Objective Assessments
and Private Practice
Jeffrey S Gallup MA LPC
Mansfield Counseling

Why should you use
assessments?
 Psychological test validity is very strong and compelling.
 Psychological test validity is comparable to medical test
validity.
 Distinct assessments provide unique sources of
information.
 Clinicians that rely exclusively on interviews are prone to
incomplete understandings.
What is
assessment and
am I allowed to
use them?
Assessment which means selecting, administering,
scoring, and interpreting instruments designed to
assess an individual's aptitudes, attitudes, abilities,
achievements, interests, personal characteristics,
disabilities, and mental, emotional, and behavioral
disorders and the use of methods and techniques for
understanding human behavior that may include the
evaluation, assessment, and treatment by counseling
methods, techniques, and procedures for mental and
emotional disorders, alcoholism and substance abuse,
and conduct disorders, but does not include the use
of standardized projective techniques or permit the
diagnosis of a physical condition or disorder.
- Texas State Board of Examiners of Professional
Counselors About the Profession - Scope of
Practice
Objective vs. Projective
Objective Tests

Ex. Minnesota Multiphasic
Personality Inventory (MMPI)

Objective test is a psychological test that
measures an individual's characteristics
independent of rater bias or the examiner's
own beliefs, usually by the administration of
a bank of questions marked and compared
against exacting scoring mechanisms that are
completely standardized
Projective Tests

Ex. Rorschach Inkblot Test

A personality test designed to let a person
respond to ambiguous stimuli, presumably
revealing hidden emotions and internal
conflicts projected by the person into the test

Projective tests have their origins
in psychoanalytic psychology, which argues
that humans have conscious and
unconscious attitudes and motivations that
are beyond or hidden from conscious
awareness.
In simpler terms
 As counselors we can use any assessment instrument (test),
that produces objective (measurable) results.
 Theses tests can measure – IQ, achievement, abilities, any
diagnostic concerns, autism spectrum disorders, addictions,
trauma, social/emotional/behavioral issues, personality,
visual motor procession, learning disabilities.
 So pretty much if you have a concern you want to measure
objectively then there is an instrument to measure it.
Plate No. 6
What do you see?
-
Typically I see a CT scan of
the brain.
Since we are all going to see
different things with
projective tests, they tend
not to be very effective in
counseling.
Aiding treatment effectiveness
 Assessments can help determine two immediate ideas.
1. Type of problem – depression, anxiety, bipolar or something
else. Then which specific symptoms are to be addressed.
2. Intensity of the problem – how severe is your clients concern.
 If done early in your work with a client it helps establish a
baseline in which progress can be measured against.
 Assessment use = Evidence Based Treatment, i.e. the new
DSM-5 Assessment Measures.
Example
As valid as medical tests

Psychological assessments shown to be as valid as medical tests - Psychological
Testing and Psychological Assessment – A review of Evidence and Issues. (Meyer
2001)


Through meta-analytic reviews, Meyer and his colleagues drew comparisons
between medical test validity and psychological test validity. They found that
both psychological and medical tests have varying degrees of validity and that
validity co-efficient for many psychological tests are indistinguishable from
those of medical tests.
The next step, then is to look at the real-world value of using psychological
assessment measures. The information gained form assessment can help to derive
more value to our clients and referral sources.
Expertise and Rapport
•
When you discuss and use an instrument with clients they
typically see you as a professional that is using every resource to
help them, and as an act of caring about them.
•
Your first results at the outset of care provide you a baseline, and
an increase in your understanding of your clients concerns.
•
When explaining the results to parents or a client, this is a great
time to develop rapport, probe further into areas that a client may
not have discussed in much detail.
Improve Morale and Decrease
early Termination
 Positive results can be reinforced by showing a client that
they are making objective improvements in their problems.
This can increase a clients positive attitude leading to a cycle
of greater or faster progress in care.
 If you have a client that maybe considering terminating
their care before they should – early termination. Using
assessments can help to show them objectively that they
have a need to continue counseling or that they are making
gains in their treatment.
Accurate Diagnosis and catching
medical Problems

Assessments tools can help you to clarify your diagnostic picture. Even when the labels are not
important, it may provide valuable clues to creating and guiding your treatment plans.

