Organized according to the sequence mental health professionals follow when conducting an assessment, Groth-Marnat’s Handbook of Psychological Assessment, Sixth Edition covers principles of assessment, evaluation, referral, treatment planning, and report writing. Written in a practical, skills-based manner, the Sixth Edition provides guidance on the most efficient methods for selecting and administering tests, interpreting assessment data, how to integrate test scores and develop treatment plans as well as instruction on ways to write effective, client-oriented psychological reports.This text provides through coverage of the most commonly used assessment instruments including the Wechsler Intelligence Scales, Wechsler Memory Scales, Minnesota Multiphasic Personality Inventory, Personality Assessment Inventory, Millon Clinical Multiaxial Inventory, NEO Personality, Rorschach, Thematic Apperception Test, and brief assessment instruments for treatment planning, monitoring, and outcome assessment.
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About the Author
GARY GROTH-MARNAT, PHD, ABPP, is an author, lecturer, researcher, and practicing clinical psychologist and neuropsychologist. He is Professor Emeritus, Pacific Graduate School, and a fellow of the American Psychological Association and the Society for Personality Assessment.
A. JORDAN WRIGHT, PHD, is an Assistant Professor in Human Development at Empire State College, State University of New York. He is the author of Conducting Psychological Assessment: A Guide for Practitioners from Wiley.
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Handbook of Psychological Assessment
By Gary Groth-Marnat
John Wiley & SonsISBN: 0-471-41979-6
The Handbook of Psychological Assessment is designed to develop a high level of practitioner competence by providing relevant practical, as well as some theoretical, material. It can serve as both a reference and instructional guide. As a reference book, it aids in test selection and the development of a large number and variety of interpretive hypotheses. As an instructional text, it provides students with the basic tools for conducting an integrated psychological assessment. The significant and overriding emphasis in this book is on assessing areas that are of practical use in evaluating individuals in a clinical context. It is applied in its orientation, and for the most part, I have kept theoretical discussions to a minimum. Many books written on psychological testing and the courses organized around these books focus primarily on test theory, with a brief overview of a large number of tests. In contrast, my intent is to focus on the actual processes that practitioners go through during assessment. I begin with such issues as role clarification and evaluation of the referral question and end with treatment planning and the actual preparation of the report itself. Although I have included some material on test theory, my purpose is to review those areas that are most relevant in evaluating tests before including them in a battery.
One ofthe crucial skills that I hope readers of this text will develop, or at least have enhanced, is a realistic appreciation of the assets and limitations of assessment. This includes an appraisal of psychological assessment as a general strategy as well as an awareness of the assets and limitations of specific instruments and procedures. A primary limitation of assessment lies in the incorrect handling of the data, which is not integrated in the context of other sources of information (behavioral observations, history, other test scores). Also, the results are not presented in a way that helps solve the unique problems clients or referral sources are confronting. To counter these limitations, the text continually provides practitioners with guidelines for integrating and presenting the data in as useful a manner as possible. The text is thus not so much a book on test interpretation (although this is an important component) but on test integration within the wider context of assessment. As a result, psychologists should be able to create reports that are accurate, effective, concise, and highly valued by the persons who receive them.
ORGANIZATION OF THE HANDBOOK
My central organizational plan for the Handbook of Psychological Assessment replicates the sequence practitioners follow when performing an evaluation. They are initially concerned with clarifying their roles, ensuring that they understand all the implications of the referral question, deciding which procedures would be most appropriate for the assessment, and reminding themselves of the potential problems associated with clinical judgment (Chapter 1). They also need to understand the context in which they will conduct the assessment. This understanding includes appreciating the issues, concerns, terminology, and likely roles of the persons from these contexts. Practitioners also must have clear ethical guidelines, know how to work with persons from diverse backgrounds, and recognize issues related to computer-assisted assessment and the ways that the preceding factors might influence their selection of procedures (see Chapter 2).
