How Does a Psychological Evaluation Help in Understanding Mental Health?

Psychological evaluation is a method to assess an individual's behavior, personality, cognitive abilities, and several other domains.[a][3] A common reason for a psychological evaluation is to identify psychological factors that may be inhibiting a person's ability to think, behave, or regulate emotion functionally or constructively. It is the mental equivalent of physical examination. Other psychological evaluations seek to better understand the individual's unique characteristics or personality to predict things like workplace performance or customer relationship management.[4]

History

Modern psychological evaluation has been around for roughly 200 years, with roots that stem as far back as 2200 B.C.[5] It started in China, and many psychologists throughout Europe worked to develop methods of testing into the 1900s. The first tests focused on aptitude. Eventually scientists tried to gauge mental processes in patients with brain damage, then children with special needs.

Ancient psychological evaluation

Earliest accounts of evaluation are seen as far back as 2200 B.C. when Chinese emperors were assessed to determine their fitness for office. These rudimentary tests were developed over time until 1370 A.D. when an understanding of classical Confucianism was introduced as a testing mechanism. As a preliminary evaluation for anyone seeking public office, candidates were required to spend one day and one night in a small space composing essays and writing poetry over assigned topics. Only the top 1% to 7% were selected for higher evaluations, which required three separate session of three days and three nights performing the same tasks. This process continued for one more round until a final group emerged, comprising less than 1% of the original group, became eligible for public office. The Chinese failure to validate their selection procedures, along with widespread discontent over such grueling processes, resulted in the eventual abolishment of the practice by royal decree.[5]

Development of psychological evaluation in 1800-1900-s

In the 1800s, Hubert von Grashey developed a battery to determine the abilities of brain-damaged patients. This test was also not favorable, as it took over 100 hours to administer. However, this influenced Wilhelm Wundt, who had the first psychological laboratory in Germany. His tests were shorter, but used similar techniques. Wundt also measured mental processes and acknowledged the fact that there are individual differences between people.

Francis Galton established the first tests in London for measuring IQ. He tested thousands of people, examining their physical characteristics as a basis for his results and many of the records remain today.[5] James Cattell studied with him, and eventually worked on his own with brass instruments for evaluation. His studies led to his paper "Mental Tests and Measurements", one of the most famous writings on psychological evaluation. He also coined the term "mental test" in this paper.

As the 1900s began, Alfred Binet was also studying evaluation. However, he was more interested in distinguishing children with special needs from their peers after he could not prove in his other research that magnets could cure hysteria. He did his research in France, with the help of Theodore Simon. They created a list of questions that were used to determine if children would receive regular instruction, or would participate in special education programs. Their battery was continually revised and developed, until 1911 when the Binet-Simon questionnaire was finalized for different age levels.

After Binet's death, intelligence testing was further studied by Charles Spearman. He theorized that intelligence was made up of several different subcategories, which were all interrelated. He combined all the factors together to form a general intelligence, which he abbreviated as "g".[6] This led to William Stern's idea of an intelligence quotient. He believed that children of different ages should be compared to their peers to determine their mental age in relation to their chronological age. Lewis Terman combined the Binet-Simon questionnaire with the intelligence quotient and the result was the standard test we use today, with an average score of 100.[6]

The large influx of non-English speaking immigrants into the US brought about a change in psychological testing that relied heavily on verbal skills for subjects that were not literate in English, or had speech/hearing difficulties. In 1913, R.H. Sylvester standardized the first non-verbal psychological test. In this particular test, participants fit different shaped blocks into their respective slots on a Seguin form board.[5] From this test, Knox developed a series of non-verbal psychological tests that he used while working at the Ellis Island immigrant station in 1914. In his tests, were a simple wooden puzzle as well as digit-symbol substitution test where each participant saw digits paired up with a particular symbol, they were then shown the digits and had to write in the symbol that was associated with it.[5]

When the United States moved into World War I, Robert M. Yerkes convinced the government that they should be testing all of the recruits they were receiving into the Army. The results of the tests could be used to make sure that the "mentally incompetent" and "mentally exceptional" were assigned to appropriate jobs. Yerkes and his colleagues developed the Army Alpha and Army Beta tests to use on all new recruits.[5] These tests set a precedent for the development of psychological testing for the next several decades.

After seeing the success of the Army standardized tests, college administration quickly picked up on the idea of group testing to decide entrance into their institutions. The College Entrance Examination Board was created to test applicants to colleges across the nation. In 1925, they developed tests that were no longer essay tests that were very open to interpretation, but now were objective tests that were also the first to be scored by machine. These early tests evolved into modern day College Board tests, like the Scholastic Assessment Test, Graduate Record Examination, and the Law School Admissions Test.[5]

Formal and informal evaluation

Formal psychological evaluation consists of standardized batteries of tests and highly structured clinician-run interviews, while informal evaluation takes on a completely different tone. In informal evaluation, assessments are based on unstructured, free-flowing interviews or observations that allow both the patient and the clinician to guide the content. Both of these methods have their pros and cons. A highly unstructured interview and informal observations provide key findings about the patient that are both efficient and effective. A potential issue with an unstructured, informal approach is the clinician may overlook certain areas of functioning or not notice them at all.[7] Or they might focus too much on presenting complaints. The highly structured interview, although very precise, can cause the clinician to make the mistake of focusing a specific answer to a specific question without considering the response in terms of a broader scope or life context.[7] They may fail to recognize how the patient's answers all fit together.

