Assessing the Problem and Testing the Psyche
Building a Better You
Five Ways to Quickly Reduce Stress
Breathe deeply and slowly.
Eat healthier foods.
Engage in a mindless, repetitive task.
Tell someone how you’re feeling.
In This Chapter
Taking history notes
Making the grade
Typing the tests
Pulling the wool
People go to a psychologist or other mental health professional usually because they’re experiencing strong negative emotions or facing difficulties in their everyday lives. Just like when visiting a general physician, a person goes to a psychologist’s office with a complaint, issue, or problem. A lot of times, the individual is looking for answers because he’s unsure about what’s really going on. The psychologist listens and tries to assess the full extent of the problem, attempting to gain a full sense of the patient’s situation. If the psychologist gets the problem wrong, she won’t be able to fix it.
It’s like this: I recently bought a new computer, took it home, set it up, and everything seemed great. I was excited to get on the Internet and start surfing around. But when I tried to connect, it didn’t work. You can imagine my frustration after spending north of a thousand dollars on a brand-new computer that wasn’t working right. I spent three frantic days trying to figure out what was wrong, changing cables, calling the Internet service provider, and talking with the store that sold me the computer. Nothing I did and no one I talked to fixed the problem.
Finally, my wife pointed out (three days later) that I had plugged a cord into the wrong jack in the back of the computer. She simply placed the cord where it belonged and connected with ease. I had incorrectly identified the problem and was therefore clueless about how to fix it. I figured that because I was a scientist I had thoroughly ruled out all possible causes and variables. Boy, was I wrong.
This chapter introduces you to the process and procedures psychologists use in clinical evaluations. Those include taking history and gathering information about the nature of the presenting problems of clients and patients. Psychological assessment and testing, two things psychologists are particularly trained well to do, are discussed, including a review of the different types of tests and evaluations a psychologist conducts.
Naming the Problem
The first step toward any solution is to recognize and clearly define the problem. Psychologists use specific tools and techniques for that very purpose. Here’s how it typically goes: A person visits a psychologist and the conversation begins with an exploration of the patient’s presenting complaint (the issue that motivated the patient to seek therapy). The discussion then gets into a more thorough information-gathering process:
Psychologist: Tell me, Mr. Smith, what seems to be the problem?
Mr. Smith: How am I supposed to know? You’re the doctor.
The “What’s the problem?” question sometimes annoys patients because they often don’t know what’s going on; they’re seeking help from a professional and expect the psychologist to have the answers. But without a thorough investigation of the patient’s situation, any mental health professional can only perform expensive guesswork. The two most common approaches to clinical assessment are formal interviews and psychological testing. I describe these processes in this section.
There may be as many interview techniques in the psychological world as there are individual psychologists out there. Everyone has a different way of getting at the relevant information. So what is the relevant information?
Most shrink-to-patient encounters begin with a discussion of the patient’s basic issue, the initial complaint or presenting problem. Very few people who come to a psychologist describe their problems according to the criteria established in the Diagnostic and Statistical Manual, the manual published by the American Psychiatric Press that most US psychologists use to diagnose mental disorders. Presenting problems tend to be vague or convoluted.
Early communication problems between the psychologist and the patient are not necessarily because people don’t understand themselves. Rather, it’s usually more an issue of vocabulary; doctors and patients use different words to describe the same problems. You say to-may-to, and I say to-mah-to. You may say you can’t sleep or stop crying, and I say you’re depressed.
To begin exploring a person’s psychological problems, a psychologist often gathers information about the patient’s family, friends, co-workers, and other major relationships in order to better understand her social, educational, and occupational functioning. Did the patient graduate from high school? Has she been able to stay gainfully employed?
Often, although people begin therapy with a lot to say and get off their chests, they’re overwhelmed and sometimes have a hard time knowing exactly how to describe their experiences. Therapy isn’t always so cut and dried, but psychologists typically try to structure the first interview with the following steps:
1. Clarify the presenting problem.
2. Gather a history of the patient’s life.
Is it an autobiography? In a way it is, except that only specific areas are covered. The most relevant aspect in a psychological interview is the history of the presenting problem. When did it all begin . . . ?
