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**\ Chapter 5- Assessment: Overview** **Classification** requires the collection of data in a process known as assessment. People are routinely assessed and classified for a variety of purposes ·   psychological assessment strategies and tools are used increasingly for a number of educational and...

**\ Chapter 5- Assessment: Overview** **Classification** requires the collection of data in a process known as assessment. People are routinely assessed and classified for a variety of purposes ·   psychological assessment strategies and tools are used increasingly for a number of educational and employment purposes **Psychological Assessment:** is an iterative decision -making process in which data are systematically collected on the person (or persons), the person's history, and the person's physical, social, and cultural environments. ·   Based on an initial understanding of the problem to be assessed, preliminary information is gathered that, in most cases, leads to a refinement of the understanding of the problem and to an alteration in assessment activities. ·   This cycle then repeats itself until the psychologist decides enough information has been collected to adequately respond to the assessment question. ·   Psychological assessment involves the gathering and integration of multiple types of data from multiple sources and perspectives. ·   At a minimum, this involves information provided by the client and information based on the psychologist's observation of the client during a clinical interview ·   All psychological assessments are undertaken to address specific goals the psychologist clearly and precisely formulates the questions to be addressed during the assessment. In turn, these questions inform the selection of the most appropriate assessment methods and instruments. Throughout the process of data collection, the psychologist generates hypotheses about the client ·   may alter or refine the initial assessment questions in order to examine these hypotheses. ·   typically leads to the use of additional assessment procedures and the review of other data. ·   must then make sense of the information and meaningfully address the inevitable inconsistencies and contradictions that occur in all assessment situations ·   prior to generating a final set of conclusions designed to answer the questions that originally led to initiating the psychological assessment, the psychologist consults with the client (and possibly others) about the accuracy of these conclusions. psychological assessment must be conducted in a manner that is informed by an awareness of human diversity and is sensitive to client characteristics, including, but not limited to, age, gender, ethnicity, culture, sexual orientation, and religious beliefs   **evidence-based assessment:** the use of research and theory to guide (a) the variable assessed, (b) the methods and measures, and (c) the manner in which the assessment process unfolds ·   it involves the recognition that the assessment process is a decision-making task in which the clinician must repeatedly formulate and test hypotheses by integrating data obtained throughout the assessment ·   identification of psychological instruments (including interviews, self-report measures, observational coding systems, and self monitoring measures) that have been demonstrated to possess solid psychometric properties. ·   developed a rating system for instruments used for specific assessment purposes (e.g., diagnosis, treatment monitoring, treatment evaluation) ·   within specific conditions (e.g., depression, self-injurious behaviours, couple conflict). ·   using statistical procedures to integrate assessment data for individual clients ·   develop scientifically sound procedures for client data to directly inform important clinical decisions Psychological assessment is the primary clinical service provided vs situations in which the psychological assessment is just one element of the clinical service **Assessment-Focused Services** are conducted primarily to provide information that can be used to address a person's current or anticipated psychosocial deficits. ·   the conclusions and recommendations provided by the psychologist may have an enormous impact on the person's life circumstances Ex. psychoeducational assessments to diagnose learning disorders and to identify cognitive strengths and weaknesses, neuropsychological assessments to evaluate the extent of cognitive and memory impairment following a severe concussion, child custody assessments ·   must use EBA tools and must follow all ethical standards in providing these services ·   In conducting the assessment, the psychologist must be cognizant of these referral factors, for they may influence the extent to which the person wishes to cooperate with the assessment, as well as motivation to emphasize psychological strengths or psychological impairments ·   It is also important that psychologists have thorough knowledge of the legal context in which their assessments will be used. Ex. assessments may be challenged by the person being assessed or by an institution or agency that initially requested the assessment (e.g., an insurance company) Psychological assessments are most commonly conducted in the context of intervention services. **Intervention-focused assessment services:** the psychological assessment is not a stand-alone service but is conducted as a first step in providing an effective intervention stand-alone assessment in which the main intent is to present conclusions and recommendations about the person's functioning; vs assessment in which the main intent is to intervene to improve the person's functioning, with the assessment data being used in support of this service **Screening:** a procedure to identify individuals who may have problems of a clinical magnitude or who may be at risk for developing such problems ·   Individuals who are screened may not have sought out assessment services; rather, they are receiving the assessment as part of the routine operations of a clinic, school, hospital, or employment setting.  