Sample Validity Of Judgment in Clinical Psychology Research Paper. Browse other research paper examples and check the list of research paper topics for more inspiration. iResearchNet offers academic assignment help for students all over the world: writing from scratch, editing, proofreading, problem solving, from essays to dissertations, from humanities to STEM. We offer full confidentiality, safe payment, originality, and money-back guarantee. Secure your academic success with our risk-free services.
A large body of research exists on the validity of judgments made by mental health professionals (Garb 1998). Most of the studies have been conducted by clinical psychologists, counseling psychologists, and psychiatrists, but important studies have also been conducted by neuropsychologists, social workers, and sociologists. The studies describe how well mental health professionals perform on a range of tasks, e.g., how well they make diagnoses and treatment decisions.
Academic Writing, Editing, Proofreading, And Problem Solving Services
Get 10% OFF with 25START discount code
Research on mental health professionals should be of interest to the general public. Many of the studies can help us to understand important social issues, e.g., the occurrence of race bias, gender bias, and other types of biases. Also, a large number of the studies bear on questions that are important for our justice system. These questions include: should mental health professionals be allowed to testify as expert witnesses? Are mental health professionals able to make accurate predictions of violence? Are they able to make accurate decisions regarding child abuse and domestic violence? Do they make appropriate judgments when petitioning to have individuals committed to psychiatric hospitals? Finally, the empirical findings should also be of particular interest to individuals who devise health care policy and decide what services to reimburse. For example, there is a new and intense controversy over the validity of judgments made by clinicians who use the Rorschach Inkblot Test (Wood et al. 1996). This controversy is well known within the field of clinical psychology, but is not yet well known by people in other professions.
There is another group that should be interested in the results from studies on mental health professionals. Consumers of mental health services should be especially interested in the results of studies on clinicians. If one includes family members of consumers of mental health services and potential consumers of mental health services, then one can conclude that virtually everyone should be interested in this research.
Overall, a huge number of studies (over 1,000) have been published on the validity of clinical judgments and most of the studies have been well designed. Yet, they are not well known outside of mental health fields. In this research paper, highlights of the research will be described. Topics include: (a) assessment of personality and psychopathology, (b) diagnosis, (c) case formulation, (d) prediction of behavior, and (e) treatment decisions. In general, mental health professionals are able to make reliable and valid judgments for some tasks, but not for others (Garb 1998).
1. Assessment Of Personality And Psychopathology
Mental health professionals almost always evaluate a client’s personality traits and psychiatric symptoms. Some clinicians also evaluate a client’s defense mechanisms. Personality traits can include characteristics like narcissism and dependence, while psychiatric symptoms can include things like hallucinations or panic attacks. A defense mechanism, as defined by psychoanalytic theory, is an unconscious strategy that protects the ego from anxiety. For example, a client may push impulses and thoughts that are unacceptable to the ego into the unconscious.
Results on reliability and validity vary for the tasks of describing psychiatric symptoms, personality traits, and defense mechanisms. Mental health professionals are often good at describing psychiatric symptoms. This should not be surprising. Clients are often able to report if they have had hallucinations, panic attacks, or other symptoms. On the other hand, inter-rater reliability varies widely for describing personality traits, and it is poor for describing defense mechanisms. Perhaps this is because these tasks require clinicians to make more inferences. Given the poor results for describing defense mechanisms, it is important to point out that many clinicians do not perform this task. Psychodynamic therapists regularly evaluate clients’ defense mechanisms, but other clinicians (e.g., cognitive behavior therapists) rarely concern them-selves with this task.
2. Diagnosis
Diagnostic classification systems have been constructed to help clinicians make diagnoses. The most commonly used classification system in the United States is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition (1994, generally referred to as DSM-IV). This classification system contains specific and explicit criteria for making diagnoses.
Clinicians’ diagnoses are reliable and moderately valid, but only when they attend to diagnostic criteria. Unfortunately, there is evidence that a significant number of clinicians do not adhere to criteria when making diagnoses. That is, many clinicians may think that they are making diagnoses according to the DSM-IV criteria, but they do not refer to the criteria when making a diagnosis, and examination of their diag noses reveals that they are not made in accordance with the DSM-IV criteria. This can lead to different types of problems including race bias, gender bias, age bias, and the underdiagnosis or overdiagnosis of some mental disorders. These problems are described below.
The most widely replicated finding for race bias involves the differential diagnosis of schizophrenia and psychotic affective disorders. African-Americans and Puerto Rican Hispanics with bipolar affective disorder (formerly called manic depression) are more likely than Whites with bipolar affective disorder to be misdiagnosed as having schizophrenia. For this reason, Black patients and Puerto Rican Hispanic patients are more likely than White patients to be overmedicated with neuroleptic medications, and their depressive symptoms are more likely to be untreated.
