Assessment and Diagnosis in Psychotherapy Essay Paper

Assessment and Diagnosis in Psychotherapy Essay Paper

Assessment and Diagnosis in Psychotherapy Essay Paper

Counseling psychology is a developmentally oriented specialty that emphasizes the integration and informed application of principles derived from basic psycholog­ical sciences such as differential, vocational, developmental, and social psychology. The practice of counseling psychology overlaps with that of clinical, industrial-organizational, management, and school psychology, making it one of the broadest and most integrative specialties in psychology.Assessment and Diagnosis in Psychotherapy Essay Paper

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Scientific Foundations of Counseling Psychology
Differential psychology, the study of the nature and extent of individual and group variability, and of the factors that determine or affect these differences, is one of two formative progenitors of counseling psychology. The objectives of differential psychology are to document individual differences in human attributes such as intelligence, personality, interests, and values that occur as a function of age, gender, race, and social class, and to identify the factors that contribute to those differences. Counseling psychologists share differential psychology’s philosophical belief in the uniqueness of each person and this provides the philosophical rationale that guides their use of assessment techniques. In practice, counseling psychologists try to gain an understanding of how each individual thinks, feels, and acts, and their assessment practices cover the entire range of human cognitive, conative, and affective attributes.


Validity, reliability, and fairness in assessment practices might be the most integral, yet misinterpreted concepts within the fields of educational and psychological assessment. The Standards for Educational and Psychological Testing (Standards; American Educational Research Association [AERA], American Psychological Association [APA], & National Council on Measurement in Education [NCME], 2014 American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: AERA.
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) provided guidelines for the development and evaluation of assessment validity that have substantial implications for professional counselors in clinical and research settings alike. Such a resource is invaluable when considering that prudently selected, administered, scored, and interpreted assessments can shape the course and trajectory of an individual’s development and wellness across the life span. Similarly, evidence-supported treatments and evidence-based practices that are nested within sensible, pragmatic, assessment-based data frameworks are instrumental for informing best practices for educational and public mental health policy. The confluence of these variables within the current sociopolitical climate has triggered a moment within our profession’s history wherein a functional understanding of measurement concepts is imperative. Alas, educational experiences and continuing education activities for many counseling professionals have been underrepresented by plainly spoken illustrations of assessment development and evaluation activities. Therefore, the aim of this special issue is to provide such support that is a useful guide to counseling practitioners, researchers, and students.

Primary care providers, the first stop for most people’s health-related complaints, operate under ever-increasing pressures to provide care for more people in less time. The average visit lasts 10 to 15 minutes, with the goal of assessing presenting symptoms (typically while simultaneously entering patient information into a computer system) to ascertain their cause and thereby provide information about how to treat them. There often isn’t time to gather the context of these symptoms, increasing the likelihood that important details can be missed. Likewise, there isn’t sufficient time to fully discuss the pros and cons of treatment options, the potential barriers to treatment and whether a patient is willing or able to follow through on the treatment recommendations.Assessment and Diagnosis in Psychotherapy Essay Paper

In contrast, mental health providers often have the luxury of coming to understand patients/clients more fully. This includes understanding and appreciating the contexts in which patients/clients find themselves, understanding how these individuals are coping and making meaning of what is happening, and forming a trusting relationship with them, which is consistently demonstrated to be predictive of adherence to care and improvements in health-related parameters.

As Thomas Sequist, assistant professor of health care policy at Harvard Medical School, stated in a New York Times article in 2008, “It isn’t that [medical] providers are doing different things for different patients, it’s that we’re doing the same thing for every patient and not accounting for individual needs.”

It can be said that medical providers are trained to identify and treat symptoms in order to identify disease so that a patient can be effectively treated — which is, in fact, their role. In contrast, mental health providers are trained to treat people and illness — illness being one’s experience of disease rather than just a compilation of symptoms or diagnostic labels.

The process of assessing for mental health symptoms

A variety of mental health conditions are characterized by symptoms that overlap with those attributable to medical conditions. For example, symptoms of an overactive or underactive thyroid mimic anxiety and depression, respectively. Psychosis can mimic neurological conditions, mood disorders can mimic endocrine disease, anxiety can mimic cardiac dysfunction and so on.Assessment and Diagnosis in Psychotherapy Essay Paper

Through training mental health clinicians to identify symptoms that may indicate a medical cause and knowing how to assess for the possibility of a medical workup, we can make earlier referrals for medical care. This, in turn, helps us to identify diagnoses more quickly, leading to easier/more efficacious treatment and better validating concerns.

One’s cultural identity and the resonance of cultural norms are also important to assess and monitor. For instance, a patient may be reluctant to engage with an English-speaking provider, may have a vastly different conceptualization of illness as punishment (in stark contrast to the Westernized biopsychosocial model) and may need validation for his or her reliance on faith and spirituality.


Collaborating as mental health clinicians directly with medical professionals toward the common goal of helping those who need our care can be invaluable. Examples include ruling out mental health disorders, identifying appropriate treatments in the case of comorbidities, providing emotional support to patients who have been diagnosed with a medical disorder and supporting physicians who may be overwhelmed. For instance, medical treaters may not know or understand the presentation of symptoms associated with trauma or the intricacies of providing trauma-informed care.

Being knowledgeable as mental health clinicians about medical-related symptoms, the language and jargon of medicine, and strategies for navigating the medical system provides us with critical credibility. This credibility can make or break our ability to collaborate as mental health clinicians.Assessment and Diagnosis in Psychotherapy Essay Paper

Providing care

At its best, behavioral medicine functions as a prevention-focused model with three levels of care:

1) Primary prevention refers to preventing a problem from emerging to begin with. Examples of this might be establishing obesity prevention programs in public schools for young children or working with high-risk families to promote safety practices. The idea is to work with groups that may be more vulnerable to risks at some point in the future and to prevent those outcomes from occurring.

2) Secondary prevention involves working with people who have developed a problem of some sort, with the goal of preventing it from worsening or becoming a larger problem. Examples include working with people who are prehypertensive in order to prevent hypertension and subsequent cardiovascular disease or stroke, and working with people with HIV to increase their adherence to antiretroviral medication to reduce viral load, making them less infectious to others and providing them with more healthy years of life.

3) Tertiary prevention refers to helping people manage an already-existing disease. This might involve increasing quality of life for people enduring a condition that won’t improve, such as a spinal cord injury, multiple sclerosis or late-stage renal disease, and supporting people in the later stages of a disease that is imminently terminal.

Transtheoretical model (stages of change)

Although mental health clinicians may be familiar with efficacious interventions for a given condition, we may not be perceived as credible if we do not understand and respect the client’s/patient’s motivation. No mental health provider’s repertoire is complete without an understanding of the transtheoretical model and how to utilize it to increase an individual’s motivation for positive change.Assessment and Diagnosis in Psychotherapy Essay Paper

Assessing where a client/patient might be in the stages of this model (precontemplation, contemplation, preparation, action, maintenance) helps us to better target our interventions in a respectful way by taking context into consideration. Clients/patients in the precontemplation stage might benefit most from education and are less likely to be receptive to recommendations for lifestyle changes, whereas those in the action stage may not need as much of an emphasis on motivation. For a thorough description of the transtheoretical model, I would refer readers to William Miller and Stephen Rollnick’s seminal work, Motivational Interviewing: Helping People Change.

Concrete needs and specific skills

The majority of causes of death and disability in the United States are those caused or treated, at least in part, by behavior. Nationally, the top 10 causes of death, according to the Centers for Disease Control and Prevention (2015), include cardiovascular and cerebrovascular disease, cancer, pulmonary disease, unintentional injuries, diabetes, Alzheimer’s disease and suicide. Changes in lifestyle, knowledge/education and interpersonal support can be successfully utilized as part of all three levels of prevention. In fact, these are areas in which mental health providers can be extremely valuable.Assessment and Diagnosis in Psychotherapy Essay Paper

Primary prevention: Data suggest that the single most preventable cause of death is tobacco use, which can dramatically increase the risk of developing cancer, pulmonary disease and cardiovascular disease. Comprehensive smoking-cessation programs can be quite effective in managing this, as can education to prevent young people from initiating cigarette use.

Sedentary behavior (and, to a lesser extent, lack of exercise) is also strongly associated with health problems, perhaps most commonly cardiovascular disease and cancer. Concrete strategies for introducing nonsedentary behaviors (using the stairs, standing up once an hour, walking) can be incorporated into one’s lifestyle with less effort than a complex exercise regimen.