3. Explore the patient’s physical health.
An assessment of the patient’s physical health and history is always important in the history-taking process mainly because many psychiatric or psychological problems can be an aspect of certain physical illnesses or conditions. That is, a psychological problem may actually be a symptom of an underlying medical condition. For example, a person may think he or she is having a panic attack (psychological) but may in fact be having a heart attack (medical/physical illness). When was his most recent physical? Does she have any major medical problems? Is he taking any medications? Does (or has) she abused drugs or alcohol? Does he have an altered state of consciousness that requires medical assessment or treatment?
4. Gather a thorough history of any psychological problems.
A psychologist wants to find out if the patient has ever suffered from depression in the past, attempted suicide, or been treated for a mental disorder in a psychiatric hospital or other type of setting. Do any family members have a history of mental illness? Is he thinking about hurting other people? Certain pieces of information are extremely important to find out if the patient’s safety is at risk. A prudent professional always takes the time to assess the most serious aspects of a case first, and no issues are more serious to a psychologist than suicide or a patient’s potential for violence.
Examining mental status
Throughout the initial interview, the psychologist looks for specific behavioral, cognitive, and emotional indicators of psychological disturbance. This is called a mental status examination (MSE). Typically, the psychologist observes these 11 mental status areas:
Appearance: Grooming, hygiene, physical characteristics, and unusual features are observed. If someone has an unusual appearance — severely underweight, disheveled, or bizarre or inappropriate grooming, for instance — outside of cultural or subcultural norms, it may be worth discussing.
Behavior: Some of the most striking signs of disturbance come from the way people act.
• Body movement: Body movements such as fidgeting, fast movements, slowed movements, or strange gestures may be relevant. Nervous individuals may fidget a lot. Depressed patients may sit slumped in their chairs. Someone with a paranoid delusion that the CIA is following him may get up and peek out the curtains every five minutes.
• Facial expressions: Facial expressions can sometimes reveal how a person is feeling. A sad, mad, immobile, or frozen expression, for example, can indicate specific moods.
Speech: Two disorders in particular, schizophrenia and bipolar disorder, include disturbances in speech:
• Schizophrenia: A patient’s speech may be disordered, jumbled, or difficult to understand. He may seem to be speaking a foreign language, using words and phrases that don’t seem to make sense. For example, I once received an anonymous phone call while volunteering at a homeless shelter. When I asked the caller if I could help him, he replied, “Stick the pin in the cushion. You called me. What do you want? The letters make me crazy . . . light bulb . . . beat the drum . . . stick the pin in the cushion . . . what do you want?” This is an excellent case of disordered speech.
• Bipolar disorder: The rate and pace of speech can be abnormal in people with bipolar disorder. Patients in a manic episode, for instance, can speak very fast and act as if they physically need to keep talking. They may jump from one topic to another.
Mood and affect: Mood describes the predominant emotions being expressed by the patient. Is she sad, happy, angry, euphoric, or anxious? Affect refers to the range, intensity, and appropriateness of a patient’s emotional behavior. Is she mildly sad or intensely sad? Does she feel anything other than sadness, or does she seem to have a full range of emotions? Another common observation of affect is called mood lability. How often and easily does mood change? Is she hot one second and cold the next?
Thought content: What people think about is relevant to any clinical evaluation. Bizarre thought content, such as delusions, can be telltale signs of the presence of a mental disorder. Less bizarre but sometimes equally disturbing thoughts, such as obsessive preoccupations and intrusive ideas, can also be signs of severe anxiety. Thoughts of death and violence are relevant to assessing suicidality and violence potential.
Thought process: Different ways of thinking can sometimes be clues to a mental disorder.
• Tangential thinking: Often a sign of thought disorder, tangential thinking is characterized by a wandering focus and the tendency to go off on tangents that are only minimally related to the topic currently being discussed.
• Clang associations: These are serious indicators of thought disorder. When someone ends a sentence with a word, and the sound of that word triggers another thought, related to the conversation only by the sound of the last word uttered, the thought process is known as a clang association. “I came home from work the other day, and the car was in the driveway . . . highway’s are crowded. Loud noises bother me . . . tree.” This type of disordered thought is unorganized and hard to follow; it doesn’t make sense.
Perception: Perceptual problems consist of hallucinations. Patients can experience auditory hallucinations (voices), visual hallucinations, olfactory hallucinations (smells or odors), gustatory hallucinations (tastes), or somatic hallucinations (strange bodily sensations, such as feeling like bugs are crawling under the skin). A very serious auditory hallucination is when patients hear a voice or voices telling them to hurt themselves or someone else. These are sometimes called command hallucinations.
