Treatment Utility of Psychological Assessment Rosemery O. Nelson-Gray

Treatment Utility of Psychological Assessment Rosemery O. Nelson-Gray Paper details: 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: r_nelson@uncg.edu 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 522 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.