Getting proper nutrition, practicing good dental hygiene and consistently wearing sunscreen, helmets and seat belts are other examples of primary prevention in behavioral medicine. Motivating people who have not (yet) experienced the negative consequences of their risk behaviors is an approach that mental health providers are trained to provide.

Secondary prevention: The rates of obesity have risen dramatically in the past decade and are associated with a wide variety of serious medical complications, including diabetes, cardiovascular disease, stroke and cancer. If treated effectively, the risk of such complications can be reduced significantly. Examples of interventions found to be useful include aerobic exercise, dietary change (such as adhering to a Mediterranean diet and managing portions) and monitoring weight loss.Assessment and Diagnosis in Psychotherapy Essay Paper

Although the specifics of these interventions may be most appropriately prescribed by dietitians and physical therapists, mental health providers can add value by helping to increase clients’/patients’ motivation and adherence, providing more thorough education about recommendations and collaborating with other providers.

Tertiary prevention: Spinal cord injury, most often caused by motor vehicle accidents, falls or violence, can have a devastating effect on a person’s life. These injuries are not reversible, but mental health providers can prove valuable in tertiary prevention efforts. These efforts might involve providing existential support; helping patients to navigate the medical system and ask for/receive support from significant others; and identifying strategies for improving quality of life and accessing tangible resources to sustain some aspects of independence.

So, how might clinical mental health counselors “break into” the system? The ideal is an integrated care model in which mental health providers are colocated within the medical setting. This serves a dual function of facilitating mental health referrals and making it easier for patients/clients to see us because we’re just down the hall or up a flight of stairs from the medical providers. It also ensures that we remain visible to medical providers and allows for us to easily demonstrate our value.Assessment and Diagnosis in Psychotherapy Essay Paper

Short of this, and for those who are less interested in focused work in behavioral medicine, the following suggestions may be helpful:

1) Attend trainings. This is a crucial first step before mental health counselors can ethically market themselves as being knowledgeable about behavioral medicine. As an example, with rates of diabetes increasing, and associated adjustment and psychological sequelae common, learning all you can about the disease and strategies for managing it provides you with some expertise and a valuable referral option. This is consistent with current recommendations for branding a practice.

2) Develop a niche. Your services can be all the more compelling if you have developed a niche for yourself that fills a gap. Research your area and the specialties that mental health providers are marketing. Is there something missing? For instance, many providers may be offering care for people who are terminally ill, but are there providers specializing in working with young people in this situation? Are people who specialize in working with pediatric cancer also advertising services to treat siblings or affected parents?

3) Being mindful of your competence and expertise, connect with medical providers and let them know that you are accepting clients. For instance, if you work with children or adolescents, consider reaching out to pediatricians. Research consistently finds that the only linkage to care someone with mental illness may have is through his or her primary care physician. Providing these physicians with literature about your services makes it easy for them to pass along your information to anyone they think may benefit. Mental health counselors can connect with medical providers via personal visits to physicians’ offices or through direct marketing to professional organizations. Note that approaching small practices may be the better option because they are less likely to already be linked with another service (hospitals often have their own behavioral health clinics/providers).

4) Connect with specialty care providers. These providers tend to have greater need of mental health professionals who are familiar with a given diagnosis.Assessment and Diagnosis in Psychotherapy Essay Paper

5) Don’t be afraid to contact a medical provider treating one of your clients. This can provide a means for collaborative care and could also serve to gain you credibility, while indicating that you are glad to take referrals. Clearly, this should be done only if clinically indicated and only with the client’s permission.

6) Finally, be prepared to describe your experience, training and competency areas in a brief fashion. In the busy world of medicine, time is quite valuable. Mental health providers’ skills in waxing poetic can get in the way of communicating the essence of what we want to get across.


This article would be incomplete without a mention of ethics. Behavioral medicine is a field rife with ethical concerns. Perhaps the most salient of these is competence. From an ethical lens, it is critical that we, as mental health counselors, recognize the limits of our competencies — that is, we are not trained in medicine and thus cannot ethically diagnose a medical condition, recommend treatments that could be potentially harmful or assure patients/clients that medical evaluations or treatments are unnecessary. All of these actions require the input and monitoring of medical treaters, who can guide our efforts in care. Patients/clients also need to be clearly informed of both our benefits to and limitations in their care. The world of medicine changes rapidly, and the half-life of training in medicine and medical care is short. Ongoing education is critical.

Let’s return to the scenario described at the beginning of this article. The shared goal for all providers — medical, psychological and other — is to provide efficacious and meaningful care in a way that improves the patient’s health and quality of life. By utilizing our respective areas of training, competencies and strengths, we can better understand the context of symptoms, which can guide our care. This is the cornerstone of providing ethical care.Assessment and Diagnosis in Psychotherapy Essay Paper

Such an endeavor seems judicious given the updates to the Standards since the previous explication in Measurement and Evaluation in Counseling and Development (MECD) by Goodwin and Leech (2003 Goodwin, L. D., & Leech, N. L. (2003). The meaning of validity in the new Standards for Educational and Psychological Testing: Implications for measurement courses. Measurement and Evaluation in Counseling and Development, 36, 181–191.
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), as well as our current zeitgeist of assessment access, use, and interpretation in which we find ourselves as counseling professionals. On one hand, the Standards appear to have shifted to speak not just to the assessment pedant, but to a broader range of consumers of assessment scores including graduate students and policymakers. This is particularly evident in the field of counselor education wherein the proliferation of assessments accompanying various professional competencies has abounded. On the other hand, unsupervised assessment use appears to be at an all-time high. One need look no further than the Internet or a smartphone’s application store to access ready-made assessments intended to quantify complex human experiences such as social-emotional competence, language proficiency, postpartum depression, and posttraumatic stress disorder. Although this unprecedented access is undeniably convenient and might prompt individuals toward better understanding their lived experiences or help-seeking behaviors, there is also a risk that misinterpretations of results could have deleterious implications. Hattie (2014 Hattie, J. (2014). The last of the 20th-century test standards. Educational Measurement: Issues and Practice, 33(4), 34–35.
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) shared this sentiment, in part, noting that this level of access without scrutiny of implications for those completing assessments represents “a critical shift from seeing tests only as a sample of items, a scoring system, and a score to seeing tests as reports about performance” (p. 34), without adequate attention to psychometric properties or context of scores. Consequently, our hope is that the content of this special issue will not only guide the development and evaluation of assessment content for use among counseling professionals, but also encourage a degree of critical thinking that supports situating the assessment experience across multiple layers of theory and evidence that promotes fairness for clients and stakeholders.Assessment and Diagnosis in Psychotherapy Essay Paper

Considering the Characteristics Defining Validity Within the Standards
We preface this introductory contribution with some general commentary related to the concept of validity as a foundation of prudent assessment practices that are intended as preliminary to the articles in this special issue. It is our belief that the discussion of processes and features representing sources of validity evidence is best situated within the context of some very important characteristics. Although scholars have offered both objections and affirming overtures about validity depicted within the Standards, some important considerations about validity have persisted as generally agreed on (Markus, 2016 Markus, K. A. (2016). Alternative vocabularies in the test validity literature. Assessment in Education: Principles, Policy & Practice, 23, 252–267.
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; Newton & Shaw, 2016 Newton, P. E., & Shaw, S. D. (2016). Disagreement over the best way to use the word “validity” and options for reaching consensus. Assessment in Education: Principles, Policy & Practice, 23, 178–197.
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). Namely, these characteristics include (a) the distinct relationship between validity and validation activities; (b) the integrated, synergistic nature of validity evidence;, (c) the satisfaction of all standards does not preclude utility of assessment scores; (d) validity is based on inferences about scores, not an assessment or test intrinsically; (e) defining the purpose of assessment scores cannot be underscored enough; and (f) without careful attention to the consequences of testing, wide access to assessments poses varied degrees of threat to test takers. To each of these points, we submit modest discourse based on our experiences using informal and formal assessments in educational, clinical, and research settings.

