Issues in the Personality Assessment of Lower-Class Patients

The recent national concerns about the poor and uneducated members of our society brings to the forefront the psychological treatment of the lower class. For many years, in state hospitals and mental hygiene clinics and now in community mental health centers, psychologists have been called upon for personality assessment of lower-class patients. The results of various studies indicate rather conclusively that lower-class people, for a variety of reasons, are much more likely to be assessed less favorably than members of the middle class. This paper is an attempt to review some factors in assessing the lower class patient so that the clinician can face these issues more clearly in his psychological assessment.     

Jehovah's Witnesses' child-rearing advice and potential psychologists' bias

This study examined agreement with and potential bias toward child-rearing advice provided in publications of Jehovah's Witnesses. A sample of 750 APA member psychologists with Ph.D.s were randomly selected and assigned to one of three groups: (1) those informed about the source of the child-rearing advice, (2) those partially informed about the source of the advice, and (3) those uninformed about the source of the advice. Each group was provided identical materials except for identifying information about the specific source. Analyses show that psychologists report high agreement with the child-rearing advice provided by Jehovah's Witnesses through their publications, primarily The Watchtower and Awake! magazines. In general, however, psychologists expressed lower agreement with advice pertaining to early dating, premarital sex, and sports participation. Significantly lower participation was found in the group who were fully informed about the source of the advice. Implications of these findings are discussed and directions for research given.     

An ecological study of the reliability of clinical judgment in executive appraisal

This research was a study of the reliability of clinical judgment findings (multitrait) across three different information sources (psychometric tests, structured interview, and psychometric tests and interview). Subjects (N = 74) were middle and senior executives of Western Canadian technical companies; clinicians (N = 3) were trained and experienced industrial psychologists. The study investigated the similarity of clinical evaluation of personological characteristics (based on an 18-factor multitrait paradigm) across the three different information sources. Subjects were independently rated by a single clinician on 18 criterion factors in each of the three information source categories. Test information source categories required the administration of approximately 12 hrs of standardized psychological assessment questionnaires to each of the 74 subjects. Interview source category involved a 1.5-hr structured interview per subject. Combined condition pooled both test and interview conditions. Generalizability of the findings was maximized by the undertaking of the experiment in a natural situation thus increasing ecological validity. Statistical treatments used were designed to assess the similarity of a clinician's evaluation of a subject based on the different category of information available about that client. Convergence (intrarater reliability) indexes range from a high of .64 to a low of .05. Results indicate a varying degree of convergence of multitrait clinical ratings dependent on clinician and trait being rated. Results are discussed in terms of implications for practitioners involved in executive personnel selection.     

Variability of attention bias in socially anxious adolescents: differences in fixation duration toward adult and adolescent face stimuli

Prior research on attention bias in anxious youth, often utilising a visual dot probe task, has yielded inconsistent findings, which may be due to how bias is assessed and/or variability in the phenomenon. The present study utilises eye gaze tracking to assess attention bias in socially anxious adolescents, and explores several methodological and within-subject factors that may contribute to variability in attention bias. Attention bias to threat was measured in forty-two treatment-seeking adolescents (age 12–16 years) diagnosed with Social Anxiety Disorder. Bias scores toward emotional stimuli (vigilant attention) and bias scores away from emotional stimuli (avoidant attention) were explored. Bias scores changed between vigilance and avoidance within individuals and over the course of stimulus presentation. These differences were not associated with participant characteristics nor with self-reported social anxiety symptoms. However, clinician rated severity of social anxiety, explained a significant proportion of variance in the bias scores for adult, but not the adolescent, stimuli. Variability in attention bias among socially anxious adolescents is common and varies as a function of stimulus duration and type. Results may inform stimulus selection for future research.     

Opinion formation in evaluating the adjudicative competence and restorability of criminal defendants: a review of 8,000 evaluations

Evaluations of competence to stand trial (CST) are the most common type of criminal forensic evaluation conducted, and courts tend to defer to clinician opinions regarding a defendant's competence. Thus, it is important to study the ways in which clinicians arrive at opinions regarding adjudicative competence and the data they consider in forming their opinions. We reviewed 8,416 evaluations conducted by forensic evaluators in Virginia over a 12 year period, and examined (a) the clinical, demographic, and criminal characteristics of a defendant as related to opinions regarding competence, predicted restorability, and impairment on "prongs" of the Dusky standard, (b) process and outcome differences in evaluations conducted by psychiatrists versus psychologists and inpatient versus outpatient evaluators, and (c) the consistency of incompetence base rates over a 10 year period. Overall, clinicians opined that 19% of defendants were incompetent and considered 23% of these unlikely to be restored to competence. Not surprisingly, psychotic and organic/intellectual disorders were most strongly associated with findings of incompetence. However, there were some notable differences between evaluations by psychologists versus psychiatrists and between evaluations conducted in inpatient versus outpatient settings.     

