Chapter 3 Clinical Assessment, Diagnosis, and Treatment

Report
Chapter 3
Clinical Assessment,
Diagnosis, and Treatment
The **** Personality Inventory
1 = strong agreement
2 = some agreement
3 = little agreement
4 = no agreement at all
The **** Personality Inventory
________ a.
I like spending time with other people.
________ b.
I have realistic dreams and goals.
________ c.
People are only looking out for their own interests.
________ d.
I have frequent nightmares.
________ e.
I prefer to use humor to cope with stress.
________ f.
When I get nervous, I have problems thinking clearly.
________ g.
I worry about how I spend my time.
________ h.
My feet and hands are usually cold.
________ i.
I’d like to travel around the world.
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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
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Clinical Assessment: How and Why Does the Client
Behave Abnormally?
• Hundreds of clinical assessment tools have been developed
and fall into three categories:
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Clinical interviews
Tests
Observations
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Characteristics of
Assessment Tools
• To be useful, assessment tools must be standardized and have clear
reliability and validity
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To standardize a technique is to set up common steps to be followed
whenever it is administered
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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
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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
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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
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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)
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Clinical Tests
• Devices for gathering information about aspects of a
person’s psychological functioning.
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Clinical Tests
Projective tests
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Require that clients interpret vague or ambiguous stimuli or
follow open-ended instruction
Psychodynamic
Most popular:
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Rorschach Test
Thematic Apperception Test (TAT)
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Clinical Test:
Rorschach Inkblot
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Thematic Apperception Test (TAT)
Clinical Tests
Personality inventories
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Designed to measure broad personality
characteristics
Focus on behaviors, beliefs, and feelings
Usually based on self-reported responses
Minnesota Multiphasic Personality Inventory
(MMPI)
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MMPI
• Consists of 567 self-statements that can be answered “true,”
“false,” or “cannot say”
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Statements describe physical concerns, mood, sexual behaviors, and
social activities
• Comprised of ten clinical scales:
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Hypochondriasis
Paranoia
Depression
Psychasthenia
Hysteria
Schizophrenia
Psychopathic deviate
Hypomania
Masculinity-femininity
Social introversion
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Clinical Test: MMPI
Minnesota Multiphasic Personality Inventory
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Graphed to create a “profile”
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Clinical Tests
Response inventories
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Usually based on self-reported responses
Focus on one specific area of functioning:
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Affective inventories (Beck Depression Inventory)
Social skills inventories
Cognitive inventories
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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.
Clinical Tests
Psychophysiological tests
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Measure physiological response as an indication of
psychological problems
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Includes heart rate, blood pressure, body
temperature, galvanic skin response, and muscle
contraction
Polygraph (lie detector)
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Clinical Tests
 Neurological and neuropsychological tests
 Neurological tests directly assess brain function by assessing
brain structure and activity
 Neuropsychological tests indirectly assess brain function by
assessing cognitive abilities (inhibition, memory, spatial
perception).
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Clinical Tests
Intelligence tests
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Typically comprised of a series of tests assessing
both verbal and nonverbal skills
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Clinical Observations
Self-monitoring
• People observe themselves and carefully record
frequency of certain behaviors, feelings, or
cognitions as they occur over time
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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
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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)
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DSM-5
• Lists approximately 400 disorders
• Describes criteria for diagnoses, key clinical features, and
related features that are often, but not always, present
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Lifetime Prevalence of
DSM Diagnoses
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DSM-5
• Requires clinicians to provide two types of
information:
• Categorical
• Dimensional
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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
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DSM-5
• Dimensional Information
• Diagnosticians also are required to assess current
severity of client’s disorder
• For each disorder, various rating scales are
suggested
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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
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DSM 5
• Key changes to DSM 5 include
• additions to and removals of diagnostic
categories
• reorganizing of categories
• changes in terminology
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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
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