



S1: that too you need that. [SU-F: (this) ] yeah okay. um, alright did, people try to go get the materials? [SU-F: yeah. ] and did that go okay? yeah okay. [SU-F: mhm ] really straightforward. um, 
SU-F: do you want us to bring both books like everyday? 
S1: definitely you'll probably wanna bring your reader [SU-F: okay ] since we're gonna be talking about that. uh, there's some useful stuff, um some of the images, that are in the textbook that i'll, talk about a little bit today just so we can all be looking at the same thing so if, if it's convenient, i mean i know that this is a particularly heavy book so you know if, it's not convenient don't bring it but, yeah um it may come in handy at times. so. um, other questions about, just the logistics of the business of the class, where things stand? no. okay. um, today oh actually one other thing yesterday i said i would bring my D-S-M-Four this is the large, uh it's it's pretty incredible it's the large uh American Psychiatric Association's effort to take all psychological disorders and put them in a, a big book with diagnostic criteria, and so i'm just gonna send this around and, look through it as we talk today. um, you know when you first get one of these you just wanna look up everybody you know and, see if you can locate, uh friends and family <SU-F LAUGH> uh so, go right ahead. alright today we're gonna talk about assessment and diagnosis. and this is inevitably placed at the beginning of this course, which is sort of a weird place for it, because, we haven't talked about what we're assessing and what we're diagnosing. you know we don't have the disorders in hand, to be working with, um, but it, it comes to make sense in the end in sort of weird way, to go ahead and start with assessment and diagnosis. and basically the issue around assessment and diagnosis is how do we, uh when confronted with a new person or a new potential patient, how do we start to understand what's going on with them what their dynamics are, what the best kind of treatment is going to be, what's going to be most effective, in trying to help them. and there's lots and lots of different ways, to do this. most times it happens in the context of a clinical interview, that a patient comes to therapy they're looking for help, and the beginning of therapy is really about sitting down with the person and trying to get a sense of, what's going on in their lives and why they've chosen to come, for psychological help. uh, usually when i do this you know i start very open-ended i sort of say, so, you know you felt like it would be helpful to come and talk, what's going on, you know and try to open it up in that way. uh but there are several things that it's really helpful to always try to get a grip on in just an interview process. uh, usually you know my what's going on question is a question about what are your symptoms what's bringing you in what's, upsetting to you. and in that i always try to find out from people, is this something that just started, is this something that's been going on for six years and you've decided now that you wanna come and start to talk to somebody about it or you wanna get some help with it. uh how bad is it? you know so if people say i've been really down. you know i say down what is down, you know what kinda down? and if they say, um you know so down that i'm not, going to my job, that's one thing, if they say so down that i often find when i'm home by myself i cry, that's another thing. we try to get sort of a, a grip on the severity of what they're talking about. um, one question that's always really critical in trying to make a diagnosis is why now? why is this person coming now, uh for help or is there something that recently happened? uh it can be very easy to sort of fall into, you know hearing all about the symptoms and never say, was there something that happened that you think is maybe th- you know causing you to feel more down? um, and often people don't even make the connection themselves and, inevitably it seems like you hear something like, oh well actually yes um, uh the woman i had been dating uh dumped me, very precipitously, three weeks ago. and i guess yeah that's sorta funny an- now that you mention it ever since then i've been feeling extremely down you know so it's, helpful to try to help, make a connection about why the person is coming for help at the time they're coming. um, usually you wanna ask about, you sort of start with really basic stuff about their physical functioning, that, uh it's easy to sort of get drawn into the psychological functioning cuz that you know it's it's very interesting and uh inherently complicated, but it's also really important when you're in the process of trying to make an assessment of, what kind of treatment is gonna be effective, to find out ho- you know are you sleeping are you eating, um, you know are you able to, uh do you have the energy that you usually have, and to find out those kinds of things. partially this can help you rule out another diagnostic possibility. um, people who have thyroid conditions the thy- you know thyroid is, uh, it's a gland that you know it's all sorts of really important hormones. uh, if your thyroid is severely out of whack it has all the exact same symptoms of depression. it's exa- it looks exactly like depression and so what you also want to avoid, is you know going, this whole whole thing deciding this person is definitely depressed it makes all sorts of sense they got a B on a paper they thought they were gonna ge- get an A