Every so often you may catch a problem that you did not anticipate. There are a variety of
medical diagnoses that mirror psychological problems, such as –
•
•
ADHD = Other Neurodevelopment profiles
Post-traumatic stress disorder = Brain Trauma
•
•
Panic Disorder = Thyroid Disorder
Depression = Epstien-Barr or Metabolic Disorders
•
Dementia = Deafness
Diagnostic Statistical Manual 5
 For further clinical evaluation and research, the APA is
offering a number of “emerging measures” in Section III of
DSM-5. These patient assessment measures were developed
to be administered at the initial patient interview and to
monitor treatment progress
 These assessments are easy too use, are available online for
free, and can be completed quickly. But will not give you indepth information about your client.
Court Testimony
 Having accurate information can help your testimony stand
during court appearances and may save you from being
cross examined in court.
 Be sure to be read your ethics and particularly in regards to
using assessments. Be aware of the validity and reliability of
the assessments that you are using and the reasons you
chose to use that particular assessment.
Validity Checking
 Almost every objective assessment has built in methods by
which to determine when the client was completed the
assessment if they were being appropriate open and honest
in their responses.
Decrease Legal Liability
 When using objective instruments it provides you further
clinical/relevant information to create your treatment planning.
Demonstrating in a forensic, malpractice, or other unforeseen
legal situation that you have solid evidence for the methods that
you are using to practice therapy.
 Objective testing is another step to having an evidence-based
practice. Projective testing is not allowed by our scope of practice.
An example of projective testing is Rorschach Ink Blot.
Increasing Rapport with
children
 When working with children assessments can help you to gain a 3rd
perspective about the child’s problems after what they parents report,
and your interview with the child.
 Then you have the opportunity to quickly get to the child’s concerns
and help them to feel as if counseling is having a positive impact on
their problems.
 Reviewing assessment results with parents can help increase their
understanding of their child’s problem, and give you further
opportunities to educate parents.

Make sure to get as many perspectives as possible – including parents, step
parents, teachers, and the client themselves.
Challenging self-diagnosis
Challenging self-diagnosis
 An objective assessment tool can help you when there is a
need to confront a poor “self ” diagnosis.
 Often we can spend a lot of time explaining to people that
their diagnosis is not the most important piece of
counseling. But showing them an objective assessment and
then explaining that it measures thoughts and behaviors is a
more effective way to help people focus on their thoughts
and behaviors.
Lack of Familiarity

Many of us have taken at least 1 class in Tests & Measurements. But have
done little with that education since then. Using a quick assessment
several times and reading through the documentation will help you figure
out how to give and score the test.

Often these assessments can be scored by adding up each of the questions
and then comparing to a table.

Reviews and further information about each test can be found at the
Buros Institute of Mental Measurements.

http://buros.unl.edu/buros/jsp/search.jsp
Example - Beck Depression Inventory

(0) I do not feel sad.

(1) I feel sad.

(2) I am sad all the time and I can't snap out of it.

(3) I am so sad or unhappy that I can't stand it.

When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is
compared to a key to determine the depression's severity. The standard cut-offs are as follows:




