1. Copyright © 2010 Allyn & Bacon This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. ISBN: 0-205-50294-6 PowerPoint for Abnormal Psychology Fourteenth Edition James N. Butcher Susan Mineka Jill M. Hooley Prepared by Andy Pomerantz Southern Illinois University Edwardsville

2. Copyright © 2010 Allyn & Bacon Chapter 4 Clinical Assessment and Diagnosis

3. Copyright © 2010 Allyn & Bacon 3 The Basic Elements in Assessment  First, the presenting problem must be identified  Situational or pervasive?  Duration?  Prior attempts to help or treat?  Self-defeating or resourceful?  How does problem impact social roles?  Does problem match any DSM-IV disorder criteria?  First, the presenting problem must be identified  Situational or pervasive?  Duration?  Prior attempts to help or treat?  Self-defeating or resourceful?  How does problem impact social roles?  Does problem match any DSM-IV disorder criteria?

4. Copyright © 2010 Allyn & Bacon 4 The Relationship Between Assessment and Diagnosis  Classifying the presenting problem is important for numerous reasons  Planning treatment  Knowledge of range of diagnostic problems in client population, which dictate needs for facilities  Insurance payment  Classifying the presenting problem is important for numerous reasons  Planning treatment  Knowledge of range of diagnostic problems in client population, which dictate needs for facilities  Insurance payment

5. Copyright © 2010 Allyn & Bacon 5 Taking a Social or Behavioral History  A good assessment should include a social history noting:  Personality factors  The social context  A good assessment should include a social history noting:  Personality factors  The social context

6. Copyright © 2010 Allyn & Bacon 6 Ensuring Culturally Sensitive Assessment Procedures  U.S. population has grown increasingly diverse in recent years  It is critical for practitioners to conduct culturally competent assessment  APA ethical code addresses need for cultural competence  Cultural variables can include ethnicity, language, SES, gender, and others  U.S. population has grown increasingly diverse in recent years  It is critical for practitioners to conduct culturally competent assessment  APA ethical code addresses need for cultural competence  Cultural variables can include ethnicity, language, SES, gender, and others

7. Copyright © 2010 Allyn & Bacon 7 The Influence of Professional Orientation  How clinicians go about the assessment process often depends on their basic treatment orientations

8. Copyright © 2010 Allyn & Bacon  For psychological assessment to proceed effectively, the client must feel comfortable with the clinician 8 Trust and Rapport Between the Clinician and the Client

9. Copyright © 2010 Allyn & Bacon 9 Assessment of the Physical Organism  Assessment of the physical organism incorporates  The general physical examination  The neurological examination  The neuropsychological examination  Assessment of the physical organism incorporates  The general physical examination  The neurological examination  The neuropsychological examination

10. Copyright © 2010 Allyn & Bacon  Many psychological problems have physical components either as  Causal factors  Symptom patterns  Therefore, it is often important to include a medical examination in the psychological assessment  Many psychological problems have physical components either as  Causal factors  Symptom patterns  Therefore, it is often important to include a medical examination in the psychological assessment 10 The General Physical Examination

11. Copyright © 2010 Allyn & Bacon The Neurological Examination  If organic brain damage is suspected, neurological tests can aid in determining the site and extent of organic brain disorder  The neurological examination may include:  An EEG  A CAT scan  A PET scan  A functional MRI  If organic brain damage is suspected, neurological tests can aid in determining the site and extent of organic brain disorder  The neurological examination may include:  An EEG  A CAT scan  A PET scan  A functional MRI 11

12. Copyright © 2010 Allyn & Bacon 12 The Neuropsychological Examination  The neuropsychological examination involves the use of an expanding array of testing devices to measure a person’s cognitive, perceptual, and motor performance as clues to the extent and location of brain damage

13. Copyright © 2010 Allyn & Bacon 13 The Neuropsychological Examination  One popular neuropsychological examination, the Halstead-Reitan battery, includes the following tests:  Halstead Category Test  Tactual Performance Test  Rhythm Test  Speech Sounds Perception Test  Finger Oscillation Task  One popular neuropsychological examination, the Halstead-Reitan battery, includes the following tests:  Halstead Category Test  Tactual Performance Test  Rhythm Test  Speech Sounds Perception Test  Finger Oscillation Task

