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176 Ethical Issues in Psychological Assessment significant personal cost. When in doubt, a psychologist always has the option of contacting the test publisher. If pub- lishers, who sold the tests to the psychologist eliciting a promise that the test materials be treated confidentially, wish to object to requested or court-ordered disclosure, they should be expected to use their own financial and legal resources to defend their own copyright-protected property. Psychologists must also pay attention to the laws that apply in their own practice jurisdiction(s). For example, Minnesota has a specific statute that prohibits a psychologist from releasing psychological test materials to individuals who are unqualified or if the psychologist has reason to be- lieve that releasing such material would compromise the in- tegrity of the testing process. Such laws can provide additional protective leverage but are rare exceptions. An editorial in the American Psychologist (APA, 1999) discussed test security both in the context of scholarly pub- lishing and litigation, suggesting that potential disclosure must be evaluated in light of both ethical obligations of psy- chologists and copyright law. The editorial also recognized that the psychometric integrity of psychological tests de- pends upon the test taker’s not having prior access to study or be coached on the test materials. The National Academy of Neuropsychology (NAN) has also published a position paper on test security (NAN, 2000c). There has been significant concern among neuropsychologists about implications for the validity of tests intended to assess malingering if such materials are freely circulated among attorneys and clients. Both the American Psychologist editorial and the NAN posi- tion paper ignore the implications of this issue with respect to preparation for high-stakes testing and the testing industry, as discussed in detail later in this chapter. Authors who plan to publish information about tests should always seek permis- sion from the copyright holder of the instrument and not presume that the fair use doctrine will protect them from subsequent infringement claims. When sensitive test docu- ments are subpoenaed, psychologists should also ask courts to seal or otherwise protect the information from unreason- able public scrutiny. SPECIAL ISSUES In addition to the basic principlesdescribed earlier in this chap- ter (i.e., the preparation, conduct, and follow-up of the actual assessment), some special issues regard psychological testing. These issues include automated or computerized assessment services, high-stakes testing, and teaching of psychological assessment techniques. Many of these topics fall under the general domain of the testing industry. The Testing Industry Psychological testing is big business. Test publishers and other companies offering automated scoring systems or national testing programs are significant business enterprises.Although precise data are not easy to come by,Walter Haney and his col- leagues (Haney, Madaus, & Lyons, 1993) estimated gross rev- enues of several major testing companies for 1987–1988 as follows: Educational Testing Service, $226 million; National Computer Systems, $242 million; The Psychological Corpora- tion (then a division of Harcort General), $50–55 million; and the American College Testing Program, $53 million. The Fed- eral Reserve Bank suggests that multiplyingthe figures by 1.56 will approximate the dollar value in 2001 terms, but the actual revenue involved is probably significantly higher, given the in- creased numbers of people taking such tests by comparison with 1987–1988. The spread of consumerism in America has seen increas- ing criticism of the testing industry (Haney et al., 1993). Most of the ethical criticism leveled at the larger companies fall into the categories of marketing, sales to unauthorized users, and the problem of so-called impersonal services. Publishers claim that they do make good-faith efforts to police sales so that only qualified users obtain tests. They note that they can- not control the behavior of individuals in institutions where tests are sent. Because test publishers must advertise in the media provided by organized psychology (e.g., the APA Monitor) to influence their prime market, most major firms are especially responsive to letters of concern from psychol- ogists and committees of APA. At the same time, such com- panies are quite readily prepared to cry antitrust fouls when professional organizations become too critical of their busi- ness practices. The Center for the Study of Testing, Evaluation, and Edu- cational Policy (CSTEEP), directed by Walt Haney, is an educational research organization located at Boston College in the School of Education (http://wwwcsteep.bc.edu). CSTEEP has been a valuable ally to students who have been subjected to bullying and intimidation by testing behemoths such as Educational Testing Service and the SAT program when the students’ test scores improve dramatically. In a number of circumstances, students have had their test results canceled, based on internal statistical formulas that few peo- ple other than Haney and his colleagues have ever analyzed. Haney has been a valuable expert in helping such students obtain legal remedies from major testing companies, al- though the terms of the settlements generally prohibit him from disclosing the details. Although many psychologists are employed by large testing companies, responses to critics have generally been issued by corporate attorneys rather than Special Issues 177 psychometric experts. It is difficult to assess the degree to which insider psychologists in these big businesses exert any influence to assure ethical integrity and fairness to individual test takers. Automated Testing Services Automated testing services and software can be a major boon to psychologists’ practices and can significantly enhance the accuracy and sophistication of diagnostic decision making, but there are important caveats to observe. The draft revision of the APA code states that psychologists who offer assess- ment or scoring services to other professionals should accu- rately describe the purpose, norms, validity, reliability, and applications of the procedures and any special qualifications applicable to their use (ECTF, 2001). Psychologists who use such scoring and interpretation services (including auto- mated services) are urged to select them