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.

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 4

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 5

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 6

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 7

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 8

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 9

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) 10

Clinical Tests Devices for gathering information about aspects of a person’s psychological functioning. 11

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) 12

Clinical Test: Rorschach Inkblot 13

Thematic Apperception Test (TAT)

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) 15

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-femininitySocial introversion 16

Clinical Test: MMPI Minnesota Multiphasic Personality Inventory Graphed to create a “profile” 17

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 18

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 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) 20

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). 21

Clinical Tests Intelligence tests Typically comprised of a series of tests assessing both verbal and nonverbal skills 22

Clinical Observations Self-monitoring People observe themselves and carefully record frequency of certain behaviors, feelings, or cognitions as they occur over time 23

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 24

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) 25

DSM-5 Lists approximately 400 disorders Describes criteria for diagnoses, key clinical features, and related features that are often, but not always, present 26

Lifetime Prevalence of DSM Diagnoses 27

DSM-5 Requires clinicians to provide two types of information: Categorical Dimensional 28

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 29

DSM-5 Dimensional Information Diagnosticians also are required to assess current severity of client’s disorder For each disorder, various rating scales are suggested 30

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 31

DSM 5 Key changes to DSM 5 include additions to and removals of diagnostic categories reorganizing of categories changes in terminology 32

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 33