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How does the diagnostic process proceed? - Chapter 1
A psychodiagnostic examination can start in two ways: the client can be referred to the diagnostician or the client can go to the diagnostician himself. Once at the diagnostician, he analyzes the client's request for help as well as the referrer's request. These are not the same type of questions. The client's request for help could be about how to overcome his compulsive behavior, while the referrer's request might be about obsessive-compulsive disorder.
Based on these questions, the diagnostician asks three types of questions:
- Does she have an obsessive-compulsive disorder?
- What factors have caused this disorder and what factors perpetuate it?
- Which treatment is right for this patient?
A diagnostic scenario is drawn up based on these questions. This contains a preliminary theory about the client's behavior. Subsequently, this theory is tested using five steps:
- Hypotheses are formulated;
- A specific research tool is chosen that can help to test the hypotheses;
- Criteria are established for when the hypotheses are or are not rejected;
- The instruments are administered, and the results are analyzed;
- Based on the results, the hypotheses are accepted or rejected.
On the basis of this assessment, they will come to a diagnostic conclusion.
What is the diagnostic cycle?
It is useful to build up the psychodiagnostic process according to De Groot's empirical (scientific) cycle. This empirical cycle consists of observation, induction, deduction, testing and evaluation. Yet this is not standard applied by diagnosticians.
What are the 5 basic questions in clinical psychodiagnostics?
There are five types of questions that often arise in psychodiagnostics. With each of these questions it is important to have a certain knowledge of psychology (knowledge base). It is best if the diagnosis answers the five basic questions in sequence and goes through the steps in the diagnostic cycle. These are the five basic questions:
1. Recognition: What are the problems?
The question that can be asked here is: what is the problem, what succeeds and what goes wrong? The recognition phase includes an inventory, description, ordering, categorization and an estimate of the seriousness of the problem behavior. The difference between and a diagnostic formulation should be considered. Classification is about categorizing someone's behavior based on the DSM. A disadvantage of a categoric classification is that it is quite limited and leads to "labeling". An advantage is that it improves the communication between information. A diagnostic formulation, on the other hand, contains more detailed information about a client's behavior and takes more into account the context in which this behavior is in place. The authors of the book advocate a diagnostic formulation.
2. Explanation: Why are there problems?
The question that can be asked is 'why are the problems there?' The statement contains 3 parts:
- The (partial) problem;
- The conditions that explain the occurrence of the problem;
- The causal relationship between 1 and 2.
The statements can be classified according to:
- The locus. This is the person or the situation. The statement can therefore be person-oriented or situation-oriented;
- The nature of the control. This is about the cause or the reason. The difference between these two is that the cause is the preliminary conditions, while the reason is the voluntary choice.
- Synchronous and diachronous explanation conditions. Synchronous explanatory conditions occurred with the behavior and diachronic explanatory conditions preceded the behavior. For example, in psychodiagnostics, the structural explanation is synchronous, there is ego weakness. The psychogenetic explanation is then diachronic, due to oral problems in the early life of the individual;
- Inducing and continuing conditions. The inducing conditions cause a behavioral problem and the continuing conditions maintain the behavior.
When dealing with a problem, it is best to look for the factors that perpetuate the problem, because they can be influenced.
3. Prediction: How will the problems develop?
The question that can be asked is: how will the problems develop in the future? This is expressed as probabilities, for example: what is the probability that the client will be able to fully resume work in the future? It is about the relationship between a predictor and a criterion. The predictor is the behavior that is present now, and the criterion is the future behavior. If there is not enough theoretical knowledge available, it is recommended to consult with colleagues.
4. Indication: How can the problems be solved?
The question posed here is 'how can the problems be solved?' What treatment does a patient need? Before an indication can be given, the explanation and prediction phase must be completed. In addition, a diagnostician must have:
- Knowledge about treatments and practitioners
- Knowledge about the relative usefulness of treatments
- Knowledge about the acceptance of the indication by the client. An indication strategy has been developed for this, which includes 4 principles:
- The client perspective is explored and made explicit;
- The diagnostician provides the client with information about treatment methods, processes and practitioners;
- The expectations and preferences of the client are compared with what the diagnostician finds suitable and useful and in consultation a number of possible treatments are formulated that both accept;
- The client chooses a practitioner and a treatment.
5. Evaluation: Have the problems been resolved?
The question posed here is 'have the problems been solved sufficiently after the treatment?' This phase looks at:
- Whether the diagnosis and treatment proposal have been taken into account in the therapy;
- Whether the process and treatment caused the change in behavior. This can be determined by looking at whether the behavior has decreased without being attributed to the treatment, or it can be shown that it made it through the treatment by means of n = 1 designs.