For example, there are now a number of instruments that are routinely used in schools to identify youth with mental health problems. Psychological services are then offered to those who have been identified as having problems ·   People may also actively seek out a screening assessment ·   The screening can be done online or in person at many community-based health care settings such as general hospitals, mental health clinics, and specialty health care providers' offices. **The goal of screening** is to identify those who may require services, with the expectation that steps will be taken to facilitate the provision of services to the individuals identified in the screening process ·   the USPSTF (2015a) recommended that depression screening be undertaken in the general adult population, especially with pregnant women and with women in the postpartum period. The task force members anticipated that such screening efforts would allow for the early identification and treatment of depression in these individuals.   ·   The USPSTF (2015b) reached a different conclusion for children and adolescents. They found no evidence that screening for depression was beneficial for children or for adolescents, but because of evidence that good screening tools and treatments exist for adolescent depression, they cautiously suggested that general screening might be useful in adolescent populations.     ·   Canadian Task Force on Preventive Health Care (2013). found no evidence that screening for depression in adults was effective in ensuring the required health services were provided. ·       recommended that, although health care practitioners should be alert to the possibility of depression in their patients, **routine screening for depression should not occur in primary care settings** **Diagnosis/Case Formulation** ·   assessment data are used to formulate a clinical diagnosis such as those listed in the DSM-5. ·   Interview data, psychological test data, and reports from significant others provide information on the symptoms the person is experiencing. ·   Information on symptoms is compared with diagnostic criteria to determine whether the symptom profile matches criteria for DSM diagnoses ·   knowing the diagnosis for a person helps clinicians communicate with other health professionals and search the scientific literature for information on associated features such as etiology and prognosis. ·   Diagnostic information can also provide key information on the types of treatment options that have been found to be effective in clinical trials ·   diagnosis can provide an initial framework for a treatment plan that can be modified to fully address the client's concerns and life circumstances **case formulation:** a description of the patient that provides information on his or her life situation, current problems, and a set of hypotheses linking psychosocial factors with the patient's clinical condition.  is now more commonly used to describe the use of assessment data to develop a comprehensive and clinically relevant conceptualization of a patient's psychological functioning. **Prognosis/Prediction** **prognosis:** predictions made about the future course of a patient's psychological functioning, based on the use of assessment data in combination with relevant empirical literature ·   psychological assessment always implies some form of prediction about the patient's future. For example, recommendations that the person seek psychotherapy to address bulimic symptoms or that special academic tutoring is needed to compensate for a learning disability imply that, without some form of intervention, the present problems will either continue or worsen. ·   The clinician's task is to use this probabilistic information in a manner that takes into account the unique circumstances of the patient being assessed. ·   Difficult to predict accurately ·   must weigh a number of variables such as time and cost, the consequences of inaccurate decisions, and the base rate of the predicted outcome Time spent on assessment may mean less time is available to provide an intervention for the patient. The cost of an assessment should not be underestimated: more time spent on assessment means that someone must cover these costs. The clinician must therefore strike a balance between the desire to obtain more information and the need to be conscious of the very real constraints that influence the scope of the assessment their selection of assessment strategies and instruments should be based on conscious choices about the types of errors they wish to minimize A misdiagnosis has the potential not only to result in ineffective treatment but also to add to the burden experienced by the individual. ·   Errors can also occur in which a person is diagnosed when, in fact, no diagnosis is warranted. For example, if a person showing signs of social awkwardness was mistakenly diagnosed with autism spectrum disorder, it could lead to both unnecessary treatment and stigmatization. **base rate:** the frequency with which a problem or diagnosis occurs in the population ·   the less frequently a problem occurs, the more likely a prediction error will occur ·   Errors in clinical prediction can occur in many assessment activities, including screening, diagnosis, and case formulation. **Situations in