Table Of ContentCONTRIBUTORS
Numbers in parentheses indicate the pages on which the authors'contributions begin.
Wendi L. Adams (431), Portland Dialectical Behavior Therapy Program,
Portland, Oregon 97239
Kendra K. Beitz (3), Department of Psychology, Eastern Michigan University,
,itnalispY Michigan 48197
Gary R. Birchler (297), Department of Psychiatry, School of Medicine,
University of California--San Diego, La Jolla, California 92093
Emily H. Bower (497), Department of Psychology, West Virginia University,
Morgantown, West Virginia 26506
Michelle Byrd (3), Department of Psychology, University of Nevada, Reno,
Nevada 89557
Barb Carver (209), School of Professional Psychology, Pacific University,
Portland, Oregon 97205
Frederick L. Coolidge (121), Department of Psychology, University of
Colorado, Colorado Springs, CO 80918
Kirsten Cullen (43), Clinical Psychology Program, Pacific University,
Portland, Oregon 97205
Shawn R. Currie (401), Addiction Centre, Foothills Medical Centre, Calgary,
Alberta, T2N 2T9, Canada
Mandy Davies (43), Clinical Psychology Program, Pacific University,
Portland, Oregon 97205
XVII
XVll I CONTIR! B UTORS
Barry .A Edelstein (497), Department of Psychology, West Virginia University,
Morgantown, West Virginia 26506
William Fals-Stewart (297), Research Triangle Institute, Research Triangle
Park, North Carolina 27709
Michael D. Franzen (529), Department of Psychiatry, Allegheny General
Hospital, Pittsburgh, Pennsylvania 21251
William J. Fremouw (547), Department of Psychology, West Virginia Univer-
,ytis Morgantown, West Virginia 26506
Alexander L. Gerlach (235), Psychologisches Institut ,I Psychologische Diag-
nostik und Klinische Psychologie, 48149 Muenster, Germany
Glen E. Getz (529), Department of Psychology, Allegheny General Hospital,
Pittsburgh, AP 21251
Andrew Gloster (461), Department of Psychology, Eastern Michigan ,ytisrevinU
,itnalispY Michigan 48197
Stephen .N Haynes (17), Department of Psychology, University of Hawaii,
Honolulu, Hawaii 96822
Nina Heinrichs (235), Institute of Psychology, Department of Clinical Psychol-
ogy, Psychotherapy, dna Assessment, Technical University of Braunschweig,
38106 Braunschweig, Germany
Benjamin .A Heinz (121), Department of Psychology, University of Colorado,
Colorado Springs, OC 80918
Stefan G. Hofmann (235), Department of Psychology, Boston University,
Boston, Massachusetts 02215
Derek R. Hopko (567), Department of Psychology, University of ,eessenneT
Knoxville, Tennessee 37996
Sandra .D Hopko (567), Cariten Assist Employee Assistance Program,
Knoxville, Tennessee 37922
Matthew .T l-luss (371), Creighton University, Department of Psychology,
Omaha, Nebraska 68178
Tracy Jendritza (431), Portland Dialectical Behavior Therapy Program,
Portland, Oregon 97239
Jill Johansson-Love (547), Department of Psychology, West Virginia ,ytisrevinU
Morgantown, West Virginia 26506
Soonie A. Kim (431), Portland Dialectical Behavior Therapy Program, Portland,
Oregon 97239
Stephanie M. LaMattina (145), Department of Psychology, University of
Maine, Orono, Maine 04469
CONTRIBUTORS XlX
Jennifer Langhinrichsen-Rohling (371), Department of Psychology, University
of South Alabama, Mobile, Alabama 36688
Kevin I'. Larkin (165), Department of Psychology, West Virginia University,
Morgantown, West Virginia 26506
C. .W Lejuez (567), Department of Psychology, University of Maryland, College
Park, Maryland 20742
Angela J. Lowery (497), Department of Psychology, West Virginia University,
Morgantown, West Virginia 26506
Danielle Maack (43), Clinical Psychology Program, Pacific University,
Portland, Oregon 97205
Chelsea MaeLane (43), Clinical Psychology Program, Pacific University,
Portland, Oregon 97205
Nathanial MeConaghy (325), School of Psychiatry, University of New South
Wales, Paddington, New South Wales 2021, Australia
E Dudley MeGlynn (189), Department of Psychology, Auburn University,
Auburn University, Alabama 36849
Peter M. Miller (279), Center for Drug dna Alcohol Programs, Department of
Psychiatry and Behavioral Sciences, Medical University of South Carolina,
Charleston, South Carolina 29425
Elias Mpofu (601), Department of Counselor Education, Counseling Psychol-
ogy dna Rehabilitation Services, Pennsylvania State University, University
