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Chapter Four: Clinical Assessment, Diagnosis, and Treatment

  • Idiographic Understanding: an understanding of a particular individual

Clinical Assessment: How and Why Does the Client Behave Abnormally?

  • Assessment: The process of collecting and interpreting relevant information about a client or research participant

  • Clinical Assessment is used to determine whether, how, and why a person is behaving abnormally + how that person may be helped

Clinical Assessment Techniques and Tools

  • Must be standardized and have clear reliability and validity

    • Standardization: The process in which common steps are set up to be followed whenever a tool is administered

    • Reliability: Consistency of assessment measures

      • Test-Retest Reliability: Participants are tested on two occasions and the two scores are correlated

      • Interrater Reliability: Different judges independently agree on how to score and interpret an assessment tool

    • Validity: The tool accurately measures what it’s supposed to measure

      • Face Validity: A tool appears valid because it makes sense and seems reasonable. doesn’t make the instrument trustworthy

      • Assessment tools should have high

        • Predictive Validity: Tool’s ability to predict future characteristics / behavior

        • Concurrent Validity: Degree to which the measures gathered from one tool agree with the measures gathered from other assessment techniques

Clinical Interviews

  • Face-to-face encounter

  • Often the first contact between client and clinician

  • Used to collect detailed info about the person and their life

  • Unstructured Interview: Clinician asks mostly open-ended questions

  • Structured Interview: Clinicians ask prepared, specific questions

    • Interview Schedule: Standard set of questions designed for all interviews

    • Mental Status Exam: Set of questions and observations that systematically evaluate the client’s awareness, attention span, memory, etc.

  • Sometimes lack accuracy - people might lie to put themselves in a better light, or just be inaccurate in their report

Clinical Tests

  • Devices for gathering info about a few aspects of a person’s psychological functioning

  • Projective Tests: Clients interpret vague stimuli and project aspects of their personality into the task

    • Rorschach test: Inkblots

    • Thematic Apperception Test: People are shown black and white pictures and asked to make up a dramatic story about each card

    • Sentence-completion Tests: Test-taker completes a series of unfinished sentences

    • Drawings

  • Personality Inventories: Individuals are asked to assess themselves

    • Minnesota Multiphasic Personality Inventory

    • Standardized

    • Display greater test-retest reliability than projective tests

  • Response Inventories: Tests designed to measure a person’s responses in one specific area of functioning, such as affect, social skills, or cognitive processes

    • Affective Inventories: Measures the severity of emotions like anxiety, depression, and anger

    • Social Skills Inventories: Respondents indicate how they’d react in a variety of social situations

    • Cognitive Inventories: Reveal a person’s typical thoughts and assumptions

  • Psychophysiological tests (measure physiological responses as possible indicators of psychological problems)

    • Polygraph / Lie Detector Test - Measures breathing, perspiration, and heart rate

  • Neurological and neuropsychological tests

    • Neurological tests directly measure brain structure and activity

    • Neuroimaging Techniques / Brain Scanning: Neurological tests that provide images of brain structure or activity, such as CT scans, PET scans, and MRIs

    • Neuropsychological Test: Detects brain impairment by measuring a person’s cognitive, perceptual, and motor performances

  • Intelligence Tests: Tests designed to measure a person’s intellectual ability

Clinical Observations

  • Naturalistic Observation: Clinicians observe clients in their everyday environments

  • Analog Observation: Clinicians observe clients in an artificial setting

  • Self-Monitoring: Clients are instructed to observe themselves

Diagnosis: Does the Client’s Syndrome Match a Known Disorder?

  • A determination that a person’s problems reflect a particular disorder

Classification Systems

  • A list of disorders, along with descriptions of symptoms and guidelines for making appropriate diagnoses

  • When certain symptoms occur together regularly and follow a particular course, clinicians agree that those symptoms make up a particular mental disorder

DSM-5

  • Lists more than 500 mental disorders

  • Describes the criteria for diagnosing the disorder and the key clinical features of the disorder

  • Categorical Info: Name of the distinct category indicated by the client’s symptoms

  • Dimensional Info: Rating of how severe a client’s symptoms are and how dysfunctional the client is across various dimensions of personality and behavior

  • Clinicians sometimes arrive at a wrong conclusion, but the label sticks and a person can be perceived differently because of it

Treatment: How Might the Client Be Helped?

  • Empirically Supported Treatment: Therapy that has received clear research support for a particular disorder and has corresponding treatment guidelines

  • Rapprochement Movement: A movement to identify a set of common factors, or common strategies, that run through all successful therapies

  • People with dif disorders may respond differently to various forms of therapy

  • Psychopharmacologist: A psychiatrist who primarily prescribes medications

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Chapter Four: Clinical Assessment, Diagnosis, and Treatment

  • Idiographic Understanding: an understanding of a particular individual

Clinical Assessment: How and Why Does the Client Behave Abnormally?

