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Chapter 3 Clinical Assessment, Diagnosis, and Treatment. 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 - PowerPoint PPT Presentation
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Chapter 3Clinical Assessment,
Diagnosis, and Treatment
The **** Personality Inventory1 = 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 helpedUsed 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
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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
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 TestsProjective tests• Require that clients interpret vague or ambiguous
stimuli or follow open-ended instruction• Psychodynamic• Most popular:• 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• 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-femininity Social
introversion 16
Clinical Test: MMPIMinnesota Multiphasic Personality Inventory
• Graphed to create a “profile”
17
Clinical TestsResponse inventories • Usually based on self-reported responses• Focus on one specific area of functioning:• 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 TestsPsychophysiological 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)
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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• Typically comprised of a series of tests
assessing both verbal and nonverbal skills
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Clinical ObservationsSelf-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
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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
concerns31
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