Intellectual functioning: This status can be casually observed by paying attention to the patient’s vocabulary, general quantity of knowledge and information, and abstract thinking ability. However, trying to figure out someone’s intellectual functioning based on observation alone is highly subjective and should only be used as a starting point for further assessment.
Attention/concentration and memory: Pay attention to whether a patient is distracted during the interview and struggling to concentrate on the task at hand. Short-term memory can be checked by asking the individual to remember a few things and checking with her a few minutes later. How well she recalls her history and provides historical information offers a measure of long-term memory. Many disorders present attention problems and memory deficits.
Orientation: Does the patient know where she is? The season? The time? Ascertaining whether a patient knows where she is in time and space is an important part of the MSE. Many serious medical conditions and neuropsychological disorders manifest signs of disorientation.
To each his own animal
If you see a middle-aged gentleman wearing a pair of famous mouse ears with a mouse nose, teeth, and whiskers in a coffee shop, you may wonder if he’s mentally ill. It’s a free country, but most people would agree that this appearance is unusual. Middle-aged men don’t normally dress up like mice. So when someone treats every day like Halloween, it’s worth asking about. No judging or jumping to conclusions; it’s just worth checking out.
Insight and judgment: Does the patient understand that she may be mentally ill? Does she understand the relationship between her behaviors and mental processes and a psychological disturbance? Insight is important for assessing how motivated a patient is going to be during treatment and whether compliance issues are likely to interfere with illness management or recovery. Addressing a patient’s judgment involves looking at the soundness of the decisions she makes and the degree of impulsivity and planning that goes on before she takes action. Judgment is especially important when assessing for dangerousness, violence potential, or suicide risk.
Checking Under the Hood with Psychological Testing
These days, any number of different disciplines are involved in the treatment of mental illness and working with people with mental disorders. Psychological testing, however, is considered the sole domain of psychologists. Although some professionals, such as school counselors and learning disability specialists, conduct psychological testing, their testing is limited in scope and to a specific problem. Psychologists are thoroughly trained in all aspects of psychological testing and are the primary professionals in this area.
Psychological testing is part of the entire psychological assessment process. Assessment is a set of scientific procedures used to measure and evaluate an individual’s behavior and mental processes. Psychologist Anne Anastasi (1908—2001), a past president of the American Psychological Association and a distinguished researcher in psychological assessment, defines a psychological test as an objective, standardized sample of behavior or mental processes. Tests can formalize data based on observations. Nearly all topics in psychology can be measured with a test.
Testing formats include surveys, pencil and paper tests, exercises and activities (like putting a puzzle together), interviews, and observation. Testing in psychology is not much different from testing in other fields. A blood test is a means of measuring an individual’s T-cell count, for example. A personality test is a way to measure some specific aspect of a person’s personality. Psychological testing uses the same idea; it just focuses on the subject matter of psychology, behavior, and mental processes.
A test is objective if it meets acceptable standards in three important areas: standardization, reliability, and validity.
Anne Anastasi considers a test properly standardized if it has a uniform procedure for administering and scoring. Control of extraneous variables allows for maximum accuracy. In other words, if I give a test differently to two different people, then I can’t very well trust the results because I’ve violated the principle of control in science.
Establishing a norm for a test is another step in standardization. A norm is a measure of the average performance for a large group of people on any given psychological test. For example, the average score on the Wechsler Adult Intelligence Scale, 4th Edition, is 100. This average score establishes a point of comparison for the test taker’s scores to be referenced to. This is called a norm and is a standard by which to compare people. Norms are established by administering the test to a large group of people, or several groups, and measuring the average performance and range of performances, something called variability. So, if I develop a test to measure problem solving. I would establish a norm or comparison group by going out and giving my test to thousands of people and documenting their performance and the range of performances. This comparison group is used to compare the scores of any individual taking the test to the thousands of other people who took the test and allows me to determine how well or how poorly any one individual test taker did in comparison to all the other people who took the test.