on, and then um miss something like a thyroid diagnosis. so it's really important to get a grip on the physical condition. one of the things that is very easy for- to forget to ask about, especially when you're confronted with a person who is clean-cut uh looks good very pulled together very articulate um is to ask about drug and alcohol abuse. and this is something that i always try to, you know make myself ask about and get out in the first session. because once, you don't ask about it it can be sometimes very hard to bring up later. and uh this is a really tricky issue when it comes to doing assessments because people are often if they are drinking a lot or doing drugs, it's usually not the thing they wanna tell you first, right people often feel quite, uncomfortable about even coming to talk to a psychologist about something going on, and so then to fess up to uh you know, drinking a fair bit or, taking drugs as a way to try manage what's going on in their lives, isn't something they're inclined to do. um, to some degree this means that psychologists have a rule of thumb that if a person says yes i drink. and you say you know how much do you drink and they say oh two or three beers a night you think okay that's six or seven beers a night you know you sort of do the, you know got a multiplier in your head. um, it's important to be specific. uh i remember when i was beginning my training i met with um, uh a young man who had who was very very depressed and who, um, was feeling suicidal and you know we're sort of having our interview and i asked you know about family history and things that had happened in his past and it turns out his dad had in fact committed suicide when this young man was in high school. um, and you know clean-cut on his way to law school very um articulate, guy and i said you know how about drinking you know, do you drink? and he said yeah a drink a little, you know and i said a little? you know cuz it's very important to be specific, and he said i usually have six to twelve beers a night and then on the weekends i really drink, and i said oh, okay and you know and then that totally changes the scope of what we're talking about and totally changes the focus of what, needs to addressed first. let me take actually a quick uh, um, move away from sort of the central thing of assessment. one of the things that psychologists have really found, about why it's so important to get a grip on the drug and alcohol, stuff early in trying to treat somebody is that you actually cannot be very helpful, psychologically to somebody who is using substances a lot. that it really um, using substances and trying to get help in a psychological manner, are are completely at cross purposes. that you know psychological help, is atry- is about trying to understand hard feelings understand what's going on, get to the bottom of things. and drugs and alcohol when used to treat bad feelings are all about trying to numb bad feelings avoid bad feelings get away from those, and so the two really don't go together very well. and, for a long time psychologists would say to people, um, well it sounds like you've got you know a pretty serious drinking problem a pretty serious drug problem or, you know there's no question that you're an alcoholic but, why don't you and i start talking and, and that'll go away once we figure out what the problem is. and after doing this for about fifty or sixty years psychologists have finally, come to the conclusion that it doesn't work, and that people would be in therapy for six seven eight years and every once in a while the therapist would say so how's the drinking? and usually the patient would say oh, same as it ever was. and it really gets in the way of any progress. increasingly, um when psychologists find out that there's a real drug or alcohol problem the thing that i have come to say is, to the person you know look it sounds like, um, you're really you know using substances a fair bit. and my experience is that uh no matter how hard you try in here it's not gonna be so helpful to you to be in therapy while you're drinking or doing a lot of drugs. and then i'll say, let's do this. why don't you stop for a couple of weeks, and see how that feels, and we'll keep meeting. uh, and let me know how it goes with the stopping, you know, it may be something you can do comfortably may not be something you can do so comfortably, let's keep talking about that. and i sort of make a contract with them, because i- for some people it turns out, that they can stop cold turkey that, you know it's something that's very contextual not a big deal, they've been you know drinking or doing a lot of drugs but they can just stop when they want. for other people they say yeah no problem absolutely i'll stop for a couple of weeks, and you check in with them a week later and you say you know so how's the stopping going, and they say oh you know it's actually not going so well i really, intended to stop, i'm not stopping. and that actually then gives the psychologist a nice opening to say you know maybe that's the first problem. you know if you're wanting to stop and you can't stop i think that's a good hint to us that, let's address that first and then we'll get back to this other stuff. so that's how, um, increasingly psychologists try to manage that. okay moving on to history of psychological disorders. uh, i always ask people you know is this the first time you've, been to a therapist? have you ever been in therapy before? have you ever sought psychological help before? and