Once practitioners have fully understood the preliminary issues discussed in Chapters 1 and 2, they must select different strategies of assessment. The three major strategies are interviewing, observing behavior, and psychological testing. An interview is likely to occur during the initial phases of assessment and is also essential in interpreting test scores and understanding behavioral observations (see Chapter 3). The assessment of actual behaviors might also be undertaken (see Chapter 4). Behavioral assessment might be either an end in itself, or an adjunct to testing. It might involve a variety of strategies such as the measurement of overt behaviors, cognitions, alterations in physiology, or relevant measures from self-report inventories.
The middle part of the book (Chapters 5 through 13) provides a general overview of the most frequently used tests. Each chapter begins with an introduction to the test in the form of a discussion of its history and development, current evaluation, and procedures for administration. The main portions of these chapters provide a guide for interpretation, which includes such areas as the meaning of different scales, significant relations between scales, frequent trends, and the meaning of unusually high or low scores. When appropriate, there are additional subsections. For example, Chapter 5, "Wechsler Intelligence Scales," includes additional sections on the meaning of IQ scores, estimating premorbid IQ, and assessing special populations. Likewise, Chapter 11, "Thematic Apperception Test," includes a summary of Murray's theory of personality because a knowledge of his concepts is a prerequisite for understanding and interpreting the test. Chapter 12, "Screening and Assessing for Neuropsychological Impairment," varies somewhat from the preceding format in that it is more a compendium and interpretive guide to some of the most frequently used short neuropsychological tests, along with a section on the special considerations in conducting a neuropsychological interview. This organization reflects the current emphasis on and strategies for assessing patients with possible neuropsychological dysfunction.
Several of the chapters on psychological tests are quite long, particularly those for the Wechsler scales, Minnesota Multiphasic Personality Inventory, and neuropsychological screening and assessment. These chapters include extensive summaries of a wide variety of interpretive hypotheses intended for reference purposes when practitioners must generate interpretive hypotheses based on specific test scores. To gain initial familiarity with the tests, I recommend that practitioners or students carefully read the initial sections (history and development, psychometric properties, etc.) and then skim through the interpretation sections more quickly. This provides the reader with a basic familiarity with the procedures and types of data obtainable from the tests. As practical test work progresses, clinicians can then study the interpretive hypotheses in greater depth and gradually develop more extensive knowledge of the scales and their interpretation.
Based primarily on current frequency of use, the following tests are covered in this text: the Wechsler intelligence scales (WAIS-III /WISC-III), Wechsler Memory Scales (WMS-III), Minnesota Multiphasic Personality Inventory (MMPI-2), Millon Clinical Multiaxial Inventory (MCMI-III ), Bender Visual Motor Gestalt Test (along with other frequently used neuropsychological tests), Rorschach, and the Thematic Apperception Test (TAT; Camara, Nathan, & Puente, 2000; C. Piotrowski & Zalewski, 1993; Watkins, 1991; Watkins, Campbell, Nieberding, & Hallmark, 1995). The California Personality Inventory (CPI) was selected because of the importance of including a broad-based inventory of normal functioning along with its excellent technical development and relatively large research base (Anastasi & Urbina, 1997; Baucom, 1985; Gough, 2000; Wetzler, 1990). I also included a chapter on the most frequently used brief, symptom-focused inventories because of the increasing importance of monitoring treatment progress and outcome in a cost- and time-efficient managed care environment (Eisman, 2000; C. Piotrowski, 1999). The preceding instruments represent the core assessment devices used by most practitioners.
Finally, the clinician must generate relevant treatment recommendations and integrate the assessment results into a psychological report. Chapter 14 provides a systematic approach for working with assessment results to develop practical, empirically supported treatment recommendations. Chapter 15 presents guidelines for report writing, a report format, and four sample reports representative of the four most common types of referral settings (medical setting, legal context, educational context, psychological clinic). Thus, the chapters follow a logical sequence and provide useful, concise, and practical knowledge.