Park, Pennsylvania 16802
Amanda M. M. Mulfinger (189), Department of Psychology, Auburn Univer-
,ytis Auburn University, Alabama 36849
Darey Clothier Norling (43), Clinical Psychology Program, Pacific University,
Portland, Oregon 97205
William O'Donohue (3), Department of Psychology, University of Nevada,
Reno, Nevada 89557
Alisa O'Riley (121), Department of Psychology, University of Colorado,
Colorado Springs, OC 80918
Thomas Oakland (601), Department of Educational Foundations, University of
Florida, Gainesville, Florida 11623
David C. .S Richard (461), Department of Psychology, Rollins College, Winter
Park, Florida 32789
Martin L. Rohling (371), Department of Psychology, University of South
Alabama, Mobile, Alabama 36688
XX CONTRIBUTORS
Johan Rosquvist (43), Counseling Psychology Program, Pacific University,
Portland, Oregon 97205
Mohamed Sabaawi (349), Human Potential Consulting Group, Alexandria,
Virginia 22314
Steven L. Sayers (63), Department of Psychiatry Philadelphia Veterans Affairs
Medical Center dna University of Pennsylvania School of Medicine, Philadel-
phia, Pennsylvania 40191
Daniel L. Segal (121), Department of Psychology, University of Colorado,
Colorado Springs, OC 80918
Sandra .T Sigmon (145), Department of Psychology, University of Maine,
Orono, Maine 04469
Nirbhay .N Singh (349), ONE Research Institute, Chesterfield, Virginia 23832
Todd A. Smitherman (189), Department of Psychology, Auburn University,
Auburn University, Alabama 36849
Tiffany M. Stewart (253), Pennington Biomedical Research Center, Baton
Rouge, Louisiana 70808
Julia Strunk (547), Department of Psychology, West Virginia University,
Morgantown, West Virginia 26506
Alecia Sundsmo (43), Clinical Psychology Program, Pacific University,
Portland, Oregon 97205
Thomas J. Tomcho (63), Philadelphia Veterans Affairs Medical Center,
Philadelphia, Pennsylvania 19104
Aaron Triteh (209), School of Professional Psychology, Pacific University,
Portland, Oregon 97205
Paula Truax (209), School of Professional Psychology, Pacific University,
Portland, Oregon 97205
Warren .W Tryon (85), Department of Psychology, Fordham University, Bronx,
New York 85401
Elizabeth Tyner (547), Department of Psychology, West Virginia University,
Morgantown, West Virginia 26506
Karin Seheetz Walsh (529), Mount Washington Pediatric Hospital, Baltimore,
Maryland 21210
Donald A. Williamson (253), Pennington Biomedical Research Center, Baton
Rouge, Louisiana 70808
Erin L. Woodhead (497), Department of Psychology, West Virginia University,
Morgantown, West Virginia 26506
PREFACE
Several texts and handbooks on behavioral assessment have been published,
most of them now outdated. Many new developments in this field cut across
strategies, computerization, virtual reality techniques, and ethical and legal issues.
Over the years many new assessment strategies have been developed and exist-
ing ones refined. In addition, it is now important to include a functional assess-
ment and document case conceptualization and its relation to assessment and
treatment planning. In general, texts and tomes on behavioral assessment tend to
give too little emphasis to work, peer, and family relationships. Many of the exist-
ing texts are either theoretical/research in focus or clinical in nature. Nowhere
are the various aspects of behavioral assessment placed in a comprehensive
research/clinical context, nor is there much integration as to conceptualization
and treatment planning. The Clinician's Handbook of Adult Behavioral Assess-
ment was undertaken to correct these deficiencies of coverage in a single refer-
ence work.
This volume on adult assessment contains 25 chapters in three sections, begin-
ning with general issues, followed by evaluation of specific disorders and prob-
lems, and closing with special issues. To ensure cross-chapter consistency in the
coverage of disorders, these chapters follow a similar format, including an intro-
duction, assessment strategies, research basis, clinical utility, conceptualization
and treatment planning, a case study, and summary. Special issue coverage
includes computerized assessment, evaluating older adults, behavioral neuropsy-
chology, ethical-legal issues, work-related issues, and value change in adults with
acquired disabilities.
