Psychological Assessment, Psychiatric Diagnosis, And Treatment Planning

Steven W. Hurt, Marvin Reznikoff, John F. Clarkin

• Publisher: Taylor & Francis
• Year: 2013
• Print ISBN:
  9781138004825
• eBook ISBN:
  9781317839088
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

First published in 1991. Using actual case material, this text shows how psychological assessment contributes to the clarification of diagnostic issues and the development of an optimal treatment plan. It covers disorders usually first evident in childhood and ends with the Axis II personality disorders.

CHAPTER 1

Psychological Testing and Psychiatric Diagnosis

In the broader sense, the purpose of psychological testing is to assess individual differences on one or more psychological variables. Clinical psychological testing as discussed in this book constitutes a specialized area of psychological testing that focuses on differentiating individuals in clinical inpatient and outpatient populations on the basis of the nature and degree of psychopathology. There are, of course, many other types of diagnostic testing, especially in the fields of medicine and education.

The meaningfulness of psychodiagnostic testing is obviously based upon the premise that there exists a taxonomy for classifying psychopathology into reliable diagnostic categories. Devising such a diagnostic classification system or nosology, however, has proven a very formidable task. Over a period of 35 years, the American Psychiatric Association has published four Diagnostic and Statistical Manuals (DSMs) (1952, 1968, 1980, 1987) with an additional version now in preparation. Each successive manual has offered more explicit and comprehensive diagnostic criteria in not always fruitful efforts to make the process of differential diagnosis more reliable.

In this introductory chapter, a selective history of psychological testing will be given, including an evaluation of its current status. Psychological Testing (1988) by Anne Anastasi has been an invaluable source of guidance and information for the preparation of the first section of this chapter and is highly recommended as an exhaustive treatment of the subject. Within the framework of the various DSM editions, an overview of past efforts to develop reliable and readily applicable diagnostic schema will also be presented.

HISTORY OF PSYCHOLOGICAL TESTING AND ASSESSMENT

Early Testing Efforts

Anastasi (1988) defines the traditional function of psychological tests as having been “to measure differences between individuals or between the reactions of the same individuals on different occasions.” Another leading authority on psychological testing, Cronbach (1949) states that what a test entails is a “systematic procedure for comparing the behavior of two or more persons.”

Contemporary psychological testing, perceived as the utilization of standardized instruments to measure various psychological functions, has its major roots in the nineteenth century. However, it is of interest to note that a comparatively well-developed program of oral civil service examinations seems to have existed in China more than 4,000 years ago (Wiggins, 1973). By the fourteenth century, the Chinese civil service selection program boasted a network of local testing centers across the nation which administered written examinations of an essay type in specially constructed testing booths. The Greeks some 3,000 years ago also employed testing procedures incorporating them in their educational system (Anastasi, 1988).

The impetus for the development of psychological tests in the nineteenth century can be traced to the growing concern with humane treatment of the mentally deficient and the insane. This, in turn, gave rise to a need to identify, differentiate between, and classify mentally impaired individuals in some sort of systematic fashion. In France, Esquirol, for example, endeavored to distinguish varying degrees of mental retardation by assessing language skills. Seguin, another French physician who subsequently came to America, experimented with methods of training the mentally deficient and developed a form board akin to a jigsaw puzzle which is still a part of performance intelligence scales.

The focuses of the experimental psychologists of the nineteenth century were largely on measuring sensory phenomena and developing generalized principles of behavior. This approach is typified by Wundt, who established a laboratory in Leipzig in 1879 where a number of the early experimental psychologists studied. When individual differences were observed under standardized conditions, they were ordinarily ascribed to a form of human error. By contrast, in the 1880s, Sir Francis Galton, the English biologist, grasped the importance of accurately assessing individual differences and similarities in connection with his research on heredity and, in effect, fathered contemporary psychological testing.

Rather than studying mental processes exhaustively in a few people, Galton was more interested in less intensive investigations of large numbers of individuals. Furthermore, he did not confine his studies to simple sensorimotor functions, but broadened his investigative approaches to include questionnaires and rating scales and devised statistical methods for analyzing his findings on individual differences.

Galton believed that sensory discrimination and reaction time tests could evaluate intellectual ability, a point of view shared by the American psychologist Cattell. Cattell, stimulated by contact with Galton, developed his own series of simple measures for assessing individual differences in intelligence, also emphasizing in his battery sensory tasks and speed of response which lent themselves to precise measurement. For the first time in the psychological literature, Cattell employed the term “mental tests” in an article written in 1890 describing a series of tests administered to college students to appraise intellectual functioning.

In approximately the same period, the German psychiatrist Kraepelin, who was a prime mover in the classification of mental illness, devised a battery of tests, tapping, among other factors, memory and fatigue susceptibility. Kraepelin was interested principally in using his tests with clinical populations. Ferrari, an Italian psychologist, was also concerned with evaluating psychopathology through a diverse series of tests encompassing motor skills, physiological measures, and even interpretation of pictures.

It remained for Binet, however, to add new scope and direction to testing. In an article appearing in 1895, Binet and Henri criticized the intelligence tests of the time as too simplistic, narrowly focused, and based on the dubious assumption that intelligence was fundamentally reducible to motor speed and sensation. They asserted, additionally, that more meaningful complex functions would not po...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Foreword
• Preface
• Chapter 1 Psychological Testing and Psychiatric Diagnosis
• Section 1 Axis I Disorders
• Section 2 Axis II Disorders
• References
• Name Index
• Subject Index