The Distinct Relationship Between Validity and Validation
The Standards identified validity as “the degree to which evidence and theory support the interpretations of test scores for proposed uses of tests” (AERA, APA, & NCME, 2014 American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: AERA.
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, p. 11). Within this statement, there is a distinct emphasis on estimations of validity being a matter of degree of indication rather than a categorical status. By contrast, validation refers to the many processes and practices implemented by researchers to accumulate evidence supporting or dispelling suppositions about the usefulness of assessment scores. In some cases, validation activities yield clear evidence for or against a particular use and interpretation, but in others, validation confirms and dispels the usefulness of scores when explaining the experiences of individuals across various intersections of identity such as age, gender, cultural expression, diagnostic presentation, educational achievement, and vocational interest. Taken together, validation is an ongoing process of estimating the usefulness of assessment scores for explaining the experiences and characteristics of individuals for a well-defined construct. From the information garnered through this process, counselors can make inferences about the degree to which a particular assessment’s scores will support accurate interpretations and inferences about their population of interest.

Validity Is Inferred From Scores and Uses, Not the Assessment Itself
Does validity refer to whether or not something measures what it is supposed to? Sure it does, in about the same degree that putting yourself in someone else’s shoes explains the relational intricacies that underlie communicating empathy. A precondition to discussing validation procedures is the proposition that validity is inferred from assessment scores and the ways they are used, not the assessment itself. That is to say, discussions of validity are always going to be in reference to the degree that scores representing a construct successfully explain important experiences or characteristics of individuals and groups. Furthermore, although scores might lead to declarations of some degree of validity based on available evidence, the application of those validity inferences could not possibly be useful for all people, for all purposes, and therefore for all interpretations (Drummond, Sheperis, & Jones, 2016 Drummond, R. J., Sheperis, C. J., & Jones, K. D. (2016). Assessment procedures for counseling and helping professionals (8th ed.). Columbus, OH: Pearson.
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). Thus, some amount of incredulity is to be expected not only when assessments are described as valid, but especially when they are treated as categorically valid indiscriminately across counseling settings and client populations. More accurately, some scores are transferable to some settings and populations, but careful consideration of important characteristics is an ethical imperative given the high-stakes nature of assessments within clinical practice.Assessment and Diagnosis in Psychotherapy Essay Paper

Validity Is a Unitary Concept
Within the Standards, validity is regarded as a unitary concept in which the degree of evidence is accumulated for or against use of scores for a particular purpose that is centered on a construct of interest. Although the degree of validity that can be inferred from an assessment procedure or set of scores is informed by multiple sources of evidence, sources of validity evidence are not synonymous with types of validity. Therefore, it is important to implement a systematic approach such as that proposed by Kelly, O’Malley, Kallen, and Ford (2005 Kelly, A. P., O’Malley, K. J., Kallen, M. A., & Ford, M. E. (2005). Integrating validity theory with use of measurement instruments in clinical settings. Health Research and Educational Trust, 40, 1605–1619.
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) when considering validation evidence that recognizes the synergistic interplay between findings that lead to a unitary representation. This prospect is complicated by trends indicating that common practices for reviewing validity evidence still present findings in separate categories without integration into a unified depiction (Cizek, Koons, & Rosenberg, 2011 Cizek, G. J., Koons, H. H., & Rosenberg, S. L. (2011). Finding validity evidence: An analysis using The Mental Measurements Sourcebook. In J. A. Bovaird, K. F. Geisinger & C. W. Buckendahl (Eds.), High stakes testing in education: Science and practice in K-12 settings (pp. 264–278). Washington, DC: American Psychological Association.
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; Hogan & Agnello, 2004 Hogan, T. P, & Agnello, J. (2004). An empirical study of reporting practices regarding measurement validity. Educational and Psychological Measurement, 64, 802–812.
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). This point underscores the importance for counselors to not solely rely on published reviews when making decisions about whether an assessment might be useful for a particular purpose. Instead, each decision should be made in consideration of the totality of relevant evidence in juxtaposition to characteristics representing the intersection of setting and population.Assessment and Diagnosis in Psychotherapy Essay Paper

Validity Evidence Encompassing All Standards Does Not Imply Utility
Although the Standards provide clear guidance for the validation activities that promote validity estimation, they also caution against viewing the five sources of validity evidence as a checklist. This is because not all types of validity evidence are required for every assessment to be determined as useful and such a checklist approach would undermine the value of professional expertise. Instead, the evidence required for developing an integrated estimation of validity should be based on the proposed uses of assessment results (AERA, APA, & NCME, 2014 American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: AERA.
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). With this in mind, counselors are compelled to consider implementing validation activities that depict a clear fit between the proposed uses of assessment scores and the type of evidence provided by each source of validity evidence.

Sources of Validity Evidence
Reliability and validity ultimately are the twin pillars of psychometric quality of assessments; however, validity is the foundation providing evidence of assessment quality. Validity is “the most fundamental consideration in developing tests and evaluating tests” (AERA, APA, & NCME, 2014 American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: AERA.
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, p. 11). The foundations of sound assessment development, use, and interpretation rest on the integration of several sources of validity evidence. Although validity is conceptualized as a unitary concept, there are nevertheless some sources of validity evidence that provide a reasonable impetus for integration by consumers of assessment scores. It is the accumulated evidence across these sources of validity that supports the interpretation of the assessment scores for their intended purpose. These sources of validity include evidence based on (a) assessment content, (b) response processes, (c) internal structure, (d) relations to other variables, and (e) evidence of consequential validity.Assessment and Diagnosis in Psychotherapy Essay Paper

Before diving into the specific sources of validity, it should be noted that although validity is the foundation of psychometric quality, it is infrequently reported among assessments that have been developed (Cizek, Bowen, & Church, 2010 Cizek, G. J., Bowen, D., & Church, K. (2010). Sources of validity evidence for educational and psychological tests: A follow-up study. Educational and Psychological Measurement, 70, 732–743.
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; Cizek, Rosenberg, & Koons, 2008 Cizek, G. J., Rosenberg, S. L., & Koons, H. H. (2008). Sources of validity evidence for educational and psychological tests. Educational and Psychological Measurement, 68, 397–412.
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; Hogan & Agnello, 2004 Hogan, T. P, & Agnello, J. (2004). An empirical study of reporting practices regarding measurement validity. Educational and Psychological Measurement, 64, 802–812.
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). Within the flagship journal of counseling, Journal of Counseling & Development, over half (60%) of assessments used lacked validity information (Wester, Borders, Boul, & Horton, 2013 Wester, K. L., Borders, L. D., Boul, S., & Horton, E. (2013). Research quality: Critique of quantitative articles in the Journal of Counseling & Development. Journal of Counseling & Development, 91, 280–290.
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), bringing into question the quality and appropriateness of the assessments and the interpretation of the scores. To use underdeveloped, and potentially invalid, assessments can bring about unintended and grave consequences. A better understanding of the five sources of validity is required to be able to both influence adequate instrument development and help reviewers and clinicians recognize sources of validity evidence to better integrate for an overall understanding of the validity of a test and its scores. Specific ways to test for these sources of validity are provided throughout this special issue.

Evidence Based on Assessment Content
Although evidence based on content might seem like one of the simplest forms of validity to address, it might not be so easy. Evidence of content validity has evolved over time and has more recently been debated as a form of validity evidence. If validity refers to the interpretation of scores, the belief is that the content itself does not equate an assessment score; yet, without content validity, other sources of validity might suffer. In its simplest form, content validity refers to the degree to which the content of an assessment is consistent with and represents the intended construct. This includes a clear operational definition of the domain measured by the assessment, individual assessment items that are relevant to the domain, and all aspects of the domain intended to be assessed are accurately and adequately measured (Sireci & Faulkner-Bond, 2014 Sireci, S., & Faulkner-Bond, M. (2014). Validity evidence based on test content. Psicothema, 26, 100–107.
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). To be lacking in content validity would mean that an assessment does not measure what it claims to measure. This could equate to construct underrepresentation, irrelevance to a particular subgroup of individuals, or missing the mark on the construct altogether. The implications of lacking content validity are perilous, as it could mean inadequate treatment, misdiagnoses, or providing certifications and licensure to individuals who are not adequately prepared.Assessment and Diagnosis in Psychotherapy Essay Paper

Evidence of validity based on assessment content is typically assessed through the use of content or subject matter experts. Asking content experts to engage in ranking or rating of items to determine the degree to which they represent the domain specified or asking them to match items to the section or domain they believe the item to represent are ways to provide evidence of validity based on assessment content. Complementary quantitative strategies, such as Lawshe’s content validity ratio (Ayre & Scally, 2014 Ayre, C., & Scally, A. J. (2014). Critical values for Lawshe’s content validity ratio: Revisiting the original methods of calculation. Measurement and Evaluation in Counseling and Development, 47, 79–86.
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; Lawshe, 1975 Laswshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 28, 563–575.
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), have been developed to estimate the consensus among content experts and facilitate developing a corpus of items that has a high probability of representing the intended constructs. Although content validity might seem simple, it is an important component of the quality of an assessment, as ultimately all other forms of validity hinge on the quality and strength of the content of an assessment. Understanding content of an instrument can also be connected to understanding individuals’ response process to each item and the assessment as a whole.

