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

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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

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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

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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

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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

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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)

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Clinical Tests

• Devices for gathering information about aspects of a person’s psychological functioning.

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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”

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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

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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

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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)

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DSM-5

• Lists approximately 400 disorders•Describes criteria for diagnoses, key clinical

features, and related features that are often, but not always, present

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Lifetime Prevalence of DSM Diagnoses

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DSM-5• Requires clinicians to provide two types of

information:• Categorical • Dimensional

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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

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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

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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