Chapter 9: Integration and Clinical Decision Making
Chapter 9 – Assessment: Integration and Clinical
Decision Making
Chapter Overview
Chapter 9 provides a wonderful integration of the four previous chapters and
leads us into the final phase of the assessment process – integration. Students
have learned how and why data is obtained, but in this chapter, they learn what
do with the data. As has been the theme throughout a number of chapters,
validity is discussed from the perspective of the patient and the clinician. Critical
thinking is often mentioned and may run as a theme in a number of psychology
courses; however, the emphasis on judgment and decision-making plays a
crucial role in both the work-up of the patient as well as the treatment plan. This
chapter stresses the importance of sound clinical judgment and clinical
standards. Students who pursue a career in psychology will be challenged
ethically, morally, and professionally everyday. This is an opportunity to provide
a model of the clinical skills necessary which will help carry them on their future
career.
Chapter Contents

Integrating Assessment Data



Threats to the Validity of Assessments and Case Formulations

Patient/Client Factors

Clinician Factors

Improving the Accuracy of Clinical Judgment
Psychological Assessment Reports and Treatment Plans


Case Formulation
Assessment Feedback
Summary and Conclusions
Learning Objectives
1. How do clinical psychologists integrate assessment data?
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Chapter 9: Integration and Clinical Decision Making
2. What is the value of assessing and then integrating data from multiple
informants?
3. What are the benefits of clinical case formulation?
4. What are the steps in developing a case formulation?
5. Discuss the errors associated with retrospective recall.
6. How does a patient’s memory impact assessment?
7. How does social desirability play into a patient’s recollection?
8. What does the research tell us about people’s ability to recall events?
9. What are the most common clinician errors in judgment?
10. What is the self-serving attributional bias?
11. What are the most common decision-making biases and heuristics?
12. How can we improve the accuracy of clinical judgment?
13. What are the principles of report writing?
14. What are the main elements of a psychological report?
15. What are the main elements of a treatment plan?
16. What is the purpose of providing assessment feedback?
17. Discuss Finn’s therapeutic model of assessment.
Up for Discussion
1. What are the concerns when assessing cognitively impaired or
psychotically ill patients?
2. How would you collaborate your assessment of a psychotically ill patient
and why?
3. Why do psychologists prefer to integrate self-report and projective test
data? What are the advantages and disadvantages?
4. In working with children and adolescents, what are the concerns about
memory?
5. How can you control for adolescents who embellish, exaggerate, and lie
during assessment? What steps would you need to ensure an accurate
assessment and proper write-up?
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Chapter 9: Integration and Clinical Decision Making
6. As a clinician, why would you not want to make inferences about a
patient’s condition unless you have fully assessed them?
7. Why are treatment plans designed for each individual patient?
8. Discuss the importance of the psychological report. How does this report
provide justification for such issues as custody, employment, disability,
and mental fitness to stand trial?
9. What are the advantages of reviewing psychological reports with family
and other medical staff on the case?
10. What challenges do psychologists face when parents disagree with the
assessment of their child?
11. Should psychologists put their own opinions and subjective findings into
a psychological report? What are the concerns with this?
Out-of-Class Activities
1. Have students watch any cable television news show, preferably where
there is a psychologist speaking about a celebrity. They could also watch
an episode of Dr. Phil. The objective is for the students to comment on
the “advice” and “assessment” that the psychologist provides to the
individual or about the celebrity. Students should refer to Table 9.3 to
defend their critique. Students should also discuss how this type of
television advice and assessment is not only detrimental to the individual
but to the field as a whole. Have them write up their findings and discuss
in class.
2. Students should research a sample psychological report and provide a
critique of it noting how it matches up with Table 9.6.
3. Students should write up a treatment plan for a mock psychiatric case.
They should include the elements discussed in Table 9.7.
4. Students should practice presenting cases to one another either in class
or out of class. Students could also write a brief biography about another
person and present to the class. This is an excellent opportunity to
highlight positives and provide constructive feedback.
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Chapter 9: Integration and Clinical Decision Making
Web Links
If you would like more information on decision-making biases and heuristics,