14. Copyright © 2010 Allyn & Bacon 14 Psychosocial Assessment  Psychosocial assessment attempts to provide a realistic picture of an individual in interaction with his or her social environment  Three procedures commonly used in psychosocial assessments include:  Assessment interviews (which may be structured or unstructured)  Clinical observation of behavior  Psychological tests  Psychosocial assessment attempts to provide a realistic picture of an individual in interaction with his or her social environment  Three procedures commonly used in psychosocial assessments include:  Assessment interviews (which may be structured or unstructured)  Clinical observation of behavior  Psychological tests

15. Copyright © 2010 Allyn & Bacon 15 Assessment Interviews  A face-to-face interaction in which the clinician obtains information about the client’s situation, personality, and behavior  Structured interviews restrict freedom to explore but increase reliability  Unstructured interviews allow for more exploration but decrease reliability  A face-to-face interaction in which the clinician obtains information about the client’s situation, personality, and behavior  Structured interviews restrict freedom to explore but increase reliability  Unstructured interviews allow for more exploration but decrease reliability

16. Copyright © 2010 Allyn & Bacon 16 The Clinical Observation of Behavior  Ideally, clinical observation takes place in a natural environment, such as a child’s behavior in a classroom or at home  However, it often takes place at the clinic or hospital where the client seeks help  Rating scales can augment clinical observations of behavior and can increase reliability and validity  Ideally, clinical observation takes place in a natural environment, such as a child’s behavior in a classroom or at home  However, it often takes place at the clinic or hospital where the client seeks help  Rating scales can augment clinical observations of behavior and can increase reliability and validity

17. Copyright © 2010 Allyn & Bacon 17 Psychological Tests  Two general categories of psychological tests for use in clinical practice are  Intelligence tests such as the WISC-IV and WAIS-III  Personality tests  Projective personality tests  Objective personality tests  Two general categories of psychological tests for use in clinical practice are  Intelligence tests such as the WISC-IV and WAIS-III  Personality tests  Projective personality tests  Objective personality tests

18. Copyright © 2010 Allyn & Bacon 18 Psychological Tests  The most commonly used intelligence tests include:  The WISC-IV and the Stanford-Binet (for children)  The WAIS-III (for adults)  These tests are individually administered and typically take 2-3 hours to administer, score, and interpret  The most commonly used intelligence tests include:  The WISC-IV and the Stanford-Binet (for children)  The WAIS-III (for adults)  These tests are individually administered and typically take 2-3 hours to administer, score, and interpret

19. Copyright © 2010 Allyn & Bacon 19 Psychological Tests  In projective personality tests  Unstructured stimuli are presented to a subject  The subject projects meaning or structure onto the stimuli  These projections reveal hidden motives  In projective personality tests  Unstructured stimuli are presented to a subject  The subject projects meaning or structure onto the stimuli  These projections reveal hidden motives

20. Copyright © 2010 Allyn & Bacon 20 Psychological Tests  Projective personality tests include:  The Rorschach Inkblot Test  The Thematic Apperception Test  The Sentence Completion Test  Projective personality tests include:  The Rorschach Inkblot Test  The Thematic Apperception Test  The Sentence Completion Test

21. Copyright © 2010 Allyn & Bacon 21 Psychological Tests  In objective personality tests  A subject is required to read and respond to itemized statements or questions  Objective personality tests include:  The MMPI-2  The MMPI includes ten clinical scales measuring psychopathology and a few validity scales measuring straightforwardness  In objective personality tests  A subject is required to read and respond to itemized statements or questions  Objective personality tests include:  The MMPI-2  The MMPI includes ten clinical scales measuring psychopathology and a few validity scales measuring straightforwardness

22. Copyright © 2010 Allyn & Bacon 22 Advantages and Limitations of Objective Personality Tests  Objective personality tests have the benefits of being cost-effective and highly reliable  They have been criticized for being too mechanistic and requiring too much reading ability and cooperation  Actuarial procedures are used for MMPI and other scientifically constructed objective tests  Objective personality tests have the benefits of being cost-effective and highly reliable  They have been criticized for being too mechanistic and requiring too much reading ability and cooperation  Actuarial procedures are used for MMPI and other scientifically constructed objective tests

23. Copyright © 2010 Allyn & Bacon 23 Advantages and Limitations of Objective Personality Tests  Computers are increasingly used in psychological testing  To gather information and to interpret or evaluate data collected via other means  Some clinicians are more reluctant than others to employ computers into their practices  Computers are increasingly used in psychological testing  To gather information and to interpret or evaluate data collected via other means  Some clinicians are more reluctant than others to employ computers into their practices