which prediction was accurate** ·   either that the prediction that an event will occur was accurate **(true positive)** ·   the prediction of a non-event was accurate **(true negative)** **Situations in which prediction was not accurate** ·   A **false positive** occurs when the psychologist predicts that an event will occur, but in fact, it does not occur (e.g., the psychologist diagnoses ADHD in a child who does not have the disorder). ·   **false negative** occurs when an event occurs that was not predicted by the psychologist (e.g., doesn't diagnose ADHD when they have it) **sensitivity:** proportion of true positives identified by the assessment. ·   dividing the number of true positives by the sum of true positives and false negatives **specificity**: proportion of true negatives identified by the assessment ·   dividing the number of true negatives by the sum of true negatives and the false positives decision about which assessment procedures to select should be informed by a thorough consideration of the procedure's sensitivity and specificity and the psychological and financial costs stemming from inaccurate clinical predictions **Treatment Planning** Treatment planning is the process by which information about the client's context (including sociodemographic and psychological characteristics, diagnoses, and life circumstances) is used in combination with the scientific literature on psychotherapy to develop a proposed course of action that addresses the client's needs and circumstances. ·   provides a clear focus for treatment and gives the client realistic expectations about the process and likely outcome of treatment. ·   The plan also establishes a standard against which treatment progress can be measured. ·   A formal treatment plan ensures that a client can provide truly informed consent for the procedures he or she is about to undertake, rather than simply agree to a vague statement about therapy. determine whether there are treatment options with established effectiveness for the types of problems the client presents ·   It is always necessary to tailor the treatment to suit the client's unique circumstances no matter how good the fit A useful treatment plan must cover three general areas: problem identification, treatment goals, and treatment strategies and tactics ·   clear statement of the **problems** to be addressed provides the necessary starting point for understanding the proposed treatment and for, eventually, determining the treatment's success ·   **Goals** can include both ultimate goals for treatment and intermediate goals that must be attained in order to reach the ultimate treatment goals. ·   a description of **treatment strategies** provides information on the general approach to addressing the clinical problems, ·   description of **treatment tactics** provides details of specific tasks, procedures, or techniques that will be used in treatment (would deal with the specific elements of treatment) **Treatment Monitoring-** Once a clear treatment plan is in place, the psychologist closely monitors the impact of treatment. ·   crucial element of effective treatment, as it enables the psychologist to change the treatment plan based upon the patient's response to treatment. ·   If a patient is progressing extremely well, it may be possible to shorten treatment or to focus subsequent phases of treatment on other issues of concern to the patient. ·   if the treatment is less than optimally effective, close monitoring of treatment progress provides an opportunity to alter the treatment All clinicians have an implicit sense of how the patient is progressing, but treatment monitoring refers to explicitly tracking progress through the use of specific questions or psychological measures **Michael Lambert**, a major contributor to the research on assessing changes due to treatment, demonstrated that routine treatment monitoring can substantially affect treatment outcome ·   found that by using monitoring data to alert clinicians to treatment progress (or lack of progress), the likelihood of client deterioration was reduced and the positive effects of psychotherapy were enhanced. ·   in the no feedback condition, Lambert and colleagues found that 21% of patients deteriorated, and 21% experienced clinically important improvements in functioning. ·   in the feedback condition, the number of clients who experienced deterioration was reduced by a third (to 13%), and the proportion of successful treatment cases increased by two-thirds (to 35%). results present a convincing argument that clinical psychologists have an ethical responsibility to routinely gather treatment monitoring data in order to enhance the likelihood of successful treatment outcome. **Treatment Evaluation-** treatment outcome data are collected to determine the extent to which psychological services such as psychotherapy are effective in achieving stated goals ·   Data gathered for treatment monitoring can affect treatment services provided to an individual client, but data gathered for treatment outcome purposes can yield information relevant to an entire psychological practice or service **Psychological Testing** a test is defined in the following manner: "An evaluative device or procedure in which a sample of an examinee's behavior in a specified domain is obtained and subsequently evaluated and scored using a standardized process" the accuracy or validity of these statements comes from the way in which the sample of behaviour was collected and interpreted and not just from the clinician's expertise, authority, or special qualifications, ·   the process used to collect and interpret the behavioural sample is a psychological test and must meet the standards established