based on evidence of the validity of the program and analytic procedures (ECTF, 2001). In every case, ethical psychologists retain responsibil- ity for the appropriate application, interpretation, and use of assessment instruments, whether they score and interpret such tests themselves or use automated or other services (ECTF, 2001). One key difficulty in the use of automated testing is the aura of validity conveyed by the adjective computerized and its synonyms. Aside from the long-standing debate within psychology about the merits of actuarial versus clinical pre- diction, there is often a kind of magical faith that numbers and graphs generated by a computer program somehow equate with increased validity of some sort. Too often, skilled clinicians do not fully educate themselves about the under- pinnings of various analytic models. Even when a clinician is so inclined, the copyright holders of the analytic program are often reluctant to share too much information, lest they com- promise their property rights. In the end, the most reasonable approach is to use auto- mated scoring and interpretive services as only one compo- nent of an evaluation and to carefully probe any apparently discrepant findings. This suggestion will not be a surprise to most competent psychologists, but unfortunately they are not the only users of these tools. Many users of such tests are nonpsychologists with little understanding of the inter- pretive subtleties. Some take the computer-generated reports at face value as valid and fail to consider important factors that make their client unique. A few users are simply looking for a quick and dirty source of data to help them make a decision in the absence of clinical acumen. Other users in- flate the actual cost of the tests and scoring services to en- hance their own billings. When making use of such tools, psychologists should have a well-reasoned strategy for incor- porating them in the assessment and should interpret them with well-informed caution. High-Stakes Testing The term high-stakes tests refers to cognitively loaded instru- ments designed to assess knowledge, skill, and ability with the intent of making employment, academic admission, gradua- tion, or licensing decisions. For a number of public policy and political reasons, these testing programs face considerable scrutiny and criticism (Haney et al., 1993; Sackett, Schmitt, Ellingson, & Kabin, 2001). Such testing includes the SAT, Graduate Record Examination (GRE), state examinations that establish graduation requirements, and professional or job entry examinations. Such tests can provide very useful infor- mation but are also subject to misuse and a degree of tyranny in the sense that individuals’ rights and welfare are easily lost in the face of corporate advantage and political struggles about accountability in education. In May, 2001 the APA issued a statement on such testing titled “Appropriate Use of High Stakes Testing in Our Nation’s Schools” (APA, 2001). The statement noted that the measurement of learning and achievement are important and that tests—when used properly—are among the most sound and objective ways to measure student performance. How- ever, when tests’ results are used inappropriately, they can have highly damaging unintended consequences. High-stakes decisions such as high school graduation or college admis- sions should not be made on the basis of a single set of test scores that only provide a snapshot of student achievement. Such scores may not accurately reflect a student’s progress and achievement, and they do not provide much insight into other critical components of future success, such as motiva- tion and character. The APA statement recommends that any decision about a student’s continued education, retention in grade, tracking, or graduation should not be based on the results of a single test. The APA statement noted that • When test results substantially contribute to decisions made about student promotion or graduation, there should be evidence that the test addresses only the specific or generalized content and skills that students have had an opportunity to learn. • When a school district, state, or some other authority man- dates a test, the intended use of the test results should be clearly described. It is also the responsibility of those who mandate the test to monitor its impact—particularly on racial- and ethnic-minority students or students of lower 178 Ethical Issues in Psychological Assessment socioeconomic status—and to identify and minimize po- tential negative consequences of such testing. • In some cases, special accommodations for students with limited proficiency in English may be necessary to obtain valid test scores. If students with limited English skills are to be tested in English, their test scores should be inter- preted in light of their limited English skills. For example, when a student lacks proficiency in the language in which the test is given (students for whom English is a second language, for example), the test could become a measure of their ability to communicate in English rather than a measure of other skills. • Likewise, special accommodations may be needed to en- sure that test scores are valid for students with disabilities. Not enough is currently known about how particular test modifications may affect the test scores of students with disabilities; more research is needed. As a first step, test developers should include students with disabilities in field testing of pilot tests and document the impact of par- ticular modifications (if any) for test users. • For evaluation purposes, test results should also be re- ported by sex, race-ethnicity, income level, disability status, and degree of English proficiency. One adverse consequenceofhigh-stakestesting is that some schools will almost certainly focus primarily on teaching-to- the-test skillsacquisition.Studentspreparedin this way maydo well on the test but find it difficult to generalize their learning beyond that context and may find themselves unprepared for critical and analytic thinking in their subsequent learning envi- ronments. Some testing companies such as the Educational Testing Service (developers of the SAT) at one time claimed that coaching or teaching to the test would have little meaning- ful impact and still publicly attempt to minimize the potential effect of coaching or teaching to the test. The best rebuttal to such assertions is the career of Stanley H. Kaplan. A recent article in