LUTEIJN & BARELDS – Chapter 1: The Diagnostic Process
Clinical psychodiagnostics = exclusive specialism of a clinical psychologist
Theory development of problems/complaints and problematic behavior
Operationalization and its measurement
Application of relevant diagnostic methods
Diagnostic process
Client's referral to diagnostician / client's direct question to the
diagnostician (request for help and referrer's request)
Provisional theory about the client
o Converting provisional theory into concrete hypotheses
o Selecting a specific set of research tools
o Making predictions about results from this set of tools
o Applying and processing instruments
o Giving reasons why hypotheses have been accepted/rejected
1. Application: analyzing and clarifying the request and the request for help
o Analyzing the request (recognition, explanation, indication) leads
to information about the referrer (referrer's frame of reference,
relationship between diagnostician and referrer, nature of the setting, distinction
between the referrer in name and the actual referrer, nature and extent of available
powers) and details about the type and content of the request (open-ended format
or closed format, nature of the setting)
o Analysis is supported by what the referrer already knows about the client and helps
to determine whether the client presented himself to the referrer and whether he
consents to examination
o Exploring the client's mindset
o Content of the client's problem
o Analyzing the file data
2. Diagnostician's reflections
o Awareness of potential biases in general clinical judgment and towards clients of
diagnostician
o New questions about the problem
3. Diagnostic scenario
o Organizing the requester's and client's questions which leads to a proposed initial,
tentative theory about the client's behavior
Questions in clinical psychodiagnostics
o Recognition: what are the problems, what works and what doesn't?
Inventory and description
Organization and categorization in dysfunctional behavior clusters or
disorders
Examination of the seriousness of the problem behavior
Through criterion-oriented measurement: recognition due to comparison to
a predefined standard
Through normative measurement: recognition due to comparison to
representative comparison group
Through ipsative measurement: recognition due to comparison of individual
itself
Classification = clinical picture is assigned to a class of problems through an
all-or-nothing principle or a more-or-less principle (DSM, personality tests)
Leads to labeling, whcih is limited and often forms the basis for
establishing comorbidity
Does facilitate communication between experts
, Diagnostic formulation = focusing on the individual and its own unique
clinical picture (holistic theory, where functional, theoretically explicit
relationships between interdependent problem behaviors and context play a
central role)
Leads to uniqueness of the individual being allowed, based on a
description of the client and its context, which helps therapy
planning
Lack of empirical support
o Explanation: why do certain problems exist and what perpetuates them?
Main problem or problem component
The locus (person/situation)
Person-oriented explanation = explanatory factor is within
the person, when behavior is viewed separately from
context
Situation-oriented explanation = explanatory events may
precede behavior that is to be explained or follow it
The nature of control
Cause is determined by previous conditions, which explains
behavior (falling from a tree where gravity is the cause)
Reason is determined by a voluntary or intentional choice,
which makes behavior understandable (falling from a tree
due to recklessness of the person)
Conditions that explain the problem's occurrence
Synchronous and diachronous explanatory conditions
Synchronous explanatory conditions = coinciding with
behavior that is to be explained at the time (structural
explanation (ego weakness, borderline personality
organization)
Diachronous explanatory conditions = preceding the
behavior (psychogenic explanation, oral fixation, problems
during separation-individuation phase)
Induced and persistent conditions
Induced explanatory conditions = giving rise to a behavioral
problem
Persistent explanatory conditions = perpetuating the
behavioral problem
Causal relationship between the first two points
Using one specific theory limits the diagnostic process and
predominantly influences and limits the indication
Eclectic theory = different theories and concepts complement each
other and reveal each other's limitations
o Prediction (risk assessment): how will the client's problems subsequently develop in
the future?
Making a chance statement about problem behavior in future, where the
chance plays a part in determining treatment proposal
Relation between a predictor and a criterion
Predictor is present behavior
Criterion is future behavior
When empirical evidence is ineffective the diagnostician may
need to still give an answer to the practical question
Using a model or clinical prediction (using meta-
analyses and intervision)
, Predictions with greatest possible degree of certainty may be
anti-therapeutic as they document a situation without taking
account of the possibility of future changes
o Indication: how can the problems be resolved?
Whether client requires treatment
Orientation = search process that involves finding which treatment and
which caregiver are most compatible with client, which does not necessarily
involve selection
Knowledge of treatments and therapists
Knowledge of relative usefulness of treatments
Knowledge of the client's acceptance of the indication
Indication strategy that takes client's preferences into
account
Client's perspective is examined and explicated
Diagnostician provides client with information about
the courses of treatment, processes, and therapists
Client's expectations and preferences are compared
to those that the diagnostician deems to be suitable
and useful
Client selects a therapist and a treatment
o Evaluation: have the problems been adequately resolved as a result of the
intervention?
