Clinical Decisions in This Chapter,

¶ … Clinical Decisions

In this chapter, the author discusses how making better clinical decisions leads to better interventions. He discusses that the counselors can use four general strategies to improve the quality of their decision-making; broadening their views of assessment, particularizing their assessments, using multiple methods of data collection, and interpreting test scores cautiously. He discusses how a broader view assessment is consistent with the biopsychosocial model of mental health, so that assessment is not about labeling, but about fully developing the client as a person. In other words, diagnosis has to go beyond traditional psychological tests.

One of the focuses of the article is the idea of contextualizing assessments, which is one way that counselors need to adjust their approaches to interviews. It is not enough to use interviews as a way of coming up with assessments, but they also need to use them as a way of providing background context to help develop ways for the counselor to best interact with patients. Likewise, counselors need to use multiple assessment methods because each method has its weaknesses, and the use of multiple methods makes it likely that weaknesses in one method will be mitigated by strengths in another method. The author also cautions against over-reliance on test scores because they indicate how well a person was performing on tests at that time period, but not why they were performing that way.

Finally, the author addresses how counselors can reduce their chances of making errors. There are four debiasing strategies he suggests: investigating alternative explanations for client behavior, considering probability and base-rate date, using confirmatory and disconfirmatory hypothesis-testing strategies, and delaying decision-making. In this way, they can make better clinical decisions.

Forensic Uses of the MMPI-2 in Neuropsychological clients

A neuropsychological disorder is a brain disorder whose symptoms include mood, behavior, perception, memory, cognition, or judgment changes. They may be organic disorders that are the results of changes in brain chemistry or disorders that are the result of traumatic brain juries; as a result, the field shows a tremendous variety. One of the difficulties in the practice of neuropsychology is the correct diagnosis of various conditions, and also seeking to find the underlying causes for symptoms that the client is manifesting. As a result, the main forensic application of the MMPI-2 is to either determine or verify a diagnosis. One way it might do so is by eliminating possible or suspected diagnoses. However, its most common forensic usage may be to help uncover instances of malingering, because there is, unfortunately, a significant amount of fraud in the area of neuropsychological disorders because they are linked to civil and criminal lawsuits and they are characterized by difficulty to diagnose, difficulty to prove or disprove, and ability to trigger disability payments.

The MMPI-2 and the Structured Inventory of Reported Symptoms (SIRS) are both used to detect malingering in neuropsychological patients. The MMPI-2 has been used successfully to detect feigning in neurological and psychiatric control groups (Klein, 2007). As a result, the MMPI-2 is the most frequently used test in forensic psychological testing. There is, however, still substantial "debate which of the four subscales is most useful for identifying malingering" (Klein, 2007). However, one of the MMPI-2's lingering problems is that it is a test where people can incorporate coaching, so that it is somewhat vulnerable to coaching.

The issue of coaching is critical in the forensics environment. This is because the goal of forensic psychology is to use neuropsychological assessment methods to help in some type of legal proceedings. These proceedings can be civil or criminal proceedings. In both civil and criminal environments, the need for accurate diagnosis can be critical to outcomes for the person being tested and for people being impacted by their testing. Moreover, it can be very important for testing to see if it can help determine causation for the complained about defects, because the litigation may be focused on trying to determine what caused defects or deficits.