Evidence Based on Response Processes
Compared to the long-standing professional discussions of what we consider the more traditional forms of validity (e.g., content, internal structure), evidence of validity based on response processes is a newer form of validity evidence, included in the Standards for the first time in 1999. Prior versions of the standards referred to this source of validity as related to construct validity (AERA, APA, & NCME, 1985 American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (1985). Standards for educational and psychological testing. Washington, DC: APA.
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). Cizek, Rosenberg, and Koons (2008 Cizek, G. J., Rosenberg, S. L., & Koons, H. H. (2008). Sources of validity evidence for educational and psychological tests. Educational and Psychological Measurement, 68, 397–412.
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) found that this source of validation is explored and stated in less than 2% of the validation studies of assessments. However, this might be due to it being a more newly discussed source of validity, or the confusion around how to explore and analyze response processes, than a matter of professional negligence. Evidence based on response process refers to “the fit between the construct and the detailed nature of the performance or response actually engaged in by the test takers” (AERA, APA, & NCME, 2014 American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: AERA.
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, p. 15). This equates to focus and understanding of the attention, perception, language, knowledge, and higher reasoning of individuals as they respond to items on an assessment. This includes whether test takers might be guessing on items on the assessment, misunderstanding a word or concept, or whether something else (e.g., anxiety, boredom, social desirability) could be influencing individuals while responding to items on the assessment.

Validation studies exploring the response process have found that having difficulty understanding a concept in the assessment can affect assessment reliability and internal structure. Having a response process, such as social desirability, anxiety, or inattentiveness, can alter what is being measured—or the construct of the assessment; it can therefore be understood how earlier versions of evidence based on response process were subsumed under the construct validity in the standards. Assessing for evidence related to response process is most frequently explored through cognitive and in-depth interviews, but has sometimes been done through observations and eye tracking, as well as response time (Padilla & Benitez, 2014 Padilla, J. L., & Benitez, I. (2014). Validity evidence based on response processes. Psicothema, 26, 136–144.
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). Knowing the evidence related to response process of a measure might alter how a researcher or clinician uses the measure or interprets the scores. Given that response process can affect scores on an assessment, from mild interference with responses to specific items to altering the entire construct measured, exploring and understanding the response process among each subgroup of individuals is essential. Response process can ultimately affect the internal structure of an assessment.

Evidence Based on Internal Structure
The extent to which items on the assessment interrelate and correspond to the framework of the presumed construct provide evidence on internal structure. There are three facets of internal structure, including dimensionality, measurement invariance, and reliability. Dimensionality refers to whether the scores should be unidimensional, or a multifactor or bifactor model. This can affect whether the assessment is compiled into one overall score or multiple scores, or can be used in both ways (having multiple subscale scores while also having one overall composite score). Consider the example of the Toronto Alexithymia Scale (TAS–20; Bagby, Parker, & Taylor, 1994 Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale-I: Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.
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), with which clinicians can use the overall total score to determine the degree to which a client exhibits alexithymia, but can also break the TAS–20 down into three subscales: difficulty describing feelings, difficulty identifying emotions, and externally oriented thinking. Dimensionality of the assessment can affect the intended use, scoring, and interpretation of the assessment.

Measurement invariance can provide information about individual items and how they might function similarly or differently across subgroups of clients. This differential functioning could be unintentional concerns with content or cognitive and response processes, or could be intentional and appropriate, but needs to be understood and examined. Finally, the aspect of reliability refers to the consistency of assessment scores across repeated administration, indicating that responses from participants on the items remain similar across time. Each of these aspects is connected to an assessment’s internal structure, and affects overall validity because it affects how we assess and interpret scores on an assessment, which in turn impact our students and clients. Evidence of internal structure is typically provided through factor analysis and goodness-of-fit models, exploring assessment scores and item responses across subgroups of individuals, as well as correlations between multiple iterations of the assessment. Both measurement invariance and misuse of dimensions on an assessment can result in inaccurate assessment scores, which then create a situation that could alter treatment decisions. Thus, the internal structure of an assessment is influential in the final scores received and subsequent interpretation. This in turn would affect the previous forms of validity evidence mentioned, but also relations to other variables.Assessment and Diagnosis in Psychotherapy Essay Paper

Evidence Based on Relations to Other Variables
Evidence based on relations to other variables is typically the most mentioned and tested aspect of validity provided on assessments. This source of validity helps to validate the construct being measured and can affect diagnoses and types of treatments provided, or adjustments to educational curriculum. It is usually represented by discussions of convergent, discriminant, criterion, and predictive validity, all of which provide evidence substantiating that the construct purported to be measured by the assessment is in fact being measured. This is typically tested using inferential statistics such as correlations and regressions with scores from other assessments or behavioral observations.

To know that an assessment measures a particular construct, or can predict future behavior, is a foundation that is depended on within clinical work. As an example, although depression is known to be related to suicidal behaviors, whether a depression inventory can actually predict suicidal behavior is another question. Through validation studies, it was found that assessments, such as the Beck Depression Inventory, can in fact be used as valid assessments to predict future suicide attempts (Desseilles et al., 2012 Desseilles, M., Perroud, N., Guillaume, S., Jaussent, I., Genty, C., Malafosse, A., & Courtet, P. (2012). Is it valid to measure suicidal ideation by depression rating scales? Journal of Affective Disorders, 136, 398–404.
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). It is through exploring the relationships between current and future behaviors and scores on assessments that we can provide evidence of the construct, as well as the appropriate clinical use of an assessment in practice. Without this source of validity evidence, we would not be able to clearly affirm if the assessment measured the stated construct, which has serious ramifications for clinical diagnoses and treatment protocols. As you could assume, not measuring the stated construct would have ramifications for the next source of validity discussed, consequential validity.

Evidence for Validity and Consequences of Testing
When considering validity, most thoughts and attempts are focused on the development of the assessment, such as item creation, evidence of content, internal structure, and the other sources of validity evidence already mentioned. However, one source of validity evidence less focused on, but exceedingly important, is the evidence of the consequences of testing, or consequential validity. Cronbach (1988 Cronbach, L. J. (1988). Five perspectives on validity argument. In H. Wainer & H. Braun (Eds.), Test validity (pp. 3–17). Hillsdale, NJ: Erlbaum.
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) argued for the importance of consequential testing when he stated that negative consequences from the interpretation of scores on an assessment should invalidate the assessment, even if those consequences were not from any flaws in the assessment itself. Evidence of validity and consequences of testing refers to the soundness of the proposed interpretation and use of assessment scores. A focus on the consequences of an assessment is important, as assessments are used not only to gather information, but to inform clinical treatment, pharmaceutical treatment, and diagnosis, to mention only a few.

Three criteria for evaluation of consequential validity were noted by Kane (2006 Kane, M. T. (2006). Validation. In R. L. Brennan (Ed.), Educational measurement (4th ed., pp. 17–64). Westport, CT: Praeger.
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), including clarity, coherence, and plausibility. Thus, validation of the consequences of testing entails a clear statement of the proposed interpretation and uses of the assessment scores, an evaluation of the interpretation and uses provided with supporting evidence, and a statement and exploration of potential alternative consequences from the interpretation and use of the assessment (Lane, 2014 Lane, S. (2014). Validity evidence based on testing consequences. Assessment and Diagnosis in Psychotherapy Essay PaperPsicothema, 26, 127–135.
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). Consequences of an assessment could be intended or unintended, but all must be considered and explored. For example, when creating a scale to test suicidal behaviors, the intended use of this assessment might be to identify risk level of engaging in or attempting suicide. The assessment developer might hope to be able to categorize individuals into no risk, slight risk, moderate risk, and high risk categories to assist counselors in making informed clinical decisions regarding immediate and future treatment. One intended consequence or use of this assessment might be to identify risk level and determine whether the client needs to be admitted to an inpatient treatment facility to stabilize or adjust medication, versus being sent home under the care and support of family until the next scheduled counseling session. However, an unintended consequence might be that the individual is stigmatized due to risk level of suicide, treated differently by family members and friends, or taken less seriously due to low level of risk of suicidal behavior potentially resulting in increases in self-harm behaviors.

