Test selection issues

[psych84]

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Unless I misunderstood you before, I thought you said that you don't use psychological tests on a majority of people.

 

[WisNeuro]

How do you rule out most people who show up at your practice?

Apples and oranges. If I remember correctly erg works at the VA, like me. In child custody evaluations, people try to look as good as they possibly can. Here at the VA, we have to deal with the opposite at times; people trying to look as bad as they can cognitively and emotionally. The context matters tremendously and the same instruments are not appropriate across all contexts.

I think we've strayed a little from target, but these issues are a lot more complex than simply giving a WAIS and MMPI and making a determination of something or the other.

 

[psych84]

I think we've strayed a little from target, but these issues are a lot more complex than simply giving a WAIS and MMPI and making a determination of something or the other.

Saying "these issues are a lot more complex than.." sounds like..there is a lot of judgement that goes into it that is hardly backed up by evidence. But correct me if you meant something different.

 

[WisNeuro]

Saying "these issues are a lot more complex than.." sounds like..there is a lot of judgement that goes into it that is hardly backed up by evidence.

Not what I meant. I think you are over-simplifying custody evals. I don't do them, so it'd be nice to hear from someone who did, but from my naive understanding of at least some experience with forensic type work, it is not simply two well-adjusted parents and the one that is slightly better off loses. Usually there is some serious **** going on, and there are significant implications for the child's development.

 

[erg923]

Unless I misunderstood you before, I thought you said that you don't use psychological tests on a majority of people.

I do not. Thats correct. If I suspect severe psychiatric disturbance based on interview, history, and behavioral observation, I refer to a service that deals with such. I do not treat severe psychiatric illness in my clinic. What does this have to do with anything?

 

[psych84]

I do not. Thats correct. If I suspect severe psychiatric disturbance based on interview, history, and behavioral observation, I refer to a service that deals with such. I do not treat severe psychiatric illness in my clinic. What does this have to do with anything?

Then why couldn't you use interview, history, and behavioral observation in custody evaluations for most of the cases? I assume there is no reason to suspect that most of them have severe psychiatric disturbances. This is my whole argument. Most of the testing in custody evaluations occurs because the psychologist has to cover his ass and because a decision HAS to be made on who has the better capacity to take care of the children. If the testing doesn't show any psychopathology, the psychologist is left in a tough place and is left to use assesments like IQ and accusations by the parents about each other as their basis for the decision. There is really nothing stopping that person from using IQ or accusations as part of their conclusions since psychopathology is not found in most cases.

 

[erg923]

Then why couldn't you use interview, history, and behavioral observation in custody evaluations for most of the cases?

Because you are serving a entity with a much higher standard. http://en.wikipedia.org/wiki/Daubert_standard

And "nothing stopping that person?" I dont follow your arguement. Possible missuse of test data by unethical practitioners in no ways means that the process is flawed. What kind of logic is that? Have you bought into the notion that most psychologists are mindless, morally flawed, money chasing robots or something?

The whole purpose of a professional ethics code is to help guide professional behavior/conduct so that a standard odf practice is adhered to and misspalication ofpsychological knowlege does NOT happen.

 

[erg923]

With all due respect, you are arguing with trained psychologists about a topic that you know very little about. If you have specific questions, ask them, but I would suggest that the Tom Cruise approach (so simple a cave man good do it) approach wont go very far here.

 

[AcronymAllergy]

It depends on the situation, and you're always weighing pros and cons/costs and benefits. In a typical primary care case, the added time and cost of doing significant diagnostic testing often isn't going to be worthwhile, as you're likely going to end up working to address the goals the patient has identified on their own (potentially with some help from you). In that setting, as erg mentioned, if longer-term and/or more in-depth assessment and intervention are required, you refer elsewhere to folks who'll be able to provide those services. For example, if the patient isn't responding to therapy, and you think it might be due to underlying reason X or Y, you refer out if assessing for X and Y is outside the scope of your current practice setting.

In a child custody case, lots of things change, including the burden and standards of proof (as erg pointed out ala Daubert). If there's psychopathology, an interview indeed may uncover it, but having additional (psychometric) data to back you up will likely be beneficial and will allow you to place greater confidence in your diagnosis/opinions. Beyond that, the psychological data is going to be less influenced by subjective factors. In the absence of psychopathology, the instruments may still be useful, depending on how they're used (and, of course, will also be useful in informing the rule out in the first place).

Psychological tests are an additional tool at our disposal...sort of like an MRI, for example. The MRI may not always tell the neurologist what they want to know (and it's never going to be interpreted in isolation), but that doesn't mean it isn't worth getting in many cases.