  • Assessment: The process of collecting and interpreting relevant information about a client or research participant

  • Clinical Assessment is used to determine whether, how, and why a person is behaving abnormally + how that person may be helped

Clinical Assessment Techniques and Tools

  • Must be standardized and have clear reliability and validity

    • Standardization: The process in which common steps are set up to be followed whenever a tool is administered

    • Reliability: Consistency of assessment measures

      • Test-Retest Reliability: Participants are tested on two occasions and the two scores are correlated

      • Interrater Reliability: Different judges independently agree on how to score and interpret an assessment tool

    • Validity: The tool accurately measures what it’s supposed to measure

      • Face Validity: A tool appears valid because it makes sense and seems reasonable. doesn’t make the instrument trustworthy

      • Assessment tools should have high

        • Predictive Validity: Tool’s ability to predict future characteristics / behavior

        • Concurrent Validity: Degree to which the measures gathered from one tool agree with the measures gathered from other assessment techniques

Clinical Interviews

  • Face-to-face encounter

  • Often the first contact between client and clinician

  • Used to collect detailed info about the person and their life

  • Unstructured Interview: Clinician asks mostly open-ended questions

  • Structured Interview: Clinicians ask prepared, specific questions

    • Interview Schedule: Standard set of questions designed for all interviews

    • Mental Status Exam: Set of questions and observations that systematically evaluate the client’s awareness, attention span, memory, etc.

  • Sometimes lack accuracy - people might lie to put themselves in a better light, or just be inaccurate in their report

Clinical Tests

  • Devices for gathering info about a few aspects of a person’s psychological functioning

  • Projective Tests: Clients interpret vague stimuli and project aspects of their personality into the task

    • Rorschach test: Inkblots

    • Thematic Apperception Test: People are shown black and white pictures and asked to make up a dramatic story about each card

    • Sentence-completion Tests: Test-taker completes a series of unfinished sentences

    • Drawings

  • Personality Inventories: Individuals are asked to assess themselves

    • Minnesota Multiphasic Personality Inventory

    • Standardized

    • Display greater test-retest reliability than projective tests

  • Response Inventories: Tests designed to measure a person’s responses in one specific area of functioning, such as affect, social skills, or cognitive processes

    • Affective Inventories: Measures the severity of emotions like anxiety, depression, and anger

    • Social Skills Inventories: Respondents indicate how they’d react in a variety of social situations

    • Cognitive Inventories: Reveal a person’s typical thoughts and assumptions

  • Psychophysiological tests (measure physiological responses as possible indicators of psychological problems)

    • Polygraph / Lie Detector Test - Measures breathing, perspiration, and heart rate

  • Neurological and neuropsychological tests

    • Neurological tests directly measure brain structure and activity

    • Neuroimaging Techniques / Brain Scanning: Neurological tests that provide images of brain structure or activity, such as CT scans, PET scans, and MRIs

    • Neuropsychological Test: Detects brain impairment by measuring a person’s cognitive, perceptual, and motor performances

  • Intelligence Tests: Tests designed to measure a person’s intellectual ability

Clinical Observations

  • Naturalistic Observation: Clinicians observe clients in their everyday environments

  • Analog Observation: Clinicians observe clients in an artificial setting

  • Self-Monitoring: Clients are instructed to observe themselves

Diagnosis: Does the Client’s Syndrome Match a Known Disorder?

  • A determination that a person’s problems reflect a particular disorder

Classification Systems

  • A list of disorders, along with descriptions of symptoms and guidelines for making appropriate diagnoses

  • When certain symptoms occur together regularly and follow a particular course, clinicians agree that those symptoms make up a particular mental disorder

DSM-5

  • Lists more than 500 mental disorders

  • Describes the criteria for diagnosing the disorder and the key clinical features of the disorder

  • Categorical Info: Name of the distinct category indicated by the client’s symptoms

  • Dimensional Info: Rating of how severe a client’s symptoms are and how dysfunctional the client is across various dimensions of personality and behavior

  • Clinicians sometimes arrive at a wrong conclusion, but the label sticks and a person can be perceived differently because of it

Treatment: How Might the Client Be Helped?

  • Empirically Supported Treatment: Therapy that has received clear research support for a particular disorder and has corresponding treatment guidelines

  • Rapprochement Movement: A movement to identify a set of common factors, or common strategies, that run through all successful therapies

  • People with dif disorders may respond differently to various forms of therapy

  • Psychopharmacologist: A psychiatrist who primarily prescribes medications