The Assessment of Post‐traumatic Stress Disorder for Workers' Compensation in Emergency Service Personnel

There is considerable debate concerning the diagnosis of post‐traumatic stress disorder (PTSD) in compensation claims. This study reviewed the quality of the assessment reports prepared by clinicians who evaluated 31 emergency service workers making PTSD‐related compensation claims. Assessments were conducted by 4‐year trained psychologists (39%), psychologists holding a masters degree (36%), and psychiatrists (19%). The assessment reports were evaluated relative to the diagnostic criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders 4th edition (2000). In the majority of cases (81%), the assessor determined that the emergency service worker had PTSD, but only one report met the minimum standard for that diagnosis. In the majority (65%) of cases the clinician failed to address the possibility of malingering. These data suggest that clinical assessment reports for PTSD frequently fail to meet minimum assessment standards.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

Assessment of ADHD: differences across psychology specialty areas

Child psychologists are frequently involved in the assessment of ADHD symptoms among school-aged youth. There is limited information regarding the extent to which psychologists adhere to recommended assessment practices and whether differences exist in assessment strategies among psychologists from different specialty areas (clinical, counseling, and school) and/or who practice in different settings (university, school, or outpatient clinic). A 3 (specialty area) x 3 (employment setting) between-groups design is used wherein 230 child psychologists completed surveys regarding diagnostic practice. Psychologists differ in adherence with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) diagnostic criteria, use of clinical interviews, and type of behavior observation. Only 15% of psychologists report using multiple methods consistent with recommended standards of best practice. Differences between groups of psychologists indicate that the diagnosis of ADHD in children is influenced by the type of psychologist conducting the evaluation and the setting in which the evaluation is conducted.     

Why are we ‘too busy?’ Problems of practitioner research in family therapy

Two psychologists with backgrounds in research who are currently practising family therapy consider the factors that make research a difficult enterprise. Similarities and differences in research and therapeutic processes are considered, including hypothesis formation and testing, the relative precision of research and clinical hypotheses, and the relative needs for promoting consistency or change in research and therapy. The rewards of each for the clinician are considered, together with the importance of institutional attitudes and provision of time and resources for research. The relevance of developments in other areas of psychological theory are considered, and suggestions are made for the forms of research and reporting that may be of greatest value to clinicians at present.     

Mental Illness and Psychiatric Treatment Among Women

When mental illness is precisely defined as a functional disorder involving acute distress or disorganization (or both), women are consistently found to have higher rates of mental illness than men. This sex difference appears to be real and not an artifact of response bias, patient behavior, or clinician bias. The higher rates of mental illness among women can be linked to aspects of their societal role and particularly to aspects of the marital role. Therapists who treat women whose mental illness is in part a response to the characteristics of conventional sex roles have no treatment alternatives that are not in some way problematic. The treatment alternative chosen has, in the broadest sense, political implications for the society at large.     

Discrimination of a low‐status outgroup: the role of ingroup threat

In the present study it was predicted that a threat to the ingroup by a high‐status outgroup would lead its members to increase the level of derogation of a lower‐status outgroup. Two experimental groups of psychologists were informed about the opinions (positive or negative) allegedly held by medical doctors regarding clinical psychologists whereas participants in the control condition did not receive any feedback. Later, all participants were asked to judge psychologists, social workers (low‐status outgroup), and medical doctors along professional and personality dimensions. As predicted, compared to participants in the positive feedback and in the control conditions, negative feedback participants increased derogation toward social workers but not toward medical doctors along the professional traits relevant to the feedback. Results are interpreted in the context of Downward Comparison Theory (Wills, 1981 ). Copyright © 2002 John Wiley & Sons, Ltd.     

A Short Measure of the Need for Affect

Summary

Widespread divergencies of opinion exist over the usefulness, the nature, the purpose, and the scientific status of clinical psychological testing. This paper seeks to order these problems in historical and philosophical perspective. Largely different values and orientations have been contributed by traditional American academic psychology, by clinical psychology, and by psychiatry. Academic psychologists advocate a rigorous scientific basis (logical positivism) for testing, which the clinician tends to find overly confining and antagonistic to his humanistic, individual centered, service orientation; while psychiatrists tend to differ greatly among themselves in their understanding of psychological testing and hence exert no uniform influence on the practice. The current trend emphasizes greater sophistication in the academic approach to testing, with advances in empiricism and computer-aided manipulation of data, while the more clinically oriented psychologists seek to strengthen their theoretical position and to demonstrate the effectiveness of their methods through studies of clinical judgment. At the same time basic methodological research to support the “clinical position” is yet too sparse. It is proposed that both academic and clinical approaches have a significant contribution to make to clinical psychological testing. Ultimately the design of psychological tests and the evaluation of their usefulness rests upon what we conceive psychological science to be, and we need to remind ourselves, in this regard, that the conception of science is subject to change.     