Relying on tests
Reliability is consistency across different testing occasions, test providers, settings, or circumstances. A reliable test should give the same result regardless of the circumstances. An inconsistent test is not reliable and therefore not very helpful for psychological testing. If I give the same person the same test on two or more occasions, will he get the same or comparable score? If the answer is yes, then the test is reliable. If I test a person, and another psychologist uses the same test on the same person, the results should be comparable; this is called inter-rater reliability. A test needs to prove reliable before being put to use by professionals. In fact, psychologists are ethically bound to use reliable tests and instruments because they are being entrusted to provide accurate and useful information. An unreliable test is not able to deliver in that regard. A psychologist wants to know if a person’s test performance is due to their own characteristics and not to the setting, circumstances, or situation. The psychologist would not be measuring what he thinks he is measuring if a test weren’t reliable. An example of reliability used in test development is test-retest reliability. This involves giving a test and then giving it again later (not too soon, of course, because you don’t want practice effects) and then seeing if the scores are close or similar.
When it comes to psychological testing, I’ve often had patients object that a test was unreliable and that it didn’t prove or measure a darn thing. They may have had a point, but only if the test was unreliable.
How do you know that a test you’re using is really measuring what it claims to measure? You may think that you’re measuring intelligence when you’re really measuring English-language aptitude. This actually happens quite often when tests are improperly used with people for whom the test has not been normed — which means that its statistical properties haven’t been established with a large population of individuals similar to the people to whom it will be applied. Tests used with people who were not part of the group the test was normed on are highly suspect and most likely invalid.
When a test measures what it claims to measure, it’s considered valid. The validity of a test is established by comparing the test with an outside measure of the psychological topic in question. If I have a test that claims to measure depression, I must compare my test findings with an already established measure of depression such as the Beck Depression Inventory.
Keep in mind that many, if not most, psychological tests measure things that are unobservable in the way other factors in other fields are. T-cells can be physically seen and therefore counted under a microscope. But intelligence cannot be viewed in the same manner. Intelligence is presumed to exist as it manifests itself in a measurable form on a psychological test. Therefore, the scientific basis on which psychological testing is formed is of utmost importance.
Psychological testing is a little more sophisticated than asking a few questions and counting up someone’s responses. It’s a scientific endeavor. Because of the complexity of psychological testing, most professionals argue that use of tests should be controlled — only qualified examiners should use them. The risk for potential oversimplification or misinterpretation is just too high when an untrained administrator attempts to diagnose a person’s mental status through testing.
Plus, if the tests are spread around indiscriminately, people may become too familiar with them and be able to manipulate their responses; thus the tests would lose their validity. Instead of measuring someone’s intelligence, for example, the psychologist may end up measuring a subject’s skill at remembering the test questions and answers that reveal the traits he wants to show.
Numerous types of psychological testing exist. Five of the most common are clinical testing, educational/achievement testing, personality testing, intelligence testing, and neuropsychological testing. Each of these different types of tests looks at a different type of behavior and/or mental process.
Clinical psychologists (psychologists who work with mental disorders and abnormal behavior) typically use clinical testing as a way to clarify diagnoses and assess the scope and nature of a person’s or family’s disturbance and dysfunction. Specific tests are designed to assess the extent to which a patient may or may not be experiencing the symptoms of a particular disorder. These are diagnostic tests. A popular example is the Beck Depression Inventory, which is designed to assess a patient’s level of depression.
Behavioral and adaptive functioning tests are two types of clinical tests that determine how well a person is doing in her everyday life and whether she exhibits specific problem behaviors. A common instrument used with children is the Child Behavior Checklist, which is designed to assess the extent of a child’s behavior problems. Another commonly used clinical test is the Conner’s Parent Rating Scale, which detects attention deficit/hyperactivity disorder (ADHD) symptoms.
In addition to disorder-specific inventories and tests, a wide variety of tests designed for other purposes lend themselves to the diagnostic process. Intelligence tests are designed to measure intelligence, but they can also show signs of cognitive dysfunction and learning disabilities. Personality tests are designed to measure personality, but they can also provide helpful insight to the types of psychological problems an individual is experiencing.
Educational and achievement tests measure an individual’s current level of academic competence. Glen Aylward, chair of the Division of Developmental and Behavioral Pediatrics at the Southern Illinois University School of Medicine, identifies three major purposes of this type of testing:
Identify students who need special instruction.
Identify the nature of a student’s difficulties in order to rule out learning disabilities.
Assist in educational planning and approach to instruction.
A typical educational/achievement test assesses the most common areas of school activity: reading, mathematics, spelling, and writing skills. Some tests include other areas such as science and social studies. A popular achievement test in wide use today is the Woodcock-Johnson Psychoeducational Battery, Revised. The test consists of nine subtests, measuring the standard areas of instruction but in more detail (mathematics is broken down into calculation and applied problems, for example).