How does the diagnostic process proceed?
The first task of a diagnostician is to analyze and specify the request and request for help, in addition he consults file data, these are reports from previous psychodiagnostic or medical research and information about, for example, school, work or family. In the analysis of a request for help, the client's perception is mainly explored with the aid of an interview or broad band screening instruments (for adults the MAP and for children the CBCL).
After the analysis of the application, there is a reflection phase, in which the diagnostician must be aware of his bias, these are prejudices. Subsequently, all questions from the applicant and client are arranged in a diagnostic scenario. From this a preliminary theory about the problem behavior of the client is drawn up from which the hypotheses follow. It is important that not all problems end up in the recognition phase, only the problems that very much limit the client and for which he or she seeks help.
What are the steps in the diagnostic examination?
The diagnostic examination consists of six steps: hypothesis formation, choice of research tools, formulation of testable predictions, administration and scoring, argumentation and report.
1. Hypothesis formation
The hypotheses that are formulated in the recognition phase are about whether there is a question of psychopathology. For hypotheses in the explanatory phase, the diagnostician uses a list of explanatory factors and chooses which one to investigate. The knowledge of the diagnostician is important in predictive hypotheses. The indication phase is mainly about which treatments and therapists are best suited to the client.
2. Choice of research resources
To answer the recognition question, the diagnostician can make use of instruments, observations, anamnestic information and data from informants. The explanation phase includes tools that focus on explanatory factors such as intelligence, cognitive skills, and context factors such as the family situation. In the prediction phase, use can be made of instruments that have predictive validity. Finally, an aid questionnaire can be used in the indication phase.
3. Formulation of testable predictions
Once the research resources have been selected, criteria must be drawn up against which the results are weighed up. Criteria can be, for example, based on the number of dimensions from the DSM that must occur in the client. The criteria must be drawn up in advance so that the diagnostician is not influenced by bias.
4. Administration and scoring
The collection and scoring of the diagnostic instruments provide both qualitative and quantitative information. The results are interpreted with the help of norm tables. The observations during the administration of the tests is also important information that is thoroughly investigated. The results are then compared against the criteria.
5. Argumentation
After the results are known, they are fed back to the hypotheses and predictions. The reliability of the instruments and sources are taken into account. If the results match the hypothesis, the hypothesis is retained. If the results contradict the hypothesis, the hypothesis will be rejected. Finally, possibly new information from the studies will also be summarized and may lead to a new diagnostic cycle.
6. Report
The report includes the results in the same steps as the diagnostic process. This report is passed on to the referrer. In the report, the conclusions of the investigation are substantiated. It indicates whether the conclusions are based on facts or whether they are interpretations. The report must be clearly described so that the applicant reads it as the diagnostician intended. If the referrer has no additions, questions or improvements to the report, the report is transferred orally to the client.
What are Diagnosis Treatment Combinations (DCBs)?
Diagnosis treatment combinations assure the client that the treatments initiated are evidence-based. Because each treatment has a fixed duration and rate, this is efficient to work with for the insurance companies. The disadvantage of working with DCBs is that clients often have multiple complaints or have no clearly defined problems, which makes it difficult to find appropriate treatment.
How do we measure the quality of diagnostics? - Chapter 2
Determining the quality of frames of referenda is done on the basis of four criteria:
- Have the elements and relationships from the theory been tested and what is the result?
- Has the theory been written down in such a way that testing is possible?
- Has theory become a source of inspiration for empirical research?
- Has research been conducted into practical applications of the theory and what is the result of this research?
How do conversations in diagnostics work? - Chapter 3
The intake interview is the first interview that is conducted during registration. Information gathering is the main goal of this. A relational goal, building a good, professional relationship, is also important in this conversation. Observations during this conversation can also provide additional information. It may be that one consultation is sufficient for advice from the diagnostician, but it may also be that additional research must be carried out, for example with tests.
How does behavioral observation work in clinical psychology? - Chapter 4
The observation of clients' behavior is called behavioral observation. The purpose of observing this is to provide clinicians with information about:
- with whom the client communicates;
- the relationships and situations in which the client is involved;
- the client himself.
A distinction can be made between every day and professional observation. The book only describes professional observation. In professional observation, a distinction can be made between standardized methods and non-standardized methods. There are not many standardized observation methods in the Netherlands. Observation is mainly done for clients for whom other test methods do not provide sufficient information or cannot be used (think of people who cannot read and therefore cannot complete a questionnaire).
What are indirect methods in research? - Chapter 5
With indirect methods, the researched is offered an unstructured task. This means that he or she must design the task himself. The way someone does this ultimately says something about that person's characteristics, preferences and ways of reaction. These methods have become popular due to psychodynamic and phenomenological theories. The psychodynamic perspective states that someone projects his or her unconscious conflicts, motives, fears, and so on. That is why these tests are called "projection tests".