The impact of expertise and sufficient information on psychologists' ability to detect malingering

Twenty-two forensic diplomates and 22 general clinical psychologists were asked to review a variety of psychological data from one of four cases (two cases of malingering and two cases of legal insanity) to determine whether data suggested malingering or insanity. Of the 44 psychologists who reviewed cases, 86.4% accurately determined whether their protocol was from a malingerer or an insane person. Forensic diplomates and clinical psychologists were equally accurate in their determinations; only three subjects from each group misidentified their case. In spite of their success, confidence levels for both groups were reported as moderate. These results contradict previous studies that have found psychologists to not only be poor detectors of malingering, but also overconfident in their ability to detect it. It is believed that the success of psychologists in this study compared to previous studies was due to improved methodology.     

Gender Role of Male Therapists in Both Professional and Personal Life

This study's purpose was to extend the distantresearch on gender roles. The specific objective was tobetter understand the gender role of male psychologists.It was hypothesized that male psychologists would exhibit an androgynous gender role.Gender role styles in professional work and in thepersonal realm were assessed. Questionnaire packets weremailed to 300 male clinical psychologists affiliated with the American Psychological Associationacross six regions within the United States. Sixty ofthe 61 participants reported being Caucasian and 1reported being Native American. Being that the sample was that of practicing psychologists, all withdoctorate degrees, the social class is presumed to be atleast upper middle class. The packets contained ademographics questionnaire and two Personal Attributes Questionnaires. Results suggest that malepsychologists do exhibit an androgynous gender role inboth professional and personal realms. A great deal ofthe prior literature indicates that androgynoustherapists have more adaptive communication skills and arebetter at assessing and treating their clients. Thisresult is therefore advantageous to therapeuticoutcomes.     

Gender bias in clinical judgment: An assessment of the analogue method's transparency and social desirability

The main purpose of this research was to determine whether clinicians discern the intent of an analogue study of gender bias in clinical judgment and, if so, whether they respond in a socially desirable manner. A total of 147 psychologists responded to a national mail survey in which they were instructed to make clinical ratings of a case summary describing either a female or male client. In one condition (the Social Desirability condition), clinicians were informed of the study's intent and instructed to respond in a socially desirable fashion. In another condition (the No Social Desirability condition), the study's intent was not revealed and clinicians were asked to guess the study's hypothesis following their ratings. Results indicate that only 10 of 100 clinicians reported having deduced the purpose of the study. The small number of guessers prohibited examination of whether guessing the intent leads to socially desirable responses. Results provide no evidence that either therapist or client gender influenced clinical judgment. Implications for evaluating experimental findings which fail to support gender bias in clinical judgment are discussed.This research was supported in part by a Biomedical Research Grant awarded to the first author when he was a faculty member at the University of Southern California. Thanks are due to Bernie Weiner and Rena Repetti for their comments on early drafts.     

Impact of planned movement direction on judgments of visual locations

The present study examined if and how the direction of planned hand movements affects the perceived direction of visual stimuli. In three experiments participants prepared hand movements that deviated regarding direction (“Experiment 1” and “2”) or distance relative to a visual target position (“Experiment 3”). Before actual execution of the movement, the direction of the visual stimulus had to be estimated by means of a method of adjustment. The perception of stimulus direction was biased away from planned movement direction, such that with leftward movements stimuli appeared somewhat more rightward than with rightward movements. Control conditions revealed that this effect was neither a mere response bias, nor a result of processing or memorizing movement cues. Also, shifting the focus of attention toward a cued location in space was not sufficient to induce the perceptual bias observed under conditions of movement preparation (“Experiment 4”). These results confirm that characteristics of planned actions bias visual perception, with the direction of bias (contrast or assimilation) possibly depending on the type of the representations (categorical or metric) involved.     

Letter-writing practices in a child and family service

This study examined the letter-writing practices in a child and family psychology service. Utilizing a grounded theory approach to data collection and analysis, six clinical psychologists (including one pilot study) were interviewed about their letter-writing practices in relation to direct clinical work and in correspondence with other professionals. Analysis of the data yielded five themes: typical practices, use of clinical and micro skills, letters addressing the relationship with the family, messages to other professionals, and beliefs about the family. Findings suggest that letters are used in a variety of ways including being an aide-mémoire of the contents of face-to-face meetings, directly addressing the therapeutic relationship with the client, demonstrating respect, and informing other professionals of psychological practices and views regarding clients and their presenting problems. It emerged that letter-writing is seen to exist in the wider context of social relationships, between the referrer, clinician and client. The results are discussed in relation to clinical practices and future areas of study.     

Recognition of names of eminent psychologists

Faculty members, graduate students, undergraduate majors, and introductory psychology students checked those names they recognized in the list of 228 deceased psychologists, rated for eminence, provided by Annin, Boring, and Watson. Mean percentage recognition was less than 50% for the 128 American psychologists, and less than 25% for the 100 foreign psychologists, by the faculty subjects. The other three groups of subjects gave even lower recognition scores. Recognition was probably also influenced by recency; median year of death of the American psychologists was 1955, of the foreign psychologists, 1943. High recognition (defined as recognition by 80% or more of the faculty group) was achieved by only 34 psychologists, almost all of them American. These highly recognized psychologists also had high eminence ratings, but there was an equal number of psychologists with high eminence ratings that were poorly recognized.