Treatment Utility of Psychological Assessment Rosemery O. Nelson-Gray
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The students will critically review the corresponding assigned article from each current week. The students will use 12 point font and APA formatting on their 3.5 pages of typewritten work. The 3.5 pages excludes the title page and the references page. Any students caught plagiarizing from the abstract of the article or copying another student’s summary will get a zero and grounds for failure in the course.
Guidelines of writing the Weekly Article Summaries and Reflections:
a) Each summary for each article should be 2 pages long.
1) If the article is a research study, you must identify (a) the hypothesis being tested, (b) the research methods (this includes identifying the Independent Variable(s), Dependent Variable(s), and the method(s) of measuring the dependent variable, and (c) identifying 2 key results or implications of the study.
2) If the article is a literature review, you must identify and elaborate upon 6 key claims or concepts from the literature review. The 6 claims must sample from the entire article rather than just initial sections of the article.
b) The reflection for each article should be 1.5 pages long.
The reflection will compare and contrast the empirical information covered in the research article with the Psychometric theories and concepts covered during the lectures and textbook readings.
Treatment Utility of Psychological Assessment
Rosemery O. Nelson-Gray
University of North Carolina at Greensboro
This article focuses on treatment utility. A definition of treatment utility was provided by S. C. Hayes,
R. O. Nelson, and R. B. Jarrett (1987): “We propose to use the phrase
the treatment utility of assessment
to refer to the degree to which assessment is shown to contribute to beneficial treatment outcome” (p.
963). Various methodologies to examine the treatment utility of assessment are summarized. Treatment
utility studies using various assessment procedures (i.e., diagnosis and functional analysis) and various
disorders (i.e., unipolar depression, social or interpersonal problems, and phobic disorders) are described.
Suggestions are made as to when elaborated assessment and/or treatment utility studies are needed.
Limitations on the generalizability of results of any particular treatment utility study are presented.
Despite progress, for most assessment procedures and devices, the treatment utility question remains:
What is the degree to which assessment is shown to contribute to beneficial treatment outcome?
People have been interested in the assessment of individual
differences in other humans since the time of Hippocrates and the
four humors. A plethora of assessment strategies and devices have
emerged, especially in recent decades, that include informal and
structured interviewing, projective tests, intelligence tests, objec-
tive tests of personality, objective tests of organic dysfunction,
rating scales, self- and other-report questionnaires, psychophysio-
logical assessment, cognitive measures, direct observation, role-
playing, and self-recording (Hayes, Barlow, & Nelson-Gray, 1999;
Willerman & Cohen, 1990).
Hunsley (2002) has made a useful distinction between testing
and assessment: “Testing involves administering a scale that re-
sults in a description based on nomothetic data, whereas assess-
ment involves interpreting test results, life history information,
collateral data, and clinical observation into a unified description
of the individual being assessed” (p. 139). Testing and assessment
have many purposes: to describe personality, intellectual, or other
functioning; to diagnose or classify; to give a prognosis or make a
prediction; to select treatment goals; to select appropriate treat-
ment; and to evaluate or revise treatment (Barrios & Hartmann,
1986).
Numerous individuals have evaluated the quality and utility of
testing and assessment strategies and devices in numerous ways. A
recent example is the report of the Psychological Assessment
Work Group (PAWG). The PAWG was commissioned by the
Board of Professional Affairs of the American Psychological As-
sociation in 1996 (a) to evaluate contemporary threats to psycho-
logical and neuropsychological assessment services and (b) to
assemble evidence on the efficacy of assessment in clinical prac-
tice. The PAWG report, summarized by Meyer et al. (2001),
reached four conclusions: (a) Psychological test validity is strong
and compelling, (b) psychological test validity is comparable with
medical test validity, (c) distinct assessment methods provide
unique sources of information, and (d) clinicians who rely exclu-
sively on interviews are prone to incomplete understanding. The
article by Meyer et al. (2001) generated four replies (Fernandez-
Ballesteros, 2002; Garb, Klein, & Grove, 2002; Hunsley, 2002;
Smith, 2002) and a counterreply (Meyer et al., 2002), all of which
are evidence of the controversial nature of any summary of the
quality and utility of psychological assessment. Taking a different
approach, Swets, Dawes, and Monahan (2000) have concluded that
psychological science, by combining objective and subjective data
with statistical prediction rules, can improve diagnostic decisions.
This special section of
Psychological Assessment
represents an-
other evaluation of psychological assessment, in particular, its
incremental utility and validity.
What Is the Treatment Utility of Psychological
Assessment?
The purpose of this article is to discuss the treatment utility of
psychological assessment. A definition of treatment utility was
provided by Hayes, Nelson, and Jarrett (1987): “We propose to use
the phrase
the treatment utility of assessment
to refer to the degree
to which assessment is shown to contribute to beneficial treatment
outcome” (p. 963). Current treatment utility questions relate to
Barrios and Hartmann’s (1986) goals of selecting appropriate
treatment and of evaluating or revising treatment. Typical treat-
ment utility questions, to be described later, include the following:
(a) Does treatment selection that is based on a particular assess-
ment result in a more successful client outcome? and (b) Does
supplying outcome data to therapists result in a more successful
client outcome?
Previously, there was little research on treatment utility of
assessment. Assessment was often not integrated into the therapy
process and was even seen as a negative intrusion into the thera-
peutic alliance. According to Blatt (1975), “Clinical psycholo-
gist
s…
often make a sharp cleavage between their roles as diag-
nostician and therapist” (p. 336). In earlier days of clinical
I thank my research assistant, John Mitchell, for his invaluable and
timely assistance with literature reviews and my student lab group for
comments on drafts of this article.