The New Yorker (Gladwell, 2001) documents not only Kaplan’s long career as an entre- preneurial educator but also the fragility of so-called test se- curity and how teaching strategies significantly improves test scores in exactly the way the industry claimed was impossi- ble. When Kaplan began coaching students on the SAT in the 1950s and holding posttest pizza parties to debrief the stu- dents and learn about what was being asked, he was consid- ered a kind of subverter of the system. Because the designers of the SAT viewed their work as developing a measure of en- during abilities (such as IQ), they assumed that coaching would do little to alter scores. Apparently little thought was given to the notion that people are affected by what they know and that what they know is affected by what they are taught (Gladwell, 2001). What students are taught is dictated by parents and teachers, and they responded to the high- stakes test by strongly supporting teaching that would yield better scores. Teaching Psychological Testing Psychologists teaching assessment have a unique opportunity to shape their students’ professional practice and approach to ethics by modeling how ethical issues are actively integrated into the practice of assessment (Yalof & Brabender, 2001). Ethical standards in the areas of education and training are relevant. “Psychologists who are responsible for education and training programs take reasonable steps to ensure that the programs are designed to provide appropriate knowledge and proper experiences to meet the requirements for licen- sure, certification and other goals for which claims are made by the program” (ECTF, 2001). A primary responsibility is to ensure competence in assessment practice by providing the requisite education and training. A recent review of studies evaluating the competence of graduate students and practicing psychologists in administra- tion and scoring of cognitive tests demonstrates that errors occur frequently and at all levels of training (Alfonso & Pratt, 1997). The review also notes that relying only on practice as- sessments as a teaching methodology does not ensure com- petent practice. The authors conclude that teaching programs that include behavioral objectives and that focus on evaluat- ing specific competencies are generally more effective. This approach is also more concordant with the APA guidelines for training in professional psychology (APA, 2000). The use of children and students’ classmates as practice subjects in psychological testing courses raises ethical con- cern (Rupert, Kozlowski, Hoffman, Daniels, & Piette, 1999). In other teaching contexts, the potential for violations of pri- vacy are significant in situations in which graduate students are required to take personality tests for practice. Yalof and Brabender (2001) address ethical dilemmas in personality as- sessment courses with respect to using the classroom for in vivo training. They argue that the student’s introduction to ethical decision making in personality assessment occurs in assessment courses with practice components. In this type of course, students experience firsthand how ethical problems are identified, addressed, and resolved. They note that the instructor’s demonstration of how the ethical principles are highlighted and explored can enable students to internal- ize a model for addressing such dilemmas in the future. Four particular concerns are described: (a) the students’ role in procuring personal experience with personality testing, (b) identification of participants with which to practice, (c) the development of informed consent procedures for References 179 assessment participants, and (d) classroom presentations. This discussion does not provide universally applicable con- crete solutions to ethical problems; however, it offers a con- sideration of the relevant ethical principles that any adequate solution must incorporate. RECOMMENDATIONS In an effort to summarize the essence of good ethical practice in psychological assessment, we offer this set of suggestions: • Clients to be tested (or their parents or legal guardians) must be given full informed consent about the nature of the evaluation, payment for services, access to results, and other relevant data prior to initiating the evaluation. • Psychologists should be aware of and adhere to published professional standards and guidelines relevant to the nature of the particular type of assessment they are conducting. • Different types of technical data on tests exist—including reliability and validity data—and psychologists should be sufficiently familiar with such data for any instrument they use so that they can justify and explain the appropri- ateness of the selection. • Those administering psychological tests are responsible for assuring that the tests are administered and scored according to standardized instructions. • Test users should be aware of potential test bias or client characteristics that might reduce the validity of the instru- ment for that client and context. When validity is threat- ened, the psychologists should specifically address the issue in their reports. • No psychologist is competent to administer and inter- pret all psychological tests. It is important to be cautiously self-critical and to agree to undertake only those eval- uations that fall within one’s training and sphere of competence. • The validity and confidence of test results relies to some degree on test security. Psychologists should use reason- able caution in protecting the security of test items and materials. • Automated testing services create a hazard to the extent that they may generate data that are inaccurate for certain clients or that are misinterpreted by improperly trained in- dividuals. Psychologists operating or making use of such services should take steps to minimize such risks. • Clients have a right to feedback and a right to have con- fidentiality of data protected to the extent agreed upon at the outset of the evaluation or in subsequent authorized releases. • Test users should be aware of the ethical issues that can develop in specific settings and should consult with other professionals when ethical dilemmas arise. REFERENCES Aiken, L. S., West, S. G., Sechrest, L., & Reno, R. R. (1990). Grad- uate training in statistics, methodology and measurement in psy- chology: A survey of PhD programs in North America. American Psychologist, 45, 721–734. American Psychological Association (APA). (1953). Ethical