Chapter Four: Clinical Assessment, Diagnosis, and Treatment

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• 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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