Educational/achievement testing is widely used in the school systems in the United States and Western Europe. When a child or older student is having a hard time in school, it’s not unusual for her to take an achievement test to get a closer look at her basic skill level. Sometimes, students have a difficult time because they have a learning disability. Part of identifying a learning disability is assessing the student’s achievement level. Other times, a student struggles because of non-academic difficulties such as emotional problems, substance abuse, or family issues. An achievement test sometimes helps to tease out these non-academic problems.
Personality tests measure many different things, not just personality. Numerous tests are designed to measure emotion, motivation, and interpersonal skills as well as specific aspects of personality, according to the given theory on which a test is based. Most personality tests are known as self-reports. With self-reports, the person answering questions about herself, typically in a pencil-and-paper format, provides the information.
Personality tests are usually developed with a particular theory of personality in mind. A test may measure id, ego, or superego issues, for example, if it originates from a Freudian view of personality development.
Getting down with MMPI-2
Perhaps the most widely used personality test in the United States is the MMPI-2, The Minnesota Multiphasic Personality Inventory, 2nd Edition. Almost all American psychologists are trained to use the MMPI-2, which is considered to be a very reliable and valid instrument. A patient’s results from a MMPI-2 test provide rich information about the presence of psychopathology and level of severity, if present. The test’s results also reveal information about the emotional, behavioral, and social functioning of the test taker. A lot of psychologists use the MMPI-2 as a way to check the accuracy of their observations and diagnoses.
The MMPI-2 test consists of 567 individual items and produces a score on nine clinical categories or scales. If a score is over a specific cutoff, it usually gets the attention of the psychologist administering the test. Psychologists consider such scores to be of clinical significance. The MMPI-2 covers a wide variety of areas, including depression, physical complaints, anger, social contact, anxiety, and energy level.
Projecting to the deep stuff
Projective personality tests are a unique breed of test. When most people think of psychological testing, these kinds of tests come readily to mind. The stereotype involves sitting across from a psychologist, looking at a card with smeared ink or a picture of somebody doing something on it, and answering questions like “What do you see here?”
(You can take a free, mock personality test at www.dummies.com/extras/psychology.)
Projective personality tests are unique because they’re based on something called the projective hypothesis, which states that when presented with ambiguous stimuli, people will project, and thus reveal, parts of themselves and their psychological functioning that they may not reveal if asked directly. It’s not like these tests are trying to trick people, though. The idea is that a lot of folks can’t exactly put words to or describe what’s going on mentally and emotionally because of psychological defense mechanisms. Some people are not conscious of their feelings. Projective tests are designed to get past the defenses and penetrate the deep recesses of the psyche.
Perhaps the most popular projective personality test and maybe even the most popular psychological test of all time is the Rorschach Inkblot Test (RIT). The RIT consists of ten cards, each with its own standard inkblot figure. None of these inkblots are a picture or representation of anything. They were created by simply pouring ink onto a sheet of paper and folding it in half. The only meaning and structure the cards have are provided by the projections of the test taker himself.
Intelligence tests may be the most frequently administered type of psychological test. They measure a broad range of intellectual and cognitive abilities and often provide a general measure of intelligence, which is sometimes called an IQ — intelligence quotient.
Intelligence tests are used in a wide variety of settings and applications. They can be used for diagnostic purposes to identify disabilities and cognitive disorders. They’re commonly used in academic and school settings. Intelligence tests have been around since the beginning of psychology as an established science, dating back to the work of Wilhelm Wundt in the early 20th century.
The most commonly used tests of intelligence are the Wechsler Adult Intelligence Scale, 4th Edition, (WAIS-IV) for adults and the Wechsler Intelligence Scale for Children, 4th Edition, (WISC-IV) for children. Each of these tests contains several subtests designed to measure specific aspects of intelligence such as attention, general knowledge, visual organization, and comprehension. Both tests provide individual scores for each subtest and an overall score representing overall intelligence. (You can take a free, mock intelligence test at www.dummies.com/extras/psychology.)
Neuropsychological and cognitive testing
Although not a new field, tests of neuropsychological functioning and cognitive ability, related specifically to brain functioning, are rapidly becoming a standard part of a psychologist’s testing toolset. Neuropsychological tests have traditionally been used to augment neurological exams and brain imaging techniques (such as MRIs, CT scans, and PET scans) but they’re being used more widely now in psychoeducational testing and other clinical testing situations.