this is a good hint uh if there's sort of a pattern of, problems you know if a person says yeah actually every three years i drop into these massive depressions, you know i've tried this i've tried that um, that's a good hint that this person maybe has a biological depression that gets kicked up from time to time, or some sort of periodic disorder. uh, it's very infortan- important to ask about family history, and also family history of psychological disorders. especially if you're talking about some of the disorders that have a more medical genetic biological basis, like depression like anxiety, it can really be helpful to make a diagnosis on that. um, i have currently i have in therapy a very, interesting seventeen-year-old girl, who has some psychotic, functioning, uh which in a seventeen-year-old is extremely concerning because usually, psychotic functioning isn't something that starts until people are in their mid-twenties. and uh it's very sort of hard to know where this is gonna go with her and what you know her long-term prognosis is, um but one of the questions i was sure to ask her parents was you know, has anybody else in your family had, you know trouble with their thinking trouble with knowing what's real and not real. and uh the mom said yeah we have a crazy aunt. you know she's always been crazy uh she does all of this really weird stuff and mom went on to describe a fairly extensive picture of very very paranoid behavior very very um, uh you know she would you know, come up with really crazy accusations and level them at people in the family and, you know she would decide one day that her kids could no longer play with any kids in the neighborhood and just had these very sort of, unusual behaviors, and that was helpful for me in trying to figure out what was going on with this adolescent to think, okay there's a good reason to think there's a genetic strain here of some sort of, psychotic functioning. um, in terms of that young woman she's we now have her on antipsychotics and she's doing a lot of therapy and she's, looking better but it's hard to know where it's gonna go with her. um, in addition to family history of psychological disorders i also, just like to ask about family history. um, and i usually sort of say you know, tell me about your family tell me wha- what it was like growing up. and this can obviously ve- be very helpful in terms of getting people to describe their situation, that if there are divorces or deaths or, uh intense interpersonal experiences in the family, um that may impact a current experience, it's really helpful to know. um finally, you kinda want to assess intellectual and cognitive functioning. usually you can do this as you're talking, you know i mean it's not that hard sometimes to tell, you know roughly, where a person stands in their sort of intellectual functioning just by how they talk how they interact, their memory their ability to stick with one topic and stay on it. this can begin to become an issue if you suspect that there may be something like, a slight retardation or, uh a learning disability um, so it's it's something that when you start talking about cognitive disorders then we'll spend a whole section on that, disorders like dementia or delirium that you'll you'll do a more thorough assessment of intellectual and cognitive functioning, for most psychological disorders it's really not that critical. uh, those are sort of the question parts of doing assessment. um, there's also a very much more subtle part of doing an assessment, that is harder to describe but ends up i think in some ways being one of the most critical parts of assessment, which is what it feels like to be with the person. uh, that a lot of times you can get a sense of, somebody's experience by really tuning in to your own experience of being with them. so let me give you a couple of examples. uh sometimes if you are a- assessing somebody who is extremely depressed, it is one of the most depressing situations you've ever been in. that they are, really lethargic they talk really slow, they they communicate this you know in their body language they're slumping, uh they don't look good, um, if you ask them you know is there anything that you feel is going well in your life right now they say, no. you know <LAUGH> and by the end of about forty-five minutes of that you're ready to like walk out, you know go home for the day, go back to bed. and that that's actually a very powerful assessment tool that sort of, wow you know before i met with that person i was feeling fine i was you know, energetic and the experience of being with them. here this is clearly a very depressed person they, you know, there's no question that that is there. um i'm gonna show you an interview, in a little bit of a man who's quite depressed. and it's funny because there's a little bit of a split between he's he's pretty talkative, he's able to talk and yet i bet as you watch it if you tune in to yourself you will feel yourself sort of slipping into more and more of a funk as you listen to him and that that is actually a really, good way to get a grip on what's going on with somebody else. and <LAUGH> another person i assessed this was probably the, uh the highest, level i had ever had of really being, um, affected by a person, which was a woman who had borderline personality disorder which we will get to. and basically that is a personality disorder where boundaries are not well in place people are, can be at times extremely disorganized. um, and, uh, have a lot of trouble in