In this report Julia has selected an assessment instrument that will be used in the mental health counseling field area of professional practice, the Beck Depression Inventory-II. Reviews of the assessment will be read to ensure that the assessment measures what it purports to measure and that the article reviews will also establish an appropriate use of that tool. Julia has also analyzed the theoretical basis of the article choice for the chosen assessment tool. In addition, Julia will compare who the test developers or publishers and independent reviewers to discuss the applicability of the assessment tool to diverse populations. Julia will provide information cited by the publisher where applicable. Along with this information, Julia will discuss how the comparison of the BDI-II to other assessments can help the counselor make an ethical judgment of the applicability of using the tool within diverse groups of clients. Finally, Julia will cite any relevant sections of the code of ethics for mental health counseling within the American Counseling Association as well as the Mental Health Professional code of ethics. It is also important to state that the names of participants used are fictional due to privacy of certain individuals.
Ethical Use of Assessment
Psychological Testing Ethics
Ethics are an essential part of administering psychological tests and it is necessary that all test users follow the ethical guidelines for assessment when using any type of psychological test. Psychological tests are an important tool in terms of many professions in an array of settings such as in clinical psychology, education, and even business. However, misuse of psychological test by the administrators is a constant and troubling issue that has the potential to harm the individuals who are taking the test and even society as a whole. For test takers, the misuse of a psychological test could result in improper diagnoses or inappropriate decision making for their therapeutic process. The misuse of tests reflects very poorly on the professional organizations along with highly trained test users. Overall this will result in poor decisions that may harm society in both an economic and mental fashion (Beck, Steer, & Garbin, 1988).
Usually test administrators do not intentionally misuse tests, but rather are not properly trained within the technical knowledge and overall testing procedure involved in administering the test. In an effort to prevent the misuse of psychological tests, psychologists developed a set of professional and technical standards for the development, evaluation, administration, scoring, and interpretation of all psychological tests. Professionals can overcome the misuse of tests simply by understanding these professional and technical standards involved in using psychological tests (Beck, Steer, & Garbin, 1988). Beck developed a manual to help the administrator of the BDI to interpret the results of the inventory, which includes fifty reviews within a thirty page manual (Conoley, 2012) In any situation in which a professional offers advice or intervenes in a person’s personal life in any way, issues regarding fairness, honesty, and conflict of interest can exist. The term ethics directly indicates any issues or practices that have the potential to influence the decision making process that involves doing the right thing.
Therefore, ethics refers to the moral aspect of right or wrong in regards to various things such as an entire society, an organization, or a culture. Among many professions, there is a set of practice guidelines which are known as ethical standards in which each member of those professions elect on such codes after debating and discussing their various concerns of these particular guidelines that would make the process of testing more effective and ethical (Beck, Steer, & Garbin, 1988). However, it is exceptionally difficult to achieve universal agreement when it comes to ethics. For example, numerous psychologists disagree with each other in terms of the proper way to interpret a client’s right to privacy. Issues such as whether knowing a client may be a danger to themselves and others should be protected from legal inquiry poses what is known as an ethical dilemma.
Ethical dilemmas are problems that will arise in which there is no clear, direct, or agreed upon moral solution. While ethical standards are not government appointed laws, violating ethical standards of an organization or profession can have numerous and varied penalties as well which can include expulsion from the organization. Testing is an essential part of the psychological network, and if used improperly, can cause harm to individuals without their knowledge. Therefore, it is necessary that an ethical use of psychological tests is provided to anyone who relies upon them (Beck, Steer, & Garbin, 1988).
Psychological Testing and Privacy
Ethical standards indisputably cover a large amount of ethical concerns and issues with a common purpose involving protecting the rights of any individual that becomes a recipient of any psychological service including testing. The Ethical Principles have a goal to respect individuals, safeguard individual privacy as well as dignity, and censure any unfair or discriminatory practices. There are many issues of concern when it comes to ethics, one such issue being the right to privacy (an enormous issue in the mental health counseling profession). The concepts of individual rights and privacy are a fundamental part of any society. The Ethical Principles affirm individual rights to privacy and confidentiality as well as self-determination, meaning that each client has the right to be able to discuss any presenting issue with their therapist and the discussion stay within the bounds of the office and to participate in the decision making of the therapeutic process.
The term confidentiality indicates that individuals are guaranteed privacy in terms of all personal information that is disclosed and that no information will then be disclosed without the individual’s direct written permission. There are times however, that confidentiality is breached because counselors within a business setting, for example, will seek out psychological information about their employees. Another example of confidentiality being breached in a professional setting is when teachers may seek prior test scores for students, however, with the good intention of understanding issues of performance (Beck, Steer, & Garbin, 1988). Counselors will also disclose any information the client discusses with them if the client intends to harm himself/herself and or others and when any type of abuse is indicated during the session.
