Chapter 3 Clinical Assessment, Diagnosis, and Treatment

1. Chapter 3Clinical Assessment, Diagnosis, and Treatment

2. Clinical Assessment: How and Why Does the Client Behave Abnormally? • Assessment: collecting relevant information to reach conclusion • Used to determine how and why person is behaving abnormally/how person may be helped • Used for several purposes • Making predictions, planning treatments, and evaluating treatments

3. Clinical Assessment: How and Why Does the Client Behave Abnormally? • Hundreds of clinical assessment tools have been developed and fall into three categories: • Clinical interviews • Tests • Observations

4. Characteristics of Assessment Tools • To be useful, assessment tools must be standardized and have clear reliability and validity • To standardize a technique is to set up common steps to be followed whenever it is administered

5. Characteristics of Assessment Tools • Reliability refers to the consistency of an assessment measure • A good tool will always yield the same results in the same situation

6. Characteristics of Assessment Tools • Validity refers to the accuracy of a tool’s results • A good assessment tool must accurately measure what it is supposed to measure

7. Clinical Interviews • Face-to-face encounters; often the first contact between client and clinician/assessor • Used to collect detailed information, especially personal history • Allow interviewer to focus on whatever topics considered most important • Focus depends on theoretical orientation

8. Clinical Interviews • Conducting the interview • Can be either unstructured or structured • In an unstructured interview, clinicians ask open-ended questions • In a structured interview, clinicians ask prepared questions, often from a published interview schedule • e.g., SCID (Structured Clinical Interview for DSM)

9. Clinical Tests Devices for gathering information about aspects of a person’s psychological functioning.

10. Clinical Tests Projective tests • Require that clients interpret vague or ambiguous stimuli or follow open-ended instruction • Psychodynamic • Most popular: • Rorschach Test • Thematic Apperception Test (TAT)

11. Clinical Test: Rorschach Inkblot

12. Thematic Apperception Test (TAT)

13. Clinical Tests Personality inventories • Designed to measure broad personality characteristics • Focus on behaviors, beliefs, and feelings • Usually based on self-reported responses • Minnesota Multiphasic Personality Inventory (MMPI)

14. MMPI • Consists of 567 self-statements that can be answered “true,” “false,” or “cannot say” • Statements describe physical concerns, mood, sexual behaviors, and social activities • Comprised of ten clinical scales: • Hypochondriasis Paranoia • Depression Psychasthenia • Hysteria Schizophrenia • Psychopathic deviate Hypomania • Masculinity-femininity Social introversion

15. Clinical Test: MMPIMinnesota Multiphasic Personality Inventory • Graphed to create a “profile”

16. Clinical Tests Response inventories • Usually based on self-reported responses • Focus on one specific area of functioning: • Affective inventories (Beck Depression Inventory) • Social skills inventories • Cognitive inventories

17. PSYCHOLOGICAL ASSESSMENT PROCEDURES • Beck Depression Inventory (BDI-II) • 0) I do not feel sad. • (1) I feel sad. • (2) I am sad all the time and I can't snap out of it. • (3) I am so sad or unhappy that I can't stand it. • Measures: changes in sleep patterns, appetite, feelings of being punished, thoughts about suicide, interest in sex • 21 questions • 0–13: minimal to no depression • 14–19: mild depression • 20–28: moderate depression • 29–63: severe depression. • Higher total scores indicate more severe depressive symptoms.

18. Clinical Tests Psychophysiological tests • Measure physiological response as an indication of psychological problems • Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction • Polygraph (lie detector)

19. Clinical Tests • Neurological and neuropsychological tests • Neurological tests directly assess brain function by assessing brain structure and activity • Examples: EEG, PET scans, CAT scans, MRI, fMRI • Neuropsychological tests indirectly assess brain function by assessing cognitive, perceptual, and motor functioning • Clinicians often use a battery of tests

20. Clinical Tests Intelligence tests • Designed to indirectly measure intellectual ability • Typically comprised of a series of tests assessing both verbal and nonverbal skills • General score is an intelligence quotient (IQ)

21. Clinical Observations Self-monitoring • People observe themselves and carefully record frequency of certain behaviors, feelings, or cognitions as they occur over time

22. Diagnosis: Does the Client’s Syndrome Match a Known Disorder? Using all available information, clinicians attempt to determine if a person’s psychological problems comprise a particular disorder

23. Classification Systems • Lists of categories, disorders, and symptom descriptions, with guidelines for assignment • Focus on clusters of symptoms (syndromes) • In current use in the U.S.: DSM-5 • Diagnostic and Statistical Manual of Mental Disorders (5th edition)

24. DSM-5 Lists approximately 400 disorders Describes criteria for diagnoses, key clinical features, and related features that are often, but not always, present

25. Lifetime Prevalence of DSM Diagnoses

26. DSM-5 • Requires clinicians to provide two types of information: • Categorical • Dimensional

27. DSM-5 • Categorical Information • Clinician must decide whether person is displaying one of hundreds of disorders listed in the manual • Some of most frequently diagnosed are anxiety disorders and depressive disorders

28. DSM-5 • Dimensional Information • Diagnosticians also are required to assess current severity of client’s disorder • For each disorder, various rating scales are suggested

29. Is DSM-5 an Effective Classification System? • Judged by its reliability and validity • DSM-5 followed certain procedures to help ensure greater reliability and validity (conducting extensive literature reviews and running field studies) • Despite such efforts, critics still have concerns

30. DSM 5 • Key changes to DSM 5 include • additions to and removals of diagnostic categories • reorganizing of categories • changes in terminology

31. Can Diagnosis and Labeling Cause Harm? • Misdiagnosis always a concern • Major issue: reliance on clinical judgment • Issue of labeling and stigma • Diagnosis may be self-fulfilling prophecy • Because of these problems, some clinicians would like to do away with the practice of diagnosis