarette smoking,
nail biting, hair pulling, study periods, or social activities, are well suited for
self-monitoring. Self-monitoring can produce highly accurate measurement,
because the behaviour is recorded as it occurs, not reconstructed from memory.
There are various devices for keeping track of the targeted behaviour. A
behavioural diary or log is an easy way to record calories ingested or cigarettes
smoked. Such logs can be organised in columns and rows to track the frequency
of occurrence of the problem behaviour and the situations in which it occurs
(time, setting, feeling state, etc.). In reviewing an eating diary with the clinician,
a client can identify problematic eating patterns, such as eating when feeling
bored or in response to TV food commercials, and devise better ways of handling
these cues.
Behavioural diaries can also help clients increase desirable but low-frequency
behaviours, such as assertive behaviour and dating behaviour. Unassertive clients
might track occasions that seem to warrant an assertive response and jot down
their actual responses to each occasion. Clients and clinicians then review the
log to highlight problematic situations and rehearse assertive responses.
Self-monitoring also has its disadvantages. Some clients are unreliable and do
not keep accurate records. They become forgetful or sloppy, or they underreport
undesirable behaviours, such as overeating or smoking, because of embarrassment
or fear of criticism.

4.8 SOCIO-CULTURAL AND ETHNIC FACTORS IN

ASSESSMENT
Researchers and clinicians must keep socio-cultural and ethnic factors in mind
when assessing personality traits and psychological disorders. When testing people
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Introduction to from other cultures, careful translations are essential to capture the meanings of
Psychopathology
the original items. However, assessment techniques that are reliable and valid
within one culture may not be so in another, even when they are translated
accurately (Bolton, 2001; Cheung et al., 2003).

For example, the Chinese version of the Beck Depression Inventory (BDI), a
widely used inventory of depression in the United States, has shown good validity
in distinguishing people with depression from people without depression (Chan,
1991 Yeung et al., 2002).

However, other investigators found that Chinese people in both Hong Kong and
the People’s Republic of China showed high levels of disturbed behaviour when
tested with a Chinese version of the MMPI (Cheung, Song, & Butcher, 1991).
When a more careful analysis was done it suggested that their test responses
reflected cultural differences rather than greater psychopathology (Cheung, 1991;
Cheung & Ho, 1997).

In other words, researchers need to disentangle psychopathology from socio-

cultural factors. Translations of assessment instruments should not only translate
words, but also provide instructions that encourage examiners to address the
importance of cultural beliefs, norms, and values, so diagnosticians and
interviewers will consider the client’s background when making assessments of
abnormal behaviour patterns.

Self Assessment Questions

1) What are the basic requirements of assessment measures?

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2) What is a clinical interview?

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3) What are psychological tests?

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 Assessment of
4) What is a neuropsychological assessment? Psychopathology, Interview
and Testing
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5) Why is it important to take cultural or ethnic factors into account in

psychological assessment?
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4.9 LET US SUM UP

People’s psychological problems, which are no less complex than people
themselves, are assessed in many ways. Clients are asked to explain their problems
as best they can. Psychologists can draw on batteries of tests that assess
intelligence, personality, and neuropsychological integrity. Many psychologists
prefer to observe people’s behaviour directly. Modern technology has provided
several means of studying the structure and function of the brain. The methods
of assessment clinicians select reflect the problems of their clients, their theoretical
orientations, and their mastery of specialised technologies.

4.10 UNIT END QUESTIONS

1) What are the three major types of clinical interviews?
2) What are the major types of psychological tests?
3) What are some of the methods used in behaviour observation?

4.11 GLOSSARY
Assessment : The process of collecting and interpreting
relevant information about a client or subject.
Reliability : A measure of the consistency of test or
research results.
Validity : The accuracy of a test’s or study’s results;
that is, the extent to which the test or study
actually measures or shows what it
claims.
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Introduction to Mental Status Examination : A set of interview questions and observations
Psychopathology
designed to reveal the degree and nature of a
client’s abnormal functioning
Battery : A series of tests, each of which produces a
different kind of data

4.12 SUGGESTED READINGS AND REFERENCES

Carson, R. C., Butcher, J. N., & Mineka, S. Abnormal Psychology and Modern
Life, 11TH edition. Pearson Education:New Delhi

Davison, G.C., Neale, J.M., Kring, A.M. Abnormal Psychology, 9th edition. Wiley
& Sons:USA.

Sarason, I.G., Sarason, B.R. 1998. Abnormal Psychology: The Problem of

Maladaptive Behaviour. Prentice-Hall of India: New Delhi.

References
Barlow, D.H., & Durand, V.M. 2007. Abnormal Psychology: An Integrative
Approach. Thomson Learning Inc., New Delhi.
Bennett, Paul. 2005. Abnormal and Clinical Psychology: An Introductory
Textbook, 2nd Ed. Open University Press, McGraw-Hill Education: England.
Carson, R. C., Butcher, J. N., & Mineka, S. 2003. Abnormal psychology and
modern life. Pearson Education: New Delhi.
Constantino, M. J., & Spofford, C.M. 2008 Encyclopedia of Counseling. Sage
Publications. ([Link]
Halgin, R.P., & Whitbourne, S.K. 1997. Abnormal Psychology: The Human
Experience of Psychological Disorders. Brown & Benchmark Publishers:
London.
Hecker, J.E., & Thorpe, G.L. 2005. Introduction to Clinical Psychology: Science,
Practice, and Ethics. Pearson Education: New Delhi.
Kenneth, S., & Trull, T. 2007. The International Handbook of Psychology.
SAGE Publications. <[Link]
Article_n21.html>.
Korchin, S.J. 2004. Modern Clinical Psychology: principles of intervention in
the clinic and community. CBS Publishers: New Delhi.
Mangal, S.K. 2006. Abnormal Psychology. Sterling publishers: New Delhi.
Pichot, P. 2003. Encyclopedia of Psychological Assessment. Sage Publications.
([Link]
Sarason, I.G., & Sarason, B.R.2005. Abnormal Psychology: The problem of
maladaptive behaviour. Prentice-Hall of India: New Delhi.
Sharma, R., 2006. Abnormal Psychology. Atlantic Publishers & Distributors:
New Delhi.

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