stan- dards of psychologists. Washington, DC: Author. American Psychological Association (APA). (1992). Ethical stan- dards of psychologists and code of conduct. Washington, DC: Author. American Psychological Association (APA). (1999). Test security: Protecting the integrity of tests. American Psychologist, 54, 1078. American Psychological Association (APA). (2000). Guidelines and principles for accreditation of programs in professional Psy- chology. Washington, DC: Author. American Psychological Association (APA). (2001). Appropriate use of high stakes testing in our nation’s schools. Washington, DC: Author. Ardila, A., & Moreno, S. (2001). Neuropsychological test perfor- mance in Aruaco Indians: An exploratory study. Neuropsychol- ogy, 7, 510–515. British Psychological Society (BPS). (1995). Certificate statement register: Competencies in occupational testing, general informa- tion pack (Level A). (Available from the British Psychological Society, 48 Princess Road East, Leicester, England LEI 7DR) British Psychological Society (BPS). (1996). Certificate statement register: Competencies in occupational testing, general infor- mation pack (Level B). (Available from the British Psychologi- cal Society, 48 Princess Road East, Leicester, England LEI 7DR) Ethics Code Task Force (ECTF). (2001). Working draft ethics code revision, October, 2001. Retrieved from http://www.apa.org/ ethics. Eyde, L. E., Moreland, K. L., Robertson, G. J., Primoff, E. S., & Most, R. B. (1988). Test user qualifications: A data-based ap- proach to promoting good test use. Issues in scientific psychol- ogy (Report of the Test User Qualifications Working Group of the Joint Committee on Testing Practices). Washington, DC: American Psychological Association. Eyde, L. E., Robertson,G.J., Krug, S. E., Moreland, K.L.,Robertson, A.G., Shewan, C. M., Harrison, P. L., Porch, B. E., Hammer, A. L., & Primoff, E. S. (1993). Responsible test use: Case studies for assessing human behavior. Washington, DC: American Psycho- logical Association. Flanagan, D. P., & Alfonso, V. C. (1995). A critical review of the technical characteristics of new and recently revised intelligence 180 Ethical Issues in Psychological Assessment tests for preschool children. Journal of Psychoeducational Assessment, 13, 66–90. Gladwell, M. (2001, December 17). What Stanley Kaplan taught us about the S.A.T. The New Yorker. Retrieved from http://www .newyorker.com/PRINTABLE/?critics/011217crat_atlarge Grisso, T., &Appelbaum, P. S. (1998). Assessing competence to con- sent to treatment: A guide for physicians and other health profes- sionals. New York: Oxford University Press. Grote, C. L., Lewin, J. L., Sweet, J. J., & van Gorp, W. G. (2000). Courting the clinician. Responses to perceived unethical prac- tices in clinical neuropsychology: Ethical and legal considera- tions. The Clinical Neuropsychologist, 14, 119–134. Haney, W. M., Madaus, G. F., & Lyons, R. (1993). The fractured marketplace for standardized testing. Norwell, MA: Kluwer. Heaton, R. K., Grant, I., & Matthews, C. G. (1991). Comprehensive norms for an Expanded Halstead-Reitan Battery: Demographic corrections, research findings, and clinical applications. Odessa, FL: Psychological Assessment Resources. International Test Commission. (2000). International guidelines for test use: Version 2000. (Available from Professor Dave Bartram, President, SHL Group plc, International Test Commission, The Pavilion, 1 Atwell Place, Thames Ditton, KT7, Surrey, England) Johnson-Greene, D., Hardy-Morais, C., Adams, K., Hardy, C., & Bergloff, P. (1997). Informed consent and neuropsychological assessment: Ethical considerations and proposed guidelines. The Clinical Neuropsychologist, 11, 454–460. Kamphaus, R. W., Dresden, J., & Kaufman, A. S. (1993). Clinical and psychometric considerations in the cognitive assessment of preschool children. In J. Culbertson & D. Willis. (Eds.), Testing young children: A reference guide for developmental, psycho- educational, and psychosocial assessments (pp. 55–72). Austin, TX: PRO-ED. Koocher, G. P. (1998). Assessing the quality of a psychological test- ing report. In G. P. Koocher, J. C. Norcross, & S. S. Hill (Eds.), PsyDR: Psychologists’desk reference (pp. 169–171). New York: Oxford University Press. McCaffrey, R. J., Fisher, J. M., Gold, B. A., & Lynch, J. K. (1996). Presence of third parties during neuropsychological evaluations: Who is evaluating whom? The Clinical Neuropsychologist, 10, 435–449. McSweeney, A. J., Becker, B. C., Naugle, R. I., Snow, W. G., Binder, L. M., & Thompson, L. L. (1998). Ethical issues related to third party observers in clinical neuropsychological evalua- tions. The Clinical Neuropsychologist, 12, 552–559. Moreland, K. L., Eyde, L. D., Robertson, G. J., Primoff, E. S., & Most, R. B. (1995). Assessment of test user qualifications: a research-based measurement procedure. American Psychologist, 50, 14–23. National Academy of Neuropsychology (NAN). (2000a). The use of neuropsychology test technicians in clinical practice. Archives of Clinical Neuropsychology, 15, 381–382. National Academy of Neuropsychology (NAN). (2000b). Presence of third party observers during neuropsychological testing. Archives of Clinical Neuropsychology, 15, 379–380. National Academy of Neuropsychology (NAN). (2000c). Test secu- rity. Archives of Clinical Neuropsychology, 15, 381–382. Ostrosky, F., Ardila, A., Rosselli, M., López-Arango, G., & Uriel-Mendoza, V. (1998). Neuropsychological test perfor- mance in illiterates. Archives of Clinical Neuropsychology, 13, 645–660. Rupert, P. A., Kozlowski, N. F., Hoffman, L. A., Daniels, D. D., & Piette, J. M. (1999). Practical and ethical issues in teaching psychological testing. Professional Psychology: Research and Practice, 30, 209–214. Sackett, P. R., Schmitt, N., Ellingson, J. E., & Kabin, M. B. (2001). High-stakes testing in employment, credentialing, and higher education: Prospects in a post-affirmative action world. Ameri- can Psychologist, 56, 302–318. Simner, M. L. (1994). Draft of final report of the Professional Affairs Committee Working Group on Test Publishing Industry Safe- guards. Ottawa, ON: Canadian Psychological Association. Vanderploeg, R. D., Axelrod, B. N., Sherer, M., Scott, J., & Adams, R. (1997). The importance of demographic adjustments on neuropsy- chological test performance: A response to Reitan and Wolfson (1995). The Clinical Neuropsychologist, 11, 210–217. Yalof, J., & Brabender, V. (2001). Ethical dilemmas in personality assessment courses: Using the classroom for in vivo training. Journal of Personality Assessment, 77, 203–213. CHAPTER 9 Education and Training in Psychological Assessment LEONARD HANDLER AND AMANDA JILL CLEMENCE 181 DIFFERENCES BETWEEN TESTING AND ASSESSMENT 182 WHY TEACH AND LEARN PERSONALITY ASSESSMENT? 