The most widely replicated finding for gender bias involves the differential diagnosis of histrionic personality disorder and antisocial personality disorder. When different groups of mental health professionals have been given identical case histories except for the designation of gender, clinicians have been more likely to diagnose women as having a histrionic personality disorder and men as having an antisocial personality disorder. Histrionic personality disorder is characterized by overly dramatic, attention seeking behaviors (e.g., uncomfortable when not the center of attention), and antisocial personality disorder is characterized by antisocial behaviors (e.g., habitual lying, having no regard for others, showing no remorse after hurting others).
The most widely replicated finding for age bias involves the differential diagnosis of organic impairment and depressive disorder. Compared to young and middle-aged patients, elderly patients are more likely to be diagnosed as having organic impairment and they are less likely to be diagnosed as having a depressive disorder, even when all of the clients are described by the same case history except for the designation of age. Of course, someone diagnosed as having organic impairment will be less likely to receive psychotherapy and antidepressant medicine.
It should be noted that even when clinicians attend to diagnostic criteria and apply them the same way for different groups of patients (e.g., for African-American and White patients), diagnoses can be biased (Widiger 1998). For example, diagnoses can be biased because diagnostic criteria, not the cognitive processes of clinicians, are biased. Diagnostic criteria are said to be biased if they are more valid for one group than for another (e.g., if diagnostic criteria for a particular disorder are more valid for males than for females). In general, little is known about whether diagnostic criteria are biased.
Research has also described other types of errors. Mental health professionals disagree strongly over whether dissociative identity disorder (formerly called multiple personality disorder) is over diagnosed or underdiagnosed. There is also a controversy over whether attention-deficit hyperactivity disorder (ADHD) is over diagnosed. Diagnoses of ADHD have doubled in frequency in recent years, while diagnoses of dissociative identity disorder have increased 10-fold. Finally, research suggests that clinicians underdiagnose mental disorders in the mentally retarded, they also underdiagnose mental disorders (e.g., major depression) in terminally ill patients, they frequently underdiagnose personality disorders, they underdiagnose substance abuse in psychiatric patients, and they underdiagnose mental disorders in individuals admitted to substance abuse treatment programs.
3. Case Formulations
The most difficult task for mental health professionals involves making causal judgments. When making causal judgments, clinicians try to explain the causes of their clients’ behaviors and symptoms. Inter-rater reliability and validity for this task is often poor. This has been true when psychodynamic clinicians described clients using psychoanalytic theory and when behavior therapists conducted functional analyses to understand the relations that exist between causal variables and behavior problems. One study on reliability will be described in detail. In this study (DeWitt et al. 1983), case formulations were made by two teams of psychodynamically trained clinicians after viewing videotapes of intake evaluations that lasted from 60 to 90 minutes. Both teams were composed of three clinicians. Descriptions were made by consensus. Each team was to, ‘Define the basic neurotic conflict(s) that lie at the core of the patients’ difficulties. Include the kind of stress to which the patient is vulnerable’ (p. 1124). Each team wrote formulations for 18 adults who sought psychotherapy for pathological grief reactions after the death of a parent. With regard to the results, agreement between the two teams was poor. Typically, they mentioned different symptoms, emphasized different conflictual areas, and formulated different cause–effect explanations.
4. Prediction Of Behavior
With regard to predicting behavior, mental health professionals have been able to make reliable and moderately valid judgments. For the prediction of suicide and the prediction of violence, inter-rater reliability has ranged from fair to excellent. However, validity has been poor for the prediction of suicidal behavior (suicidal behavior refers to suicide gestures, suicide attempts, and suicide completions). For example, in one study (Janofsky et al. 1988), mental health professionals on an acute psychiatry in-patient unit interviewed patients and then rated the likelihood of suicidal behavior in the next seven days. They were not able to predict at a level better than chance. In contrast to the prediction of suicidal behavior, predictions of violence have been more accurate than chance. In fact, though the long-term prediction of violence is commonly believed to be a more difficult task than the short-term prediction of violence, both short-and long-term predictions of violence have been moderately valid. Finally, the validity of clinicians’ prognostic ratings has rarely been studied, but there is reason to believe that clinicians’ prognostic ratings for patients with schizophrenia may be too pessimistic (patients with schizophrenia may do better than many clinicians expect).
5. Treatment Decisions
Perhaps the most important task is to make treatment decisions. Unfortunately, many problems exist with the treatment decisions made by clinicians. Problems that will be described include: poor inter-rater reliability, nonconformance with ethical and legal issues, and the use of controversial techniques.