Progress of therapeutic process and results of treatment
Establishes whether the therapy took account of the diagnosis and
treatment proposal
Establishes whether the process and treatment have brought about
a change in the client's behavior and experience
By establishing whether complaints/problems decreased
By proving the changes were caused by therapy
Empirical cycle
1. Observation: collecting and classifying empirical materials, which provide the basis for
forming thoughts about the creation and persistence of problem behavior
2. Induction: formulation of theory and hypotheses about behavior
3. Deduction: deriving testable predictions from hypotheses
4. Testing: using new materials to determine the (in)correctness of predictions
5. Evaluation
o Empirical cycle is for scientific research not for psychodiagnostic practice
Diagnostic examination
1. Hypothesis formulation
o Recognition question: presence of psychopathology through DSM categories
o Explanation question: listing explanatory factors and their predisposing or
perpetuating roles
o Predictive question: based on empirical knowledge of successful predictors
o Indication question: assuming which treatment and therapist(s) are best suited
based on recognition, explanation, prediction, how client formulates the problem
(theory of illness), the type of expected help (theory of healing), and the
achievement expected (theory of health)
2. Selection of examination tools
o Linked to hypothesis and nature of question, psychometric quality of instruments,
and efficiency considerations
o Recognition question: objective instruments that are tailored to more disorders or
specific psychopathological profiles
, o Explanation question: different testing of hypotheses which focuses on explanatory
factors
o Prediction question: instruments with predictive validity
o Indication question: using additional questionnaire
3. Formulation of testable predictions
o Establishing criteria
o Helps reduce confirmation bias
4. Administration and scoring
o Provision of qualitative and quantitative information
5. Argumentation
o Linking step 4 to the hypothese and predictions
o Concluding pros and cons
o Reaching a conclusive outcome
6. Report (for the referrer)
o Results of diagnostic examination by distinguishing facts, interpretations of the facts,
and conclusions, acknowledging sources
o For effective communication about the client
Diagnosis and treatment combinations, DTCs
Work is more efficient and cost-effective
Clients usually have more than one problem who feels that all are equally serious, which
makes choosing a department difficult and arbitrary
Having complaints that are not well defined may lead to problematic urgent referrals
Overlooking more important existing disorders
Assumes and interaction between a diagnosis and a treatment, which is usually not the case
Insufficient time to carry out a comprehensive diagnostic examination of the problem(s)
Clinical psychodiagnostics = exclusive specialism of a clinical psychologist
Theory development of problems/complaints and problematic behavior
Operationalization and its measurement
Application of relevant diagnostic methods
Diagnostic process
Client's referral to diagnostician / client's direct question to the
diagnostician (request for help and referrer's request)
Provisional theory about the client
o Converting provisional theory into concrete hypotheses
o Selecting a specific set of research tools
o Making predictions about results from this set of tools
o Applying and processing instruments
o Giving reasons why hypotheses have been accepted/rejected
1. Application: analyzing and clarifying the request and the request for help
o Analyzing the request (recognition, explanation, indication) leads
to information about the referrer (referrer's frame of reference,
relationship between diagnostician and referrer, nature of the setting, distinction
between the referrer in name and the actual referrer, nature and extent of available
powers) and details about the type and content of the request (open-ended format
or closed format, nature of the setting)
o Analysis is supported by what the referrer already knows about the client and helps
to determine whether the client presented himself to the referrer and whether he
consents to examination
o Exploring the client's mindset
o Content of the client's problem
o Analyzing the file data
2. Diagnostician's reflections
o Awareness of potential biases in general clinical judgment and towards clients of
diagnostician
o New questions about the problem
3. Diagnostic scenario
o Organizing the requester's and client's questions which leads to a proposed initial,
tentative theory about the client's behavior
Questions in clinical psychodiagnostics
o Recognition: what are the problems, what works and what doesn't?
Inventory and description
Organization and categorization in dysfunctional behavior clusters or
disorders
Examination of the seriousness of the problem behavior
Through criterion-oriented measurement: recognition due to comparison to
a predefined standard
Through normative measurement: recognition due to comparison to
representative comparison group
Through ipsative measurement: recognition due to comparison of individual
itself
Classification = clinical picture is assigned to a class of problems through an
all-or-nothing principle or a more-or-less principle (DSM, personality tests)
Leads to labeling, whcih is limited and often forms the basis for
establishing comorbidity
Does facilitate communication between experts
, Diagnostic formulation = focusing on the individual and its own unique
clinical picture (holistic theory, where functional, theoretically explicit
relationships between interdependent problem behaviors and context play a
central role)
Leads to uniqueness of the individual being allowed, based on a
description of the client and its context, which helps therapy
planning
Lack of empirical support
o Explanation: why do certain problems exist and what perpetuates them?