How do we measure intelligence? - Chapter 6
Intelligence is often measured using a general intelligence test. This often consists of a number of subtests. Intelligence tests often include verbal, spatial, numerical, and abstract items. The verbal items are used to measure the crystallized intelligence and the non-verbal items to measure the fluid intelligence.
Intelligence tests are standardized by means of a large group of subjects of various ages and educational levels. The performance of a person is compared to the performance of a group of peers and is expressed in IQ. This is a normally distributed construct with a mean of 100 and a standard deviation of 15.
What are questions and methods in neuropsychology? - Chapter 7
Neuropsychology is a field of science where the relationship between the brain and behavior is studied. Many disciplines are involved, such as neurology, psychiatry, geriatrics, rehabilitation sciences, family medicine, speech therapy and physiotherapy. In the history of the development of neuropsychology, there has always been a switch between localizationism (designating specific parts of the brain as the cause of disorders) and holism (a more general picture of the brain). Gall's phrenology is the best-known example of a localization theory. Broca and Wernicke's research into language disorders aphasia due to brain damage was also an example of a localization theory.
What are personality questionnaires? - Chapter 8
Personality questionnaires are used to plot individual differences on personality traits or traits. The term personality can be defined as the more or less stable characteristics of an individual that are consistent across different situations and explain why one person differs from the other.
How are questionnaires used to measure problems? - Chapter 9
General psychopathology questionnaires are questionnaires used to assess the psychological functioning of an individual. These questionnaires mainly provide useful information about the nature and severity of a client's complaints. The questionnaires can also be used for therapy evaluation.
What are Clinical Computer Diagnostics? - Chapter 10
Computer diagnostics can be used in tests where it is not mandatory to have a test leader. There is little research on computer diagnostics in the Netherlands compared to the United States. Most of the research published in the Netherlands concerns the MMPI. In addition to personality tests, computer diagnostics are also used in neuropsychological tests. Opinions about the reliability of this method differ widely.
What are the ethical aspects of diagnostics and how does reporting work? - Chapter 11
Ethical rules are very important when performing diagnostics. The professional association of psychologists (NIP) has therefore developed a professional ethic for psychologists. They have drawn up four guidelines based on certain principles: responsibility, integrity, respect and expertise. These guidelines are detailed in the General Standard Test Use (AST) of the NIP. There are several important points such as the engagement relationship, expertise, confidentiality, voluntary participation and the provision of information.
What are Dynamic Personality Diagnostics? - Chapter 12
The DTP is an interpretation model for structural personality diagnostics. This chapter is about the DTP of the Dutch Abbreviated MMPI.
How does a diagnostic decision-making process proceed? - Chapter 13
To clarify how a psychodiagnostic examination can proceed, this book provides an example of a client referred for memory complaints. On the basis of the empirical cycle (the diagnostic cycle) it is discussed how a psychodiagnostic examination proceeds in this person.
How does the diagnostic process in dementia proceed? - Chapter 14
Psychological diagnostics is often used when there are questions related to dementia. Dementia involves disorders in cognitive functions such as goal-oriented action, memory, orientation, language use, spatial awareness, perception and psychomotor skills. In addition, there may be anxiety and / or depression, which sometimes makes dementia difficult to investigate. Many patients with dementia can still live at home in the absence of severe dementia. The degree of dependence of patients therefore depends on how severe or advanced the dementia is.
How does the forensic psychodiagnostic examination proceed? - Chapter 15
Forensic psychology is a specialization within psychology. In forensic psychology, there are specific requirements for the tests used (the test methods), the reporting and the expertise of the psychologist or diagnostician. Compared to a clinical diagnostician, the forensic diagnostician has a very different relationship with his client. It is often the case that a client within forensic psychology does not voluntarily participate in the investigation. Also, it is not the well-being of the client that is central (which is often the case in clinical psychology) but finding the truth about a crime. This also increases the likelihood of socially desirable answers and deception by the person under investigation. For these reasons, higher demands are placed on the forensic psychodiagnostic examination compared to diagnostic examination in a clinical context. There is also a separate professional code for forensic psychologists. For example, this code states that the psychologist or diagnostician must substantiate his statements about the client in detail and that he must examine various, sometimes contradictory hypotheses to answer the questions that are asked.
What is a practical example of the Dynamic Theory-Based Profile Interpretation? - Chapter 16
This chapter provides an example of a DPT of the NVM. The following questions were asked:
- Is there a borderline personality disorder?
- What is the personality structure of a client?
- How can the non-response to treatment be explained?
- Which treatment policy will have to be used?