relationships a lot of trouble maintaining boundaries in relationships, and and this woman on top of that um, was having an extremely hard time she was very disorganized in her life, um, didn't function particularly well, and so the very first time i met her i went out to the waiting room to get her and i brought her into my office, and she had with her, um, a bunch of Saltines in you know how like a Saltine wrapper like you take out of a cardboard box, she had that and it was open and she had a big Coke without a lid on it and a straw, and so she comes into my office <LAUGH> you know and just there's stuff all over immediately there's crumbs all over and she says do you want some do you want so- want a cracker? an- and and i, said no no why don't you come on sit down and she's like okay, do you mind if i eat? and i said no no no that's fine. so i have a little table in my office and so she sets up her whole thing i mean and and i had just met this woman and she proceeds to eat those Saltines and i mean there's Saltine stuff like everywhere in my office in about five minutes. and so i'm trying to give my you know my t- what's going on you know how can i help you and she could not keep track of my questions at all. i mean she really, was all over the place, um, and you know i said is there anything in particular that's bringing you in now? and she said yeah yeah i've had this relationship and she goes on to describe this relationship but then suddenly it turns out she's not describing the relationship she started out describing she's now describing the relationship from three years ago, and they all kind of blended together in the way she was talking about it, um, and, so i you know i i've got this set of questions i wanna ask her and it's really clear to me there's no way i'm gonna get through these questions, and even whatever i get i'm gonna have to really sort out later. uh, and <LAUGH> i- finally it was the end of our time together, and i could tell this was gonna be a problem too, that getting her out of the office was gonna be an issue. and so, about five minutes before it's time to stop i say, we have about five minutes until it's time for us to stop so let me just ask you a couple more questions and then we'll wrap up. you know so trying to prime her for this. uh, so then, you know that, was a disaster you know she, talks and talks and talks and talks, and i say, okay you know well it's time for us to stop you know would you like to come back? and she doesn't answer that question but goes back to something else she was talking about. it finally comes to the point where i actually had to stand up, right, in order for us to leave the office i have to stand up, and say okay, you know let's find another time to meet. and um, so finally, uh that worked and she left, and in the next half hour i proceeded to lose my keys, left my bag somewhere, um started four projects that i did not finish uh, and i realized that i had completely absorbed, the experience of what this woman's life is like, i mean this extremely disjointed, confused, um having a hard time, you know keeping boundaries separate, starting and finishing something, and i thought, wow you know i, you know in a half an hour picked up, you know in the forty-five minutes together we- you know picked that up, um, and i think i just got a tiny glimpse into what her life feels like for her all the time, and much worse, than what this last half hour felt like me for me. so, those are the kinds of things that, are can be really helpful. there can also be um, mor- other interpersonal interaction stuff that happens like, uh sometimes you meet with somebody and they absolutely give you the worst creeps you've ever had in your whole life and you can't quite put your finger on it but you <LAUGH> lea- you leave thinking gosh i hope that person doesn't hav- find my number, you know that an- and that's something to respond to, you know that it doesn't happen that often and when it happens you have to listen to that and you have to think okay what was going on in that interaction, that i feel really creeped out now having met with that person. um, another thing that can sometimes happen, is that people can be very um, critical of, me. you know that they'll say, now, you have a PhD do you have a PhD? and i'll say mhm yeah and they'll say now where'd you get your PhD, <LAUGH> you know i'll say, uh you know i got it at, University of Michigan. and how about college where'd you go to college, and the- and they'll turn it into a, a grilling session of my credentials. and, um usually i'll say something like it sounds like you have a lot of questions about my, credentials. <LAUGH> you know and and try to get you know get it back to them and what that's about. but then, and that's a good hint. you know either this person's feeling anxious about my abilities to help them or they're feeling, you know or maybe it's somebody who's very narcissistic and they only wanna be with the best therapist in the whole wide world you know and, and that those are things you can start to take in early. okay so that's sort of the fun part of doing diagnosis (sorta) all that kind of detective work, involved. let me show you an interview and this one is a more semistructured interview and it's um, a man being interviewed who is depressed and he's being interviewed with a, um, not quite as free form as what i'm describing here. but the interviewer sort of follows up questions. and so, i think i can do this all the way from over here. um, see what you think. 