0–9: indicates minimal depression
10–18: indicates mild depression
19–29: indicates moderate depression
30–63: indicates severe depression.
Infringement on client time
 Most of these tools can be completed in about 5 to 10 minutes. I
suggest that you score between client sessions, and then review the
results the next week.
 This encourages clients to come back next week and gives you
something to talk about and assists you in getting right to their
concerns vs. “shooting the breeze”.
 Typically once we are familiar with an assessment tool it should
only take a few minutes to completely score the test and be ready
to discuss the results.
Costs & Insurance Concerns
 Instruments in the public domain are typically free to use or very
inexpensive for you to purchase and keep in your office or clinic.
 In dealing with insurances companies by having objective testing
results can help in completing chart reviews and decrease the
amount of time you spend discussing your treatment plans.
 Recently Aetna has started to pay a small amount to cover your
use of the assessments tool.
Qualifications
Level A: There are no special qualifications to purchase these products.
Level B: Tests can be purchased by individuals with: Certification by or full active
membership in a professional organization (ASHA, AOTA, APA, AERA, ACA, AMA,
NASP, NAN, INS) that requires training and experience in a relevant area of assessment. A
master’s degree in psychology, education, occupational therapy, speech-language pathology,
social work, or in a field closely related to the intended use of the assessment, and formal
training in the ethical administration, scoring, and interpretation of clinical assessments.
Level C: Tests with a C qualification require a high level of expertise in test interpretation,
and can be purchased by individuals with: Licensure or certification to practice in your state
in a field related to the purchase. OR A doctorate degree in psychology, education, or
closely related field with formal training in the ethical administration, scoring, and
interpretation of clinical assessments related to the intended use of the assessment.
Test Publishers

Pearson – www.pearsonassessments.com

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PAR – www.parinc.com


Phone: 1.800.331.8378
Western Psychological Services – www.wpspublish.com


Phone: 1.800.627.7271
Phone: 1.800.648.8857
Hawthorne Educational Services, Inc. - www.hawthorne-ed.com

Phone: 1.800.542.1673
 DSM-5 Online
Assessments
Further
Resources
 http://www.psychiatry.or
g/practice/dsm/dsm5/o
nline-assessmentmeasures
 Essentials of Assessment
Report Writing –
published by Wiley
Publishers
Objective Assessments in Private Practice By Jeffrey S Gallup MA LPC NCC and Kathryn Johnson MA LPC NCC 1 WHY SHOULD I USE ASSESSMENTS IN MY PRACTICE 
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Clinicians that rely exclusively on interviews are prone to incomplete understandings. Psychological test validity is very strong and compelling. Distinct assessments provide unique sources of information. Psychological test validity is comparable to medical test validity. 2 ASSESSMENTS IN SIMPLER TERMS As counselors we can use any assessment instrument (test) that produces objective (measurable) results. That we are qualified to purchase from the testing publishers. Publishers generally categorize their tests into the following areas 
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Adult Clinical Autism Spectrum Disorders Child Clinical Cognitive, Achievement, & Learning Development & Adaptive Behavior Industrial‐Organizational Neuropsychology Occupational Therapy & Sensory Processing Social, Emotional, & Behavioral Issues Speech‐Language‐Hearing There is an amazing amount of assessments available to us, the Buros Mental Measurement Yearbook has been reviewing and cataloging psychometric assessments since 1938. 3 AIDING TREATMENT EFFECTIVENESS Using assessments helps you to reach the goal of providing EVIDENCE BASED TREATMENT – helping you to determine the exact problem to be treated and how severe that problem is, then as you continue to provide care you can use assessments to help objectively determine the progress you are making. Your first results at the outset of care provide you a baseline, and an increase in your understanding of your clients concerns. Assessments tools can help you to clarify your diagnostic picture. Even when the labels are not important, it may provide valuable clues to creating and guiding your treatment plans. Every so often you may catch a problem that you did not anticipate. There are a variety of medical diagnoses that mirror psychological problems, such as – 