ROLE OF THE CLINICIAN
The central role of clinicians conducting assessments should be to answer specific questions and aid in making relevant decisions. To fulfill this role, clinicians must integrate a wide range of data and bring into focus diverse areas of knowledge. Thus, they are not merely administering and scoring tests. A useful distinction to highlight this point is the contrast between a psychometrist and a clinician conducting psychological assessment (Maloney & Ward, 1976; Matarazzo, 1990). Psychometrists tend to use tests merely to obtain data, and their task is often perceived as emphasizing the clerical and technical aspects of testing. Their approach is primarily data oriented, and the end product is often a series of traits or ability descriptions. These descriptions are typically unrelated to the person's overall context and do not address unique problems the person may be facing. In contrast, psychological assessment attempts to evaluate an individual in a problem situation so that the information derived from the assessment can somehow help with the problem. Tests are only one method of gathering data, and the test scores are not end products, but merely means of generating hypotheses. Psychological assessment, then, places data in a wide perspective, with its focus being problem solving and decision making.
The distinction between psychometric testing and psychological assessment can be better understood and the ideal role of the clinician more clearly defined by briefly elaborating on the historical and methodological reasons for the development of the psychometric approach. When psychological tests were originally developed, group measurements of intelligence met with early and noteworthy success, especially in military and industrial settings where individual interviewing and case histories were too expensive and time consuming. An advantage of the data-oriented intelligence tests was that they appeared to be objective, which would reduce possible interviewer bias. More important, they were quite successful in producing a relatively high number of true positives when used for classification purposes. Their predictions were generally accurate and usable. However, this created the early expectation that all assessments could be performed using the same method and would provide a similar level of accuracy and usefulness. Later assessment strategies often tried to imitate the methods of earlier intelligence tests for variables such as personality and psychiatric diagnosis.
A further development consistent with the psychometric approach was the strategy of using a "test battery." It was reasoned that if a single test could produce accurate descriptions of an ability or trait, administering a series of tests could create a total picture of the person. The goal, then, was to develop a global, yet definitive, description for the person using purely objective methods. This goal encouraged the idea that the tool (psychological test) was the best process for achieving the goal, rather than being merely one technique in the overall assessment procedure. Behind this approach were the concepts of individual differences and trait psychology. These assume that one of the best ways to describe the differences among individuals is to measure their strengths and weaknesses with respect to various traits. Thus, the clearest approach to the study of personality involved developing a relevant taxonomy of traits and then creating tests to measure these traits. Again, there was an emphasis on the tools as primary, with a de-emphasis on the input of the clinician. These trends created a bias toward administration and clerical skills. In this context, the psychometrist requires little, if any, clinical expertise other than administering, scoring, and interpreting tests. According to such a view, the most preferred tests would be machine-scored true-false or multiple choice-constructed so that the normed scores, rather than the psychometrist, provide the interpretation.
The objective psychometric approach is most appropriately applicable to ability tests such as those measuring intelligence or mechanical skills. Its usefulness decreases, however, when users attempt to assess personality traits such as dependence, authoritarianism, or anxiety. Personality variables are far more complex and, therefore, need to be validated in the context of history, behavioral observations, and interpersonal relationships. For example, a T score of 70 on the MMPI-2 scale 9 (mania) takes on an entirely different meaning for a high-functioning physician than for an individual with a poor history of work and interpersonal relationships. When the purely objective psychometric approach is used for the evaluation of problems in living (neurosis, psychosis, etc.), its usefulness is questionable.