There are many ways that the issues associated with the interview process can be mitigated. The benefits to more formal standardized evaluation types such as batteries and tests are many. First, they measure a large number of characteristics simultaneously. These include personality, cognitive, or neuropsychological characteristics. Second, these tests provide empirically quantified information. The obvious benefit to this is that we can more precisely measure patient characteristics as compared to any kind of structured or unstructured interview. Third, all of these tests have a standardized way of being scored and being administered.[7] Each patient is presented a standardized stimulus that serves as a benchmark that can be used to determine their characteristics. These types of tests eliminate any possibility of bias and produce results that could be harmful to the patient and cause legal and ethical issues. Fourth, tests are normed. This means that patients can be assessed not only based on their comparison to a "normal" individual, but how they compare to the rest of their peers who may have the same psychological issues that they face. Normed tests allow the clinician to make a more individualized assessment of the patient. Fifth, standardized tests that we commonly use today are both valid and reliable.[7] We know what specific scores mean, how reliable they are, and how the results will affect the patient.

Most clinicians agree that a balanced battery of tests is the most effective way of helping patients. Clinicians should not become victims of blind adherence to any one particular method.[8] A balanced battery of tests allows there to be a mix of formal testing processes that allow the clinician to start making their assessment, while conducting more informal, unstructured interviews with the same patient may help the clinician to make more individualized evaluations and help piece together what could potentially be a very complex, unique-to-the-individual kind of issue or problem .[8]

Modern uses

Psychological assessment is most often used in the psychiatric, medical, legal, educational, or psychological clinic settings. The types of assessments and the purposes for them differ among these settings.

In the psychiatric setting, the common needs for assessment are to determine risks, whether a person should be admitted or discharged, the location the patients should be held, as well as what therapy the patient should be receiving.[9] Within this setting, the psychologists need to be aware of the legal responsibilities that what they can legally do in each situation.

Within a medical setting, psychological assessment is used to find a possible underlying psychological disorder, emotional factors that may be associated with medical complaints, assessment for neuropsychological deficit, psychological treatment for chronic pain, and the treatment of chemical dependency. There has been greater importance placed on the patient's neuropsychological status as neuropsychologists are becoming more concerned with the functioning of the brain.[9]

Psychological assessment also has a role in the legal setting. Psychologists might be asked to assess the reliability of a witness, the quality of the testimony a witness gives, the competency of an accused person, or determine what might have happened during a crime. They also may help support a plea of insanity or to discount a plea. Judges may use the psychologist's report to change the sentence of a convicted person, and parole officers work with psychologists to create a program for the rehabilitation of a parolee. Problematic areas for psychologists include predicting how dangerous a person will be. The predictive accuracy of these assessments is debated; however, there is often a need for this prediction to prevent dangerous people from returning to society.[9]

Psychologists may also be called on to assess a variety of things within an education setting. They may be asked to assess strengths and weaknesses of children who are having difficulty in the school systems, assess behavioral difficulties, assess a child's responsiveness to an intervention, or to help create an educational plan for a child. The assessment of children also allows for the psychologists to determine if the child will be willing to use the resources that may be provided.[9]

In a psychological clinic setting, psychological assessment can be used to determine characteristics of the client that can be useful for developing a treatment plan. Within this setting, psychologists often are working with clients who may have medical or legal problems or sometimes students who were referred to this setting from their school psychologist.[9]

Some psychological assessments have been validated for use when administered via computer or the Internet.[10] However, caution must be applied to these test results, as it is possible to fake in electronically mediated assessment.[11] Many electronic assessments do not truly measure what is claimed, such as the Meyers-Briggs personality test. Although one of the most well known personality assessments, it has been found both invalid and unreliable by many psychological researches, and should be used with caution.[12][13]

Within clinical psychology, the "clinical method" is an approach to understanding and treating mental disorders that begins with a particular individual's personal history and is designed around that individual's psychological needs. It is sometimes posed as an alternative approach to the experimental method which focuses on the importance of conducting experiments in learning how to treat mental disorders, and the differential method which sorts patients by class (gender, race, income, age, etc.) and designs treatment plans based around broad social categories.[14][15]

Taking a personal history along with clinical examination allow the health practitioners to fully establish a clinical diagnosis. A medical history of a patient provides insights into diagnostic possibilities as well as the patient's experiences with illnesses. The patients will be asked about current illness and the history of it, past medical history and family history, other drugs or dietary supplements being taken, lifestyle, and allergies.[16] The inquiry includes obtaining information about relevant diseases or conditions of other people in their family.[16][17] Self-reporting methods may be used, including questionnaires, structured interviews and rating scales.[18]

Personality Assessment

Personality traits are an individual's enduring manner of perceiving, feeling, evaluating, reacting, and interacting with other people specifically, and with their environment more generally.[19][20] Because reliable and valid personality inventories give a relatively accurate representation of a person's characteristics, they are beneficial in the clinical setting as supplementary material to standard initial assessment procedures such as a clinical interview; review of collateral information, e.g., reports from family members; and review of psychological and medical treatment records.