24. Copyright © 2010 Allyn & Bacon 24 Developments in Practice 4.4: Esteban’s MMPI-2 Profile and Report

25. Copyright © 2010 Allyn & Bacon The Integration of Assessment Data   Assessment data from various sources must be integrated into a coherent working model   Integration can be done by one mental health professional or a team   Sometimes, a definitive picture emerges   Sometimes, there are discrepancies that necessitate further assessment   Assessment data from various sources must be integrated into a coherent working model   Integration can be done by one mental health professional or a team   Sometimes, a definitive picture emerges   Sometimes, there are discrepancies that necessitate further assessment 25

26. Copyright © 2010 Allyn & Bacon 26 Ethical Issues in Assessment  Ethical issues in assessment include:  Potential cultural bias  Theoretical orientation of the clinician  Underemphasis on the external situation  Insufficient validation  Inaccurate data or premature evaluation  Ethical issues in assessment include:  Potential cultural bias  Theoretical orientation of the clinician  Underemphasis on the external situation  Insufficient validation  Inaccurate data or premature evaluation

27. Copyright © 2010 Allyn & Bacon 27 Classifying Abnormal Behavior  Classification involves the attempt to delineate meaningful subvarieties of maladaptive behavior  The benefits of classification include:  The introduction of order  The enabling of communication  The enabling of statistical research  Insurance issues  Classification involves the attempt to delineate meaningful subvarieties of maladaptive behavior  The benefits of classification include:  The introduction of order  The enabling of communication  The enabling of statistical research  Insurance issues

28. Copyright © 2010 Allyn & Bacon 28 Reliability and Validity  A classification system’s usefulness depends largely on its reliability and validity

29. Copyright © 2010 Allyn & Bacon 29 Differing Models of Classification  Three basic approaches include:  The categorical approach– a patient is healthy or disordered, but there is no overlap  The dimensional approach– the patient may fall along a range from superior functioning to absolutely impaired functioning  The prototypal approach– a conceptual entity depicts an idealized combination of characteristics, some of which the patient may not have  Three basic approaches include:  The categorical approach– a patient is healthy or disordered, but there is no overlap  The dimensional approach– the patient may fall along a range from superior functioning to absolutely impaired functioning  The prototypal approach– a conceptual entity depicts an idealized combination of characteristics, some of which the patient may not have

30. Copyright © 2010 Allyn & Bacon 30 Formal Diagnostic Classification of Mental Disorders  The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) are the two major classification systems in use  ICD is more commonly used in Europe  DSM is more commonly used in the U.S.  DSM purports to be a categorical system, but it is in fact prototypal  The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) are the two major classification systems in use  ICD is more commonly used in Europe  DSM is more commonly used in the U.S.  DSM purports to be a categorical system, but it is in fact prototypal

31. Copyright © 2010 Allyn & Bacon 31 Formal Diagnostic Classification of Mental Disorders  DSM has five axes  Axis I: The particular clinical syndromes or other conditions that may be the focus of clinical attention  Axis II: Personality disorders, mental retardation  Axis III: General medical conditions  Axis IV: Psychosocial and environmental problems  Axis V: Global assessment of functioning  DSM has five axes  Axis I: The particular clinical syndromes or other conditions that may be the focus of clinical attention  Axis II: Personality disorders, mental retardation  Axis III: General medical conditions  Axis IV: Psychosocial and environmental problems  Axis V: Global assessment of functioning

32. Copyright © 2010 Allyn & Bacon 32 Formal Diagnostic Classification of Mental Disorders  Mental health professionals should be aware of the downsides of labeling  It may close off further inquiry  Patients may play out the expectations of their “role”  Others may stigmatize the labeled person  Nevertheless, arriving at such a diagnosis is usually required before the commencement of clinical services  Mental health professionals should be aware of the downsides of labeling  It may close off further inquiry  Patients may play out the expectations of their “role”  Others may stigmatize the labeled person  Nevertheless, arriving at such a diagnosis is usually required before the commencement of clinical services

33. Copyright © 2010 Allyn & Bacon 33 Unresolved Issues  DSM is periodically revised  Revision efforts are currently underway  Personality disorders may be revised to reflect a more dimensional perspective  PTSD criteria may be revised to allow for “indirect” traumatization (e.g., 9/11 attacks)  DSM is periodically revised  Revision efforts are currently underway  Personality disorders may be revised to reflect a more dimensional perspective  PTSD criteria may be revised to allow for “indirect” traumatization (e.g., 9/11 attacks)

34. Copyright © 2010 Allyn & Bacon End of Chapter 4