The technology of scanning techniques picks up on the presence of brain damage, but neuropsychological tests serve as a more precise measure of the actual functional impairments an individual may suffer from. Scans say, “Yep, there’s damage!” Neuropsychological tests say, “. . . and here’s the cognitive problem related to it.”
Neuropsychological testing is used in hospitals, clinics, private practices, and other places where psychologists work with patients who are suspected of neuropsychological impairment. People suffering head trauma, developmental disorder, or other insults to the brain may need a thorough neuropsychological examination.
A popular neuropsychological test is actually not a test at all but a collection of tests called a test battery. The Halstead-Reitan Neuropsychological Test Battery includes numerous tests that measure neuropsychological constructs such as memory, attention and concentration, language ability, motor skills, auditory skill, and planning. The battery also includes an MMPI-2 and WAIS-IV test. Completing the battery requires several hours, and it’s never done in one sitting, so going through a neuropsychological evaluation can take several weeks and be costly. However, when conducted by a competent professional, the testing can yield a tremendous amount of helpful information.
Many neuropsychological instruments are available; some are comprehensive, like the Halstead-Reitan, and some are designed to measure a specific function such as language or attention. Whether a neuropsychological evaluation is conducted using a comprehensive instrument or a collection of individual instruments to create a profile of neuropsychological strengths and weaknesses, the following areas of neuropsychological functioning are typically assessed:
Executive Functions: Focusing, planning, organizing, monitoring, inhibiting, and self-regulating
Communication and Language: Perceiving, receiving, and expressing self with language and nonverbal communication
Memory: Auditory memory, visual memory, working memory, and long-term memory
Sensormotor Functions: Sensory and motor functions, including hearing, touch, smell, and fine and gross muscle movements
Visual-Spatial Functions: Visual perception, visual motor coordination, visual scanning, and perceptual reasoning.
Speed and Efficiency: How fast and how efficient thinking is
Keeping Them Honest
An important tip that a psychologist doesn’t typically find out about in graduate school is that not everybody coming in for an evaluation or assessment is honest. What? No way! Hard to believe, maybe, but it’s true. Unfortunately, some people who seek a psychological assessment and evaluation, or have been ordered to get it, engage in what psychologists call dissimulation and malingering.
Dissimulation in assessment occurs when a client conceals, distorts, and alters his true abilities, concerns, and other characteristics for various motives. Dissimulation is deception. Within the assessment context, a person may dissimulate by concealing or distorting some deficit or disorder by “faking good” or “faking bad.” Malingering is a “faking bad” process in which a person deliberately feigns, fakes, or exaggerates symptoms or deficits.
Why would someone want to “fake good” when getting a psychological assessment or evaluation? This most often occurs when the results of the psychological assessment are being used for some sort of selection or screening process such as employment, background check, parenting evaluation in a divorce proceeding, or risk assessment.
When I worked in forensics (see the free online article "Exploring Human Differences: Culture, Gender, and Sexuality" at www.dummies.com/extras/psychology for details on forensic psychology), one of the duties I performed was to assess the violence risk of prison inmates convicted of serious violent crimes who were approaching a parole evaluation. My job was to estimate how likely it was that an individual would commit more violent crimes or offenses if freed. My evaluation played a big part in whether an inmate was granted parole, so these people had plenty of incentive to present themselves as a low risk and "fake good."
On the other side, why would anybody want to make herself seem to be mentally ill? Plenty of reasons exist for presenting such a picture, but most often it’s for money. A common “faking bad” scenario is when a person tries to demonstrate an inability to hold down a job and therefore qualify for compensation without working (such as Social Security benefits) during an employment disability evaluation.
It’s not all just about money, though. When someone’s arrested and accused of a crime, she can sometimes get away with a lighter punishment — or even be found not guilty — if a mental disorder is to blame. This is a gamble that some accused people are willing to make, and “faking bad” is the road to take.
The bad news for the dissimulators and malingerers out there is that psychologists have tools, methods, and specialized techniques of evaluation and assessment that are specifically designed to sniff out deception, poor effort, exaggeration, and dishonesty. Many test instruments themselves have built-in components and scales to measure dishonesty factors. Special interview techniques and lines of questioning can help with this as well. In fact, in the business of forensic assessment, there is good money to be made on being an expert in picking out the fakers, and these professionals pride themselves on being able to detect deception.