for psychological tests ·   reliability, validity, and norms Psychological tests are frequently used in legal and quasi-legal contexts, such as when a judge must decide on child custody or when a tribunal rules on whether to award a disability pension to an injured worker. Without safeguards to ensure that psychological tests meet scientific standards, it would be possible for any set of questions to be called a test and its results to be assumed to provide scientifically accurate and valid information. **Assessment vs Testing** **testing** occurs when a particular device is used to gather a sample of behaviour from a client, a score is assigned to the resulting sample, and comparisons with the scores of other people are made in order to interpret the client's score. **Assessment** is more complex and multifaceted than testing and may or may not involve the use of psychological tests. ·   requires the integration of life history information and clinical observation of the client with, in most cases, the results obtained from psychological tests and information provided on the client by significant others in the clients life ·   doctoral-level psychologists were likely to be partial users of EBA, whereas other professionals were likely to be infrequent EBA users ·   assessment of children requires that a much larger number and variety of tests and measures be used than is typically the case for adults ·   The collection of diverse forms of information and the subsequent integration of this information are defining aspects of psychological assessment **Gary Groth-Marnat-** "The central role of the clinician performing psychological assessment is that of an expert in human behavior who must deal with complex processes and understand test scores in the context of a person's life" **Psychometric Considerations** **Standardization-** consistency across clinicians and testing occasions in the procedure used to administer and score a test. ·   Without standardization, it is virtually impossible for the psychologist to replicate the information gathered in an assessment or for any other psychologist to do so. ·   test results are likely to be highly specific to the unique aspects of the testing situation and are unlikely to provide data that can be generalized to testing by another psychologist, let alone to other situations in the person's life ·   test developers provide detailed instructions regarding the nature of the stimuli, administrative procedures, time limits, and the types of verbal probes and permissible responses to the client's questions. ·   Instructions are provided for scoring the test **Reliability** ·   reliability refers to the consistency of the test, including whether all aspects of the test contribute in a meaningful way to the data obtained **(internal consistency)** ·   whether similar results would be obtained if the person was retested at some point after the initial test **(test-retest reliability),** ·   whether similar results would be obtained if the test was conducted and/or scored by another evaluator **(inter-rater or inter-scorer reliability).** Reliable results are necessary if we wish to generalize the test results and their psychological implications beyond the immediate assessment situation. Standardization of stimuli, administration, and scoring are preconditions for good reliability but do not ensure adequate test reliability. ·   simply because high levels of reliability have been found for an instrument when used with young adults, it should not be assumed that comparable levels of reliability will be found when used with older adults. ·   Reliability influences how much error there is in a test score. ·   This can be extremely important in clinical work where precise test cut-off scores are used, such as in determining whether a child's measured intelligence is high enough to warrant access to a gifted school program **Validity-** evaluating both the degree to which there is evidence that the test truly measures what it purports to measure and the manner in which the test results are interpreted. ·   A standardized test that produces reliable data does not necessarily yield valid data **evidence of content validity:** the extent to which the test samples the type of behaviour that is relevant to the underlying psychological construct **evidence of concurrent validity**: the extent to which scores on the test are correlated with scores on measures of similar constructs. **evidence of predictive validity:** the extent to which the test predicts a relevant outcome. **evidence of discriminant validity:** the extent to which the test provides a pure measure of the construct that is minimally contaminated by other psychological constructs. **evidence of incremental validity**: the extent to which a measure adds to the prediction of a criterion above what can be predicted by other sources of data. ·   because a test is valid for specific purposes within specific groups of people, it does not follow that it is valid for other purposes or groups ·   We should not automatically assume that a test that has been shown to be valid for members of one ethnic group will be valid for members of a different ethnic group. **Norms-** To meaningfully interpret the results obtained from a client, it is essential to use either norms or specific criterion-related cut-off scores ·   Without such reference information, it is impossible to determine the precise meaning of any test results ·   test developers establish norms ·   decisions must be made about the populations to which the test is to be applied. ·   It is possible to establish norms for comparing a specific score to those that might be obtained within the general population or