Inter-rater reliability has been poor for several judgment tasks. Two examples will be given. In one study (Felton and Nelson 1984), six clinical psychologists, all trained in behavioral assessment, were asked to formulate specific treatment plans for three clients. When psychologists conducted interviews, treatment plans were in agreement only 59 percent of the time. When psychologists conducted interviews and also used questionnaires and role-playing sessions to collect additional assessment information, treatment plans were in agreement only 62 percent of the time. Inter-rater reliability has also been poor when psychiatrists have made decisions about whether a patient with major depressive disorder should receive psychotropic medicine, electroconvulsive treatment, and/or psychotherapy (e.g., Keller et al. 1986). Differences in the amount and type of treatment could not be explained by variation in the clinical characteristics of patients. The best predictor of treatment was medical center, indicating that the type of treatment severely depressed patients receive depends largely on which hospital they go to.
For some decision tasks, many mental health professionals make decisions that are not in agreement with legal and ethical principles. For example, several studies have reported that many psychiatrists do not make appropriate judgments about committing a patient to a hospital. For example, in one study (Bagby et al. 1991), 26 percent of the individuals depicted as meeting the criteria for involuntary hospitalization were not recommended for commitment. At the same time, 20 percent of those who did not meet the legal standard for commitment were recommended for involuntary hospitalization.
Another example will also illustrate how many mental health professionals make decisions that are not in agreement with legal principles. Mental health professionals are mandated by law to report child abuse, but a widely replicated finding in clinical judgment research is that large numbers of clinicians do not report child abuse (e.g., Brosig and Kalichman 1992). This may sometimes occur because they are unfamiliar with mandatory reporting laws, and it may sometimes occur because they believe it will interfere with treatment.
Some mental health professionals use treatment interventions that are controversial. For example, one controversy involves the recovery of lost memories. Some clinicians will inform their clients that they believe their emotional problems are due to having been abused. They may say this even when the clients have no memory of having been abused. They may believe the client has been abused because of some of the client’s symptoms, e.g., low self-esteem or sexual dysfunction. Clinicians may then use a variety of techniques to help clients ‘remember’ having been abused. For example, they may tell the clients that they were abused and repeatedly ask them to remember the events. Unfortunately, these interventions may lead a client to ‘remember’ an episode of abuse that never occurred.
6. Discussion
Though biases and errors sometimes occur, it is important to note that clinicians’ judgments are frequently reliable and valid. For example, diagnoses are moderately useful when they are made by clinicians who attend to the DSM-IV criteria. When made appropriately, diagnoses can inform us about the nature, course, outcome, and recommended treatment for patients. It is also important to note that many clinicians use treatment interventions that have been supported by empirical research. Empirically validated treatment interventions used by psychologists are listed in the Winter 1995 issue of The Clinical Psychologist and in subsequent issues of the journal.
Bibliography:
- American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV, 4th edn. American Psychiatric Association, Washington, DC
- Bagby R M, Thompson J S, Dickens S E, Nohara M 1991 Decision-making in psychiatric civil commitment: an experimental analysis. American Journal of Psychiatry 148: 28–33
- Brosig C L, Kalichman S C 1992 Clinicians’ reporting of suspected child abuse: a review of the empirical literature. Clinical Psychology Review 12: 155–68
- DeWitt K N, Kaltreider N B, Weiss D S, Horowitz M J 1983 Judging change in psychotherapy: reliability of clinical formulations. Archives of General Psychiatry 40: 1121–8
- Felton J L, Nelson R O 1984 Inter-assessor agreement on hypothesized controlling variables and treatment proposals. Behavioral Assessment 6: 199–208
- Garb H N 1998 Studying the Clinician: Judgment Research and Psychological Assessment. American Psychological Association, Washington, DC
- Janofsky J S, Spears S, Neubauer D N 1988 Psychiatrists’ accuracy in predicting violent behavior on an inpatient unit. Hospital and Community Psychiatry 39: 1090–4
- Keller M B, Lavori P W, Klerman G L, Andreasen N C, Endicott J, Coryell W, Fawcett J, Rice J P, Hirschfeld R M A 1986 Low levels and lack of predictors of somatotherapy and psychotherapy received by depressed patients. Archives of General Psychiatry 43: 458–66
- Widiger T A 1998 Invited essay: Sex biases in the diagnosis of personality disorders. Journal of Personality Disorders 12: 95–118
- Wood J M, Nezworski M T, Stejskal W J 1996 The comprehensive system for the Rorschach: A critical examination. Psychological Science 7: 3–10
ORDER HIGH QUALITY CUSTOM PAPER
Always on-time
Plagiarism-Free
100% Confidentiality