A Model to Approaching and Providing Feedback to Patients Regarding Invalid Test Performance in Clinical Neuropsychological Evaluations

Abstract

The use of symptom validity assessment has become commonplace in clinical neuropsychological evaluations. However, clinicians often struggle with how to provide patients with feedback regarding invalid responding or effort, because of the sensitive nature of the information that must be conveyed. A conceptual framework for providing such feedback is outlined in clinical neuropsychological evaluations, and recommendations for how to handle complaints are offered. Our feedback model is not meant to apply to individuals referred by attorneys or other non-clinical third parties (e.g., independent medical examination companies).

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“…If a client requests a neuropsychological assessment but there is uncertainty regarding expectations and/or the purpose, the assessment process and the treatment might be complicated (Gorske & Smith, 2009). For example, clients, and practitioners in health care and social services, sometimes request that a clinical psychologist provide a specific neuropsychiatric diagnosis (Carone, Iverson, & Bush, 2010;Vakil, 2012). In such cases, considerable expectations and hopes might be tied to a diagnosis, which is understandable, because a diagnosis provides not only comprehension but also acknowledgment from others.…”

“…This approach might paradoxically collide with a desire to be identified with a diagnosis (Bailey, 2005;Cooper, 2004). In fact, some clients might exaggerate their difficulties in order to receive a certain diagnosis (Carone et al, 2010) and need to be understood from the context of the Downloaded by [University of Otago] at 08:08 05 July 2015 suffering that is experienced. Clients might, perhaps for good reasons, sense that they need to exaggerate their difficulties to be listened to and taken seriously.…”

“…In such cases, conflicts might arise, and fear of the client's reactions might lead practitioners to omit feedback that is comforting but inaccurate (Carone et al, 2010). Conflicts might be counteracted if, before the neuropsychological assessment, the client and practitioners discussed the notion that assessment will be conducted with an open mind (Carone et al;Gorske & Smith;Vakil, 2012).…”

“…In such cases, considerable expectations and hopes might be tied to a diagnosis, which is understandable, because a diagnosis provides not only comprehension but also acknowledgment from others. The diagnosis has the capacity to relieve suffering connected to shortcomings and, in some cases, even provide rewards, such as medication or permission for sick leave, that are connected to the diagnosis (Carone et al;Dige, 2010). If expectations and hopes tied to a specific diagnosis become pervasive, there is a risk that the practitioner's openness to different explanations and possibilities is affected and that an assessment process becomes rushed.…”

“…The process of feedback is fundamental, because feedback is the link between assessment and treatment planning (Carone et al, 2010;Gorske, 2008). Furthermore, during the assessment process, discoveries might be in accordance with expectations, or might be surprising, and perhaps disappointing.…”