Lane (2014 Lane, S. (2014). Validity evidence based on testing consequences. Psicothema, 26, 127–135.
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) provided three questions to consider in validation of consequences of assessments: (a) What does the assessment proclaim to do? (b) What are the arguments for and against the intended claims? (c) What are the unintended outcomes or consequences (both positive and negative) of the assessment scores? The answers to these questions can provide evidence of consequential validity by providing clarity of the intended use and interpretation of the assessment, logical links and evidence of how these interpretations can lead to decisions and actions, and empirical evidence that the interpretations and actions are credible and fall within the scope of the intended use of the assessment.

Although each of these sources of validity can be explored discretely, it is the integration of these sources that provides a sound validity argument. Each source of validity usually cannot be explored or answered within one study, but this is more of a long-term process that ultimately never ends (AERA, APA, & NCME, 2014 American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: AERA.
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). Information can be gleaned from validation studies in the development of the assessment, but also inferences can be drawn from each subsequent study that uses the assessment. These sources of evidence assimilate into the unitary concept of validity. Having knowledge of these sources allows researchers and counselors to use assessments with confidence, while denouncing the use of invalid, haphazardly created assessments.Assessment and Diagnosis in Psychotherapy Essay Paper

Rationale and Organization of Special Issue Content
This special issue of MECD has been prepared as a support to educators, clinicians, and scholars whose professional activities could be supported through clear, plainly spoken depictions of strategies that support inferences about the degree of validity associated with a particular assessment. Such an endeavor is warranted when considering that many master’s-level counselors might have received only one course in advanced psychometrics and doctoral-level counselor educators often rely on exemplars from related professions to guide best practice. Therefore, this special issue is intended to provide a practical support for master’s-level counselors and doctoral-level counselor educators who are interested in the theories and methods that will not only support contributions to the knowledge base available to within MECD, but also support increased precision in the measurement of counseling outcomes by practitioners and scholars alike.

Readers will find three articles supporting the development of psychological and educational assessments through developing content-oriented evidence (Lambie, Blount, & Mullen, 2017 Lambie, G. W., Blount, A. J., & Mullen, P. R. (2017). Establishing content-oriented evidence for psychological assessments. Measurement and Evaluation in Counseling and Development, 50, 210–216.
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/this issue) and use of cognitive interviewing (Peterson, Peterson, & Powell, 2017/this issue), as well as issues associated with translations and cross-cultural validation (Lenz, Gómez Soler, Dell’Aquilla, & Uribe, 2017 Peterson, C. H., Peterson, N. A., & Powell, K. G. (2017). Cognitive interviewing for item development: Validity evidence based on content and response processes. Measurement and Evaluation in Counseling and Development, 50, 217–223.
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/this issue). Six articles depict strategies for the evaluation of assessment validity and precision through exploratory factor analysis (Watson, 2017 Watson, J. C. (2017). Establishing evidence for internal structure using exploratory factor analysis. Measurement and Evaluation in Counseling and Development, 50, 232–238.
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/this issue), confirmatory factor analysis (Lewis, 2017 Lewis, T. F. (2017). Evidence regarding the internal structure: Confirmatory factor analysis. Measurement and Evaluation in Counseling and Development, 50, 239–247.
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/this issue), Rasch methodology (Willse, 2017 Willse, J. T. (2017). Polytomous Rasch models in counseling assessment. Measurement and Evaluation in Counseling and Development, 50, 248–255.
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/this issue), estimating reliability and precision of scores (Bardhoshi & Erford, 2017 Bardhoshi, G., & Erford, B. T. (2017). Processes and procedures for estimating score reliability and precision. Measurement and Evaluation in Counseling and Development, 50, 256–263.
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/this issue), and strategies for establishing evidence with conceptually related variables (Balkin, 2017 Balkin, R. S. (2017). Evaluating evidence regarding relationships with criteria. Measurement and Evaluation in Counseling and Development, 50, 264–269.
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/this issue; Swank & Mullen, 2017 Swank, J. M., & Mullen, P. R. (2017). Evaluating evidence for conceptually related constructs using bivariate correlations. Measurement and Evaluation in Counseling and Development, 50, 270–274.
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/this issue). Two articles support the evaluation of fairness of assessment practices and interpretations through inspecting construct irrelevance and construct underrepresentation (Spurgeon, 2017 Spurgeon, S. L. (2017). Evaluating the unintended consequences of assessment practices: Construct irrelevance and construct underrepresentation. Measurement and Evaluation in Counseling and Development, 50, 275–281.
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/this issue) and use of assessment scores with individuals not represented in the normative sample (Hays & Wood, 2017 Hays, D. G., & Wood, C. (2017). Stepping outside the normed sample: Implications for validity. Measurement and Evaluation in Counseling and Development, 50, 282–288.
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/this issue).Assessment and Diagnosis in Psychotherapy Essay Paper

Counseling Psychology
Counseling psychology is a general practice and health service provider specialty in professional psychology. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well‐being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms.

Specialized Knowledge
Across all stages of development (i.e., childhood, adolescence, adulthood and older age), counseling psychologists focus on:

Healthy aspects and strengths of clients (whether being seen as individuals, couples, families, groups or organizations. Environmental/situational influences (how cultural, gender and lifestyle issues shape people’s experiences and concerns). Issues of diversity and social justice (e.g., advocacy). The role of career and work in peoples’ lives.
Problems Addressed
The problems addressed by counseling psychology are addressed from developmental (lifespan), environmental and cultural perspectives. They include, but are not limited to:

School and career/work adjustment concerns. Making decisions about career and work, and dealing with school‐work‐retirement transitions. Relationship difficulties‐including marital and family difficulties. Learning and skill deficits. Stress management and coping with negative life events. Organizational problems. Dealing with and adjusting to physical disabilities, disease or injury. Personal/social adjustment. The development of one’s identity. Persistent difficulties with relating to other people in general. Mental disorders.
Skills & Procedures Utilized
The procedures and techniques used within counseling psychology include, but are not limited to:Assessment and Diagnosis in Psychotherapy Essay Paper

Individual, family and group counseling and psychotherapy. Crisis intervention, disaster and trauma management. Assessment techniques for the diagnosis of psychological disorders. Programs/workshops that educate and inform the public about mental health, school, family, relationship and workplace issues so that problems can be prevented before they start or reduced before they get worse. Consulting with organizations. Program evaluation and treatment outcome (e.g., client progress). Training. Clinical supervision. Test construction and validation. Research methodologies for scientific investigations.
Population Served
Clients served by counseling psychologists include individuals, groups (including couples and families) and organizations. Counseling psychologists work with individual clients of all ages, such as children who have behavioral problems; late adolescents with educational and career concerns or substance abuse problems; adults facing marital or family difficulties, career changes, or overcoming disabilities; and older adults facing retirement. They work with groups to assist them in finding solutions to many of these same problems, as well as to improve the personal and interpersonal functioning of group members. Counseling psychologists also consult with organizations (e.g., businesses) and work groups to help provide a work environment in which people can succeed, and to enhance the ability of organizations to increase productivity and effectiveness.


As an applied specialty, counseling psychology evolved from the vocational guidance movement that began in the early 1900s, and the study of the effects of work on the individual continues to be an important focus of counseling psychology. Plato’s notion that people should be matched to occupational environments to achieve optimal work outcomes was elaborated by Frank Parsons (1909) during the first decade of the twentieth century, and further developed by the Minnesota Employment Stabilization Research Institute during the depression of the 1930s. The person-environment it philosophy is expressed most completely in Lloyd H. Lofquist and Rene V. Dawis’s (1969) theory of work adjustment, which explains how matching individuals and occupational environments leads to better productivity, more satisfied workers, and job stability.Assessment and Diagnosis in Psychotherapy Essay Paper

Counseling psychologists are unique among the psychological specialties in the attention they give to the measurement of vocationally relevant attributes of the individual (e.g., aptitudes, abilities, and interests) and the occupation (e.g., the demands and benefits of the job). Counseling psychology emphasizes the informed application of principles derived from basic scientific discoveries about the nature of work and of people’s relations to work. John Holland’s theory that there are six basic personality types and occupational environments—realistic, investigative, artistic, social, enterprising, and conventional—is used almost universally by counseling psychologists to organize information about occupational environments and vocational interests. Dale Prediger’s (1982) demonstration that occupational environments differ in the extent to which they require interactions with people as opposed to things, and with data as opposed to ideas, is another heuristic that counseling psychologists use to organize knowledge about the relations between individuals and their work.