Psychological Testing and Anonymity
Another term involved with an individual’s right to privacy is known as anonymity. Anonymity refers to the practice of obtaining information through the use of tests while concealing the identity of the participant involved. Anonymous testing is more commonly used in double-blind studies in which the researchers are completely unaware of the identity of the participants of the study. It is suggested that anonymous testing may provide more validity in terms of accurate and truthful information about participants because participants will be more likely to answer questions truthfully about themselves when their identity is not revealed (Beck, Steer, & Garbin, 1988).
Psychological Testing and Informed Consent
Another important issue is the right to informed consent which means that the client has the right to know exactly what is happening at all times during the testing and therapeutic process during therapy. Self-determination is a right to every individual which means that individuals are entitled to complete explanations as to why exactly they are being tested as well as how the results of the test will be utilized and what their results mean. These complete explanations are commonly known as informed consent and should be conveyed in such a way that is straight-forward and easy for examinees to understand which is most of the time done in a language in which the client understands what is being explained to them. In the case of minors or those with limited cognitive abilities, informed consent needs to be discussed with both the minor examinee themselves as well as their parent or guardian (Beck, Steer, & Garbin, 1988).
However, informed consent should not be confused with parental permission. Counselors have a responsibility to ensure that the minor examinee as well as their parent or guardian understand all implications and requirements that will be involved in a psychological test before it is even administered. In addition to the issue of informed consent, participants are also entitled to be prompted with an explanation of the test results in a language structure that they understand. However, due to the fact that some test results may influence the participant’s self-esteem as well as behavior, it is crucial that a trained professional explain the results to the participant in a sensitive and understanding manner so that the participant responds to the items on the test with accuracy (Beck, Steer, & Garbin, 1988).
Psychological Testing and Stigma
Another issue that involves ethics in terms of psychological tests is the right of protection from stigma. In conjunction with the participant’s right to know and understand their results, researchers need to be careful not to use any labels which might be interpreted as a stigma when describing the results in terms of and to the participant. Counselors and researchers must refrain from using terms such as “insane,” “feebleminded,” or “addictive personality”. Therefore, the results that the client receives, along with the parent or guardian in cases involving minors, should be describe in a positive way so that the growth and development of the participant is not disrespected in any way (Beck, Steer, & Garbin, 1988). Beck Depression Inventory versus Beck Depression Inventory-II Beck Depression Inventory (BDI) was designed to evaluate the possibility and severity of depression along with suicidality issues. The BDI was developed by Aaron Beck and his associates back in 1961 as a structured interview. Even though Beck is known for using a cognitive therapy methodology, the BDI is not designed in that fashion. Beck used language that was conducive of a fifth grade level to develop twenty-one items from which the participant can choose a level of severity from four option with each particular item.
Cautions that Conoley (2012) mentioned in the review are those of fakability and social desirability. The individual participant may not be entirely truthful when choosing the severity of his or her level for items on the inventory. He or she may score higher or lower depending on how the individual responds to the inventory. Julia has also found that sometimes a participant has suffered from depression for a length of time in which makes responding to the items difficult since this individual may feel as though what is normal for him or her may not be normal for another individual. For example, Elka may score lower but has been presenting with depression much longer than Norma who scored higher due to the adult onset of depression versus the early onset of depression. Even though the BDI has been used extensively for about twenty-five years prior to revision in 1987 and again in the 1990s. Many articles touted the use of the BDI causing psychologists and therapists to use the original version created by Aaron Beck. The most recent BDI revised the original version with the rewording of fifteen out of twenty-one of the items due to discriminatory wording.
The most recent revision also took into account the changes that were made to the Diagnostic Manual for Mental Illness which correlate with the criteria for depression on a much higher level. It is plausible to have a more recent version created due to the Diagnostic Manual revision this past year in 2013. All versions of the BDI are designed to evaluate the probability of depression and suicidal tendency for individuals aged thirteen and over for a timeframe of five to ten minutes of the participant choosing the criteria associated with each item. The most recent version of the BDI has also revised to avoid sex and gender discrimination. These factors make the BDI-II a much stronger assessment tool which the counselor uses to evaluate the client’s presenting symptoms of depression (Arbisi & Farmer, 2012).
Psychological Testing and BDI-II
All of the ethical issues discussed above come into play when the counselor tests for depression of a client including the severity and longevity of the presenting symptoms of depression. Mental health counselors use the BDI-II to evaluate the possibility and severity of depression with which the client presents, in which it does. Usually the client will make a statement concerning the longevity of their presenting symptoms of depression which gives the counselor an idea of how long the client has been feeling depressed. Both are helpful in not only appropriately diagnosing the severity of the depression but also knowing what steps to take in the way of a treatment plan.
