In observance of Mental Illness Awareness Week, we spoke with Dr. John Spores about his new book, Clinician’s Guide to Psychological Assessment and Testing: With Forms and Templates for Effective Practice.
Why is standardized psychological testing so important and why don’t clinicians administer these tests more often?
Standardized testing maximizes objectivity in diagnosis with its emphasis on consistent guidelines for administering, scoring, and interpreting the data, and comparing such quantitative scores to a norm-reference sample of individuals. For example, this means that the behavioral symptoms of a five-year-old male are compared to other five-year-old males with comparable demographic characteristics. Furthermore, these tests yield uniform or standard scores which provide essential information regarding how extreme, or statistically aberrant, that child’ behaviors are compared to others of the same age, gender, and other pertinent demographic characteristics. Therefore, for instance, standardized tests allow the objective determination that five-year-old Tommy’s hyperactivity and impulsivity is higher than 98% of comparable children, which supports a diagnosis of Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type (ADHD-HI).
Clinicians do not administer such tests more often for myriad reasons for which I will address two so as to be succinct. First, psychologists receive little or no training in how to pre-certify such testing with third-party payers. Second, to date, there exists no current reference which guides testing psychologists through the entire process, from receiving the initial referral and questions to be addressed, to ordering the proper well-targeted tests and a reasonable number of testing hours, and completing the process in an efficient, effective, and financially viable manner. My book, Clinician’s Guide to Psychological Assessment and Testing: With Forms and Templates for Effective Practice, is the first of its kind to provide a practical comprehensive guide in conducting such testing, including greater than 60 electronic forms for completing this process.
How did standardized psychological testing and assessment come to be a significant part of your own practice?
I consistently observed mental health clinicians of all specialties either list a patient’s diagnosis or diagnoses in a perfunctory manner (e.g., Adjustment Disorder with Anxiety; Bipolar Disorder NOS), or list a sequence of diagnoses which were unequivocally paradoxical (e.g., Bipolar Disorder NOS, Mood Disorder NOS, and Adjustment Disorder with Depressed Mood). In actuality, such disorders are directly contradictory. This frequently indicates confusion on the part of the clinician and a trial-and-error approach to treatment intervention to the detriment of the patient and/or family members seeking relief from severe emotional distress.
Standardized testing was capable of providing much more discernible and precise diagnoses, and simultaneously precluding the deleterious practice of listing excessive and/or contrary diagnoses. The post-test results facilitated more efficacious and adequately designed interventions which decreased treatment duration and maximized symptom remission and psychological growth.
How have the ways in which mental health professionals test for and assess psychological disorders changed over the last few years?
The essential problem is that in general it has not changed. Graduate students are continuously trained to administer, score, and interpret single major tests, and to interpret all aspects of a patient’s psychological characteristics and functioning over and above the relevant diagnostic questions. This invariably leads to excessive testing and testing requests from third-party payers (e.g., asking for approval of nine hours of testing in a single case), the latter who have become understandably cynical and resistant in the age of reducing costs of health care. Predictably, this is the same ineffectual manner in which newly practicing psychologists initiate their testing practice subsequent to graduation.
On a positive note, the specific tests are much better designed, with impressive reliability and validity, including remarkably sophisticated and accurate validity scales for test instruments in which we rely on the rater’s honesty and accuracy. There are also remarkably useful standardized tests which disguise the interpretation outcome so as to effectively circumvent the attempts of those who intentionally attempt to distort the results. The key is to identify an efficacious test inventory which will address most diagnostic questions and related referral questions. My book, Clinician’s Guide to Psychological Assessment and Testing, accomplishes this objective.
How has your legal education and background informed this book?
My legal education has informed this book in innumerable ways, although I can share three of the most influential. First, at the core of an effective legal education is the teaching of the art of polemics (i.e., argument, controversy, or persuasion). An effective argument must be succinct, on point, internally consistent, and possess the capability of reputing evidence to the contrary. This directly influenced the report writing style espoused in my book, which fundamentally is a blend of solid scientific reasoning and persuasive argument. Second, legal practice is remarkably pragmatic in that practice manuals and forms have pervaded the legal field. In contrast, in the area of psychological testing, publications have been excessively academic and theoretical, hence being of little usefulness to psychologists practicing in the field. There has been a rather chronic and deleterious historical schism in psychology between academicians and clinicians, wherein the former emphasize operational definitions and facts gleaned within the context of experimentally controlled conditions, and clinicians who rely more on general and perhaps nebulous theoretical principles (e.g., ego strength) and the pragmatism of general strategies of psychotherapeutic intervention (e.g., interpretation for enhancing insight). My pragmatic legal training and scientific training in clinical psychology has permitted me to bridge this gap. Third, and more patently, my legal education was directly responsible for the final chapter on competency to stand trial psychological evaluation, which demonstrates the application of scientific standardized psychological testing principles to the determination of whether or not the criteria set out within a legal statute have been met.
What has been your experience with standardized psychological testing in your practice? Share your comments below.