Psychological assessment is most useful in the understanding and evaluation of personality and especially of problems in living. These issues involve a particular problem situation having to do with a specific individual. The central role of the clinician performing psychological assessment is that of an expert in human behavior who must deal with complex processes and understand test scores in the context of a person's life. The clinician must have knowledge concerning problem areas and, on the basis of this knowledge, form a general idea regarding behaviors to observe and areas in which to collect relevant data. This involves an awareness and appreciation of multiple causation, interactional influences, and multiple relationships. As Woody (1980) has stated, "Clinical assessment is individually oriented, but it always considers social existence; the objective is usually to help the person solve problems."
In addition to an awareness of the role suggested by psychological assessment, clinicians should be familiar with core knowledge related to measurement and clinical practice. This includes descriptive statistics, reliability (and measurement error), validity (and the meaning of test scores), normative interpretation, selection of appropriate tests, administration procedures, variables related to diversity (ethnicity, race, age, gender), testing individuals with disabilities, and an appropriate amount of supervised experience (Turner, DeMers, Fox, & Reed, 2001).
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Table of Contents
Chapter 1 Introduction 1
Organization of the Handbook 1
Role of the Clinician 3
Patterns of Test Usage in Clinical Assessment 6
Evaluating Psychological Tests 10
Validity in Clinical Practice 23
Clinical Judgment 26
Phases in Clinical Assessment 32
Recommended Reading 37
Chapter 2 Context of Clinical Assessment 39
Types of Referral Settings 39
Ethical Practice of Assessment 50
Assessing Diverse Groups 59
Selecting Psychological Tests 67
Computer-Assisted Assessment 72
Recommended Reading 74
Chapter 3 The Assessment Interview 77
History and Development 78
Issues Related to Reliability and Validity 82
Assets and Limitations 84
The Assessment Interview and Case History 86
Mental Status Evaluation 93
Interpreting Interview Data 99
Structured Interviews 100
Recommended Reading 111
Chapter 4 Behavioral Assessment 113
History and Development 115
Issues Related to Reliability and Validity 117
Assets and Limitations 120
Strategies of Behavioral Assessment 121
Recommended Reading 136
Chapter 5 Wechsler Intelligence Scales 139
Testing of Intelligence: Pros and Cons 139
History and Development 142
Reliability and Validity 147
Assets and Limitations 151
Use with Diverse Groups 153
Meaning of IQ Scores 156
Cautions and Guidelines in Administration 159
WAIS-IV/WISC-V Successive-Level Interpretation Procedure 161
Wechsler Indexes and Subtests 173
Assessing Brain Damage 196
Assessing Additional Special Populations 204
Short Forms 209
Recommended Reading 213
Chapter 6 Wechsler Memory Scales 215
History and Development 216
Reliability and Validity 222
Assets and Limitations 224
Use with Diverse Groups 226
Interpretation Procedure 227
Interpreting Patterns of Index Scores 230
Comparing Scores on the WAIS-IV and the WMS-IV 238
Additional Considerations: Malingering and Evaluating Change 241
Recommended Reading 242
Chapter 7 Minnesota Multiphasic Personality Inventory 243
History and Development 246
Reliability and Validity 251
Assets and Limitations 255
Use with Diverse Groups 259
MMPI-2 Interpretation Procedure 263
MMPI-2 Computerized Interpretation 272
MMPI-2 Validity Scales 273
MMPI-2 Clinical Scales 279
MMPI-2 2-Point Codes 302
MMPI-2 Content Scales 328
MMPI-A Content Scales 331
MMPI-2 Harris-Lingoes and Si Subscales 334
MMPI-2 Critical Items 337
MMPI-2 and MMPI-A Supplementary Scales 338
MMPI-2-RF Interpretation Procedure 341
MMPI-2-RF Validity Scales 346
MMPI-2-RF Higher-Order Scales 353
MMPI-2-RF Restructured Clinical Scales 355
MMPI-2-RF Specific Problem Scales 361
Interest Scales 366
MMPI-2-RF Personality Psychopathology Five Scales 366
Recommended Reading 370
Chapter 8 Personality Assessment Inventory 371
