CSIRA POSITION PAPER ON PSYCHOLOGICAL TELE ASSESSMENT
Due to the present pandemic situation (COVID-19), strict confinement has been imposed in many countries and, whenever possible, in-presence face-to-face psychological services switched to remote interactions through the internet.
Ethical issues have to be raised, and answered:
Are remote and virtual relationships equivalent to in-presence face-to-face relationships?
Is this model of intervention equally efficient?
Answers: Some therapeutic techniques (mainly CBT) have studied these issues (Brearly, 2017; Cullum et al., 2006; Galusha-Glasscock et al., 2016; Harrell et al., 2014; Parmanto et al., 2013; Smith et al., 2017; Wadsworth et al., 2018; Wright, 2018) and showed that, under strict conditions (security, confidentiality, informed consent), the therapeutic process keeps its integrity and is as efficient as the traditional model.
Concerning psychological consultations by telephone (a practice with a long history) or videoconference, a practice widespread since video communications are accessible to anyone with a computer or a smartphone, it seems to be impossible to make sound research on these practices and these means of communication are easily accessible to non-professionals and impossible to control.
Concerning psychological assessment, there exists 3 kind of tests (not mentioning gadget applications (intellectual IQ, emotional IQ, personality quick tests found on the internet which are, at best, recreational activities):
Self-reports, which are easy to put on-line, and should not pose problems in validity.
Cognitive and neurological tests: some rely on computer technology and are already
presented via a computer screen for measuring speed, response correctness, attention span, executive functions, in general all cognitive faculties that can be easily and precisely measured via computer technology.
Personality tests, which require a specific relational environment. (See below).
Ethical question n° 1
- Based on the principle of integrity, is a test valid if administration procedures are modified?
Answer. The International Test Commission is adamant: respect of administration instructions is a key requirement to ensure validity of results and reduce the error margin to a minimum. If administration of a test is modified, it will be considered as a new form of test which validity and reliability must be scientifically demonstrated before it is used.
Ethical question n° 2
- Based on the principle of professional integrity, is psychological assessment reduced to collecting test results (even valid test results)?
Answer. No. Psychological assessment is a complex mix of relation with the client, observation, verbal and postural exchanges, test completion, and careful integration of all data (including client history, symptoms reported and observed, analysis of the psychologist reactions and feelings during assessment) before a final picture of the client is formulated.
In a nutshell: psychological assessment is not integer when performed out of the embodied presence of the client.
Ethical question n° 3
- Based on the responsibility and accountability of the psychologist, how urgent and crucial is the assessment for the well-being or health of the client?
Answer. In the majority of cases, the purpose of a psychological assessment is to understand and describe the actual psychological functioning of a person, their resources and vulnerabilities, the unique mechanisms of possible psychopathologies, and the appropriate treatment to recommend.
In these cases, stressful and unusual circumstances (in times of war, disasters, society upheavals or pandemic diseases requiring physical distancing and isolation) lead psychologists to simply postpone the assessment. Not only assessment is not urgent but also the assessment would catch a situational functioning (increase of anxiety, fear of death, basic vital worries, preoccupations around the health of family and friends) instead of the necessary trait aspects. Psychologists should then turn to a consultation mode, give verbal support to their clients, either in-presence or by remote means when social isolation is compulsory.
In a minority of cases, the aim of an assessment could be a contribution to diagnosis. Questions then are: how urgent this diagnosis? And: how important is the use of tests for a diagnosis?
Answer. 1) Whereas a medical diagnosis can be very urgent and need urgent treatment, a psychological / psychiatric diagnosis does not seem to present any urgency. In cases of crises, psychotic episodes, suicide attempts, the person is cared for in psychiatric wards, treatments delivered, there usually is no rush for determining a final diagnosis.
2) Psychological assessment is in fact not aimed at producing a psychiatric diagnosis. A diagnosis is essentially determined by a clinician (psychologist or psychiatrist) without testing.
Considering the above statements, psychologists should interrogate their own motivations for pursuing at all costs psychological assessment. If the well-being or health of their client is not at stake, would the motive be personal financial considerations?
Some organisations (e.g. Interorganizational Practice Committee for Neuropsychology (IPCN), R-PAS for the Rorschach test) suggest to recourse to a “facilitator” i.e. a person even non-professional asked to assist in presence the client through the assessment procedure. Concerning neuropsychological tests, the IPCN clearly states that there is so far no evidence supporting the validity of remote testing. As for the Rorschach test, it is evident that remote administration, with or without facilitator, constitutes a considerable breach of integrity. It introduces considerable modifications of administration procedures (therefore leading to invalid results) and it cannot be performed without endangering test security (in the case the Rorschach test cards are directly sent to the client, which is recommended by the R-PAS authors), or testing integrity (in the quasi unavoidable possibility that people will use images of Rorschach cards found on the net).
In extraordinary circumstances, such as the COVID-19 world pandemic present situation, psychological assessment must be postponed so as to preserve its integrity and validity.
Remote assessment is not equivalent to in-presence assessment, as the APA recognises (see
Psychology assessment does not consist in collecting tests results.
A clinical psychologist is not a “technician” (anyone can administer an available test).