182 Learning Assessment Teaches Critical Thinking and Integrative Skills 182 Assessment Allows the Illumination of a Person’s Experience 183 Assessment Can Illuminate Underlying Conditions 183 Assessment Facilitates Treatment Planning 183 Assessment Facilitates the Therapeutic Process 183 The Assessment Process Itself Can Be Therapeutic 184 Assessment Provides Professional Identity 184 Assessment Reflects Patients’ Relationship Problems 184 Personality Assessment Helps Psychologists Arrive at a Diagnosis 184 Assessment Is Used in Work-Related Settings 184 Assessment Is Used in Forensic and Medical Settings 184 Assessment Procedures Are Used in Research 185 Assessment Is Used to Evaluate the Effectiveness of Psychotherapy 185 Assessment Is Important in Risk Management 185 PROBLEMS OF LEARNING PERSONALITY ASSESSMENT: THE STUDENT SPEAKS 185 PROBLEMS OF TEACHING PERSONALITY ASSESSMENT: THE INSTRUCTOR SPEAKS 186 LEARNING TO INTERVIEW 187 THE IMPORTANCE OF RELIABILITYAND VALIDITY 188 TEACHING AN INTRODUCTORY COURSE IN PERSONALITY ASSESSMENT 188 TEACHING AN ADVANCED COURSE IN PERSONALITY ASSESSMENT 189 IMPROVING ASSESSMENT RESULTS THROUGH MODIFICATION OF ADMINISTRATION PROCEDURES 192 TEACHING STUDENTS HOW TO CONSTRUCT AN ASSESSMENT BATTERY 193 ASSESSMENT AND CULTURAL DIVERSITY 195 TEACHING ETHICAL ISSUES OF ASSESSMENT 195 ASSESSMENT APPROACHES AND PERSONALITY THEORY 196 LEARNING THROUGH DOING: PROFICIENCY THROUGH SUPERVISED PRACTICE 196 ASSESSMENT TEACHING IN GRADUATE SCHOOL: A REVIEW OF THE SURVEYS 197 ASSESSMENT ON INTERNSHIP: REPORT OF A SURVEY 198 AMERICAN PSYCHOLOGICAL ASSOCIATION DIVISION 12 GUIDELINES 198 POSTGRADUATE ASSESSMENT TRAINING 199 ASSESSMENT AND MANAGED CARE ISSUES 199 THE POLITICS AND MISUNDERSTANDINGS IN PERSONALITY ASSESSMENT 200 PERSONALITY ASSESSMENT IN THE FUTURE 202 The Assessment of Psychological Health and the Rise of Positive Psychology 202 Focused Measures of Important Personality Variables 203 Therapeutic Assessment 203 Assessment on the Internet 204 Research on the Interpretive Process 204 Expanded Conception of Intelligence 204 REFERENCES 205 Webegin this chapter with a storyabout an assessment done by one of us (Handler) when he was a trainee at aVeteransAdmin- istration hospital outpatient clinic. He was asked by the chief of psychiatry to reassess a patient the psychiatrist had been seeing in classical psychoanalysis, which included heavy emphasis on dream analysis and free association, with little input from the analyst, as was the prevailing approach at the time. The patient was not making progress, despite the regimen of three sessions per week he had followed for over a year. The patient was cooperative and appropriate in the inter- view and in his responses to the Wechsler Adult Intelligence Scale (WAIS) items, until the examiner came to one item of the Comprehension subtest, “What does this saying mean: ‘Strike while the iron is hot’?” The examiner was quite sur- prised when the patient, who up to that point had appeared to be relatively sound, answered: “Strike is to hit. Hit my wife. I should say push, and then pull the cord of the iron. Strike in baseball—one strike against you. This means you have to hit 182 Education and Training in Psychological Assessment and retaliate to make up that strike against you—or if you feel you have a series of problems—if they build up, you will strike.” The first author still remembers just beginning to un- derstand what needed to be said to the chief of psychiatry about the type of treatment this patient needed. As the assessment continued, it became even more evident that the patient’s thinking was quite disorganized, especially on less structured tests. The classical analytic approach, with- out structure, eliciting already disturbed mentation, caused this man to become more thought disordered than he had been before treatment: His WAIS responses before treatment were quite sound, and his projective test responses showed only some significant anxiety and difficulty with impulse control. Although a previous assessor had recommended a more struc- tured, supportive approach to therapy, the patient was unfortu- nately put in this unstructured approach that probed an unconscious that contained a great deal of turmoil and few ad- equate defenses. This assessment was a significant experience in which the assessor learned the central importance of using personality assessment to identify the proper treatment modality for pa- tients and to identify patients’ core life issues. Illuminating experiences such as this one have led us to believe that as- sessment should be a central and vital part of any doctoral curriculum that prepares students to do applied work. We have had many assessment experiences that have reinforced our belief in the importance of learning assessment to facili- tate the treatment process and to help guide patients in con- structive directions. The approach to teaching personality assessment described in this chapter emphasizes the importance of viewing assess- ment as an interactive process—emphasizing the interaction of teacher and student, as well as the interaction of patient and as- sessor. The process highlights the use of critical thinking and continued questioning of approaches to assessment and to their possible interpretations, and it even extends to the use of such a model in the application of these activities in the assessment process with the patient. Throughout the chapter we have em- phasized the integration of research and clinical application. DIFFERENCES BETWEEN TESTING AND ASSESSMENT Unfortunately, many people use the terms testing and assess- ment synonymously, but actually these terms mean quite dif- ferent things. Testing refers to the process of administering, scoring, and perhaps interpreting individual test scores by ap- plying a descriptive meaning based on normative, nomothetic data. The focus here is on the individual test itself.Assessment, on the other hand, consists of a process in which a number of tests, obtained from the use of multiple methods, are adminis- tered and the results of these tests are integrated among them- selves, along with data obtained from observations, history, information from other