Psychologists' judgements of diagnostic activities: deviations from a theoretical model

Abstract

In this article, we describe an investigation into the diagnostic activities of practicing clinical psychologists. Two questionnaires were filled in by 313 psychologists. One group of psychologists (N = 175) judged the necessity of diagnostic activities; the other group (N = 138) selected the activities they would actually perform. Results showed that more participants thought that diagnostic activities were necessary than there were participants who intended to actually perform those activities. Causal analysis, by generating and testing diagnostic hypotheses to form an integrated client model with an explanation for the problem, was judged least necessary and would not be performed. We conclude that a discrepancy exists between the number and types of activities psychologists judged to be necessary and they intend to actually perform. The lack of attention for causal analysis is remarkable as causal explanations are crucial to effective treatment planning.

Psychologists’ Diagnostic Processes during a Diagnostic Interview

“…Also, it is commonly used to communicate assessment findings to others, which requires psychologists to make their considerations explicit in terms that are commonly shared (such as DSM-IV classifications) and easily understandable. The findings in this study confirm previous findings from a study by Groenier et al (2008), which showed that psychologists judge an analysis of the client's complaints and symptoms to be more important than diagnostic formulation. The prescriptions of for example the Diagnostic Cycle (De Bruyn et al, 2003) do not seem to be fully followed.…”

“…The majority (56%) did not work from any specific theoretical background. A previous study (Groenier et al, 2008) showed that theoretical background, together with other background variables, explained less than 10% of variance in activities psychologists would perform. …”

“…Unfortunately, as Garb (1998) concluded, reliability and validity of these diagnostic decisions are low, although the final treatment proposals are often adequate. An explanation is provided in studies showing that psychologists do not always carry out all parts of the diagnostic process appropriately, even when explicitly asked to do so (Eells, Kendjelic, & Lucas, 1998;Groenier, Pieters, Hulshof, Wilhelm, & Witteman, 2008). In most of these studies assessment situations were artificial, and it remains unclear whether psychologists in actual practice would perform and report all parts of the diagnostic process.…”

“…Indeed, earlier studies (e.g. Bus & Kruizenga, 1989;Groenier et al, 2008) pointed out that psychologists did not follow the resource-demanding formal rules of hypothesis generation and testing. They tended to rely on routine and to focus on analyzing the client's complaints and problems and selecting a treatment method, rather than on generating and testing possible explanations for problems.…”

Scientific and social challenges for clinical psychology

“…Case conceptualization is the basis of therapy planning. As shown by Groenier, Pieters, Hulshof, Wilhelm, and Witteman (2008), clinical psychologists formulate explanatory diagnosis much less often than it seemed they did, particularly in the context of decision regarding the planned therapy. If they engage in such activity, they often do so in less complicated cases, in which empirical evidence on the effectiveness of various treatment programs is available (Groenier Pieters, Witteman, & Lehman, 2013).…”