<MOVIE STARTS 20:02> 
S1: Bernie if you wanna come over here so you can [SU-M: yeah ] see.
<MOVIE ENDS 30:09> 
S1: okay, you wanna stop it here? <P :04> could you guys feel that? i mean di- i mean he he as he's talking and he he answers questions and he looks okay but could you feel, the sort of the monotone and the bleakness, you know that you can kind of get that, vibe from him. um, that video also raises an important issue around always checking about people's suicidality, and this is something that you also wanna be sure when assessing somebody, to touch base about. um, and it's usually it's something that you very are naturally drawn to when you work with somebody who's presenting with depressive symptoms that you always sort of say, have you had thoughts about hurting yourself or wanting not to be alive? um, but it's something that you actually have to ask everybody, and it can really be a surprise sometimes because people can present with a very chipper, you know oh yeah no things are mostly fine i'm just worried about this relationship, and then you know you- so in those situations i usually say i know this probably sounds like kind of a question out of the blue but, here's something that's important for me to ask, have you ever had thoughts about hurting yourself or wishing you weren't alive? and i've been surprised by often people will say yeah actually i do think about that sometimes and and that that really um, changes the whole nature of the assessment you're doing. uh in part because, uh obviously the safety is the major, thing you've gotta protect before you do anything else, and so, if somebody does indicate to you that they're thinking about killing themselves or they've had that thought, it's then really important to assess how real that threat is. and often if you say you know oh that sounds like you know pretty serious, is that something you've thought that you really might do or is it something that just kind of goes through your mind and then you let it go? often people say oh it's you know it's just a thought it's like i would never do it usually and that's, the response and that's where they leave it. but sometimes they'll say oh no i it's something i think about sometimes it's an option, i consider, and then you sort of have to take it another step and you say, is it something that you've ever thought about having a plan for how you would do it, and sometimes people will get off, the track there and they'll say oh you know i mean i kinda think about but i don't you know I don't even know how i would ever do it it's you know something i wouldn't do. and of course as you're asking all these questions it's a it's a pretty, anxiety provoking situation and so you sorta hafta, say oh okay you know if it's something they say yeah yeah no i, mean no my husband has a gun and he keeps it in the garage you know an- and i know it's there you know so then you sort of have to proceed and say you know do you have bullets for the gun. and you know if the person says no no no we don't buy bullets you know that that's you know you sort of, relieving. and if she says yeah well actually i normally keep the bullets separate but i know where they are, and (then) so you can see how this really_ you proceed down this line, and if it becomes clear, through this line of questioning that there's a real risk that if this person leaves your office that they're, you know having talked about this a little bit, told somebody else that they're gonna think, you know, i can go through with that. um, you actually can't let them leave your office. you know you have to say this is really serious it sounds like your safety's in question, um, we need to make a plan, um, and this you know can be a very awkward and difficult way to meet somebody <LAUGH> and start a therapy, but obviously they've come for help so, you do all you can to help them. um on a slightly lighter note <LAUGH> i had a really incredible experience with this when i was just starting out as a therapist and um, i, uh, i was meeting with a young woman who was very very upset about a break up and, so you know, but she seemed very you know fine. i i wasn't particularly worried about suicidality but i asked anyway. i said you know, sometimes when people are this upset they think about hurting themselves is this a thought you've ever had? uh and she says no, she said, well maybe a little bit. sometimes y- you know when i'm really mad at my boyfriend i feel like, you know, boy i could make him pay. and so i th- i say, you know have you ever thought about how you would do something like this? she said no no, except for i am allergic to peanut butter so if i took- if i ate peanut butter that would kill me. <SU-F LAUGH> and so then what's the question i had to ask next? do you have any peanut butter? <SS LAUGH> (you you feel like such an idiot) i had to ask her this cuz it's her plan. and she says oh no i don't buy peanut butter you know. and so that was the end of it. but i thought i never thought i would be asking somebody do you have