professionals, and information from other sources—friends, relatives, legal sources, and so on. All of these data are integrated to produce, typically, an in-depth understanding of the individual, focusedonthereasonstheper- son was referredforassessment.This process ispersonfocused or problem issue focused (Handler & Meyer, 1998). The issue is not, for example, what the person scored on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), or what the Rorschach Structural Summary yielded, but, rather, what we can say about the patient’s symptomatology, personality struc- ture, and dynamics, and how we can answer the referral ques- tions. Tests are typically employed in the assessment process, but much more information and much more complexity are involved in the assessment process than in the simple act of testing itself. Many training programs teach testing but describe it as as- sessment. The product produced with this focus is typically a report that presents data from each test, separately, with little or no integration or interpretation. There are often no valid clear-cut conclusions one can make from interpreting tests in- dividually, because the results of other test and nontest data often modify interpretations or conclusions concerning the meaning of specific test signs or results on individual tests. In fact, the data indicate that a clinician who uses a single method will develop an incomplete or biased understanding of the patient (Meyer et al., 2000). WHY TEACH AND LEARN PERSONALITY ASSESSMENT? When one considers the many advantages offered by learning personality assessment, its emphasis in many settings be- comes quite obvious. Therefore, we have documented the many reasons personality assessment should be taught in doctoral training programs and highlighted as an important and respected area of study. Learning Assessment Teaches Critical Thinking and Integrative Skills The best reason, we believe, to highlight personality assess- ment courses in the doctoral training curriculum concerns the importance of teaching critical thinking skills through the process of learning to integrate various types of data. Typi- cally, in most training programs until this point, students have Why Teach and Learn Personality Assessment? 183 amassed a great deal of information from discrete courses by reading, by attending lectures, and from discussion. How- ever, in order to learn to do competent assessment work stu- dents must now learn to organize and integrate information from many diverse courses. They are now asked to bring these and other skills to bear in transversing the scientist- practitioner bridge, linking nomothetic and ideographic data. These critical thinking skills, systematically applied to the huge task of data integration, provide students with a tem- plate that can be used in other areas of psychological func- tioning (e.g., psychotherapy, or research application). Assessment Allows the Illumination of a Person’s Experience Sometimes assessment data allow us to observe a person’s ex- perience as he or she is being assessed. This issue is important because it is possible to generalize from these experiences to similar situations in psychotherapy and to the patient’s envi- ronment. For example, when a 40-year-old man first viewed Card II of the Rorschach, he produced a response that was somewhat dysphoric and poorly defined, suggesting possible problems with emotional control, because Card II is the first card containing color that the patient encounters. He made a sound that indicated his discomfort and said, “A bloody wound.” After a minute he said, “A rocket, with red flames, blasting off.” This response, in contrast to the first one, was of good form quality. These responses illuminate the man’s style of dealing with troubling emotions: He becomes angry and quickly and aggressively leaves the scene with a dramatic show of power and force. Next the patient gave the following response: “Two people, face to face, talking to each other, dis- cussing.” One could picture the sequence of intrapsychic and interpersonal events in the series of these responses. First, it is probable that the person’s underlying depression is close to the surface and is poorly controlled. With little pressure it breaks through and causes him immediate but transitory disorganiza- tion in his thinking and in the ability to manage his emotions. He probably recovers very quickly and is quite capable, after an unfortunate release of anger andremovinghimself from the situation, of reestablishing an interpersonal connection. Later in therapy this man enacted just such a pattern of action in his work situation and in his relationships with family members and with the therapist, who was able to understand the pattern of behavior and could help the patient understand it. A skilled assessor can explore and describe with empathic attunement painful conflicts as well as the ebb and flow of dynamic, perhaps conflictual forces being cautiously con- tained. The good assessor also attends to the facilitating and creative aspects of personality, and the harmonious interplay of intrapsychic and external forces, as the individual copes with day-to-day life issues (Handler & Meyer, 1998). It is pos- sible to generate examples that provide moving portraits of a person’s experience, such as the woman who saw “a tattered, torn butterfly, slowly dying” on Card I of the Rorschach, or a reclusive, schizoid man whom the first author had been seeing for some time, who saw “a mushroom” on the same card. When the therapist asked, “If this mushroom could talk, what would it say?” the patient answered, “Don’t step on me. Everyone likes to step on them and break them.”Thisresponse allowed the therapist to understand this reserved and quiet man’s experience of the therapist, who quickly altered his ap- proach and became more supportive and affiliative. Assessment Can Illuminate Underlying Conditions Responses to assessment stimuli allow us to look beyond a person’s pattern of self-presentation, possibly concealing un- derlying emotional problems. For example, a 21-year-old male did not demonstrate any overt signs of gross pathology in his initial intake interview. His Rorschach record was also unremarkable for any difficulties, until Card IX, to which he gave the following response: “The skull of a really decayed or decaying body with some noxious fumes or odor com- ing out of it. It looks like blood and other body fluids are dripping down on the bones of the upper