within specific subgroups of the general population ·   may not always be representative of scores that would be obtained by others. three main categories of test norms: percentile ranks, standard scores, and developmental norms ·   A **percentile rank** indicates the percentage of those in the normative group whose scores fell below a given test score. ·   To develop a **standard score**, a z-score is calculated ·   **developmental norms** are used when the psychological construct being assessed develops systematically over time. **Chapter 6 \-- Assessment: Interviewing and Observation**   ** Interviewing**     ** Clinical Assessment Interviews vs. Psychotherapeutic Interviews**   ** Structure of Interviews**   ** Children Interviews**   ** Observation in Assessment**     ** Ethical Issues: Limits of Confidentiality **     ** Unstructured Assessment Interviews**       ** Semi-Structured Diagnostic Interviews** ** Modifications for Children (semi-structured interviews)**     **[General Issues in Interviewing]**   ** Attending Skills **     ** Contextual Information**   ** Culturally Sensitive Interviewing**   **Defining Problems and Goals**   ** Assessing Suicide Risk**     ** Interviewing Couples**     ** Interviewing Families **   ** Interviewing Children and Adolescents **     ** Observations**     ** Self-Monitoring** **Chapter 7: "Assessment: Intellectual and cognitive measures"** ** ** [Defining Intelligence] [ ] Psychologists have made many attempts to define intelligence:         [Theories of Intelligence] [ ] Factor models:       Hierarchical models:       Information processing theories:     [ ] [Assessing Intelligence: The Clinical Context] [ ] [ ] [ ] [Wechsler Intelligence Scales] [ ] Background Issues             Administration, Scoring, and Interpretation Issues       Canadian Normative Data         Wechsler Adult Intelligence Scale -- 4^th^ Edition (WAIS-IV)       Wechsler Intelligence Scale for Children -- 5^th^ Edition (WISC-V)       Wechsler Preschool and Primary Scale of Intelligence -- 4^th^ Edition (WPPSI-IV)       [Other Intelligence Scales] [ ]   [ ] [Selected Cognitive Assessment Scales] [ ] Wechsler Memory Scale -- 4^th^ Edition (WMS-IV)       Wechsler Individual Achievement Test -- 3^rd^ Edition (WIAT-III) - Linkage with Wechsler Intelligence Tests: - Subtests and Composite Scores: - Canadian Version Adaptations: - Changed items (e.g., currency, spelling, units of measurement) to align with Canadian context. - Normative data collected from a representative Canadian sample. - Reliability: - Subtests: Most average reliability values \>.80. - Composite scores: Average reliability values ranged from.91 to.98. - Short-term test-retest reliability values for subtests and composite scores ranged from.73 to.97. - Validity: - Demonstrates expected patterns of association among subtests and composite scores. - Correlates with other cognitive measures.    **Chapter 8 Pgs. 169-174 -- Assessment: Self-Report and Projective Measures** Introduction The person-situation debate **Self-presentation biases** Developing culturally appropriate measures **Pg. 175 - 179** [The Clinical Utility of Self-Report and Projective Measures] - Clinical utility: - - - - - [Self-Report Personality Measures] - The most commonly used personality inventories:  - 1\. Minnesota Multiphasic Personality Inventory - available in forms for adults (MMPI-2 and MMPI-2-RF) and adolescents (MMPI-A & MMPI-A-Rf)  - 2\. Millon Clinical Multiaxial Inventory-IV (for adults) and the Million Adolescent Clinical Inventory (for adolescents)  - 3\. Personality Assessment Inventory  MMPI-2 and MMPI-A - Most commonly taught and used self-report personality measures  - Background issues:  - - - - Revised in 1982 based on issues with wording, outdated content, and non-representativeness - - - Recent major developments: - - - - - - MMPI-2 Validity Scales - Cannot Say (?): This scale is the total number of unanswered items. A large number of unanswered items indicate defensive responding - Lie Scale (L): A measure of self-presentation that is unrealistically positive. - Infrequency Scale (F): A measure of self-presentation that is very unfavourable. This can indicate a desire to present oneself as having severe psychopathology, or it can be an accurate report of substantial distress, disorganization, and confusion. - Defensiveness Scale (K): A measure of unwillingness to disclose personal information and problems. The scores on some of the clinical scales are adjusted based on the test taker's K score. - Back F Scale (FB): Measures a possible change in self-presentation which may be due to a change in test-taking strategy  - Variable Response Inconsistency Scale (VRIN): A number of the items for this scale have either similar or opposite content. The VRIN measures the tendency to answer these item pairs inconsistently and may reflect random or confused responding to the test. - True response inconsistency scale (TRIN): based on answers to item pairs that are opposite in content. A very high score indicates a tendency to give "True" answers indiscriminately; a very low score indicates a tendency to give "False" answers indiscriminately. - MMIP-2 Clinical Scales  - - - - - - - - - - MMPI-Content Scales  - - - - - **Pg. 180-186**  ** Norms, Reliability, and Validity**     ** Administration, Scoring and Interpretation**     **[Other Clinical Measures of Personality Functioning]** ** ** ** The Million Measures: MCMI-III and MACI** ** ** ** Personality Assessment Inventory (PAI)**   ** Self-Report Measures of Normal Personality Functioning**     ** Self-Report Checklists of Behaviours and Symptoms**     ** Achenbach System of Empirically Based Assessment** **187-192** **SCL 90- R** ·   The