An appreciation of the relevance of developmental psychology to the discipline of counseling psychology began to emerge at mid-century. Anne Roe’s (1956) theory of the effects of parent-child interactions on vocational choice, Donald Super’s (1955) theory of the developmental progression of careers, and Carl Rogers’s (1942) theory of personality development were instrumental in awakening counseling psychologists to the importance of developmental theory and research, and in expanding the focus of counseling psychology. An emphasis on growth, development, and prevention are core values of the specialty of counseling psychology, and many of the assessment and intervention practices of counseling psychology are intended to facilitate normal developmental processes.Assessment and Diagnosis in Psychotherapy Essay Paper

Stanley Strong’s (1968) interpretation of the counseling interview in terms of elemental social-cognitive processes made salient the status of counseling psychology as a form of applied social psychology. The constructs investigated by social psychologists are often the focus of counseling psychology assessment and intervention practices. Counseling psychology research and practice is concerned with the influence of social-cognitive processes on people’s attitudes (e.g., in-group bias), perceptions (e.g., fundamental attribution error and unrealistic optimism), decision making (judgmental overconfidence and illusory correlation), and the effects of group processes on individual behavior (e.g., conformity, obedience, and social facilitation).

Diversity of Counseling Psychology Practice
Counseling psychologists provide services to a diverse array of clients, many of whom also are served by clinical. industrial-organizational. management, and school psychologists. Individual counseling psychologists typically specialize in one area of practice and use assessment techniques that have their greatest applicability in that area.

The work activities of many counseling and clinical psychologists are largely indistinguishable. Members of both specialties engage in psychotherapy with clients who range from the severely and chronically impaired to those suffering from situationally and developmentally mediated difficulties. The developmental orientation of counseling psychologists distinguishes their work most clearly from that of clinical psychologists and psychoanalysts. Counseling psychologists, child-clinical psychologists, and school psychologists also work extensively with children and adolescents. School psychologists work primarily in educational settings with teachers, administrators, and social workers, and they often limit their work with children to assessment. Counseling psychologists work with children and adolescents in the full range of service settings and their work typically emphasizes the use of assessment procedures as a prelude to initiating developmentally oriented interventions.Assessment and Diagnosis in Psychotherapy Essay Paper

Other counseling psychologists specialize in working with clients who are similar to those served by industrial-organizational and management psychologists. Both counseling psychologists and human services personnel provide interventions such as individual counseling, individual psychological testing, career planning workshops, organizational assessment programs, formal training programs. Consultation, mentoring, and developmental programs for special target groups (e.g., high-potential. terminated. female. and minority employees; supervisors; employed spouses; and parents l. Industrial-organizational and management psychologists often view issues and concerns from an organizational perspective. however. and their interventions are intended to help organizations function more effectively. In contrast, counseling psychologists are concerned about the functioning and development of the individual.

Counseling Psychology Assessment Practices
The assessment practices of counseling psychologists and related specialists have been the focus of numerous studies. Psychologists have surveyed professors who teach graduate level assessment classes, and studied the assessment practices of psychologists and predoctoral interns employed in community mental health agencies; medical. Veteran’s Administration, and psychiatric hospitals; internship sites that provide adult or adolescent inpatient services; counseling centers; and centers for the developmentally disabled. However, much of this research has included psychologists from multiple specialties and findings have been reported only for the aggregate group, thereby obscuring any differences in the assessment practices of the psychological specialties. Furthermore, the accuracy of the few surveys that have focused exclusively on the assessment practices of counseling psychologists is suspect.

Evolution of Counseling Specialties
Counseling psychology expanded into new settings to treat previously undeserved clients during the 1980s and 1990s, and this evolution of the specialty has not yet run its course. For these reasons, it is not possible to describe the present assessment practices of counseling psychologists with absolute precision, despite the continuing stream of research on this issue.Assessment and Diagnosis in Psychotherapy Essay Paper

Time Allocated to Assessment and Diagnosis
Psychological assessment is an important activity for most counseling psychologists, regardless of the type of setting in which they work or the type of clientele they serve. A national survey of the work activities of members of the American Psychological Association Division of Counseling Psychology revealed that most of these counseling psychologists collected data about their clients (80.3%) and identified problems and made diagnoses (76.6%). Close to 40% of the time these counseling psychologists spent in counseling activities (and over 20% of their total professional time) was devoted to assessment and diagnosis. Results from surveys consistently confirm that close to 20% of counseling psychologists’ total professional time is devoted to assessment activities.

Assessment Procedures Used by Counseling Psychologists
Testing and assessment are not the same; much psychological assessment does not involve the formal use of objective or projective techniques. More than 80% of counseling psychologists report that they use interviews and observation to collect data about clients. Counseling psychologists regard using the interview as an assessment technique as central to their professional identity and they believe that is one of their most important job functions.

The tests used most frequently by counseling psychologists include objective and projective personality tests, individually administered tests of cognitive functioning, vocational interest tests, and brief scales to assess specific symptomology. The specific assessment procedures used by counseling psychologists vary somewhat as a function of the setting, client characteristics, and reason for seeking services. Projective techniques are used with greater frequency in psychiatric settings whereas interest, aptitude, and objective personality tests are used more frequently in counseling and community mental health centers. Some tests are designed for use with specific age ranges, so counseling psychologists who work with adult clients use tests that are different from the tests used by those who work with children and adolescents.Assessment and Diagnosis in Psychotherapy Essay Paper

Overall, the tests that are most frequently used by counseling psychologists to measure cognitive functioning are the Wechsler Adult Intelligence Scale-III (WAIS-III). Wechsler Intelligence Scale for Children-III (WISC-III), and the Stanford-Binet Intelligence Scale, Fourth Edition (SB), The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is the most widely used test for objective personality assessment. The Bender-Gestalt Visual-Motor Test (Bender-Gestalt) and various forms of the Draw-A-Person Test (DAP) provide projective assessments of personality and cognitive functioning, The most frequently used projective personality tests are the Rorschach Inkblot Test (Rorschach), Thematic Apperception Test (TAT), various forms of the Sentence Completion Tests (SCT), and the House-Tree-Person test (HTP), Although not ranked in the top 10 in terms of overall usage, university professors strongly advise counseling psychology students to learn to use the Strong Interest Inventory (SII), a vocational interest test, in addition to the MMPI-2 and WAIS-III, In keeping with the broad integrative nature of the specialty, counseling psychologists use a diverse array of instruments.

Many service agencies use a standard assessment battery with all who seek services. This practice insures that all clients will have the benefit of a comprehensive assessment program. and it establishes a uniform set of instruments on which the staff psychologists are expected to develop proficiency. The typical standard assessment battery includes both objective and projective tests to assess personality and cognitive functioning. The tests most commonly included in the standard assessment battery are the WAIS-III, WISC-III, MMPI-2, Rorschach, TAT, Bender-Gestalt. Figure Drawings, and SCT.Assessment and Diagnosis in Psychotherapy Essay Paper

In addition to the tests mentioned above, counseling psychologists use the SIl, Kuder Occupational Interest Inventory (KOIS), and Self-Directed Search (SDS) to assess vocational interests. They also have some familiarity with the Armed Services Vocational Aptitude Battery (ASVAB), the Differential Aptitude Test (DAT), and the General Aptitude Test Battery (GATB) which assess a broad sample of school and work-related aptitudes.

Other tests widely used by counseling psychologists are the Peabody Picture Vocabulary Test (PPVT) and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) to assess cognitive functioning, the Chil­dren’s Apperception Test (CAT), a projective test of personality, and the Sixteen Personality Factors Questionnaire (16PF), California Psychological Inventory (CPI), and Edwards Personal Preference Schedule (EPPS), which are objective personality tests. Brief scales most commonly used for assessing specific symptomology are the Beck Depression Inventory (BDI), and Symptom Check List-90 (SCL-90). The assessment of neuropsychological functioning has not been a common work activity of counseling psychologists, but recently counseling psychologists have begun to develop expertise in that area. The tests most frequently used to assess neuropsychological functioning are the

Halstead-Reitan Neuropsychological Battery, the Wechsler Memory Test, Benton Visual Relation Test, and Luria Nebraska Neuropsychological Battery.Assessment and Diagnosis in Psychotherapy Essay Paper

Importance of Assessment to Professional Identity
The percentage of counseling psychologists who identify testing and measurement as their primary area of interest has declined since the mid-1970s, but counseling psychologists still rate assessment and diagnosis activities as important aspects of their work and as central to their professional identity. Work activities that are rated as important for defining the professional role of the counseling psychologist include collecting data about clients, using interviews and observations, problem identification and diagnosis, and using objective personality inventories, individual intelligence tests, vocational interest inventories, and aptitude tests. Those same work activities plus projective techniques are rated by counseling psychologists as central to their professional identity.