any peanut butter? <SS LAUGH> so okay. lighten that up. um, let's talk about psychological tests. so there's interviewing, um, which is my personal favorite way, of trying to figure out what's going on. but there're also tests, and these can be used obviously in a much broader sense you can give the test to a lot of people at the same time, um sometimes they can be very helpful in trying to get a grip on, um specific issues that you're trying to assess, and when we talk about tests we always have to talk about validity and reliability, and this is stuff that is probably familiar to you from Introductory Psychology. uh, all these kinds of validity that you have here on your, um, in your notes, are fancy names for what is basically common sense. and since you've got the definitions right there i'm gonna go through this pretty fast, and just give you examples. face validity is that you're giving a test that measures what it appears to measure. um, basically if you're asking, if you're doing a test of anxiety you want your questions to look like they're anxiety questions. you want them to ha- say things like you know do you ever feel panicked or nervous, does your stomach ever feel upset, do you ever have a hard time falling asleep right very sort of straightforward, tests should be_ look like tests of what they are. um, content validity, uh starts to get more interesting. basically, any phenomenon that we're trying to assess, usually has several aspects involved. so to return to, anxiety as an example. anxiety has cognitive components, you know if people are thinking about it they're thinking, oh my gosh i'm never gonna get all my work done this is terrible uh you know, uh i'm behind, it has physical components that people feel physically anxious they may feel nauseous they may feel sweaty they may have headaches, uh their heart may pound, it has emotional components right that they think, they feel dread, they feel scared, they feel nervous all the time. and so a good test of something like anxiety, is going to target all of those. and that's what content validity is is it asks about all of the content areas that are relevant to the thing you're trying to assess. so a bad test of anxiety would only say, do yo- does your heart pound sometimes? do you break out in a sweat? does your stomach feel bad? right? those are the those are the, at times the physiological effects of anxiety, but that's not a really good anxiety test. a good anxiety test is gonna ask about a lot more than that. okay concurrent validity. does the test you're working with yield the same results as other established tests in that area? okay. so say there is a fantastic anxiety test out there it's been around for fifty years, it's really well done, it's really well validated, everybody knows it's a good test, um, and we'll call it anxiety test number one. you give this anxiety test number one to an anxious person, and they score a ninety-five, right, which on that test means really anxious. say then i develop my own, fancy new anxiety test number two. and i develop this and i sit down and i come up with a bunch of questions i think are good anxiety questions, and i give it to the same person who just got a ninety-five on the anxiety test number one. if that person on my test scores a four, for anxiety on a scale of a hundred, i'm gonna p- start to doubt the test i've just developed. a really good solid test, anxiety test number one, this person's got a ninety-five, on my test, they don't even show up as anxious, probably a problem with my test. so part of how we develop new tests is we make sure they match with the results of other good old tests. um, if there's a good old test you may be wondering why you <LAUGH> need a new test sometimes you wanna come up with a shorter form, maybe the good old test has a hundred and fifty questions and people don't like it or they start to blow off the questions at the end of the form, so you need to come up with a smaller more efficient one, but you wanna know that it's at least as sturdy as the test that you are trying to replace. uh, predictive validity, if you have a test that you're using that's trying to predict behavior, you wanna make sure that it actually predicts the behavior it says it's going to, I-Q tests are a great example of this, um, the do- idea behind an I-Q test is you've got somebody really smart they should be going out and doing smart things right, so if you continue to give I-Q tests and get really high scores but, uh people don't seem to be able to perform well academically they don't seem to be able to perform well in other areas, you start to wonder, uh if this is a measure of intelligence how come it's not predicting too intelligent behavior? are we actually measuring something other than intelligence here? uh, finally there's construct validity. and this is probably the most complex one, is the test measuring what it's supposed to measure, not something else? the absolute best example of this is probably the S-A-T. and a lot of people've had questions