including some examples you can try that illustrate various biases and heuristics,
look at some of these websites:
http://www.nku.edu/~garns/165/pptj_h.html
http://www.prioritysystem.com/reasons1.html
In 2002, the cognitive psychologist Dr. Daniel Kahneman won the Nobel Prize for
Economics for his research on how people make decisions under conditions of
uncertainty. You can read his Nobel Prize lecture on his research here:
http://nobelprize.org/nobel_prizes/economics/laureates/2002/kahnemannlecture.pdf
There are many websites that provide examples of psychological assessment
reports written for different purposes. Here are some of them, including some
sites that have computer-based interpretative reports for specific assessment
instruments:
http://www.msresource.com/format.html
http://faculty.pepperdine.edu/shimels/Courses/Sample%20Reports/713Sample2.
pdf
http://www.education.com/reference/article/sample-assessment-psychologicalreport/
This website provides instruction on how to write a psychological report.
http://www.drmillslmu.com/Testing/psyrepor.htm
Rights and Responsibilities of Test Takers: Guidelines and Expectations
http://www.apa.org/science/ttrr.html
The APA has a website on the various aspects of psychological testing. It is
called the Testing Information Clearinghouse
http://www.apa.org/science/testclearinghs.html
Video Suggestions
Treating Co-Occurring Disorders (DVD, color, 76 min.) Explaining that treatments
integrating mental health and substance abuse issues offer clients long-term
hope and optimism, this program with Robert E. Drake shows how to create
personalized and comprehensive treatment plans. 2006, Insight Media.
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Chapter 9: Integration and Clinical Decision Making
Workers’ Compensation Law (Video, color, 30 min) In addition to involvement
with the care and assessment of injured workers who are covered by workers’
compensation, nurses may also be involved in preventing or detecting fraud in
workers’ compensation claims. This video reviews the types of injuries covered
by workers’ compensation and addresses nursing implications. 1999, Insight
Media.
The Art of Critical Decision Making (DVD, color, 30 min. each) In this lecture
series, Michael Roberto explores how individuals, groups, and organizations
make effective decisions and offers techniques to enhance the effectiveness of
decision-making skills. The series covers such topics as cognitive biases,
decision-making traps, framing, intuition, reasoning by analogy, making sense of
ambiguous situations, groupthink, constructive conflict, creativity, and
brainstorming. 2009, Insight Media.
A Decision Making Framework for Clinical Ethics (DVD, color, 53 min.)This DVD
provides a framework for making clinical ethical decisions and explores the
framework through case studies. It explains that healthcare workers must be
familiar with ethical principles and understand their relationships to clinical
practice. 2002, Insight Media.
Ethical Dilemmas and Decision Making, (DVD, color, 76 min.) This program
defines six standards implicit in the nurse-patient relationship (autonomy,
freedom, beneficence, veracity, privacy, and fidelity) and provides examples that
elucidate ways to implement ethical principles. 1995, Insight Media.
Problem Solving and Decision Making (DVD, color, 25 min.) This program
teaches how to think critically and use brainstorming to generate new ideas. It
also details the steps of the decision-making process. 1995, Insight Media.
Psychology of Power (DVD, color, 58 min.) In this program, Deborah Gruenfeld
examines the psychological effects of power, including single-mindedness in
decision making, orientation to action, disinhibition, and depersonalization of
others. Gruenfeld emphasizes the importance of checks and balances against
abuses of power and considers the positive results of power. 2005, Insight
Media.
Subtle Boundary Dilemmas: Ethical Decision Making for Helping Professionals
(DVD, color, 23 min.) Featuring dramatizations, this DVD helps professionals
explore the complex nature of setting limits and provides a concrete approach to
ethical decision making. 1995, Insight Media.
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Chapter 9: Integration and Clinical Decision Making
Suggested Readings
Groth-Marnat, G. (2003). Handbook of psychological assessment (4th ed.).
Hoboken, NJ: John Wiley & Sons.
Hersen, M. (Ed.). (2004). The comprehensive handbook of psychological
assessment (Vols. 1–4). New York: John Wiley & Sons.
Harvey, V. S. (1997). Improving readability of psychological reports. Professional
Psychology: Research and Practice, 28, 271-274.
Antony, M. M., & Barlow, D. H. (2002). Handbook of assessment and treatment
planning for psychological disorders. New York: Guilford Press.
Eells, T. D. (Ed.). (2006). Handbook of psychotherapy case formulation (2nd ed.).
New York: Guilford Press.
Garb, H. N. (1998). Studying the clinician: Judgment research and psychological
assessment. Washington, DC: American Psychological Association.
Beech, J.R. (2009). How to Write in Psychology: A Student Guide. WileyBlackwell.
Beins, B.C. & Beins, A.M., (2008). Effective Writing in Psychology: Papers,
Posters, and Presentations. Blackwell Publishing.
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