Many individuals have contributed to the development of this work. First, I
thank the contributors for sharing their expertise with us. Second, I once again
XX1
XXl I PREFACE:
thank Carole Londeree, my excellent editorial assistant, and my graduate student
assistants (Cynthia Polance and Gregory May) for their technical expertise. And
finally, but hardly least of all, I thank Nikki Levy, my publisher at Elsevier, for
understanding the value and timeliness of this project.
Michel Hersen
Forest Grove, Oregon
1
OVERVI EW OF B EHAVIORAL
ASSESSMENT WITH
ADULTS
WILLIAM O'DONOHUE
Department of ygolohcysP
ytisrevinU of adaveN
Reno, Nevada
KENDRA K. BEITZ
Department of ygolohcysP
Eastern Michigan ytisrevinU
,itnalispY Michigan
MICHELLE BYRD
Department of ygolohcysP
ytisrevinU of adaveN
,oneR Nevada
INTRODUCTION
Behavioral assessment can be best understood by explicating its relationship
to three contexts: (1) its role with respect to the general purposes of assessment
in science; (2) its role with respect to traditional assessment; and (3) its current
and historical roles in behavior therapy and applied behavior analysis. This
chapter will examine behavioral assessment in these three contexts as well as
discuss issues such as: (a) some of the common difficulties posed in the task of
accurate measurement; (b) controversies concerning how behavioral assessment
instruments ought to be evaluated; and (c) the ethics of behavioral assessment.
Clinician's Handbook of Adult Behavioral thgirypoC (cid:14)9 2006 yb ,reiveslE Inc.
Assessment 3 llA rights .devreser
4 GENERAL ISSUES
PLACING BEHAVIORAL ASSESSMENT
IN CONTEXT
MEASUREMENT IN SCIENCE AND SCIENTIFIC
CLINICAL PRACTICE
Measurement can be seen to be one of the most fundamental activities of
science. Results of measurement provide five clinicians with the basic data
or facts that can be used for them to make relevant clinical decisions. Scientists
have to be able to accurately detect the presence or absence of something
(for example, "Are there bacteria present in this sample?"). Thus, detection is a
measurement process and as such can be deceptively difficult. Advances in
instrumentation often are necessary before something can be detected (for
instance, the invention of the telescope revealed other planets as well as
irregularities on the surface of the moon). Clinically, the behavior therapist is
sometimes interested in a detection task (for example, "Is my patient still
using drugs? .... Does this individual have pedophilic interests? .... Is this patient
having suicidal thoughts?"). Detection can be difficult because the target may be
covert (e.g., as in fantasies) and/or the patient may have an interest in providing
distorted information (e.g., as with substance abusers) or may even be difficult
for the client to know and therefore report accurately (e.g., when he or she first
started smoking). Screening instruments such as the Prime MD or HEAR are
examples of attempts to detect the presence or absence of a wide variety of
problems.
In addition to being either present or absent, some entities allow for quantifi-
cation. Things are not simply hot or cold; they have a temperature. Another mea-
surement task, then, is to accurately measure quantity. One problem in behavioral
science is the frequent lack of clarity as to whether some entity can be quanti-
fied. Although it is obvious that cigarette smoking can be quantified (10 ciga-
rettes/day vs. 20/day), it is not clear whether something like sex drive can be
(what scale would this even be measured on---can we compare quantities of male
vs. female sex drive?). Sechrest (1963) has provided a cogent criticism of some
existing measures, such as the Beck Depression Inventory (BDI), because
although some tests give the illusion of quantification (a BDI score of 36 vs. one
of 18), they really do not provide much quantifiable information. We cannot say
that the first score represents "twice" the depression of the latter score; moreover,
we cannot even say that a higher score represents "more" depression, for this
would assume that each question has the identical weight for the composite
depression score. For example, if the BDI is "only" 18, does this mean that the
patient is no longer suicidal? Does it mean that she is less dysphoric? These crit-
ical dimensions are weighted the same as ones that might be regarded as less
indicative of depression (e.g., sex drive). All these reasonable questions cannot
be answered from such numbers. It is possible for the score to lower, but some
of what are generally considered to be the more serious symptoms of depression
OVERVIEW OF BEHAVIORAL ASSESSMENT WITH ADULTS 5
can actually increase in the "lower" composite score when individual items are
considered.