about the S-A-T, and whether it's actually measuring you know school ability intel- and intelligence or if it's measuring multiple choice test taking skill. right, because people sort of ar- you know have this idea that there is such a thing as skill at taking multiple choice tests there's some people who, you know don't perform very well on long written tests but if you give 'em a multiple choice test they're gonna absolutely ace it. um also as you, i'm sure remember it the S-A-T takes a fair a bit of endurance right, you have to be patient <LAUGH> you have to be willing to sit there you know a- for hours filling out little bubble forms, uh, and maybe that's a skill of its own. and so people have said you know a high S-A-T score may not be, you know that this person is somehow brilliant, it may be that they're really really patient, they're able to make good choices on multiple choice exams, and a low S-A-T score may not reflect poor school ability it may reflect that this person is impatient or impulsive, or you know they choke when they get to a multiple choice test, uh and so that construct validity of the S-A-T has been called into question a lot. mkay, any question about those, so far? okay let me mo- move on to reliability then. um, and basically reliability, the best way to think about it is test consistency, meaning a test has to be able to give you consistent results across a variety of situations. uh, one example of this is test retest reliability. if you give somebody a test and you come back to them six months later and give them the same test, are they gonna get roughly the same score? you want them to do that. that would be good test retest reliability. what you don't want you know assuming your s- testing a stable trait, what you don't want is to give somebody an I-Q test one week and they get a hundred and forty and then you come back six months later and their I-Q has dropped down to a hundred. right that this is not something_ we don't think I-Q shifts around like that, so we think that test must not be so good, if that's what's happening. um, another thing is alternate form reliability, that there are times when people wanna use two different forms of the same test. uh for example, you know, when i teach a large class i'll usually generate a couple of different exams, uh obviously i want these exams to be consistent in terms of their difficulty of questions the things on them, you know to be fair to students. and so if i give one exam, and you know, ninety-five o- percent of the students who take that exam score in the ninety percent range and above and then the other <LAUGH> exam (in) ninety-five percent score in the sixty percent range or above, bad reliability right these are not reliable exams they're not consistent with each other. um, another version of that is that we have I-Q tests for different ages, there's an I-Q test for kids who are preschoolers and I-Q test for kids who are lo- you know lower schoolers, um and then there's one for middle schoolers and then there's one for high schoolers and adults. and even though these are completely different tests and they, you know use very different methods for assessing little kids than you assess adults, they should all come up with roughly the same score if you test somebody across their lifetime. um, and i've been impressed actually the current I-Q tests that we use, uh actually do. they u- i've done testings with high schoolers with their um, lower school I-Q scores in front of me, and they usually come up with very similar results which is a good you know it means the I-Q tests are sturdy and well designed. um, internal liab- reliability. you want different parts of the same test to produce roughly the same result results. uh basically this means that your questions are sort of even in their level of difficulty, even in terms of assessing roughly the same things. uh another way of putting that if i um, uh give an exam with a hundred questions, i should be able to select, thirty questions out of there and the average of those should be very close to the average of the whole one hundred. that that really speaks to the stability, and reliability, of the test. finally there should be interrater or interjudge reliability. if it's the kind of test that's done by observation, and so say for an example, um i've got a test of, um how well decorated somebody's home is, right and i go in and i've got my little decorator home, thing. and i score that person's home, on that quality. somebody should be able to take the same form i have and get roughly the same results. you know that i- this the form should be designed well enough that, two different people who fill out the same form on the same topic are gonna come up with roughly the same results. does that make sense? okay. um... moving on, there are lots of different kinds of tests for assessing, psychopathology, and of course the issues of validity and reliability that i've talked about so far apply to all of these. um, first ones are biological tests. these are pretty