Unique Assessment Practices of Counseling Psychologists
Counseling psychologists are relatively unique in their use of tests to assess vocational and college major interests and in their use of information about school- and work-related aptitudes. This is illustrated by a 1980s survey, which gives the percentage of their practice that counseling psychologists devoted to specific testing activities: vocational and career (8.4%), diagnosing psychopathology (4.6%), intellectual assessment (4.3%), determining academic status (1.2%), and determining organicity (1.1%). Counseling psychologists give greater emphasis to vocational assessment and they make less use of projective tests than clinical psychologists do.Assessment and Diagnosis in Psychotherapy Essay Paper

The percentage of counseling psychologists who reported using objective personality inventories (67%), occupational information (64%), vocational interest inventories (62%), individual intelligence tests (57%), aptitude tests (52%), and projective techniques (46%) in their work also illustrates their greater concern about educational and career development issues. Nevertheless, the practice of counseling psychology is broad. Counseling psychologists report that they administer an average of 7.5 objective tests and 1.8 projective tests a week; they administer objective tests to 35.9% of their clients and projective tests to 11.4%. The most frequently used tests in counseling centers, staffed more frequently by counseling psychologists than other specialists, include the SII, MMPI-2, EPPS, SCT, KOIS, Rorschach, WAIS-III, and DAT.

Counseling psychologists’ emphasis on identifying the psychological attributes of work environments and integrating this information into their practice is relatively unique among the applied specialties of psychology. Counseling psychologists have pioneered the development of taxonomic systems for organizing information about vocational interests and occupational environments. Roe’s (1956) theory-based classification of occupations into eight interest/personality groups, each of which was further divided into six levels of complexity, was the forerunner to Holland’s Occupational Classification (HOC) system. Lofquist and Dawis’s (1969) empirical description of the psycholog­ical benefits provided by occupational environments demonstrated the feasibility and advantages of classifying occupations on the basis of their effects on people. The HOC system, which classifies occupations in terms of vocational interests and level of complexity, emphasized the relation between personality and vocational interests, and it revolutionized the way in which interest test results are organized and presented. Holland’s theory has achieved widespread acceptance and influenced research in personality psychology as well as theory, research, and practice in counseling psychology.Assessment and Diagnosis in Psychotherapy Essay Paper

Another relatively unique assessment practice of counseling psychology is the self-administering, self-scoring, self-interpreting test. Holland pioneered this assessment procedure with his SDS, a vocational interest inventory. The rationale underlying self-interpreting tests such as the SDS is that many persons need reliable and valid information rather than counseling or psychotherapy. The self-interpreting test is intended to provide them with the information they need without involving a relatively high-priced psychological specialist. The idea underlying the self-interpreting test has now been incorporated into computer-based guidance programs such as SIGI. The use of self-interpreting tests is still largely confined to the vocational psychology sub-specialty of counseling psychology, but some tests such as the Neuroticism, Extroversion, Openness Personality Inventory-Revised (NEO PI-R) have developed self-interpreting forms and other interests tests such as the Campbell Interest and Skills Survey (CISS) are developing self-interpreting forms.

Unresolved Issues in Counseling Psychology
Careers in PsychologyPurpose of Assessment
Investigating the practical utility of assessment procedures and their potential improvement requires a careful specification of the purposes of the assessment procedure. Actually, this issue is given scant attention by the discipline, but most counseling psychologists appear to use assessment procedures for one of three purposes. One purpose is to obtain information for making predictions. For example, counseling psychologists use assessment procedures to obtain diagnostic information that they can use in deciding how to work effectively with their clients, or to obtain predictive information that they can use in advising a client about future courses of action. Counseling psychologists also use assessment procedures to obtain descriptive information which they believe will help them understand their client better. Prediction is inherent as a secondary objective in this purpose. A third potential application is to use assessment procedures as an intervention. For example, counseling psychologists sometimes interpret the results of the assessment procedure to their client to increase their insight into or sensitivity to important developmental issues and to stimulate their thinking about those issues.Assessment and Diagnosis in Psychotherapy Essay Paper

The reasons university professors give when asked why students need to learn to use psychological tests provides a different perspective that illustrates the influence of guild issues on the discipline. University professors gave approximately equal ratings to professional reasons (i.e., provides information about personality structure, saves the therapist time. enables accurate behavior prediction. and increases client-therapist rapport) and guild concerns (i.e., satisfies legal requirements, provides a specialty. satisfies institutional demands, and enhances therapist prestige).

Each of these objectives requires that counseling psychologists be able to extract accurate information from their assessment procedures, draw accurate inferences from that information, and accurately convey the results to their clients in a manner that they can understand. There is scant evidence documenting the ability of counseling psychologists to satisfy these requirements.

Interview as Assessment Technique
The interview is the assessment technique most widely used by counseling psychologists, but psychometric assessment devices have numerous advantages over the interview. Tests possess a wealth of experience (that is incorporated into the norm groups) and they are not overly influenced by unusual or graphic cases. When used with a client, tests can be thought of as conducting a standard interview with the client, after which they report descriptive information (scores) having an approximately known level of reliability. The test scores suggest inferences having an approximately known validity. In contrast, counseling psychologists take years to amass the experience the test possesses at the beginning, conduct semistandard interviews, obtain descriptive information having an unknown reliability, draw inferences having an unknown validity (that is undoubtedly lower than the validity of the inferences drawn by the tests), and often have a backlog of clients waiting to be seen. Furthermore, the reliability and validity of tests is subjected to repeated scrutiny by both supporters and critics while the reliability and validity of the interview as an assessment device is virtually never examined.Assessment and Diagnosis in Psychotherapy Essay Paper

The continued reliance of counseling psychologists on the interview as an assessment technique is undoubtedly due to three factors. First, it is not practical to use a test for everything the psychologist needs to know. Many psychologists use tests to obtain a significant part of the information they need and they use the interview to obtain information about the overall context into which the test information fits. In addition, most counseling psychologists pride themselves on being skillful interviewers, and the use of the interview to obtain diagnostic information is central to the professional identity of most counseling psychologists. Finally, while most counseling psychologists regard tests as useful but limited tools, they genuinely enjoy working with people.

Making Predictions from Tests
In 1954, Paul Meehl called attention to the fact that trained therapists are not as accurate in making predictions from tests as a statistical formula. This finding was met with considerable resistance, and today it is largely ignored by practicing therapists. To date 136 research studies have compared the ability of trained therapists to predict important future behaviors of an individual using both test and non-test information with the accuracy of a statistical formula. The statistical formula is almost always more accurate. This phenomenon is attributable to several of the factors already mentioned: Individual therapists are slow to amass experience, are prone to forget some cases, give too much weight to graphic cases, are unable to determine the proper weight to give various factors, and are likely to be influenced by irrelevant considerations.Assessment and Diagnosis in Psychotherapy Essay Paper

Despite the overwhelming evidence of the superiority of actuarial predictions, the use of test information in clinical practice is virtually unchanged since the first publication of Meehl’s book. A continuing challenge to counseling psychologists is to learn how to better integrate the results of assessment procedures into their clinical practice. The time is propitious for a careful examination of this issue, given the national concern about the cost effectiveness of mental health services, and the resulting movement toward managed care.

Effects of Test Interpretation
Leo Goldman cautioned in 1961 that counseling psychologists may not be very effective in interpreting test information, but counseling psychologists have largely ignored this warning. Recently, Howard E. A. Tinsley and Serena Chu reviewed 65 studies that directly investigated test interpretation outcomes. Most of the research has focused on the interpretation of aptitude and ability tests; virtually no research has examined the interpretation of vocational interest tests or the use of tests in individual psychotherapy, couples counseling, family counseling, substance abuse counseling, or any of the many other specialty areas in which counseling psychologists function. They found that few studies have been competently done or adequately reported, and that the research is fraught with methodological weaknesses (e.g.. flawed criteria, use of an immediate follow-up. lack of random assignment, and lack of a control group). Consequently, they concluded that there is no coherent body of evidence demonstrating the efficacy of test interpretation as an intervention.Assessment and Diagnosis in Psychotherapy Essay Paper

The research evidence provides tenuous support for only three conclusions: that the use of visual aids improves the effectiveness of test interpretation, that group test interpretation methods are as effective as individual test interpretation methods, and that the individual test interpretation interview is preferred to a group test interpretation by those receiving the interpretation. However, cost analyses reveal that individual interpretations are six times more costly than group interpretations. Given the greater cost and lack of demonstrated superiority of the individual test interpretation, there appears to be no rational basis for providing individual test interpretations in situations where group test interpretations are feasible.