ADHD = Other Neurodevelopment profiles Post‐traumatic stress disorder = Brain Trauma Panic Disorder = Thyroid Disorder Depression = Epstien‐Barr or Metabolic Disorders Dementia = Deafness 4 DECREASING LIABILITY When using objective instruments it provides you further clinical/relevant information to create your treatment planning. Demonstrating in a forensic, malpractice, or other unforeseen legal situation that you have solid evidence for the methods that you are using to practice therapy. 5 INCREASING RAPPORT AND CHALLENGING SELF‐DIAGNOSIS When working with children, assessments can help you to gain a 3rd perspective about the child’s problems after what their parents report, and your interview with the child. Then you have the opportunity to quickly get to the child’s concerns and help them to feel as if counseling is having a positive impact on their problems. Reviewing assessment results with parents can help increase their understanding of their child’s problem, and give you further opportunities to educate parents. Often we can spend a lot of time explaining to people that their diagnosis is not the most important piece of counseling. But showing them an objective assessment and then explaining that it measures thoughts and behaviors is a more effective way to help people focus on their thoughts and behaviors. 6 CONCERNS 6.1
LACK OF FAMILIARITY Many of us have taken at least 1 class in Tests & Measurements. But have done little with that education since then. Using a quick assessment several times and reading through the documentation will help you figure out how to give and score the test. Often these assessments can be scored by adding up each of the questions and then comparing to a table. 6.2
INFRINGEMENT ON CLIENT TIME & COST Most of these tools can be completed in about 5 to 10 minutes. I suggest that you score between client sessions, and then review the results the next week. This encourages clients to come back next week and gives you something to talk about and assists you in getting right to their concerns vs. “shooting the breeze”. Instruments in the public domain are typically free to use or very inexpensive for you to purchase and keep in your office or clinic. In dealing with insurances companies by having objective testing results can help in completing chart reviews and decrease the amount of time you spend discussing your treatment plans. 7 PUBLIC DOMAIN ASSESSMENTS 
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Hamilton Anxiety Scale Depression Anxiety Stress Scale Center for Epidemiological Studies Depression Scale Adult Attachment Scale Instrument and Scoring CAGE Questionnaire (CAGE) Internet Addiction Test (IAT) Adult ADHD Self Report Scale (ASRS v1.1) Buss‐Perry Aggression Questionnaire (AGQ) Generalized Anxiety Disorder 7 Item (GAD‐7) Hamilton Anxiety Rating Scale (HAM‐A) Liebowitz Social Anxiety Scale (LSAS) Panic and Agoraphobia Scale (PAS) Spence Children’s Anxiety Scale (SCAS) Social Phobia Inventory (SPIN) Taylor Manifest Anxiety Scale (TMAS) Zung Self‐Rating Anxiety Scale (SAS) Autism Spectrum Quotient (AQ) Childhood Autism Spectrum Test (CAST) Altman Self‐Rating Mania Scale (ASRM) Young Mania Rating Scale (YMRS) Edinburgh Postnatal Depression Scale (EPDS) Geriatric Depression Scale (GDS) Kutcher Adolescent Depression Scale (KADS‐11) Major Depression Inventory (MDI) Montgomery‐Asberg Depression Rating Scale (MADRS) Zung Self‐Rating Depression Scale (SDS) Eating Disorders (2) Binge Eating Scale (BES) Eating Attitudes Test 26 Item (EAT‐26) Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) Empathy Quotient (EQ) Personality Type Indicator (PTI) 8 TEST PUBLISHERS & RESOURCES Pearson – www.pearsonassessments.com Phone: 1.800.627.7271 PAR – www.parinc.com Phone: 1.800.331.8378 Western Psychological Services – www.wpspublish.com Phone: 1.800.648.8857 Hawthorne Educational Services, Inc. ‐ www.hawthorne‐ed.com Phone: 1.800.542.1673 9 FURTHER RESOURCES DSM‐5 Online Assessments http://www.psychiatry.org/practice/dsm/dsm5/online‐assessment‐
measures Essentials of Assessment Report Writing – published by Wiley Publishers 10 REFERENCES Buros Center for Testing – www.buros.org Texas LPC Board Code of Ethics ‐ https://www.dshs.state.tx.us/counselor/lpc_ethics.shtm Texas LPC Board Scope of Practice ‐ https://www.dshs.state.tx.us/counselor/lpc_scope.shtm Psychological Assessments shown to be as valid as medical tests – https://www.apa.org/monitor/julaug01/psychassess.aspx Psychological testing and psychological assessment. A review of evidence and issues – http://www.ncbi.nlm.nih.gov/m/pubmed/11279806