Symptom Checklist-90-Revised used general measure of distress. ·   interpersonal sensitivity, phobic anxiety, and hostility. ·   Respondents are asked to indicate the extent to which they have been distressed by various symptoms over the past two weeks. ·   Norms---although not nationally representative---are available for various groups, including non-patient adults, non-patient adolescents, psychiatric inpatients, and psychiatric outpatients. ·   The internal consistency and test-retest reliability values (over one week) based on data from these normative groups all exceed.75. ·   considerable evidence that most subscales do not adequately measure the constructs they are designed to assess. ·   scale tends to overpathologize. ·   substantial intercorrelation among the subscales and little evidence for the divergent validity of the subscales   **Outcome Questionnaire 45** ·   three subscales: symptom distress, interpersonal relations, and social role functioning. ·   these subscales provide a good overview of a client's psychosocial functioning that takes only five minutes or so to complete. ·   Because of high inter-scale correlation, it is probably most appropriate that the total score be used as an indicator of client distress ·   psychometrically strong across a range of populations ·   useful tool for assessing change over the course of psychological services **Beck Depression Inventory** ·   is a 21-item checklist with a multiple-choice format ·   It is designed to evaluate the severity of depressive symptoms experienced in the past two weeks. ·   Based on normative data, cut-offs are provided to classify the symptoms as minimal, mild, moderate, or severe ·   original BDI, it does not provide sufficient detail to determine whether a person meets diagnostic depression for a mood disorder ·   measure is a psychometrically strong tool for assessing depressive symptoms in adolescents and adults. ·   scores can drop appreciably simply due to repeated administration of the Such findings are concerning, as they indicate that the BDI-II may yield imprecise results when used for treatment-monitoring purposes. **CHldrens Depression Inventory 2** ·   is a self-report checklist designed to evaluate recent (in the past two weeks) symptoms of depression in children ·   it does not distinguish between heightened levels of depressive and anxious symptoms, but no depression checklist is particularly good at making this distinction. ·   CDI can result in substantial decreases in reported symptoms Overall, though, the CDI 2 appears to be a solid measure of depressive symptoms in youth **Projective Measures of Personality** ·   presentation of ambiguous items or stimuli. That is, regardless of whether the measure relies on pictures, colours, incomplete sentences, drawings, or puppets, there is no inherent meaning to the stimulus material, just as there are no obvious right and wrong answers. ·   A core assumption is that the ambiguity of the material requires the individual to make sense of the stimulus, and in the process of doing that, aspects of the individual's personality are revealed. clinical use of projective measures is not characterized by the standardization and rigorous attention to scientific principles that are the hallmarks of cognitive science techniques projective tests such as the Rorschach Inkblot Test, the Thematic Apperception Test, and projective drawings were not developed in a manner consistent with psychological test-construction guidelines. ·   most projective tests used in clinical settings do not have standardized administration, scoring, or interpretation guidelines ·   and only the Rorschach has normative data **The Rorschach inkblots** ·   developed by Swiss psychiatrist Hermann Rorschach ·   consist of 10 cards, each containing symmetrical inkblots, some coloured and some in black and white. Test takers are asked to report what they see in these ambiguous stimuli. The Comprehensive System (CS) devised by John Exner is now considered the principal scoring system for the Rorschach ·   The CS offers clear information on administration and scoring, with extensive tables and computer software available to aid in the interpretation of the test results. ·   But administration errors are easy to make even if the examiner is careful, has received training in the CS, and is well supervised, ·   these errors are likely to have a substantial impact on the examinee's Rorschach responses and test scores A major problem for the CS norms is the likelihood that non-patient norms overpathologize normal individuals---a phenomenon found for both child and adult sample ·   a series of norms (called the International Reference Samples) has been published for the CS that draws on data from over 5,800 people from 16 countries ·   indicated that the Rorschach should not be used with youth. On the positive side, the norms for adults are less pathologizing than are the CS norms ·   reasonable validity/reliability ·   Rorschach should not be used to provide diagnostic information ·   The Rorschach is likely to have value in research examining personality structure and correlates. ·   clinical psychologists have a responsibility to evaluate their assessment and treatment services in light of professional standards and scientific evidence ·   Too many shortcomings to be clinically useful  **Chapter 9 -- Assessment: Integration and Clinical Decision-Making** Integrating assessment data Case Formulation Threats to the validity of assessments and case formulations Psychological assessment reports and treatment plans ·  Clients receiving therapeutic treatment developed a stronger working relationship with therapist and were less likely to prematurely terminate treatment