torso and the eyes are glowing, kind of an orange, purplish glow.” To Card X he responded, “It looks like someone crying for help, all bruised and scarred, with blood running down their face.” The stu- dent who was doing the assessment quickly changed her stance with this young man, providing him with rapid access to treatment. Assessment Facilitates Treatment Planning Treatment planning can focus and shorten treatment, result- ing in benefits to the patient and to third-party payors. In- formed treatment planning can also prevent hospitalization, and provide more efficient and effective treatment for the pa- tient. Assessment can enhance the likelihood of a favorable treatment outcome and can serve as a guide during the course of treatment (Applebaum, 1990). Assessment Facilitates the Therapeutic Process The establishment of the initial relationship between the patient and the therapist is often fraught with difficulty. It is important to sensitize students to this difficult interaction because many patients drop out of treatment prematurely. Although asking the new patient to participate in an 184 Education and Training in Psychological Assessment assessment before beginning treatment would seem to result in greater dropout than would a simple intake interview be- cause it may seem to be just another bothersome hurdle the pa- tient must jump over to receive services, recent data indicate that the situation is just the opposite (Ackerman, Hilsenroth, Baity, & Blagys, 2000). Perhaps the assessment procedure al- lows clients to slide into therapy in a less personal manner, de- sensitizing them to the stresses of the therapy setting. An example of an assessment approach that facilitates the initial relationship between patient and therapist is the recent research and clinical application of the Early Memo- ries Procedure. Fowler, Hilsenroth, and Handler (1995, 1996) have provided data that illustrate the power of specific early memories to predict the patient’s transference reaction to the therapist. The Assessment Process Itself Can Be Therapeutic Several psychologists have recently provided data that demonstrate the therapeutic effects of the assessment process itself, when it is conducted in a facilitative manner. The work of Finn (1996; Finn & Tonsager, 1992) and Fischer (1994) have indicated that assessment, done in a facilitative manner, will typically result in the production of therapeutic results. The first author has developed a therapeutic assessment ap- proach that is ongoing in the treatment process with children and adolescents to determine whether therapeutic assessment changes are long-lasting. Assessment Provides Professional Identity There are many mental health specialists who do psychother- apy (e.g., psychologists, psychiatrists, social workers, mar- riage and family counselors, ministers), but only psychologists are trained to do assessment. Possession of this skill allows us to be called upon by other professionals in the mental health area, as well as by school personnel, physicians, attorneys, the court, government, and even by business and industry, to pro- vide evaluations. Assessment Reflects Patients’ Relationship Problems More and more attention has been placed on the need for as- sessment devices to evaluate couples and families. New mea- sures have been developed, and several traditional measures have been used in unique ways, to illuminate relational pat- terns for therapists and couples. Measures range from pencil- and-paper tests of marital satisfaction to projective measures of relational patterns that include an analysis of a person’s in- terest in, feelings about, and cognitive conceptualizations of relationships, as well as measures of the quality of relation- ships established. The Rorschach and several selected Wechsler verbal sub- tests have been used inauniquemannertoillustrate the pattern and style of the interaction between or among participants. The Rorschach or the WAIS subtests are given to each person separately. The participants are then asked to retake the test together, but this time they are asked to produce an answer (on the WAIS; e.g., Handler & Sheinbein, 1987) or responses on the Rorschach (e.g., Handler, 1997) upon which they both agree. The quality of the interaction and the outcome of the collaboration are evaluated. People taking the test can get a re- alistic picture of their interaction and its consequences, which they often report are similar to their interactions in everyday relationships. Personality Assessment Helps Psychologists Arrive at a Diagnosis Assessment provides information to make a variety of diag- nostic statements, including a Diagnostic and Statistical Manual (DSM) diagnosis. Whether the diagnosis includes descriptive factors, cognitive and affective factors, interaction patterns, level of ego functions, process aspects, object rela- tions factors, or other dynamic aspects of functioning, it is an informed and comprehensive diagnosis, with or without a diagnostic label. Assessment Is Used in Work-Related Settings There is a huge literature on the use of personality assessment in the workplace. Many studies deal with vocational choice or preference, using personality assessment instruments (e.g., Krakowski, 1984; Muhlenkamp & Parsons, 1972; Rezler & Buckley, 1977), and there is a large literature in which per- sonality assessment is used as an integral part of the study of individuals in work-related settings and in the selection and promotion of workers (Barrick & Mount, 1991; Tett, Jackson, & Rothstein, 1991). Assessment Is Used in Forensic and Medical Settings Psychologists are frequently asked to evaluate people for a wide variety of domestic, legal, or medical problems. Read- ers should see the chapters in this volume by Ogloff and Douglas and by Sweet, Tovian, and Suchy, which discuss as- sessment in forensic and medical settings, respectively. Assessments are often used in criminal cases to determine the person’s ability to understand the charges brought against him or her, or to determine whether the person is competent to stand trial or is malingering to avoid criminal responsibility. Problems of Learning Personality Assessment: The Student Speaks 185 Assessments are also requested by physicians and insurance company representatives to determine the emotional corre- lates of various physical disease processes or to help differentiate between symptoms caused by medical or by emotional disorders. There is now an emphasis on the