Quantification is important because many of the questions we are curious
about depend on it. Correlation questions (roughly, questions about the preser-
vation of rank order) can depend on it. Correlation questions are interesting
because they provide information about the "relatedness" of variables; a correla-
tion of zero rules out a causal relationship. We need to know basic questions of
more or less when we see if rank order is preserved. Clinically, we are often inter-
ested in reducing or increasing something (e.g., reducing smoking or increasing
assertive behavior) and thus are interested in quantity.
Measurement is foundational to science in its focus on detection (presence or
absence) and its focus on quantity in correlation or causal questions. It is also,
then, fundamental to clinical science. We often want to know whether clinical
problems are present or absent (and we may use screening devices to accomplish
this), or we may want to know therapy status (perhaps to see if we are on the
fight track or even if termination is possible) and thus we may be interested in
measuring quantity (e.g., number of cigarettes smoked).
BEHAVIORAL ASSESSMENT AND TRADITIONAL
ASSESSMENT
Assessment has played a key but changing role in the history of psychology
and clinical psychology. Initially, because psychology had not gone clinical yet,
assessment occurred only in the context of basic research. Therefore, in the late
19th and early 20th centuries, psychologists such as Ebbinghaus (Hergenhahn,
2001) were interested in the number of correctly recalled nonsense symbols, and
Watson and Raynor (Morris, 2000) were interested in the amount of fear-and-
approach behavior of Little Albert. At times, psychologists were assessing vari-
ables that might have some clinical interest, but they were not using this
information to make diagnoses (or other clinically relevant problem statements)
or to develop and implement treatment plans. Psychologists and others in this
period were interested in intellectual testing, sometimes to address basic issues,
such as racial differences, and sometimes, more practically, to help predict and
understand school performance. Thus, intelligence tests, such as the Stanford
B inet, were developed around the turn of the century.
Such tests set the stage for the first quasi-clinical use of tests by psychologists.
They were employed in educational settings but functioned to help identify devel-
opmentally delayed individuals and in general to understand and predict academic
performance. This was critical because psychologists began to be seen as pro-
fessionals who had specialized measurement technologies that were useful for
such practical questions. These tests often met standards that can be seen as some
of the first recognition and implementation of contemporary psychometrics. They
were standardized in administration and scoring; they were evaluated on the
extent of the validity of inferences made from them (e.g., correlation coefficients
6 GENERAL ISSUES
were reported between the preservation of rank order of these test scores and class
rank).
Two other very different developments in traditional testing occurred around
the time of World War II. The first was the use of psychological testing to attempt
to discern cognitive and personality capabilities to determine aptitude for differ-
ent positions in the military. This can be seen as a further development of edu-
cational aptitude testing. The other was the development of projective testing as
part of the growth of psychoanalytic psychotherapy during this period.
One important aspect to note is that assessment was born in the context of
controversy. Intelligence testing existed in the practical controversies concerning
racial differences in intelligence as well as in the controversies concerning the
relative importance of nature vs. nurture. When one side of the debate did not
like the data produced by a study, one avenue of attack was the quality (either
psychometric or assumptions involved in the test) of the test utilized in the study.
Projective testing also became controversial (see Garb, Wood, & Lilenfeld, 2002).
It was controversial both within psychodynamic theory, as different branches
began to disagree about what important constructs ought to be involved in testing
(e.g., id impulses vs. ego-based constructs), as well as outside psychodynamic
theory, as scholars began to question the interrater reliability and validity of these
tests.
This raises an important and thorny issue in measurement: What in traditional
psychometric theory is considered construct validity? Measurement, because, it
also involves a causal process (it is a reaction to the test stimulus), can be coher-
ent only if the constructs are well formed. One cannot answer the question, for
example, of how long a piece of string is. "Piece of string" is a construct that
does not carve nature at its joints.
However, after WWII, partly because the needs of casualties from the war
overwhelmed psychiatry, psychologists began to go beyond their role as tester
to a role that involved actually delivering therapy. Thus, they had needs to
assess questions that were relevant to conducting therapy, such as diagnostic
questions and outcome status. This produced a burgeoning of test development
and, unfortunately, somewhat less of a growth of psychometric evaluation of
these tests.
BEHAVIORAL ASSESSMENT
Goldfried and Kent (1977, p. 409), in a classic statement of the differences
between traditional and behavioral assessment, noted:
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desab no snoitpmussa more elbanema ot direct laciripme test dna more tnetsisnoc htiw
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