Correspondence concerning this article should be addressed to Rose-
mery O. Nelson-Gray, Psychology Department, University of North Caro-
lina at Greensboro, P.O. Box 26170, Greensboro, North Carolina. E-mail:
[email protected]
Psychological Assessment
Copyright 2003 by the American Psychological Association, Inc.
2003, Vol. 15, No. 4, 521–531
1040-3590/03/$12.00 DOI: 10.1037/1040-3590.15.4.521
521
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
psychology, most psychotherapists practiced according to the gen-
eral school of therapy in which they had been trained. When
clinicians apply the same general approach to most of their clients,
assessment data can have few treatment implications (e.g., Wallen,
1956). In a study of 132 clinicians, Meehl (1960) reported that
only 17% of the clinicians felt that prior knowledge or assessment
of the patient was important in effective treatment. In Meehl
’
s
study, a more important factor in determining treatment was the
type of training the clinician received. More recently, in a survey
of 25 therapists (O
’
Donohue, Fisher, Plaud, & Curtis, 1990),
personal preference was still the most important influence reported
in choosing a treatment method. Across their 75 cases, most
therapists reported using no systematic decision procedure in
choosing assessment techniques, treatment goals, or treatment
methods. Braden and Kratochwill (1997) deplored the paucity of
studies evaluating the treatment utility of psychological assess-
ment within the school psychology setting.
With the advent of more and more specific interventions in both
clinical and school settings, the need for guidance by assessment
data in choosing among types of treatments becomes more obvi-
ous. In the words of Korchin and Schuldberg (1981),
Compared to the early days of clinical psychology, today there are
literally hundreds of competing types of psychosocial interven-
tion
s…
what qualities of this person, or aspects of his or her life
situation and environment, recommend that he or she be seen in what
type of therapy, with what kind of therapist, using what kind of
technique? This is the question facing us today. (p. 1155)
Similarly, but in the words of Gordon Paul (1969),
“
What
treatment, by whom, is most effective for this individual with that
specific problem, under which sets of circumstances, and how does
this come about?
”
(p. 44). Haynes (1993) notes
“
The integration of
assessment data into treatment decisions remains one of the least
researched aspects of applied psychology
”
(p. 252).
As treatments have become more specific, so have assessment
devices and strategies. The earlier eras in clinical assessment
tended to emphasize global measures of personality. Such person-
ality assessments may have rarely altered the diagnostic judgments
or treatment decisions of clinicians (Adams, 1972). Many contem-
porary assessment devices, however, are more specific, focusing
on specific behaviors, cognitions, or disorders. Given both the
plethora of specific treatments and the specificity of assessment
devices, the treatment implications of assessment can be
investigated.
Methodologies to Investigate Treatment Utility of
Psychological Assessment
Hayes et al. (1987) described several methodologies used to
investigate the treatment utility of psychological assessment. At
that time, there were few examples of studies utilizing these
methodologies. In describing and elaborating on some of these
methodologies in this article, a single example of each methodol-
ogy is provided for illustration. In subsequent sections, reference is
made to these same methodologies when other studies are de-
scribed in different contexts.
Methodology of Manipulated Assessment
One methodology to examine the treatment utility of psycho-
logical assessment is an experimental methodology known as
manipulated assessment.
In this type of study, assessment data are
at issue. A single group of subjects is randomly divided into two
or more subgroups, and either the collection of or availability of
assessment data is varied systematically. The therapist then de-
signs and implements treatment in accordance with the available
data. For example, data from a particular device may be made
available for only one subgroup. For illustrative purposes, a re-
search program by Lambert and colleagues (e.g., Lambert, Hansen,
& Finch, 2001) has investigated the effects on patient outcomes
when half of the therapists were provided with weekly feedback
about patient progress, including notifying therapists about pa-
tients who were not making adequate progress (i.e., possible treat-
ment failures). This program of research suggests that providing
therapists with information about patient progress has a significant
and substantial effect on outcome for patients generally, and spe-
cifically, for those who show a poor initial response to treatment.
Presumably, the mechanism that produced this improvement was
alterations in the therapists
’
behavior or treatment approach in
response to this weekly feedback. This research program uses the
methodology of manipulated assessment to show that providing
therapists with weekly patient outcome data has treatment utility,
that is, it improves patient outcomes in therapy.
Methodology of the Manipulated Use of Assessment
Information
A second methodology to examine the treatment utility of
psychological assessment is also an experimental methodology,
called the
manipulated use of assessment information.
Here, the
same assessment information is available for all subjects; but the
researcher manipulates the way that the assessment information is
used. In an illustrative study by Nelson-Gray, Herbert, Herbert,
Sigmon, and Brannon (1989), nine depressed women each re-
ceived the same assessment battery. Three women received treat-
ment matched to each woman
’
s main problematic behavioral re-
sponse class, three women received treatment that was mismatched
to each woman
’
s main problematic behavioral response class, and
three women received a package treatment for depression. The
results strengthened two hypotheses: that both (a) the matched
treatments and (b) the package treatment were effective in allevi-
ating depression, more so than the mismatched treatment. This study
provides some support for the treatment utility of treatment matching,
that is, providing treatment that matches a particular client problem.
Methodology of Obtained Differences in Assessment
Information
A third methodology to examine the treatment utility of psy-
chological assessment is also experimental, the methodology of
obtained differences in assessment information.
Here, participants
are divided into groups nonrandomly, on the basis of assessment
differences. Participants then receive one type of treatment. If
outcome differs between the groups, the treatment utility of the
participants assessment differences is shown. For example, Keller
(1983) found that a group of depressed community volunteers with
low pretreatment scores on the Dysfunctional Attitude Scale
(DAS; Weissman & Beck, 1978) showed a greater response to
cognitive therapy than did their depressed counterparts with high
scores. Keller argued that these data contradict the notion in
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NELSON-GRAY
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