Beck Depression Inventory-II and Diversity
BDI-II has been modified and or translated into several different languages to address diversity in several cultures, such as Mexican-American, Chinese, as well as the elderly and older women groups. The items are modified in a way so that each group understands what the item is addressing as well as the ethnicity of each diverse group. Depression presents itself differently across cultural groups. What displays as depression in a Caucasian is most likely not display in an identical way with another culture group, such as African-American, Hispanic, Latino, Norwegian, etc. (Joe, Woolley, Brown, Ghahramanlou-Holloway, & Beck, 2008). The BDI-II has also been modified to address differences between adolescents, adults, and elderly. The elderly population has a much different presenting issue with depression.
BDI-II and Counselor Judgment
The counselor must make a sound judgment in choosing the BDI-II for use in evaluating a client’s presenting issues concerning depression, which includes comparing the BDI-II to other depression inventory assessments such as the CAD (Clinical Assessment of Depression) or the PHQ-9 (Patient Health Questionnaire-9). While the BDI-II is comparable to the PHQ-9 in statistical analysis, the CAD seems to be more accurate in evaluating clinical depression. However, the CAD consists of fifty questions which take about ten minutes or more to complete. For this factor alone the client may not accurately respond to the items on the CAD due to the length even though studies show that it results in a more accurate evaluation of depression (Arbisi & Farmer, 2012; Faxlanger, 2009; Kung, Alarcon, Williams, Poppe, & Frye, 2012).
Even though the cost of the BDI-II cost much more than the CAD, the CAD is a relatively new assessment that has not had the longevity that the BDI-II has. The PHQ-9 does not have a cost connected to the assessment, but it is not as well-known as the BDI-II. Once Julia has established herself as a mental health counselor, she will explore the three tests further to see the effectiveness of each test compared to the other so that she can make a judgment on which test is more accurate and effective in diagnosing her clients (Arbisi & Farmer, 2012; Faxlanger, 2009; Kung, Alarcon, Williams, Poppe, & Frye, 2012).
In conclusion, the BDI-II seems to be the most effective assessment tool in diagnosing clinical depression. The American Mental Health Counselors Association Code of Ethics (2000) reports that the counselor is responsible for ensuring that each client is assessed appropriately including using the most appropriate test for the client’s presenting issues for diagnosis. The Code of Ethics also cautions the counselor in privacy, interpretation of the results, and to be trained for the assessments in which he or she will use in practice. As before stated, Julia will explore all options for testing for diagnosing clients as well as continued training in testing and interpretation of the results of each test used in practice.
American Mental Health Counselors Association (2000). Code of ethics. Retrieved March 9, 2014 from www.amhca.org/assets/content/CodeofEthics1.pdf
Arbisi, P. A., and Farmer, R. F. (2012). Beck depression inventory-ii. Mental Measurements Yearbook and Tests in Print. Accession Number: TIP07000275. Mental Measurements Review Number: 14122148. Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77-100. Cappeliez, P. (1989). Social desirability response set and self-report depression inventories in the elderly. Clinical Gerontologist, 9(2), 45-52. Dahlstrom, W. G., Brooks, J. D., & Peterson, C. D. (1990). The Beck Depression Inventory: Item order and the impact of response sets. Journal of Personality Assessment, 55, 224-233. Gatewood-Colwell, G., Kaczmarek, M., & Ames, M. H. (1989). Reliability and validity of the Beck Depression Inventory for a White and Mexican-American gerontic population. Psychological Reports, 65, 1163-1166. Joe, S., Woolley, Ghahramanlou-Holloway, M., Brown, G. K., Beek, A. T. (2008). Psychometric properties of the Beck Depression Inventory-II in low-income, African American suicide attempters. Journal of Personality Assessment Volume 90, Issue 5, 2008. Retrieved March 8, 2014 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729713/ Kung, S., Alarcon, R. D., Williams, M. D., Poppe, K. A., Moore, M. J., Frye, M. A. (2012). Comparing the Beck Depression Inventory-II (BDI-II) and Patient Health Questionnaire (PHQ-9) depression measures in an integrated mood disorders practice. Journal of Affective Disorders, Volume 145, Issue 3, Pages 341-343, 5 March 2013. Retrieved March 9, 2014 from http://www.jad-journal.com/article/S0165-0327%2812%2900586-1/abstract Faxlanger, L. (2009). The clinical assessment of depression vs. the Beck depression inventory. Retrieved March 9, 2014 from http://lisamarie1019.blogspot.com/2009/09/clinical-assessment-of-depression-vs.html Steer, R. A., Beck, A. T., & Brown, G. (1989). Sex differences on the revised Beck Depression Inventory for outpatients with affective disorders. Journal of Personality Assessment, 53, 693-703. Steer, R. A., Beck, A. T., & Garrison, B. (1986). Applications of the Beck Depression Inventory. In N. Sartorius & T. A. Ban (Eds.), Assessment of depression (pp. 121-142). Geneva, Switzerland: World Health Organization. Talbott, N. M. (1989). Age
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