A major innovation of the last three decades has been the development of self-interpreting interest inventories such as the SDS and CISS. Only seven investigations have evaluated the effectiveness of self-interpretation. The paucity of research represents a rather alarming indifference on the part of the discipline to the need to evaluate this important innovation in test interpretation. Typically, no differences among the modes of test interpretation were found.Assessment and Diagnosis in Psychotherapy Essay Paper

Caveat Emptor
Despite the centrality of assessment to the work and professional identity of counseling psychologists, the incremental utility of assessment in counseling has not been established. Assessment practices rest more on folklore and assumptions of utility than on empirically demonstrated benefits. Psychology has given painstaking attention to the development of procedures for evaluating the reliability and validity of measuring instruments (i.e., tests), and training in the use of assessment devices is required for all counseling psychologists. However, insufficient attention has been given to the reliability and validity of the assessment practices of counseling psychologists. In medicine, the Food and Drug Administration has the authority to insist that the efficacy of drugs be demonstrated in rigorously controlled research studies and that the potential side-effects of the drug are evaluated before the drug is approved for use in patient care. Counseling psychology needs to adopt an analogous procedure for evaluating the efficacy of assessment techniques and practices.

The psychological assessment (also called the biopsychosocial or psychiatric assessment) gathers information to diagnose any mental disorder that the person may have; it is the first step in treating a diagnosed disorder. The process typically starts with a chief complaint or presenting problem—this is usually what prompts the person to seek help. A complete psychological assessment should include:Assessment and Diagnosis in Psychotherapy Essay Paper

biopsychosocial history
neurological assessment
psychological testing (if applicable)
physical examination (if required by a psychiatrist )
brain imaging (if necessary)
Once complete, the assessment will help establish either a tentative or definitive diagnosis . With this information, the clinician can inform the patient of the results, and treatment can begin.

Accurate information gathering and objective notes are essential for psychological assessment. However, these can be difficult to obtain if the person is not willing to disclose all necessary information, either out of embarrassment or through denial that symptoms of a mental problem even exist.


The psychological assessment, an extremely effective and accepted diagnostic tool, is a structured interview that has several parts:

identifying information
chief complaint (presenting problem)
history of present illness
past medical and psychological history
personal history
family history
substance abuse history
mental status examination (MSE)
Before beginning, the clinician should introduce himself or herself and attempt to make the person comfortable in a professional setting. A common fluency in language or competent translator is essential for information gathering and questioning.Assessment and Diagnosis in Psychotherapy Essay Paper

Identifying information
These are general and emotionally neutral questions that usually include name, age, occupation, and marital status.

Chief complaint (presenting problem)
This consists of questions such as “Why are you seeking psychological help today?” that reveal past mental disorders and/or the symptoms that made the person seek psychotherapy . The patient’s responses can also help the clinician ask pertinent questions during other parts of the interview, and can help clarify the presence of symptoms.

History of present illness
The patient describes the onset of signs and symptoms that comprise the current mental problem.

Past medical and psychological history
Because medical problems—including thyroid disease, Parkinson’s disease, head trauma, and brain infections—can cause psychological symptoms, a thorough medical history must be taken. The interviewer also asks about previous psychological/psychiatric treatment, including hospitalization , outpatient or substance abuse treatment, and medication prescribed for mental disorders. The treatment’s duration, effectiveness, and outcome is also noted.

Personal history
This portion of the assessment provides information on the patient’s entire life, beginning with prenatal development, including maternal abortions, nutrition, and drug use during pregnancy; birth trauma; and birth order. The patient’s life is then discussed in distinct phases:Assessment and Diagnosis in Psychotherapy Essay Paper

EARLY CHILDHOOD (INFANCY–THREE YEARS). Questions include information about temperament, walking, talking, toilet training, nutrition and feeding, family relationships, behavioral problems, hospitalization, and separation from early childhood caregivers.

MIDDLE CHILDHOOD (THREE–11 YEARS). Pertinent information will be gathered concerning learning, relationship with peers and family, behavioral problems, and general personality development.

ADOLESCENCE (12–18 YEARS). Information typically includes school history, behavioral problems, and sexual development.

ADULTHOOD. This section details the patient’s education, sexual history, relationships and/or marriages, peer relationships, occupation, and current circumstances.

Family history
Family history is crucially important since many mental disorders can be inherited genetically. Additionally, family interactions may affect the patient’s symptoms and disorder.

The psychological assessment (also called the biopsychosocial or psychiatric assessment) gathers information to diagnose any mental disorder that the person may have. A complete psychological assessment should include: complete and extensive medical and psychological history, neurological assessment, and may also include further tests and imaging studies. Once complete, the assessment will help establish a diagnosis. (Photo by John Henley, The Stock Market. Reproduced by permission.)
The psychological assessment (also called the biopsychosocial or psychiatric assessment) gathers information to diagnose any mental disorder that the person may have. A complete psychological assessment should include: complete and extensive medical and psychological history, neurological assessment, and may also include further tests and imaging studies. Once complete, the assessment will help establish a diagnosis.
(Photo by John Henley, The Stock Market. Reproduced by permission.)
Substance use history
This portion of the psychological assessment details information on the patient’s use of both illicit drugs (opiates, cocaine, alcohol, marijuana, hallucinogens, and depressants) and legally prescribed medications, as well as nicotine and caffeine. Questions usually focus on age of first use, age of last use, period of heaviest use, usage within the past 30 days, frequency, quantity, and route of usage. Tolerance and dependence, if present, are noted, as are the patient’s treatment history, any medical complications (AIDS, for example), and legal problems associated with usage (such as driving or operating a vehicle or machine while impaired).Assessment and Diagnosis in Psychotherapy Essay Paper

Mental Status Examination (MSE)
This assesses the patient’s mental state, and begins by evaluating:

Appearance—hygiene, general appearance, grooming, and attire.
Behavior—abnormal movements, hyperactivity and eye contact with the interviewer.
Speech—fluency, rate, clarity, and tone, all of which may indicate the patient’s mental state. A fast-talking person, for example, may be anxious. Speech can also reveal intoxication or impairment as well as problems in the mouth (i.e. dentures, cleft palate) or speech impairment.
The examiner then goes on to assess other aspects of the patient’s mental state, such as mood, thought process, and cognition, beginning with a question such as that suggested in the Merck Manual of Geriatrics.” I would like to ask you some questions about your feelings, your thinking, and your memory as a routine part of the examination. Is that all right with you?”

Mood and affect
These outward manifestations of the patient’s mental state are important indicators. The clinician can ask the patient to describe his or her current mood (“How do you feel? Are you happy? Sad? Angry?”). The patient’s affect, or emotional state, however, is observed and interpreted by the clinician throughout the interview, and described in standardized terms, such as excitable, flat, inappropriate, or labile (rapidly shifting).Assessment and Diagnosis in Psychotherapy Essay Paper

Thought process and content
Thought process (or form) indicates whether or not the interviewee is properly oriented to time and place. Thought content reveals how connected, coherent, and logical the patient’s thoughts are. The interviewer may ask the patient to identify themselves and loved ones, to name the current date, and/or to describe the route taken to the examiner’s location. The patient’s responses to questions can indicate disturbances in thought, such as circumstantial thinking (circuitous, persistent storytelling), tangential thinking (response not pertinent to the question) black/white (extreme) thinking, and impoverished (minimally responsive) thinking. Disturbed thought content can also indicate delusions , hallucinations , phobias, and obsessions. In addition, the examiner may question the patient about suicidal and/or homicidal thoughts.

Cognition refers to the patient’s attention, awareness, memory (long-, intermediate-, and short-term), general knowledge, abstract thinking ability, insight, and judgment. The interviewer may ask the patient to spell a word forward and backward, identify the current president, read and/or write something, compare two objects, and explain the meaning of common sayings.

Read more: Assessment and Diagnosis in Psychotherapy Essay Paper


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