incredible. um, and mostly we use these for looking at people where we think there is a brain disorder, that is causing psychopathology. uh obviously we wanna do this on a living subject um, you know, one of the problems with Alzheimer's is you actually cannot conclusively diagnose Alzheimer's until somebody has died. uh because you need to look at certain brain abnormalities, and right now we have no way of looking at those brain abnormalities while the person is still alive. there are however, a couple of unbelievably cool tests that you can use to look at somebody's brain while they're still alive and awake. um one of them is an M-R-I, has anybody ever had an M-R-I? you get 'em for knee surgeries and all sorts of things. uh, the cool thing about M-R-Is is that they can actually take an X-ray of soft tissue. you know before the M-R-I, you could only X-ray things that were, hard like bones. and M-R-Is actually use technology that allows doctors to look at soft tissue through skin. it's a pretty incredible thing. uh, the same can be done to look at the structure of the brain, and look at how the brain is functioning and you can basically take an X-ray of the brain. um, you can find out things like the presence of cancer, right if somebody also has psychotic symptoms and you think maybe they have a tumor, that is causing these, that's a very effective way to try to check, um, you can also, look to see if the ventricles of their brain which are the open spaces of their brain, are growing which means their brain is shrinking, uh which is sometimes found in schizophrenia, the- these are all things you can do i'll show you some pretty cool tape on this. another a- and i think these are absolutely unbelievable are PET scans, i doubt anybody here has ever had a PET scan. a PET scan is a positron emission tomography and this is in your in your textbook. and basically what happens, is you go to the hospital, to get this done and you drink radioactive, juice. uh Kool-aid they put radioactive [S2: i had that. ] you ha- you know about this?
S2: yeah cuz i had, stress fractures in my feet [S1: oh okay ] and they (xx) and it like shows up on the screen and it glows 
S1: yeah it's this incredible thing you drink uh, d- what was your drink like that you had?
S2: i don't_ it was it was kinda like Kool-aid and so- it was so weird but it tasted good.
<SS LAUGH> 
S1: um, maybe you can get some for class. uh so they put radioactive isotopes in a liquid. and you drink them. the way it works on the brain, this is absolutely amazing. there is glucose in this radioactive i- isotope and glucose is something your body metabolizes when it's metabolizing actively. they then, um, give people mental tasks, while they have their head in a CAT scan, something like a CAT scan, machine. and when your brain is working different parts of your brain work to do different tasks, but when your brain is working, it metabolizes glucose, and so in those areas that are metabolizing more glucose you get a concentration of radioactivity. and basically it looks like the weather charts when you're watching to see if a storm is coming through you know how they get the radar and they've got the, the thunderstorm is where there's the red and then it goes from there, that's exactly what it looks like in the brain and we'll, i'll show you that. and so you can really see if people's brains are working right, by seeing which parts are using the most glucose at the right time, and if the right parts are using glucose, at the right time. uh, and so this can be hugely helpful in, not only looking at the physical structure of the brain which is what the M-R-I can do, but in looking at the actual functioning of a- of a living brain as it's actually functioning. um, let me show you uh a couple of the segments, they have um, i think the second one shows, a schizophrenic person who is, um supposed to be doing a task and his brain does not light up in the right ways. which is a hint, um, as to what may happen in schizophrenia, with brain processes. <P :14> so PET scan so it's positron emission tomography and that's this is the radioactive isotope stuff.
<P :07> <VIDEO CLIP STARTS 47:41> 
S1: this is the schizophrenic man.
<VIDEO CLIP ENDS 50:25> <P :06> 
S1: so now this is just_ looks at soft structure it doesn't look at functioning, but this is the X-ray of, soft tissue. 
<P :06> <VIDEO CLIP STARTS 50:42> <VIDEO CLIP ENDS 51:40> 
S1: i'm gonna stop it there. isn't that amazing. i just, think that's unbelievable could somebody, turn the T-V off? (it just has a button.) thank you very much. we have an option right now. do people wanna take a five minute bathroom break? um, why don't we do that. uh just cuz it's, this is a long two hour stretch. so the bathrooms are right there, or just get up and take a stretch um, right next to the, water fountains and then we'll come back in five minutes and by my watch it's five minutes after ten right now. so, if people need to, do that please feel free. 
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