Main article: Minnesota Multiphasic Personality Inventory

MMPI

History

Developed by Starke R. Hathaway, PhD, and J. C. McKinley, MD, The Minnesota Multiphasic Personality Inventory (MMPI) is a personality inventory used to investigate not only personality, but also psychopathology.[21] The MMPI was developed using an empirical, atheoretical approach. This means that it was not developed using any of the frequently changing theories about psychodynamics at the time. There are two variations of the MMPI administered to adults, the MMPI-2 and the MMPI-2-RF, and two variations administered to teenagers, the MMPI-A and MMPI-A-RF. This inventory's validity has been confirmed by Hiller, Rosenthal, Bornstein, and Berry in their 1999 meta-analysis. Throughout history the MMPI in its various forms has been routinely administered in hospitals, clinical settings, prisons, and military settings.[22][non-primary source needed]

MMPI-2

The MMPI-2 consists of 567 true or false questions aimed at measuring the reporting person's psychological wellbeing.[23] The MMPI-2 is commonly used in clinical settings and occupational health settings. There is a revised version of the MMPI-2 called the MMPI-2-RF (MMPI-2 Restructured Form).[24] The MMPI-2-RF is not intended to be a replacement for the MMPI-2, but is used to assess patients using the most current models of psychopathology and personality.[24]

MMPI-2 and MMPI-2-RF Scales[25][26]

Version Number of Items Number of Scales Scale Categories

MMPI-2 567 120 Validity Indicators, Superlative Self-Presentation Subscales, Clinical Scales, Restructured Clinical (RC) Scales, Content Scales, Content Component Scales, Supplementary Scales, Clinical Subscales (Harris-Lingoes and Social Introversion Subscales)

MMPI-2-RF 338 51 Validity, Higher-Order (H-O), Restructured Clinical (RC), Somatic, Cognitive, Internalizing, Externalizing, Interpersonal, Interest, Personality Psychopathology Five (PSY-5)

MMPI-A

The MMPI-A was published in 1992 and consists of 478 true or false questions.[27] This version of the MMPI is similar to the MMPI-2 but used for adolescents (age 14–18) rather than for adults. The restructured form of the MMPI-A, the MMPI-A-RF, was published in 2016 and consists of 241 true or false questions that can understood with a sixth grade reading level.[28][29] Both the MMPI-A and MMPI-A-RF are used to assess adolescents for personality and psychological disorders, as well as to evaluate cognitive processes.[29]

MMPI-A and MMPI-A-RF Scales[30][31]

Verson Number of Items Number of Scales Scale Categories

MMPI-A 478 105 Validity Indicators, Clinical Scales, Clinical Subscales (Harris-Lingoes and Social Introversion Subscales), Content Scales, Content Component Scales, Supplementary Scales

MMPI-A-RF 241 48 Validity, Higher-Order (H-O), Restructured Clinical (RC), Somatic/Cognitive, Internalizing, Externalizing, Interpersonal, Personality Psychopathology Five (PSY-5)

NEO Personality Inventory

The NEO Personality Inventory was developed by Paul Costa Jr. and Robert R. McCrae in 1978. When initially created, it only measured three of the Big Five personality traits: Neuroticism, Openness to Experience, and Extroversion. The inventory was then renamed as the Neuroticism-Extroversion-Openness Inventory (NEO-I). It was not until 1985 that Agreeableness and Conscientiousness were added to the personality assessment. With all Big Five personality traits being assessed, it was then renamed as the NEO Personality Inventory. Research for the NEO-PI continued over the next few years until a revised manual with six facets for each Big Five trait was published in 1992.[20] In the 1990s, now called the NEO PI-R, issues were found with the personality inventory. The developers of the assessment found it to be too difficult for younger people, and another revision was done to create the NEO PI-3.[32]

The NEO Personality Inventory is administered in two forms: self-report and observer report. It consists of 240 personality items and a validity item. It can be administered in roughly 35–45 minutes. Every item is answered on a Likert scale, widely known as a scale from Strongly Disagree to Strongly Agree. If more than 40 items are missing or more than 150 responses or less than 50 responses are Strongly Agree/Disagree, the assessment should be viewed with great caution and has the potential to be invalid.[33] In the NEO report, each trait's T score is recorded along with the percentile they rank on compared to all data recorded for the assessment. Then, each trait is broken up into their six facets along with raw score, individual T-scores, and percentile. The next page goes on to list what each score means in words as well as what each facet entails. The exact responses to questions are given in a list as well as the validity response and amount of missing responses.[34]

When an individual is given their NEO report, it is important to understand specifically what the facets are and what the corresponding scores mean.