Main problem or problem component
The locus (person/situation)
Person-oriented explanation = explanatory factor is within
the person, when behavior is viewed separately from
context
Situation-oriented explanation = explanatory events may
precede behavior that is to be explained or follow it
The nature of control
Cause is determined by previous conditions, which explains
behavior (falling from a tree where gravity is the cause)
Reason is determined by a voluntary or intentional choice,
which makes behavior understandable (falling from a tree
due to recklessness of the person)
Conditions that explain the problem's occurrence
Synchronous and diachronous explanatory conditions
Synchronous explanatory conditions = coinciding with
behavior that is to be explained at the time (structural
explanation (ego weakness, borderline personality
organization)
Diachronous explanatory conditions = preceding the
behavior (psychogenic explanation, oral fixation, problems
during separation-individuation phase)
Induced and persistent conditions
Induced explanatory conditions = giving rise to a behavioral
problem
Persistent explanatory conditions = perpetuating the
behavioral problem
Causal relationship between the first two points
Using one specific theory limits the diagnostic process and
predominantly influences and limits the indication
Eclectic theory = different theories and concepts complement each
other and reveal each other's limitations
o Prediction (risk assessment): how will the client's problems subsequently develop in
the future?
Making a chance statement about problem behavior in future, where the
chance plays a part in determining treatment proposal
Relation between a predictor and a criterion
Predictor is present behavior
Criterion is future behavior
When empirical evidence is ineffective the diagnostician may
need to still give an answer to the practical question
Using a model or clinical prediction (using meta-
analyses and intervision)
, Predictions with greatest possible degree of certainty may be
anti-therapeutic as they document a situation without taking
account of the possibility of future changes
o Indication: how can the problems be resolved?
Whether client requires treatment
Orientation = search process that involves finding which treatment and
which caregiver are most compatible with client, which does not necessarily
involve selection
Knowledge of treatments and therapists
Knowledge of relative usefulness of treatments
Knowledge of the client's acceptance of the indication
Indication strategy that takes client's preferences into
account
Client's perspective is examined and explicated
Diagnostician provides client with information about
the courses of treatment, processes, and therapists
Client's expectations and preferences are compared
to those that the diagnostician deems to be suitable
and useful
Client selects a therapist and a treatment
o Evaluation: have the problems been adequately resolved as a result of the
intervention?
Progress of therapeutic process and results of treatment
Establishes whether the therapy took account of the diagnosis and
treatment proposal
Establishes whether the process and treatment have brought about
a change in the client's behavior and experience
By establishing whether complaints/problems decreased
By proving the changes were caused by therapy
Empirical cycle
1. Observation: collecting and classifying empirical materials, which provide the basis for
forming thoughts about the creation and persistence of problem behavior
2. Induction: formulation of theory and hypotheses about behavior
3. Deduction: deriving testable predictions from hypotheses
4. Testing: using new materials to determine the (in)correctness of predictions
5. Evaluation
o Empirical cycle is for scientific research not for psychodiagnostic practice
Diagnostic examination
1. Hypothesis formulation
o Recognition question: presence of psychopathology through DSM categories
o Explanation question: listing explanatory factors and their predisposing or
perpetuating roles
o Predictive question: based on empirical knowledge of successful predictors
o Indication question: assuming which treatment and therapist(s) are best suited
based on recognition, explanation, prediction, how client formulates the problem
(theory of illness), the type of expected help (theory of healing), and the
achievement expected (theory of health)
2. Selection of examination tools
o Linked to hypothesis and nature of question, psychometric quality of instruments,
and efficiency considerations
o Recognition question: objective instruments that are tailored to more disorders or
specific psychopathological profiles
, o Explanation question: different testing of hypotheses which focuses on explanatory
factors
o Prediction question: instruments with predictive validity
o Indication question: using additional questionnaire
3. Formulation of testable predictions
o Establishing criteria
o Helps reduce confirmation bias
4. Administration and scoring
o Provision of qualitative and quantitative information
5. Argumentation
o Linking step 4 to the hypothese and predictions
o Concluding pros and cons
o Reaching a conclusive outcome
6. Report (for the referrer)
o Results of diagnostic examination by distinguishing facts, interpretations of the facts,
and conclusions, acknowledging sources
o For effective communication about the client
Diagnosis and treatment combinations, DTCs
Work is more efficient and cost-effective
Clients usually have more than one problem who feels that all are equally serious, which
makes choosing a department difficult and arbitrary
Having complaints that are not well defined may lead to problematic urgent referrals
Overlooking more important existing disorders
Assumes and interaction between a diagnosis and a treatment, which is usually not the case
Insufficient time to carry out a comprehensive diagnostic examination of the problem(s)