History and Development 373
Reliability and Validity 373
Assets and Limitations 375
Use with Diverse Groups 377
Interpretation Procedure 377
Validity Scales 380
Clinical Scales 384
Treatment Scales 404
Interpersonal Scales 408
Additional Clusters 410
Critical Items 415
Recommended Reading 416
Chapter 9 Millon Clinical Multiaxial Inventory 417
History and Development 419
Reliability and Validity 424
Assets and Limitations 427
Use with Diverse Groups 431
Interpretation Procedure 432
Validity Scales 436
Clinical Personality Patterns 439
Severe Personality Pathology 476
Clinical Syndromes 486
Severe Syndromes 488
Recommended Reading 488
Chapter 10 NEO Personality Inventory 489
History and Development 490
Reliability and Validity 491
Assets and Limitations 493
Use with Diverse Groups 494
Interpretation Procedure 495
Recommended Reading 512
Chapter 11 The Rorschach 513
History and Development 514
Reliability and Validity 518
Assets and Limitations 523
Use with Diverse Groups 527
Comprehensive System: Administration 528
Comprehensive System: Coding 531
Comprehensive System: Scoring the Structural Summary 536
Comprehensive System: Interpretation 539
R-PAS: Administration 581
R-PAS: Coding 584
R-PAS: Scoring the Structural Summary 592
R-PAS: Interpretation 593
Recommended Reading 614
Chapter 12 Screening for Neuropsychological Impairment 615
History and Development 617
Interviewing for Brain Impairment 620
Domains of Neuropsychological Functioning 624
Bender Visual-Motor Gestalt Test, Second Edition 633
Repeatable Battery for the Assessment of Neuropsychological Status Update 645
Recommended Reading 652
Chapter 13 Brief Instruments for Treatment Planning, Monitoring, and Outcome Assessment 653
Selecting Brief Instruments 654
Symptom Checklist-90-R and Brief Symptom Inventory 655
Beck Depression Inventory–II 662
State Trait Anxiety Inventory 666
Recommended Reading 670
Chapter 14 Treatment Planning and Clinical Decision Making 671
Development and Approaches to Treatment Planning 672
Intervention Options 677
Clinical Decision Making 679
Case Formulation 680
Understanding the Problems 683
Understanding Problem Context 692
Treatment-Specific Client Characteristics 696
The Systematic Treatment Selection (STS)/Innerlife Approach 703
Recommended Reading 705
Chapter 15 The Psychological Report 707
General Guidelines 708
Format for a Psychological Report 730
Sample Reports 743
Recommended Reading 772
Appendix A Test Publishers/Distributors 773
Appendix B Testing Organizations 777
Author Index 857
Subject Index 895
What People are Saying About This
"In the 5th edition of his very helpful text, Handbook of Psychological Assessment, Groth-Marnat once again assembles information about the history, development, and latest research on the major psychological assessment instruments in current use. He also gives wise and clear advice about the general process of clinical assessment, and about how to integrate information into a useful psychological report. I was particularly fascinated with the sample reports Groth-Marnat assembled from different settings, which give a sense of the breadth of assessment practice today.
This handbook will be extremely useful to students beginning their careers in psychological assessment, and to experienced assessors who want a handy resource when needed."
–Dr. Stephen Finn
"This Handbook is absolutely at the top of the “to read” list, or should be, for serious scholars of psychological measurement methods. Already known for its attention to detail and it’s depth, this edition of the Handbook has been given greater breadth through the addition of several great features: 1) The literature has been critically updated, 2) sections for working with special populations have been added, and 3) its content is tuned to important changes in the field. In all this, it has retained Groth-Marnat’s great clarity and devotion to being accurate and useful."
–Larry E. Beutler, PhD, ABPP; Stanford University School of Medicine
[The book's] purpose has been splendidly realized by Groth-Marnat, who has combined current scientific and clinical understandings in clear writing with an excellent sense of organization.