biopsy- chosocial approach, in which personality assessment can tar- get emotional factors along with the physical problems that are involved in the person’s total functioning. In addition, psychoneuroimmunology, a term that focuses on complex mind-body relationships, has spawned new psychological as- sessment instruments. There has been a significant increase in the psychological aspects of various health-related issues (e.g., smoking cessation, medical compliance, chronic pain, recovery from surgery). Personality assessment has become an integral part of this health psychology movement (Handler & Meyer, 1998). Assessment Procedures Are Used in Research Assessment techniques are used to test a variety of theories or hypothesized relationships. Psychologists search among a large array of available tests for assessment tools to quantify the variables of interest to them. There are now at least three excellent journals in the United States as well as some excel- lent journals published abroad that are devoted to research in assessment. Assessment Is Used to Evaluate the Effectiveness of Psychotherapy In the future, assessment procedures will be important to in- sure continuous improvement of psychotherapy through more adequate treatment planning and outcome assessment. Maruish (1999) discusses the application of test-based assess- ment in Continuous Quality Improvement, a movement to plan treatment and systematically measure improvement. Psy- chologists can play a major role in the future delivery of men- tal health services because their assessment instruments can quickly and economically highlight problems that require at- tention and can assist in selecting the most cost-effective, ap- propriate treatment (Maruish, 1990). Such evidence will also be necessary to convince legislators that psychotherapy services are effective. Maruish believes that our psychometri- cally sound measures, which are sensitive to changes in symp- tomatology and are administered pre- and posttreatment, can help psychology demonstrate treatment effectiveness. In addi- tion, F. Newman (1991) described a way in which personality assessment data, initially used to determine progress or out- come, “can be related to treatment approach, costs, or reim- bursement criteria, and can provide objective support for decisions regarding continuation of treatment, discharge, or referral to another type of treatment” (Maruish, 1999, p. 15). The chapter by Maruish in this volume discusses the topic of assessment and treatment in more detail. Assessment Is Important in Risk Management Assessment can substantially reduce many of the potential legal liabilities involved in the provision of psychological services (Bennet, Bryan, VandenBos, & Greenwood, 1990; Schutz, 1982) in which providers might perform routine baseline assessments of their psychotherapy patients’ initial level of distress and of personality functioning (Meyer et al., 2000). PROBLEMS OF LEARNING PERSONALITY ASSESSMENT: THE STUDENT SPEAKS The first assessment course typically focuses on teaching stu- dents to give a confusing array of tests. Advanced courses are either didactic or are taught by the use of a group process model in which hypothesis generation and data integration are learned. With this model, depression, anxiety, ambiva- lence, and similar words take on new meaning for students when they are faced with the task of integrating personality assessment data. These words not only define symptoms seen in patients, but they also define students’ experiences. Early in their training, students are often amazed at the unique responses given to themost obvious test stimuli. Train- ing in assessment is about experiencing for oneself what it is like to be with patients in a variety of situations, both fascinat- ing and unpleasant, and what it is like to get a glimpse of someone else’s inner world. Fowler (1998) describes stu- dents’ early experience in learning assessment with the metaphor of being in a “psychic nudist colony.” With this metaphor he is referring to the realization of the students that much of what they say or do reveals to others and to them- selves otherwise private features of their personality. No fur- ther description was necessary in order for the second author (Clemence) to realize that she and Fowler shared a common experience during their assessment training. However, despite the feeling that one can no longer insure the privacy of one’s inner world, or perhaps because of this, the first few years of training in personality assessment can become an incredibly profound educational experience. If nothing else, students can learn something many of them could perhaps learn nowhere else—what it is like to feel examined and assessed from all an- gles, often against their will. This approach to learning cer- tainly allows students to become more empathic and sensitive [...]... effects of two test interpretation styles in counseling: A field study Journal of Counseling Psychology, 44 , 40 0 40 5 Hartman, W., & Fithian, M (1972) Treatment of sexual dysfunction Long Beach, CA: Center for Marital and Sexual Studies References Hershey, J., Kopplin, D., & Cornell, J (1991) Doctors of Psychology: Their career experiences and attitudes toward degree and training Professional Psychology: ... psychological testing: New teachers and new tests Journal of Training and Practice in Professional Psychology, 6, 45 –50 Sigman, S (1989) Parallel process at case conferences Bulletin of the Menninger Clinic, 53, 340 – 349 Rezler, A., & Buckley, J (1977) A comparison of personality types among female student health professionals Journal of Medical Education, 52, 47 5– 47 7 Riethmiller, R., & Handler, L (1997a) Problematic... internship training: A review Professional Psychology: Research and Practice, 28, 47 5 48 5 Sugarman, A (1981) The diagnostic use of countertransference reactions in psychological testing Bulletin of the Menninger Clinic, 45 , 47 5 49 0 References 209 Sugarman, A (1991) Where’s the beef? 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(2000b). Presence of third party. neuropsychological testing. Archives of Clinical Neuropsychology, 15, 379–380. National Academy of Neuropsychology (NAN). (2000c). Test secu- rity. Archives of Clinical Neuropsychology, 15, 381–382. Ostrosky,. should be aware of and adhere to published professional standards and guidelines relevant to the nature of the particular type of assessment they are conducting. • Different types of technical data